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Below are the 9 most recent journal entries recorded in tcronin's LiveJournal:

Wednesday, March 25th, 2009
8:07 pm
Meaning in suffering

One patient experience that has stuck with me for years is from when I met a former Hurricane Katrina patient working at a restaurant. CL, ODMT's clinical psychologist and I had gone for dinner at the newly reopened Irene's restaurant this evening in New Orleans' French Quarter. CL and some of my other teammates happened to walk past the restaurant during the day, and noted the delicious garlic smells wafting from the kitchen. While waiting for the waiter, CL and I had been talking about heading out on this deployment. Someone on the street had asked CL why she would do something like going out on a medical team like this.

Our waiter, JP, was an older gentleman with an accent that we couldn't quite place. CL asked him where he came from, and he replied that he was from Wales, but he'd been in New Orleans for 40 years. He also said that he was 2 months shy of his 80th birthday, and other than undergoing peritoneal kidney dialysis four times a day (and also averred that, if one is going to the doctor for kidney problems, one may as well do the dialysis religiously and properly, or just not bother doing the dialysis at all). He then apologized for mentioning the dialysis - I reassured him that we didn't mind at all, that CL and I were on one of the medical teams here in the city and medical details weren’t going to spoil our dinner. He ended up staying at the table and telling us his story.

Of course, he lived in New Orleans. He's been in the restaurant business for 60 years, working in Switzerland, Paris, London and, for the last 40 years, "As of December 13th this year," in New Orleans. He's served the Queen of the Netherlands, and a famous silent movie star, "who was the most gracious person I've ever served." His neighborhood flooded after Katrina hit, and he'd lost everything - he got out with just his shoes, socks, t-shirt and shorts. He didn't even have a pair of underwear with him. He'd just started a round of dialysis a few minutes before soldiers and police showed up outside his home with guns.

“You have to evacuate right now or you'll probably end up shot”, they said.

“Alright, but I can't leave without my little dog and my little cat.”

“You can't take them”, they said.

“I won't leave without them.”

His partner, "who's French Italian, so you can imagine what kind of temper he can have," began speaking firmly to the police and soldiers. "You can't leave this man here - he just had an operation three days ago, and he's on dialysis."

The soldiers and police relented, and allowed them all to board the canoe - Little Dog and Little Cat included. Little Dog and Little Cat, if I remember correctly, he's had for about 10 years. Little Cat is a calico with a nose that's half black, and half white. He got Little Cat when he rescued her from a dumpster that someone had thrown her in. He climbed all the way into the dumpster to get her out, and handed her to some people outside so that he wouldn't have to drop her off the side. He then needed the help of those people to get out of the dumpster himself - they built him a staircase of sorts out of boxes so he could climb out.

They canoed JP to a helicopter, which flew him, sitting on the floor with Little Dog and Little Cat, first to the New Orleans airport triage center, and then he was flown to Louisiana State University, landing on the football field and taken into the arena. There the doctors and nurses, he said, took excellent care of him, gave him new clean and dry clothes from the Red Cross, and the veterinary school took in Little Dog and Little Cat while he was being cared for. CL and I were working at the New Orleans airport triage center, although we have no idea if we saw him there. I like to think that I didn't, that the only time I've met him he was in his waiter's uniform - clean, pressed tuxedo shirt, black tie, tidy black apron with crisp creases - not dirty and smelly from the floodwaters, wearing only his soaked undergoing-dialysis clothes.

JP met his doctor while at LSU, and his doctor flew him, on the doctor's American Express, to Jacksonville to stay. JP managed to be able to carry on his little dog and little cat on the plane.

When JP got back home, his neighborhood was destroyed. Wiped out. Nothing left to salvage. The destruction was worse, he said, than what he remembered in Germany in World War II, when he'd flown a Lancaster bomber for two years.

He pointed at a photograph on the wall of a person in a parade, wearing a bright red dress with an enormous feathered red hat. "That's me two years ago at Mardi Gras. They say they'll have Mardi Gras again, but I don't think that it will be the same. Maybe. We'll see."

The reader might be wondering what this has to do with the theme of meaning in suffering. Additionally, as a health care provider, I also face the question about the meaning of my work, much like the question posed CL by a passerby. To me, there is no inherent meaning in suffering – disease or disaster is a state, an event, a status, a characteristic. The meaning exists in how we – as patients, as victims, as responders, as doctors, even as bystanders – confront, interpret or simply how we accept. JP sought to overcome his illness, his disaster. He treated his renal failure stubbornly, refusing to compromise his treatment even though his city was destroyed around him. You could see his values, how he approached his life through his other actions as well – how he rescued Little Cat, how he presented himself.

Wednesday, December 17th, 2008
11:01 pm
Student reception
This evening was the 'Student Appreciation Reception' or somesuch - an excuse for the students in all the classes at CCLCM to get together and eat free appetizers. I dragged Sandy along, and she got to meet some of the first years students as well as more of the faculty.

One of the faculty members we were talking to was Dr. Prayson, a pathologist who is significantly involved with the school. As it happens, he was on call at the time. He got paged while we were there to go down to the lab and look at some frozen sections(*). I jokingly asked if Sandy and I could come along. He said yes. So, we went along with him to the path lab (we'd pretty much eaten our fill by this point anyway), and we both got to look at some sections while Dr. Prayson described what we were looking at. Sandy correctly identified a piece of rectum as being cancerous after having looked at a slide with some tubular dysplasia (often a precancerous condition) from the same patient. We also saw some bits of tissue from around a hip replacement that was having problems (we were looking for neutrophil invasion, a sign that some bad inflammation was happening). Happily, the hip patient didn't have the inflammatory pathology.

(*) Frozen sections are usually samples taken from a patient in surgery - they're frozen to make them sliceable, and stained and mounted on a slide immediately. They get inspected while the patient is still in surgery. This is so the surgeon can make decisions during that surgery about how to proceed.
Tuesday, September 30th, 2008
1:49 am
Touchy Feely Tuesday
So our assignment was to write a 'patient narrative' in response to the short story "Death of Bed 12" (Excerpt here). I think the patient part got away from me and from being the main focus, but hey - we're not graded anyway! A for effort!


"Salaamu `Aleykum".  My name is Muhammad Ali Akbar. What am I doing here? Do you mean in Kuwait or in the hospital? The hospital? Better you ask me why I am in Kuwait - I don't know why I am in the hospital. I'll tell you how I came to be in Kuwait, then maybe you can tell me why I am in the hospital.


I grew up in Sohar, where my father was a fisherman. Sohar was the birthplace of Sinbad the Sailor - did you know that? He - my father - had a small fishing boat. I would go out with him when I was small, and help him catch fish. I grew up on his boat. My sister worked with my mother selling the fish at the souq - we had a booth there. When I was about 15, I tired of going out into the same bay,  catching the same fish, so I left to work on a grand sailboat that traveled all over the Gulf - moving cargo, taking people. I was full of energy then - running all over the boat, swarming up the rigging and up the mast, not like now. Now I can barely get out of bed. I had too much energy back then - one night, I fell out of the rigging and broke my leg in three places. It never healed right. See how it's still bent? After that, the captain couldn't use me anymore, but he did let me stay on the boat until I got home.  In the meantime, my father had sold his boat, and my sister had gotten married to the son of the man who owned the souq. My father had given some of the money from the boat to my sister, and so he gave me some when I got home so I could start my own business. Sohar was full of broken sailors - or so it seemed to me - so I went to Nizwa. There, I set up a table where I made bags for the apricot farmers, repaired shoes - you pick up these skills on a sailboat, repairing the sails, you understand. There, I fell in love with my Khadija. Oh, Khadija… well, we married, and oh, we were happy. Children came, as they do. Five little ones, one after another. But then.. You heard of the new imam there, and the troubles in Nizwa. The planes came, and bombed the town.. Our home was destroyed. My table and tools - demolished. And my Khadija was.. gone. I found her three days later in the pile of rock that was our home. I couldn't bear to stay in Nizwa. My love, my life, was gone. Maybe this is when my blood got sick.


Like I said, I couldn't stay. I left my children with my sister and her husband - I couldn't care for them. The boat I used to work on was in port. I talked to the first mate - he remembered me - and he let me travel to Kuwait in exchange for repairing some old sails. I came here, to Kuwait, because I heard of how rich all the people are. I got by doing odd jobs for a few months, saving some money and sending some back to my sister for the children. Just a couple of months ago, I saved enough to get a table and a space for repairing shoes. I thought that doing all the work was why I'd been getting tired. I'd been sick - I think I caught the grippe on the boat on that last trip - but I never really got better. I didn't feel much like eating, either. I thought this was good - I had to send money back for my .. our children. Just before I put down the rent for the table, I started feeling this pain through my bones - from my broken leg, I thought. The doctors say this is all why I'm here, but what good does that do? Why won't they tell me what I have to do to get better? The thing that brought me here, to the hospital. I'm embarrassed to say. Alright, I'm too weak to argue anyway. I was peeing blood. That brought me here. 


The doctors say I have something called leukemia. I ask the nurse what this is - she says I have 'sick blood'. I don't know what this means. I have been in the hospital for two weeks now, but I do not feel any better. I feel worse. The doctors, they stop by two or three times a day, listen with their stethoscopes and talk to each other. They look at me, but they don't talk to me. The nurses talk to me, though I don't feel much like talking. I don't feel much like anything. I hear them calling the other patients by pet names. I'm too weak to resist when they shove me around the bed - giving me a bedpan, grabbing my arm to steal even more blood. I refuse to cooperate - unless they use my full name. It's my only way to protest. And maybe it's the only way anybody will remember that I've been here. The man across the hall - he has a stomach ulcer. People will remember him - he has visitors all the time. They even bring him sweets, and he has an ulcer! Sometimes he comes over to bring the sweets, but I don't have any appetite. Nothing tastes good anymore. I want to save the sweets, send them to my children the next time I can send them something, but they won't last. Instead, I bribe the nurses with them, to call me by my full name. They should know it - it's written here on my box, after all.


What's in the box? Nothing anyone would be interested in. I like to make the nurses guess. I don't think the doctors have even noticed it. I have the paperwork for my table - well, not mine anymore, since I haven't been able to pay the rent, but maybe the man next to me saved my tools for me. I have a picture of my father that was all I could save from the house. Oh - and two more things. Do you know why I escaped the bombs? No? I bought some earrings for my darling Khadija - we had been together for six years. I was coming back home when the bombs fell. I saved them for my eldest daughter, for when she's old enough to be married. Please, hand me the box. I'll show them to you. Here…. Oh, can you pick up the earring for me? I'm afraid I can't. I don't know where it is - I stopped seeing two hours ago.


Maybe the next time I see these earrings, I'll see them on my Khadija.

Tuesday, November 28th, 2006
12:55 am
50 Sci fi books
This is a list of the 50 most significant science fiction/fantasy novels, 1953–2002, according to the Science Fiction Book Club. Bold the ones you've read, strike-out the ones you hated, italicize those you started but never finished and put an asterisk beside the ones you loved.

There are some books whose titles I left unmolested that I may have actually read, and then forgot.

1. The Lord of the Rings, J.R.R. Tolkien*

2. The Foundation Trilogy, Isaac Asimov
3. Dune, Frank Herbert
4. Stranger in a Strange Land, Robert A. Heinlein
5. A Wizard of Earthsea, Ursula K. Le Guin
6. Neuromancer, William Gibson*
7. Childhood's End, Arthur C. Clarke

8. Do Androids Dream of Electric Sheep?, Philip K. Dick
9. The Mists of Avalon, Marion Zimmer Bradley
10. Fahrenheit 451, Ray Bradbury
11. The Book of the New Sun, Gene Wolfe
12. A Canticle for Leibowitz, Walter M. Miller, Jr.
13. The Caves of Steel, Isaac Asimov

14. Children of the Atom, Wilmar Shiras
15. Cities in Flight, James Blish
16. The Colour of Magic, Terry Pratchett*
17. Dangerous Visions, edited by Harlan Ellison
18. Deathbird Stories, Harlan Ellison
19. The Demolished Man, Alfred Bester
20. Dhalgren, Samuel R. Delany
21. Dragonflight, Anne McCaffrey
22. Ender's Game, Orson Scott Card*
23. The First Chronicles of Thomas Covenant the Unbeliever, Stephen R. Donaldson
24. The Forever War, Joe Haldeman*
25. Gateway, Frederik Pohl*

26. Harry Potter and the Philosopher's Stone, J.K. Rowling*
27. The Hitchhiker's Guide to the Galaxy, Douglas Adams*
28. I Am Legend, Richard Matheson
29. Interview with the Vampire, Anne Rice
30. The Left Hand of Darkness, Ursula K. Le Guin*
31. Little, Big, John Crowley
32. Lord of Light, Roger Zelazny
33. The Man in the High Castle, Philip K. Dick

34. Mission of Gravity, Hal Clement
35. More Than Human, Theodore Sturgeon
36. The Rediscovery of Man, Cordwainer Smith
37. On the Beach, Nevil Shute
38. Rendezvous with Rama, Arthur C. Clarke
39. Ringworld, Larry Niven

40. Rogue Moon, Algis Budrys
41. The Silmarillion, J.R.R. Tolkien
42. Slaughterhouse-5, Kurt Vonnegut
43. Snow Crash, Neal Stephenson
44. Stand on Zanzibar, John Brunner
45. The Stars My Destination, Alfred Bester
46. Starship Troopers, Robert A. Heinlein
47. Stormbringer, Michael Moorcock
48. The Sword of Shannara, Terry Brooks
49. Timescape, Gregory Benford
50. To Your Scattered Bodies Go, Philip Jose Farmer
Monday, October 2nd, 2006
4:11 pm
Sunday, August 27th, 2006
8:17 pm
Won a free trip to Atlanta!
Thanks, Hurricane Ernesto!

The Oregon team, along with a bunch of others, are being staged for Ernesto. I belive that many of the August teams are already in the field.

We'll be heading out for Atlanta on Tuesday, and will stage there. After the storm passes over, there'll be some damage assessment, and only then will we know what, if anything, we'll have to do. The storm itself keeps curving east - the way it looks now, it'll lose more strength over Cuba than was forcast yesterday, and will have a lot less opportunity to build up windspeed over the Gulf. There's a pretty good chance that we'll go down, sit around a couple of days, and then come right back. Since this is the first hurricane of the season, and since it's just about the 1 year anniversary for Katrina, there are a lot of politicians watching the response for this one, and they'll probably be deploying a lot more resources than needed.

I'm the planning chief as well as communications chief for this mission. This is the first time (drill or real) that I'm doing the planning role. Under the Incident Command System, the planning chief works on preparing for the next operational period - so, working on what'll happen 12 hours out.
Tuesday, August 15th, 2006
8:56 pm
5 days for a 3/4 day drill?
So the drill itself only lasted 'till early afternoon for us.

At 9am, the fake nuke went off (ok, they just raised a red balloon, but it was a jolly balloon). We staged nearby, and went in when we were called. We had the tents (4 19'x35' tents and a 20' octagon) set up and the partial medical gear (we didn't unpack absolutely everything) unloaded in 65 minutes. Not too shabby! There was quite a delay before we got the patients. The Honolulu Fire Department was to decontaminate the patients. When they arrived, however, and opened the envelope with their info for the scenario, someone had written the background radiation level with rem units, not millirem, so it read 1000x more than it was supposed to. The FD, quite properly, got the hell out of there. We watched them blast back out and went 'huh'. Once that was worked out, we started getting a bunch of 'patients' (actually a bunch of Marine recruits who'd been volunteered) to move through. We got a lot less than anticipated, so there was some amount of standing around.

The electronic medical records system had some issues at the start. The generators were running poorly, and Hawaii's battery-backup power strips were DOA (they hadn't been charged in the 2+ years since they got them). Whenever the power went down, the WiFi access point went down, which killed the connection between the computers in the patient tents and the server. No connection, no entering of records. Oops.

At the hot-wash (debriefing), we went over the good & bad points, patted each other on the back, and then I got a grass skirt and coconut bra for my birthday. Cool! It was a bit (ok, a lot) small for me, though.
Monday, August 14th, 2006
3:03 pm
Hawaii Improvised Nuclear Device drill update
It's Monday afternoon. We're at Bellows Air Force Station on the east side of Oahu. We got in to Honolulu Saturday around noon, got to the hotel (Best Western near the airport), and were then cut loose for the day. Some of us went out to the beach for a few hours, went for drinks at the Don Ho restaurant and then went back to the hotel for dinner. Sunday morning we headed out about 11am (there was _supposed_ to be new NDMS badges processed, but FEMA fell through once again). We went to Ft. S(something) for electronic medical records training (new Toughbook tablets, Oracle database and wireless networking - pretty nifty, actually), and then proceeded on to Bellows AFS where we'll be 'till Wednesday. We're staying in an abandoned dorm here - the buildings have been empty for 3 years or so. We got power working, and have running water, but the toilets are broken so we get the porta-potties (4 for 60ish people). You'll note the conspicuous absence of air conditioning, so I slept for crap last night. The caterers handling breakfast were about an hour late, too, so there were lots of coffee-deprived zombies sitting around early this morning, too.

Today was planning in the morning for command staff (including yours truely), and then training and more planning in the afternoon. Tomorrow morning is go time. There'll be about 550 people total in the drill, including some letter agencies. Ooooh, secret. They told us "There's a place with concertina wire and Marine guards with no sense of humor. Don't go in there. It's DNEA, and they're beyond top secret level clearance." DNEA, you'll be interested to know, stands for Domestic Nuclear Event Attribution. What they do is to test (in the field) radioactive material, and then be able to state "This bomb came from Ajerbajzan, from lot 342, dated 1967." I presume this is based on the exact ratio of nucleotides in the fallout. Military will be handling decontamination, Honolulu fire department will be here, bunch of others. Fun will be had by all.
Saturday, August 12th, 2006
6:16 am
At PDX on the way to Hawaii
I'm sitting at Coffee People in the PDX D concourse, with only 2 hours left to finish my banana smoothie. Since I was concerned about the security lines, what with liquids being banned and all, I showed up extra early. Good thing, too, since it took 5 whole minutes to breeze through screening. Would have been shorter, but I had to go through the metal detector twice - I forgot I was wearing my official military BDU belt with its metal buckle. Oops. On the bright side, Powell's, in its infinite wisdom, opened early this morning inside the concourse, and was selling books already when I went past it at 5:45.

I wasn't the only person to show up early. There was a huge lineup of baggage at the luggage scanning machines. The TSA guys there were triaging the bags, sorting by when the flight left. I'm thinking by 9am, everyone with a morning flight will have already been through, and TSA will all be sitting around doing the crossword.

I'm trying this trip without my security blanket.... err... laptop. I'm just bringing my Palm TX and keyboard instead so I can see how that goes. I managed to resist the urge to turn around and get it once I got a block away.
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