I did swear off blogging . . .

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And it lasted a few days. I'm busy here! I had to get my Little Lattes off to two new schools and Monsieur bought a car. The laundry! The meals! Oh, and the new French press coffee maker! Endless cups of coffee!

I might add that I've started drinking it warm. Not hot. Not yet. Warm. I'm expanding my repertoire of iced drinks.

But damn, people keep sending me the most interesting stuff! Stuff that gets me excited, gets my blood pressure up (higher), makes my toes tingle, and makes me wanna attack my computer and eat it whole. Without further ado, I give you a tour of the world on Med Marg's hot air balloon (or just hot air):

First up, on Dr. Latte's reading list are two titles available from Amazon:

1. The Blood of Strangers by Frank Huyler: Oh my God. This came via a recommendation of Michael Ruhlman, a fellow Ohioan. I wish he'd invite me to dinner. I only live a few miles, okay 100, down the road. I picked up this slim volume and was once again unimpressed by a book cover. Hmmm....I read the first vignette by Dr. Huyler. Well, okay, maybe I can live with the cover. I read the second. The third. I finished the book and looked at the clock and realized that I had a few minutes left to sleep before starting our new kindergarten routine. Crap. Climb aboard Dr. Huyler's mind and relive the magic, exhaustion, deprivation, and exhilaration of taking care of real, live humans, much like yourself. I felt like I was inside his stale 4am scrubs, pacing around the ICU waiting for a disaster, which almost always comes. I smelled the stinky feet; I poured myself more coffee, and I marvelled that this man can write elegiacally about ETTs and central lines and other very non-romantic stuff. Wow. I'm still reeling from this book. I can't wait to read it again, but it must not be tonight. Tonight I must sleep.

2. A Death Prolonged, by Jeff Gordon MD: If I have any success at all in my professional life; if I checked my ego and exhaustion at the door of a hospital room and dredged up some compassion from somewhere, if I went to the literature (or the Wash Manual, especially Dr. G's beloved the first chapter on fluid balance) then it's thanks to Dr. Gordon. It's thanks to many other wonderful teachers, but oh, Dr. Gordon. A brainiac, a devilish gentle wit, an uber-doctor, a force of nature teacher. If you know him you'll love his book. If you don't know him you might find it terribly earnest and occasionally a bit heavy on the end-of-life discussion. You WILL never want to be intubated or resuscitated. Dr. G knows what he's talking about. I've patrolled the halls of a hospital much like the "Mercy Hospital" in his book and can tell you that there's much to love and much to despair. The first time you code an 85 year old whose ribs turn to dust under your hands you realize that life really isn't like television. You know you're not on t.v. when you stab the femoral artery of a nearly, well, should-be dead 90 year old with metastatic prostate cancer who should be a no-code, and watch the syringe slowly fill with very dusky blood and wish this poor man could die in peace, not naked, without 40 people jamming drugs, yelling orders, crushing bones, and jamming huge breathing tubes down his throat.

Meanwhile, back at the ranch in my full-time job plus as Mommy, I've been swinging into high gear for school breakfasts. We used to get breakfast supplied at our childcare center. Now Mommy has to factor in five more meals into her week. I'll have more about that later, no doubt, because I just can't shut the hell up, on my OTHER blog Three Squares, but for today I chanced upon these two interesting little nuggets:

Planning for breakfast prevents skipping top meal of the day

This is the height of hypocrisy for me since I skip breakfast nearly every day unless you count 1.5 pots of coffee with milk (1%. Who can do skim? That's insulting.) and a banana as breakfast. Which I then wash down with either more coffee, a huge iced tea, or a giant Diet Coke. Nevermind. Anyway, I sat down with the kids about two weeks ago and we made a big list of breakfast things we like and can do in the morning before school. We put them on a rotating schedule. I let them assign the particular day. This article gives me some new stuff to think about. The school gave me a recipe for a "breakfast cookie" which I am intrigued by. It really sounds like more of a granola bar plus, but that says "cardboard" whereas "cookie" says "eat me".

Time Magazine had a scary little ditty about processed food. It starts with a story about a pig:

Somewhere in Iowa, a pig is being raised in a confined pen, packed in so tightly with other swine that their curly tails have been chopped off so they won't bite one another. To prevent him from getting sick in such close quarters, he is dosed with antibiotics. The waste produced by the pig and his thousands of pen mates on the factory farm where they live goes into manure lagoons that blanket neighboring communities with air pollution and a stomach-churning stench. He's fed on American corn that was grown with the help of government subsidies and millions of tons of chemical fertilizer.

No thank you. We just finished our first hand-reared pig, which cost less than pig at the grocery store, purchased directly from the farmer. Delicious. Now, I work full-time plus, have two small kids, a husband who works as much as he possibly can. I have MANY outside work commitments, and I managed to arrange a hand-reared pig. It cost less than a nice car payment. So can you.

But wow, that depressing pork stuff stressed me out. I need a glass of wine. But is it good for me? Via Dr. Wes, a review by a hepatologist on the benefits of vin:

Does wine really prevent heart problems?

Sad to say, maybe, maybe not. Jury is still out. Remember, you play with fire as you engage your corkscrew. Oh, and remember: FOOD IS NOT MEDICINE. Say it with me: FOOOOOOOOD IIIIIZZZZZZ NOOOOOOT MMMMMEEEEEDDDECIIIIIINNNNNNNN. And I'm not the only one who says so. Dr. Apstien from Harvard (but don't get me started on the damn raisin again) agrees with me.

Must give a nod to an interesting piece about healthcare reform on Dr. Kevin recently by yet another Dr. Gordon. They are all around me! This Dr. Gordon wrote something entitled:

Is healthcare a public good?

He writes:

By definition “public goods” are not well distributed by market mechanisms. Americans are very accepting of some public goods, i.e. police and fire departments, national military forces, the GPS system, water distribution and sewage treatment plants, education, radio frequencies and the internet. Looked at from an economic and a public policy perspective, health services are the epitome of a “public good.” This is what is meant by the phrase “Health Care is A Human Right!” Hospitals, ambulance systems, mosquito control, TB control, restaurant inspections, sanitation, and vaccines are all good examples.

Interesting stuff. Treat healthcare like a public utility. I agree with him, right up until the end. I'm not sure about single payer, although I totally buy into a public option. Add 20% profit on to the public option for the Government. We all get the money back one way or other other, and it makes the deck a little more even for private insurers. I've said it once, I've said it 50,000 times in the last day alone: Your health care is already rationed. It doesn't matter who is paying for it, unless you're paying out of your pocket and you have really, really deep pockets. For those who feel as though maybe you shouldn't be subsidizing the poor, the naked, the immigrants, the people too lazy to work, hey, you already are. They get sick too and you and I are already picking up the tab. Have you priced a Tylenol in the hospital? The price is padded to cover all those people you think might not deserve insurance. You don't get as much insurance for your premiums and copays because hospitals and everybody else charge them more to cover, to some degree, for the uninsured. Leave the moral argument aside, there are better ways to do what you're already doing.

And insurance companies are evil. But don't believe me. Listen to Dr. Rob:

Why I get Angry.

A dear friend and reader sent me this from CNN:

Why primary care doctors are fed up

The author writes:

People are making a huge assumption in this reform effort that as we extend coverage to millions who don't have health insurance, there will be doctors there to actually provide the health care. Fewer and fewer medical students are choosing primary care and many primary care doctors are leaving the field . . .

I have been richly rewarded by my patients over the decades as they have appreciated my judgment and skills. Isn't it a shame that after all this time and with skills honed by decades of experience, many of us can no longer afford to work as a physician?

Amen. I've left the primary car bigtop because I couldn't sustain a fairly modest income. I'm standing in a little tent in a tiny corner of the field (students get sick too) and am continually reminded of the shortage of primary care providers by my former patients, who have my phone number and email and call me to complain about their inability to secure new physicians. I'm outraged for them. But hey, it's going to get worse.

Go read Dr. Crippen. He's a primary care provider from the NHS and I wish I practiced with him! I do believe I'd laugh my ass off 50 times a day at his utterances. Or maybe he's more reticent, less opinionated in real life. He writes:

Obama is tackling the festering sore, the national disgrace, of those millions of Americans who have no health care at all. They would love to wait a few weeks for a hip-replacement. Beats not getting one at all because you have no money. The uninsured Americans are from no definable constituency. They are poor, they are black, they are Latino. Few will speak up for them. This President is trying and he might, he just might, for the first time, get something done.

It is a disgrace, frankly. He goes on:

There is nothing like health care reform to get the fly-over zone, Ku Klux Klan supporting facist-hyena, boonie-bred American to sit up and take interest. The American right-wing, the insurance companies, big business, and all the racist red-necks are mobilising. They are misrepresenting the NHS, they are tarring it with the word "socialized". We have seen nothing like it since the "better dead than red" paranoia of the 1960s.

Meow! Read it all at:

Shitting on your own doorstep

I cannot leave on such a note, however. I take you to the best photography magazine in the world, the NYTimes. No matter how crazy my day; no matter how frustrated I am; no matter how much I feel like flushing my head down the toilet, I can always dip a toe into their Lens blog and receive sensory nourishment. From (somewhat accurate) pithiness in the UK, I take you to middle America, where I live. And love.

Cowboys and Photojournalists

I bookmarked it and I swear on a big stack of Bibles that I'll smile every time I look at these pictures, I'll study them for clues, and I'll go on then being a little less overwhelmed for a few minutes. If you click out to nothing else in my little carnival, go to the fair.

My daughter just told me she couldn't sleep, then rolled over and went to sleep, as small children can do. Oh, my dear baby girl, with the still full cheek of the small child, beloved silkie clutched in her hand. Good night, sweetie. Good night, gentle readers. Sleep well.