All the Wrong Places

Turns out I'm a teeny, tiny bit shallow. Or perhaps a bit more than that. Maybe a lot more. I have, for a variety of not terribly good reasons, recently joined an on-line dating site, and although I like to think that my new found shallowness is a result of the process requisite in the internet dating system, the reality is I just don't like horse lipped girls. If in a smile I see a line of a teeth and a line of gums instead of two rows of pearly whites, I click on through. And of course if I see too many pearly whites, a full mouth reminiscent of something terrible I cannot quite recollect, I get a bit terrified. And then there's girls with eyeballs too close together. And girls with moon facies. And girls with "a few extra pounds."

It has been about a month or so since I have started these Internet dating shenanigans, and it has been interesting. I have learned a lot about a lot of things. Mostly, though, I have learned that there is big money in Internet dating these days. People give you money for simply hosting nothing more than a glorified classifieds. It's genius. But the empty money pit that is Match.com aside I have also learned....

That although at first I felt bad for the... if I may be a bit blunt and wholly lacking in sensitivity... ugly, women out there who just want a little love too, it turns out that, if their prior relationship status and other demographics are any evidence, they get more than their fair share of loving. Specifically full contact, sweaty-style sexual loving. Hopefully with the lights off.

That I cannot stand people who punctuate, spell, and capitalize however and whenever they choose. I by no means majored in English composition myself, but if you cannot manage enough energy in this match making endeavor to actually hold the shift button while striking your key of choice or correct an obviously misspelled, indecipherable collection of consonants I begin to worry about commitment levels.

That I apparently every two or three emails write something so terribly offensive, personal, or just plain creepy as hell that the ladies are compelled to terminate conversation with me without further comment. Perhaps it's the, "so when are we going to do it?" I sometimes interject with. Maybe I shouldn't close every letter with that?

And, lastly, that this is all making me into a pretty terrible person. I have enjoyed the experiment, if you will, but it breeds primarily self centeredness and personal myopia. Constantly you are asked to decide if a woman measures up to whatever standard it is you have decided to measure them by. Constantly you are compelled to ask yourself what it is *you* want in a woman. Constantly you are focused on your life, your desires, your lack of love. Perhaps in the end I will meet Miss Super Awesome and our love will multiply making this not just an exercise in critically appraising the opposite sex, but the reality is I, and it seems many others, will likely not find anyone and all we'll have to show for our efforts is a whole lot of hours focused on what we want. This isn't to say greater insights of a character building nature cannot come about -- and certainly often you must first identify your flaws before you can rectify them -- but I would gamble when all is said and done a few months from now all I will have collected is a list of physical traits that irk me and a slightly smaller bank account.

But on a happier note. A Smithsonian dog with goggles.

The Land of Happy People

I forgot what it was like. Being happy sometimes. It turns out in the Emergency Department (ED) they feel this way quite a bit. I am not sure why, whether it's their natural disposition or a combination of poorly regulated and documented narcotics in the trauma bay, but the ER docs are by and large good people. Friendly, happy, good-natured, and not too terribly demanding. Almost makes me want to be an ED physician myself were it not for the fact that I strongly dislike the style of medicine they practice. Nevertheless, this month has been the first month I have had two consecutive smiles and it kind of hurt the corners of my mouth a bit. It has also been the first month that I pulled a rock out of a 4 year old's nose using a pediatric foley catheter and the only month I pulled a shark-tooth shaped piece of glass from its location embedded in a woman's foot, but those are neither here nor there. The point is the ER doctors have reminded me of what it is like to be genuinely, consistently happy and for that I am grateful. I have eaten almost nothing but breakfast for the past month as a result of the wacky hours, but dysgeusia is a small price to pay for that.

Oh, and today the Fighthing Texas Aggies will beat the UConn Huskies in the NCAA tournament. I know this because I have stayed up late at night and had visions. Visions of glory.

It Was a Dark and Stormy Night

It has been a number of months since San Antonio has had a good rain. Yesterday, and today, we finally had one. And then my car battery died.

It is actually not quite the coincidence that it sounds. It turns out that I regularly am in the habit of not turning my lights off when I park my truck when it's raining outside yet still light out. This thing seems to happen about once a year. Nevertheless, usually it is not 12:00 midnight and usually it is not 40 something degrees out and usually I am not stuck on an Air Force base after having being working all evening. Thankfully, after the base's security forces refused to jump me (they apparently have a strict no-helpfulness policy), my dear, good, gracious, reliable friend Beau who happened to be working an overnight shift was there to help me restart my car. It took about 30 minutes to get it all done seeing as the cables were never quite long enough and we had to push my truck out of its parking spot to get closer, but we did it. We were both soaked, Beau was possibly hypothermic, and I had lost faith in my country. (Seriously base police, you cannot give me a jump in the middle of the night in the middle of a storm? Seriously?) On the relatively slow drive home, sometimes it seems like San Antonio was designed specifically with the purpose of flooding in mind, I was treated to one more bit of excitement as getting off the highway I, and the car slightly adjacent of me, disappeared into a sea of water that effectively submerged our vehicles and made me exclaim, "Oh, shi-" right as the cameras cut away. Perhaps it's good that it doesn't rain here too much.

But internship progresses. I am in the ER now. Because last week I was doing evening shifts from 1500 to 2300 and there are not always patients at the ER from 1500 to 2300 thereby leading to my early release some days I have not had a consistent schedule for most of it. I am wholly disoriented. Every day feels like Sunday and every hour like roughly 9 pm. I never know quite what I should be eating, when I should be eating it, and if I am eating enough or too much in a day (not that I likely could eat too much though.) I'd guess the time right now but I'm as likely to be 5 hours off as 1, and it's not like I would know what to do with that information anyway. At least I still know who I am, that I live in San Antonio, and that Ronald Reagan is president.

The Audacity of Economics

What I have always loved about chemistry is that, at its base, it is so simple, reliable, and efficient it is almost mathematic. Writing a chain of chemical equations is itself like writing out a series of arithmetic problems; under the right circumstances, when all variable are appropriately controlled for, compound X will always react with element Y to produce exactly the same amount of molecule Z. Despite this apparent simplicity, it is chemistry, this illustrated mathematics, that shapes and animates life. It is beautiful, in a way, how such complex things can be reduced down to such a clean and basic level.

And then there's economics. The social sciences are many levels removed from the cause and effect of the hard sciences. Despite attempts and protests to the contrary economic and political studies have never been able to provide us with truths resembling anything like a mathematical proof or scientific law. And despite this, or perhaps because of this, everyone seems to be an expert in these very fields. The lack of hard set, verifiable data which should produce caution in interpretation instead seems to provoke people to fits of interpretive grandiosity. A few ideas and perhaps a few examples are all that are needed for people to make sweeping, dogmatic generalizations on how our economy, and indeed all economies, should be run. This has never been more true, or so it seems, than now in our current crisis with our current president. Stimulus or no stimulus? Bailout or no bailout? Nationalization, socialism, and communism or private enterprise, free markets, and minimal governance? It is with all this ballyhoo that I feel led to share the only three things about economics that I know: the Keynesian multiplier, the Laffer curve, and Adam Smith.

The Keynesian Multiplier -
Sometimes a little money goes a long way. Or so the idea itself at least goes. In certain circumstances $5 will go a lot further than $5. For example, suppose I were to give five bucks to my dear old friend Eddie Spaghetti to build me an interstate highway. Being the managerial type, Eddie keeps a small portion of this as his income and then highers the appropriate laborers, engineers, and undocumented migrant workers to get the job done. Each of those individuals of course takes their share in turn (and spends it on food, clothing, and assorted dry goods further stimulating the merchants of those respective items as well.) The $5 is not done, however. Beyond labor, the few dollars spent in capital and supplies required to build this highway can all themselves come from other proprietors and entrepreneurs, and the resulting freeway will create economic opportunity for further economic investments spreading the wealth even further. Five dollars can thus be spent many times over stimulating the economy in a way a simple tax cut may not necessarily do. The spending is effectively multiplied. And even though all projects conceivably multiply to some extent, it is often state directed projects, such as the construction of bridges, airports, and port facilities, which are the biggest multipliers. Theoretically, if spent wisely and judiciously enough the projects would pay for themselves and would be less empty "spending" and more investive "stimulus." Thus we have, in simplified form, government driven, stimulus supported recovery.

The Laffer Curve -
But suppose we could do it another way. What if we could, instead of deficit spend, deficit save? Lower tax rates and still, at the end of the day, have more in the way of total tax income? That's where the supply sided recoverists sally forth with the all-triumphant Laffer curve. Like the Keynesian multiplier, it breaks down a whole lot of complex economics, digests it, and spits out nothing but lean, pure economic truth. Unlike the multiplication trick of before, however, we must now work with a parabola. This parabola, basically described, suggests that if we were to look at tax rates vs total tax revenue we would find that on opposing extremes of taxation rates we will receive no actual money in taxes. On the near end of the graph if taxed nothing then no matter how much business we have there will be no revenue for the state, and, conversely, on the far end of the graph if we tax too much profit will be impossible, no one will do business, and we will still end the day with zero net income. Conceivably then there should be a sweet spot somewhere in the middle of this curve where tax rates are primed just right to maximize tax revenues. More importantly, if we have taxed to excess and are thus descending down the curve from this maximum we should be able to actually increase total tax inflows by lowering tax rates -- something that at least on superficial analysis would seem counterintuitive. Thus by taxing Eddie Spaghetti less he and his highway building cohorts will reinvest their added profits and business will boom to such an extent that when we send out our tax gatherers at the end of the year we actually have more money. In short, privately driven, tax cut supported recovery.

Adam Smith -
So what should we do? Deficit spend or deficit save? Supply or demand?!

I sure the hell don't know.

But maybe... Adam Smith does? What does the patron saint of economics have to say? Is he a Reaganite or a FDR at heart?

"It is not from the benevolence of the butcher the brewer, or the baker that we expect our dinner, but from their regard to their own interest. We address ourselves, not to their humanity, but to their self-love, and never talk to them of our own necessities, but of their advantages."

Uhmm....

"It is not very unreasonable that the rich should contribute to the public expense, not only in proportion to their revenue, but something more than in that proportion."

But....

"The man of system, on the contrary, is apt to be very wise in his own conceit; and is often so enamoured with the supposed beauty of his own ideal plan of government, that he cannot suffer the smallest deviation from any part of it. He goes on to establish it completely and in all its parts, without any regard either to the great interests, or to the strong prejudices which may oppose it. He seems to imagine that he can arrange the different members of a great society with as much ease as the hand arranges the different pieces upon a chess-board. He does not consider that the pieces upon the chess-board have no other principle of motion besides that which the hand impresses upon them; but that, in the great chess-board of human society, every single piece has a principle of motion of its own, altogether different from that which the legislature might choose to impress upon it. If those two principles coincide and act in the same direction, the game of human society will go on easily and harmoniously, and is very likely to be happy and successful. If they are opposite or different, the game will go on miserably, and the society must be at all times in the highest degree of disorder."

Okay. It is settled then. I have no idea what I am talking about, and will not pretend otherwise.

Hopefully much of the rest of America can agree to do the same.

Little Pig, Little Pig, Let Me In

I may shortly be kicking down the door of my own apartment. That is if there's an apartment left for me to kick into. Despite almost half a year of waiting my fancy, shiny new apartment downtown is still not fit for living in. The latest problem? A huge water pipe apparently exploded flooding floors 6 through 9. Or something like that, it involved lots of waters and freak inexplicable accidents keeping me out of my rightful home. Perhaps it's for the best, though, God seems to have a thing against this place. I may be saving myself some heart ache, and perhaps a case of boils, if this whole thing falls apart.

Since I haven't mentioned my own current housing crisis much before let me start at the relative beginning.

A long, long time ago, feels like three years but I guess it was about 9 months, I was in the market for buying a house. I looked around, found some places, my family duly let me know they were terrible places, and so I looked around some more. Finally, I found the greatest place. Unfortunately it was around this time, shortly before starting my work as an intern, that I decided that no, in fact, I did not wish to buy a house. The appeal of free artistic license, spacious guest bedrooms to have family over in, and a backyard to build a garden upon were dshed by the reality that as an intern everything but basic hygiene gets neglected. And so I moved into the base housing. Unfortunately base housing is only free for a month (and apparently my base housing was also home to a family of fearless cockroaches), and so I moved into some friends' place. Josh and Sarah were newly weds, however, and their house was way the hell away from everything so I duly sought out alternative residence number three. That's when I found my good friend, then complete stranger, Laura Gallo. After some brief negotiations she set me up in her second guest bedroom and I was set for the next two to three months.

Or so it was to be. I had found, what I thought at least, would be the apartment equivalent of my previous dream house. The Vistana. "Lofty Living Downtown" their ridiculous and somewhat pretentious advertisement claimed. It was conveniently placed between both hospitals, in a different setting than the suburban wasteland I had been living in for 8 years, and 9 stories up giving me the wonderful sunset view I had long sought after. And all for a fairly reasonable price. Unfortunately my official move in date, mid-October came around and because of the previous spring's epic rains construction was behind schedule. I would be moving in in November. November came and again it was pushed back. Now it was December. December came and that too was wrong. We're going to play it safe and say first week of February. And what happened when the first week of February came around? "Mr. Crabtree, we're sorry but we're going to have to push back the moving date one more time. How does March 6th sound?" "March 6th? My favoritest day, sounds great."

And now we come to February 26th. I had thought maybe March 6th really would be the day. Even started planning renting a moving truck and reboxing my stuff. But now comes a pipe flood and once more I must wait. Current move in date is unknown pending further catastrophe. I am expecting either a zeppelin to broadside the place or a pterodactyl attack. I eagerly await the call.

Ahh Man, Who Dumped My Stuff?

Last week I diagnosed hypoaldosteronism all by my little old self. A turning point? Have I become a real doctor? Will I cure all disease?

The next day I dumped a glass of milk onto the kitchen floor when I tried to transfer a paper towel full of mini donuts into the same hand.

In other residency news: I have a friend who has a patient who regularly schedules appointments to see her in clinic only to talk at great length about nothing at all. Today I heard through the thin exam room walls, "... and then the preacher said, 'you are what you are because you want to be!' And I fell down and praised Jesus!" This went on at length for about 10 - 15 minutes until I heard the staff, who was apparently also in the room with my friend helping assess the gentleman, say matter of factly, "Sir. What exactly do you want us to do for you?" And the booming story continued.

Oh crazy people. What would internal medicine clinic be without you?

Where's Adam? I'll Kill Him!

First. The funniest thing I have heard in a good time. (A good time being roughly three months or a fortnight.)

While doing Board Review questions during Morning Report one day on medicine wards we got to a peculiar question:

You are given report of a a 32 year old man who awoke from sleep to find a bat lying on the floor next to his bed...

Everyone's immediate answer to the question not yet asked was, "examine the man for bat bites!" to evaluate for rabies. We thought ourselves pretty smart for knowing the connection between rabies and bats, but then we were told, as the question progressed, that he had no evidence of being bitten. So as everyone stirred briefly reconsidering their choices, someone else in the room shouted out, "examine the bat for human bites!"

I am probably the only one who laughed at that and yet I am content with it.

But to the point. Another fireworks story. Or, if you know my family, *the* fireworks story.

Some background. My birthday is the day before the Fourth of July. One year, some year that will remain unspecified in a place unspecified, my brother and a cousin of mine, Matthew, decided to light some of our firework stash off the day before in celebration. It was all uneventful till we got to one particular firework, the UFO.

The story. I am still not sure what the UFO is. I suppose that's why it's called the UFO. It appeared to just be a brick with a fuse. Or maybe a deck of cards wrapped in a cheap wrapper with a small rubber dome on one side and piece of string dangling from the other. Whatever it was, not knowing what it was or what it would do did not stop us from lighting it. First the fuse burned down slowly as one would expected. Then, while on the ground, it began spinning tight circles on the cement not as one would expect. And finally, as it was inevitably going to do, it shot off straight into the sky with such speed that we really had no idea which direction it flew off into. It did this, however, only after bursting into flames. That, it turns out, is a UFO.

Concerned that sending a ball of fire into the air on a warm summer day could be potentially dangerous we temporarily stopped our firework lighting festivities and set about the yard and surrounding area looking for any signs of its remains. After about 5 - 10 minutes of completely uneventful searching we decided that no answer was a good answer and so resumed our previous activities. It would be another 10 - 15 minutes before we heard a middle aged Hispanic woman call out from the street below, "Sir! Sir! Your house is on fire!"

I was apparently the only one who heard the lady because I was the only one who looked up to see that, indeed, a small patch of our roof was going up in flames. I passed word on to my brother and cousin and off we were to find whatever it was we could find to put it out. For my brother and cousin that meant grabbing the hose and throwing my cousin onto the roof. For me that meant running for the fire extinguisher I remembered seeing in the camper out in front of the house. For the roofer that just happened to be passing by and somehow saw the smoke, that meant leaping over the fence and joining my cousin atop the burning shingles. Despite all the immediate excitement it was a relatively tiny fire, maybe a foot by two or three feet, and it was quickly doused by the unstoppable combination of garden hose and fire extinguisher. Within a few minutes the excitement was over. The firefighting, however, apparently was not.

We watered the embers a bit more, poked around a bit, and then waited for our family to come home. The Super Roofer gave us some advice, gave us his card, and then promptly went back to his secret lair. It was about twenty to thirty minutes before anyone got back, that being my brother-in-law Patrick. With my brother conveniently in the bathroom at the time it was left to me and my cousin to inform him of the news. "Ok, Patrick. Don't freak out, but we had a small problem. We kind of lit the roof on fire -- but we put it out it's ok!" His immediate response? "Adam! Did Adam do this?! I'll kill him!" We calmly explained that we were all collectively guilty and so, in time, he calmed down. It was now time to call the firefighters apparently. I am not sure why this was necessary -- the fire had been out for a good half hour -- but call the fire department we did, and in no time they were out, atop the roof, and carving a 6 foot by 4 foot hole in it.

The threat of fire was still not over with, though. After the crashing of fire hatchets came the flow of hundreds of gallons of water pouring through the now gaping hole and, as it saturated and then tore through the ceiling, into the dining room. And so the day was saved. Or made entirely worse I suppose we will never know. Either way, their jobs being done the fire fighters went back to their secret lair, we were given a stern talking to by the fire marshal, and that was that. That evening we celebrated my birthday at the Spaghetti Factory, and enjoyed ourselves some spumoni ice cream. A month later my family had a new roof and new set of recessed track lighting. The firefighters, I'm sure, enjoyed swinging their axes at things. Everyone agreed, it was the best birthday ever.