Reader Comment: A Child’s Chest Pain

A reader recently commented on the SW101 post Will My Child Have A Heart Attack with a disturbing letter about her child.  It has now been granted its own blog.  I have written my own comments in throughout the letter in red italics to make me appear extra important and potentially infallible.

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Thank you for that article. My typically healthy 6 year old daughter has been complaining of chest pain, burning on the left side of the neck and feeling her heart “in her throat” as she says. This is not a big deal.  Kids say this stuff all the time.  It goes along with the ubiquitous ”Tummy ache”, “I’m full”, “My eyes hurt”, “I need a drink of water”, and “Where’s my bear you can’t expect me to sleep in such harsh conditions so until you find my bear I’m going to sit here and attempt to poop my pants in protest so start lookin’ quick, POPS.”

She says it goes too fast and she gets dizzy and has actually passed out several times while doing minimal activity. This IS a big deal.  Kids don’t do this…ever.  True loss of consciousness in a 6 year old kid has a genuine cause.  In the elderly, things like autonomic instability lead to syncopal episodes (pass out when they stand up).  Add 90 years to your kid’s life, and your letter wouldn’t have won itself a full blog post.

I have taken her to several Dr’s, only to be told “kids don’t have heart attacks”.  I agree.  Kids don’t.  Adolescents do, however.  And young adults in their early 20’s do too. I’m at my wit’s end with this and worry over it constantly.  You’re right to be.  The hair is starting to stand up on the back of my neck over this one.

She had bloodwork to check her cholesterol about 14 months ago and it was high. Genetics..ding!  ding!  ding!  That, or you’ve set her up with a continuous Big Mac infusion pump through her sleeping hours.

She recently had it checked again and it was 259. That’s worse than mine…and I’m 37 spending most of my time with my butt glued to a chair while I hover like an anxious hen over my blog. Her sister (age 10) had a cholesterol level of 126. Luck of the draw, kid.  I’d see the bet and raise it if I were her. They eat virtually the same thing and my 6 year old is only 40 lbs, so she isn’t overweight. Another sign of a genetic component…which makes this just fantastically unfair.

This is now starting to affect her normal playing routine because she says running/playing make it hurt worse. REALLY bad sign.  Kids run.  Especially skinny kids.  They RUN.

I’ve been told it’s constipation ?, seriously?, reflux probable in ADULTS, heartburn same thing…grown ups, not kids, pulled sternum maybe the strangest musculoskeletal diagnosis I’ve ever heard….but so far no Doctor feels it is anything to worry about.  Are you seeing actual doctors…in actual America?  I hear the medical system on the plains of Balinor is a bit iffy.

She had a EKG and it showed she was tachycardic based on her age?  EVERY kid is tachycardic compared to an adult and a few arrythmias this is like saying “oh, we had some red wine”.  Some arrythmias KILL YOU, others are meaningless…and everything in between.  What kind of arrythmia?, however her pediatrician feels that could be normal for her age. ‘Could be?‘

Her teacher at school tells me she complains 5-10 times a day and says ‘my heart hearts’.  My 3 year old boy is obsessed with candy, but I’d guess he rarely actually asks for it 10 times in one 24 hour period (considering he sleeps for about 14 of them).

We live in a very small town population 4?, and have to travel 120 miles to a ped. cardiologist worth it…however they won’t see her without a referral and her pediatrician doesn’t feel it is necessary I suspect an insurance issue.  How hard is it to make a referral, even if only to help reassure mom?

If you have any suggestions for me I would love to hear them. I’m worried
that even though diet has been modified and the rest of the family has no cholesterol issues (grandparents do) that this high level is affecting her.  Do you know of any other tests that I could suggest her Doctor perform? Short of a cardiac catheterization, I’m not aware of any other helpful tests in this situation. He has also shrugged off any suggestions of a heart echo.

Final Thoughts – (I’ll dispense with the red italics, even though it makes me feel Extremely Important):

I can’t be certain that your story is completely true, because I don’t know you and haven’t seen your daughter’s medical file.  It also rings a bit fantastical since I’ve spent lots of time around pediatricians and have never seen one as cavalier as what you describe based on the small amount of information you’ve provided me.  As a rule, I do not believe that many doctors are lazy, incompetent, negligent…or drunk.  If you’re going to a licensed child specialist physician, they probably know what they’re talking about.

That said, IF your story is completely true, my advice is to knock on doors – pound on them if you have to.  Walk up to any door with an M.D. on it (be wary of any other initials except perhaps D.O.) – until you get a referral to a pediatric cardiologist for an echo.  Women walked for 5 solid hours under the Haitian sun to have their child seen in our clinics when I did relief work there, so you can cross vast distances for your child too.

The echo, in my opinion, is the first place to start.  Your child also probably needs medication for the cholesterol issue – or will in the very near future – and if your pediatrician seems to be cavalier about this, you may need to look for one that is more aggressive.  But diet changes won’t help this situation much, and exercise could be dangerous until you rule out structural heart disease.  It’s almost impossible to find cardiomyopathy without imaging, and totally impossible to find early atherosclerosis without a significant work up by a cardiologist.

Rest assured, there is a doctor out there who will find in in their writing hand to put in 10 minutes and refer you to a specialist if your story is as legit as it appears on this blog.  If it takes spending a week in a larger city, fine.  If it takes getting on an airplane, DO IT!  If what you said is true, and there are no additional conveniently omitted facts, your child needs to see a specialist.  Do NOT stop pestering doctors until she does.

Finally, let me say that while my heart goes out to you, remember that I am a doctor…but not YOUR doctor.  And this is a blog, not my clinic.  As you can see by my responses, I’m giving my honest opinion, but also being silly.  I write this blog for fun, not to extend my day at the office.  Therefore, these responses qualify only as  suggestions and musings, not medical advice.  A licensed physician, who has actually seen your daughter and evaluated her entire history, is the one who needs to make a real recommendation in this situation.  It completely annoys me that I find it necessary to say that….the world these days is run by lawyers.

All joking and useless lawyer pandering aside, my responses in this blog really boil down to one thing:  Keep knocking….

Movie Review – Avatar

I enjoyed myself fully last night as I entered the world of ‘Avatar’, James Cameron’s new sci-fi epic that already handily broke a 1 billion-dollar landmark record of some kind.  I’d watch the show again tonight if I could.  I’d probably watch it every night for a week like my high school buddies did for “Bill and Ted’s Excellent Adventure” once upon a time.

You don’t have to care – or understand – the point of the movie to completely enjoy the stunning visual spectacle presented in wide-screen, 3D wonder.  In fact, I’d advise constraining yourself specifically to the visual effects and skip putting any real thought to the message of the movie.  In essence, just sing along with the song, but don’t think about what the words actually mean.

The story follows an ex-Marine named Jake as he becomes part of a mission to subjugate – or at least translocate - the natives on a strange new planet (a moon actually, but does it matter?).  On the n0t-so-subtly-named Pandora, the “aliens” congregate around an enormous tree set in the middle of a seemingly endless forest.  They stand about 11 feet tall, with blue skin and luminous yellow eyes and they all seem to carry bow and arrows and daggers.  These blue and tall but otherwise disappointingly human-shaped beings generally seem happiest when attending their frequent tribe-wide drum fests – with a terminally simplistic 2/4 beat rhythm that sounds like it might have been pounded out on cool Senegalese drums the Anglo orchestra bought in bulk.

These earthy aliens have a sacred, mystical, spiritual connection to the forest where they live; generally behaving like any nature-loving tribe the Europeans successfully decimated a little over a century ago in North America.  In a complete creative hiatus, at one point nature is even called a “mother”.  Why not a father, or brother, or just skip the nuclear family reference to nature entirely?  The descriptor ‘Mother Earth’ is so unoriginal, it ranks up there with Bless You and Dot Com.

Although 2 hours and something like 40 minutes, you can easily sum up the movie in one phrase: “Dances With Wolves”…but with pterodactyls you can ride.

Basically – Marine makes contact with natives through project financed by aggressive and ethics-challenged Big Business company.  Marine plans on helping his financiers destroy said natives.  Instead, he inadvertently falls in love with natives in general, and one curvaceous native in particular.  He then becomes the enemy of his former bosses, ultimately leading the meek, dumb, dark-skinned simpletons to victory over superior white man.

I haven’t decided if this REALLY tired theme of the White Male swooping down into a primitive race, seeing their genuine good, and then becoming their Great Savior is completely racist.  Some are saying it absolutely is.  I don’t really think that was the intent.  I just think it was lazy writing by a white male who deep-down believes that white men are still the best hope for the world.  That they still run it, ultimately.  But it is possible that white men really don’t have much to offer the world anymore – that we’ve had our time and made our mark.  Maybe it’s time for some non-white, non-men to run the countries, write the laws, own the companies and save fictional worlds.  Maybe the white boy has done about all he can.

Big Business takes a major hit in this movie.  It gets portrayed as the denizen of all Evil in life.  That said, it’s Big Business that has paid for every iota of scientific discovery that has occurred on Pandora.  The science taking place on this moon (and taking place on our earth) is an elevated form of existence, no question, but in both worlds it mostly exists because of Big Business, either directly or through taxes.  Scientists – and artists – need to accept the fact that to live in that enlightened world of thought and wonder and possibility depends on their benefactor’s mundane ability to sell widgets.  Big Business is rarely genuinely evil.  True, figuring out when to inject some profit-endangering humanistic principles into a business plan does takes some skill and is occasionally gotten wrong. But for the most part, if business didn’t make the poet, at least it feeds him.

The actual “avatar” is a living being made to look like the aliens, but controlled by the mind of a human.  The human links to the avatar neurologically, so it can only be controlled by one specific human.  Thus, the human lies in a coffin-like body-pod that connects him/her to their specific avatar.  Upon falling into a coma in the pod, the avatar wakes up and the mind of the comatose human controls it.

Soohh...who gets to clean this thing?

The doc in me couldn’t help but get hung up on this part of the movie.  First, all humans need to sleep.  But since the avatar wakes up as soon as the human “sleeps”, and since controlling the avatar is a conscious process, the human never actually does sleep.  For some evolutionary reason I can’t fathom, REM sleep is the foundation of all life.  This inconvenient fact defies even the mighty pen of James Cameron.  By the end of the movie, after staying awake vicariously with the characters, I felt like I’d been on call in the hospital for days on end (felt like I was back in residency again).

Also, the human lays in this coffin thing for hours and hours.  At the least, he’s gotta pee himself on a regular basis, to say nothing of the inevitable bowel movement here and there.  Plus, the main character’s avatar hooks up with the sexy female alien.  Depicted as the first consummating night of an eternal love bond – thus likely a multicoital affair – envisioning the scene (and smell) inside the pod after this particular night left me a bit squeamish.

As mentioned, the power of this movie is in the visuals.  It is a “looker” many times over.  But the general message is tired, probably slightly racist, and denigrates the U.S. Military (or at least leads the audience to exult in the widespread slaughter of American soldiers/mercenaries).  That said, perhaps our culture really should take the main theme of the story to heart.  After all, we DID decimate the Native American culture, and based on my experiences on the Crow Reservation in Montana, I’d say we continue to.  We’re also strikingly obtuse in our dealings with tribal cultures in the Middle East today.  Listening to people from a different culture – rather than melting them with daisycutters and circling drones – has some merit.

But I do wish the movie had added a little post-modernism into the mix and eschewed the evil-good idea altogether.  It didn’t have to pit the American Axis of Evil (big business + U.S. Army) against a pristine tribal culture practically perfect in every way.  Historic Native American tribes were often duplicitous, aggressive, thieving and hateful (many still are today).  They rarely trusted each other from tribe to tribe and may have been just as irresponsible had one tribe attained the raw power that the U.S. Government currently has.  The Arab tribes we’re tangling with recently have a litany of faults and cobwebby dark corners too.  But they are also a just, priceless, sacred, honorable people.  This dichotomy exists in virtually every race in our world.  Americans seem to hate this complexity in our fiction – it’s easier to hate one thing and love another and then watch them duke it out.

Yeah, YEAH! Die lame-oh Americans! Wait, didn't an American make this movie?

Thus, the conflict in the movie could have been between two parties filled with faults and frailties but ultimately imbued with genuine honor, honesty and a respect for the rights of others.  Standing between them is something they both deeply need and want (trees, mineral ore…whatever).  In life, conflicts almost always boil down to two parties who both have blood on their hands, but both are essentially good, honorable…and in the right.  e.g., Palestine wants the land, Israel wants the land, both have been evil at times, both have been angelically good at times, and each have some form of legitimate claim to the exact space of real estate.  Stick that conundrum in your avatar’s virtual peace pipe and take a deep drag, nature-brother.

Depicting this nuanced world may have weakened the sense of righteous rage as the Army went Operation Flatten Everything.  It may have lessened the gloating release when the Ultimate Bad Guy finally met his ignominious end.  But it would have made a better movie.  It would have made the written story as complex as those fantastic visuals, and created a worthy counterpart to such a sparkling, wondrous vision.

Where’d They Go?

For those wondering where all the blogs have gone – I was on a once/week or better output for over a year – I’ve been distracted (this is not newsworthy).  Lately, the particular distraction has been my novel (this, maybe, is).

Yes, like every 3rd human on planet earth, I’m writing a book.  And one not all that creative, I suppose, since it’s basically “Star Trek” but with minimized people in a tiny ship inside a human body.

Same Thing...Just Smaller

Entitled “The Journals of the Micro Project,” I started writing the book waay back during my first year of med school to help me survive…med school.  Anatomy and physiology, in particular.  Then I just kept going, as I kept taking more classes.  Then I started writing the story to help me make sense of my feelings about religion and international politics (since we were living in Israel), how the American social order relates to dreamers and idiosyncratic personalities…and even how I feel about the city of Jerusalem.  Yeah, that all got in there.  Possibly some funniness and mildly-believable sexual tension stuff too.

I knew about the likes of “Inner Space” when I started my story.  But since I was using it to help myself understand and remember facts about medical science, I didn’t care about any sort of “hook” or “unique voice” or “poetic angle” so important to selling fiction.  I wrote it for me…not to foist on the rest of the world.

Then I started hearing the cha-CHING of literary greatness when I learned that the average novel makes an author less than $5000.  I figured ‘Daaang, I gotta get me some o dat action!”  Immediately, I began working on crafting a novel that everyone would like to read and pay, oh, 2-3 bucks for.  By ‘everyone’, I suppose I’m referring to Jr. High super-dorks with a left brain so big and a right brain so atrophied they walk in left-leaning circular arcs all day.  But so be it!  Friends are friends, even if they eat Captain Trilithium for breakfast.

Suddenly, things like verbs, quotation marks, PLOT, coherence and originality actually mattered.  Whoah.  Pressure.  So, I put a lot of work into all the mechanic stuff during residency, usually at the Bayview Deli in downtown Olympia.  The manager there gave me permission to hole up and write all day.  Sitting in that cafe, looking through giant bay windows onto Puget Sound, studying its many moods – from glistening to tumultuous, from deathly still to rollicking and granular, from green to blue to silver to explosions of orange and red and purple – remains one of my life’s favorite memories.  And that 2nd floor of the Bayview Deli remains one of my favorite places…making a respectable run at the Armenian Tavern in the Old City of Jerusalem.

As I sat there, pondering what kind of Eternal Being could possibly drum up the idea of a vision like the Sound, the distant snow-capped Olympic mountains and all the glorious splendor of trees, hills, clouds and wind that make up the southern edge of Budd Bay, I figured I was writing a freaking MASTERPIECE.  Move over, Bill’s Faulkner and Shakespere.  Make room for the New Guy.  Who wouldn’t write a masterpiece when surrounded by such divine poetry?

The guy's on a throne...how'm I supposed to compete with that?!

But, like a tire iron to the face, I learned only recently about a similar story written by Isaac Asimov, which was based on a movie screenplay.  I guess it was written in the ’50’s – when all anyone cared about were those evil Commies – but aside from that political angle, my story apparently bears many similarities (I am mortally afraid to read his book, lest I find that all my plot ideas have been used up).  So, turns out that more than one person on the planet has, at one time or another, imagined what it might be like to travel around inside the human body.

If you want my opinion, he’s a damn inconsiderate un-original jerk, Asimov.  Depending on your definition of “time”, Asimov pretty much totally ripped off my idea and then went back to the 1950’s and wrote the killer app (we’re talking sci-fi here…it’s an arguable point).  And really, how many ideas did that guy use up on his stuff, anyway?  Couldn’t he have left at least a science fiction crumb for anyone else?

Oh well.  By the time I learned about the Asimov thing, I was too far in to quit.  So, tired drivel though it likely will turn out to be, I’ve been putting some of the final touches on the book.  All 150,000 words of it.  It’s all I do with my spare time.  I get home from work, play with kids, help with the dinner/bed axis, try to give eye-contact to anyone who is talking, chill in front of the T.V. for a bit, then I attack the book till 12 or 1 every night, even when I have to be up at 0630.  The result? A sadly neglected blog, baggy eyes, and a book that now needs professional help (arguably, like its author).  Once off to a good editor (bro, you’re up!), I suppose I’ll get back to some regular blogging.

But until then, dear SW101 nation, bear with me as I pursue this 8-going-on-9-year exercise in being told, “Don’t give up the stethescope, Dr. Delusion”.

Oh-NineHundred

Nothing makes an Army drill sargent (prounounced something like ‘Sar-Ughnt’) more testy than when a good number of his/her unit skips morning physical training.

I take that back…there’s a veritable Olympics of things competing to be the thing a drill sargent hates the most.  But showing up late for PT is definitely on the list.

One of my jobs is to set up patients with this Army thing called a Profile.  THE profile.  After a few months here, I can say in all certainty that the profile is my own personal battlefield.  Everything I do seems to revolve around this paean to administrative oversight.

Simply put, the profile defines what an injured soldier can and can’t do.  They get very specific: Soldier may mix cocktails, but d/t a herniated C-4 disk, he may not tip his head back to drink them.

Oh MAN...we can't come in 'till 9. Super tired...

One of the big reasons I see patients is to “review the profile.”  Read between the lines, and typically, the visit is really about the patient trying to get some other restriction put on their profile.  Restrictions that will make most soldiers ecstatic and drive a drill sargent nuts.

The most ubiquitous profile restriction is the “0900 work call”.  Prounounced “Oh-9 call”.

Droopy-eyed private: “Uh, man, sir, uh.  Need an Oh-9 profile.  TONS of sleep meds. Can’t get up for 0630 PT.  Help.  Desperate and all that.”

Me, Dr. Naive:  ”Ok.”  Fill out form.

Private: “THANKS, man.  Can I get Oh-9 profiles for the rest of my X-Box buddies.  Now that I can stay up all night playing Soldier of Fortune, I need my buddies cuz we compete against each other.”

“Soldier of Fortune…isn’t that pretty bloody.”

Evil smile, “YEAH, totally.  We just run around shooting everybody.”

“K.  Why are you on meds again?”

“Can’t sleep.  PTSD.  Keep seeing people get shot when I close my eyes.”

Embellished only slightly, I’m coming to the point where I can’t see a SINGLE medical reason to approve someone for 0900 work call.  Sleep meds don’t last forever.  If you take them at 7pm and are in bed by 0800, you should be able to get up in time for PT.

I’m asking around to doctors I know:  Any medical reason you can think of to allow someone to come in at 0900 rather than 0630?

The Toilet Excuse? Really?

“I need more drugs because I had a heart attack yesterday and in my monumental pain I flushed my Percocet down the toilet.”

I stare.

 

AWwww, MAN, I don't know WHAT happened, man.

“No really.  I’m serious.  I don’t know what’s going on with my heart and I accidentally flushed my drugs down the toilet when it was causing me, like, serious pain.  I REALLY need some more.  I’m in like 24/10 pain.”

 

“That’s a pretty strange fraction.”

“Well, that’s how bad it is.”

I hope my eyes are at least a little more than half-closed, “Dude.  That’s your excuse?  Really?  That’s the best you have for me?  Flushed?”  My ever-blindingly cheerful mood deflates a bit.

“Well, it was the case manager who told me to come to you for more Percocet.  I tode her Dr. SW101 isn’t cool with narcs, so I figured you wouldn’t go for it, but she told me to try.”

“So, the NURSE made you do it?”

“No…well (looks hopefully at me), uh, maybe?”

 

Dr. SW101 set me UP!

He did utter one truth, I’m not cool with writing for unfathomable doses of highly-addictive, mind-altering substances that have outrageous street value and regularly cause the utter destruction of families, careers and lives.

 

He’s right.  I’m not cool with that.

Sometimes it feels like I’m just sitting in my clinic handing out bullets…each one stamped with “If this causes a disaster of any kind, please blame Dr. SW101.  His bank account number is 7749220485, and you can find his children at 13 XX street, usually after 6pm.  Punish him accordingly for making such a mockery of his Doctor’s Oath, society, God, the memory of Elvis, Stonehenge, Hello Kitty, Gooeyducks..and everything else even remotely sacred to humanity.”

But I’m used to that.  I’m used to being the candy man.  What I’m NOT used to, is being taken for so dimwitted that the medical equivalent of ‘the dog ate my homework’ excuse might work on me.

“You’re really using THAT one on me?”

“Look man,” (whips out his Blackberry Smartphone, provided free of charge by the Army to help with his healing), “I got pictures of the pills in the toilet.”

I decline the visual.  Don’t even need it.

“You’d need to pin my face to a cork-board with something in the range of 34,000 thumbtacks to talk me into giving you more narcotics with that lame excuse.”  I say.  What I DON’T say is that aside from fighting the good fight against blatant drug addicts (I do take care of true heroes; he’s not one of them), I’m just flat-out annoyed at the excuse.

“Frankly, you’re story is miserable.  Put in a little work, and you might score a few hits out of me for creativity.  I’ve been known to drop a few Vikes on someone just to tribute their impeccible style alone.”

“Style?”

“Yeah, you know, do some deep-thinking before you try get me to double your daily horse-halting, blue whale-euthanizing, brontosaurus-stupefying doses of addictive opiates.”

“Liiike, a better story?”

“Yep.  I loovvve fiction.”

“Um, like what?”

“The doc I’m replacing was partial to “I washed ‘em in my uniform”, so I’d say that’s a little, uh faded haha no pun intended *aHEM*, sorry, not making light of your “pain” or whatever, just a little side-joke for this glorious Army morning.  Anyway, where was I?”

“You were helping me come up with a story to score more narcs out of you.”

“Oh YEAH.  Thanks!  Let’s see, maybe I can help you….next time, try something along the lines of:

 

They're real. Seriously.

After a valiant but ultimately tragic battle, a saber-tooth tiger ripped your friend’s head off.  In desperation, you heroically dispatched said wildcat with your bare hands (careful with the back).  Then, without pausing to consider yourself, you gave him your ENTIRE BOTTLE of pills strong enough to drive the entire population of Gambia into rehab.

 

Unfortunately, when he swallowed them – since his head was removed from his body – your pills just dropped out on the ground, all slimy and spit-covered and quickly dissolved.  Thinking fastly, you propped his body up and then held his head over what you figured was the esophagus part of  your life-long friend’s neck so the remaining few pills – “Damn you, Johnny, swallow! – dropped out and settled into one of his neck-tubes, hopefully not the trachea.  Then you got him to a local ER, where they skillfully re-attached his head.

ONLY THEN, after your friend was recovering (he just might pull through, snif), did you think of yourself, realizing that you were, in fact, out of drugs for your endless back pain and heart attacks which you’ve been suffering from since you were born, 20 years ago.”

“That would work?”

“No.  But honestly, that story has more credibility than, ‘I flushed ‘em, brah, gimme some more.”

8 Pigeons? I’ll Check the Regs…

I love urban legends:  The one about the killer calling the babysitter from inside the house, or the acne that turned out to be a quivering pod of spider eggs.  You know, all those.

But my favorite is the one about how you can cause pigeons and seagulls to explode by giving them Alka-Seltzer.  I’m serious.  EXPLODE.

This myth is cool for the science-fair, medico-extravagance of it.  But I also harbor a fairly pathological grudge against seagulls.  Sure, their winsome cry carrying on the breeze hearlds the nearness of the endless sea.  Thousands of poems and stories and paintings concern themselves with these ocean-going fowl.  But I lost all romance toward the seagull when a GIANT group of them ate an entire bag – including the bag – of Chips A’hoy cookies while my buddy and I were surfing once.  I’m STILL looking forward to eating those cookies, and that was 8 years ago.

Why do they explode?  Apparently, birds have a one-way alimentary tract, which means they can’t burp.  Give them something effervescent, all that gas has nowhere to go aaaaand – POW! Alice, straight to the moon.

You can understand, then, why my favorite patient currently is a guy who actually tested this one-way-no-burp-POW! theory.  For all my grudges against the birds, I’m still too much of a softy to actually blow them up.

Not Jake, though.  He went for it.  And still doesn’t feel bad about it.

He went with pigeons – same class as seagulls, if I was the ornithologist in charge – and trying out the theory got him kicked out of the Army.  ’Course, he tried it on 8 birds at the same time.  After he stuffed them into his commanding officer’s new Chevy Tahoe.

“So, it really works, then?  They blow up?”

“Yeah, it works.”  He said, looking bored and chewing on a cuticle as I nearly wept with laughter.

“They ALL exploded in your commander’s car?”

 

Uugggh, did you eat a bunch of those little white crackers too?

Suddenly he perked up, eyes sharp and intelligent, “Nah, not all of ‘em.  Some just shit all over the place.”

Imagining his commander’s reaction the next morning after finding the most colossal mess of all time, just brightens my day every time I think about it.

 

By some miracle, this guy got away with his life after that episode.  More miraculously, after getting CHAPTERED out of the military (basically a court-martial without the court or jail), he got back into the Army just a few years later. “On a wavier for bi-polar disorder, in remission.”  He said with a wicked smirk.  ”Needed a paycheck.”

I can only imagine the ever-positive recruiter.  ”Oh, well, 8 pigeons?  Only 8?  I’ll check the regs…there’s probably nothing in there that expressly forbids entry into the military for blowing up birds.  No problem, man.  I’m sure we’re good.  Now, I can’t promise you a bonus, you understand..”

Now he’s on his way back out of the military, via my unit.  He’s wry, filled with black, intelligent wit and flat-out hates authority.  I’m not sure I’d call this a mental disorder… but in the Army, a guy like this is nothin’ but stark-raving nuts.

Of course, once he gets bored…he’ll be back.

 

POOF!

 

 

20

Giant Party at the Brandenburg Gate

20 year ago tomorrow, the Berlin Wall was breached.  The first East Berliner to make it across – legally – was a woman named Angelika Wachs (news to me…old hat to everyone over here).

Algelika Wachs

My favorite band of all time – U2 – performed a live show in Berlin this past Thursday to start the festivities, which will continue through this week.  We live 3 hours from Berlin, and may as well still be in Olympia, unfortunately.  The celebration isn’t history…but it will get close and I’d love to be there.

The U2 show was free.  All you had to do was get a ticket via the internet.  And you had to do it within a 3 hour time-span because that’s how long the 10,000 available tickets were available.  Being a free concert, you might find the need for tickets a bit ironic.

Even more ironic:  if you didn’t have a ticket, you couldn’t see the show.  Why?  Because MTV (the show’s producers) had erected – you guessed it – a WALL to obscure the performance.

Danger: Broccoloi

 

An R-rated food. Must be 17 or accompanied by adult to eat safely.

Highly-intelligent child holds up half-eaten stem of steamed broccoli:

“Dad, will this make me dead?”

 

Family doctor Dad replies, “ABSOLUTELY, son.  Some stuff just wasn’t meant to be eaten by 3-year old boys.  Put it down quietly before you mom sees, and go get the chips.”

Collapse!

I'm SO sick...can't taxpayers just pay for my life?

Patient: “I think my body is shutting down” (but really I just want you to write me a doctor’s note saying I never have to go to work again d/t incurable back pain)

Me:  ”No, you’ll be fine. And sorry, but you need to go to work.  Neurosurgery won’t see you any more.  Pain management won’t see you anymore.  Things are as good as they’re gonna get.”

Patient:  Ok.  Well, thanks for try…try…uh….”

Stands half-up, then collapses on the floor.  ”Unresponsive”

Nurse:  OMG!  Call the ambulance.

I lift up her arm, hover it over her face, let it drop. “Limp” arm performs a curious “S” shaped drop maneuver, conveniently missing her face.  Vitals: 121/87, HR 84

Me: “You’re fine, ma’am.  Just let me know when you want to wake yourself up and get off the floor of my office.  I’ll be over here charting.”

Patient:  Suddenly revives…miraculously.  ”What hap…happened?”  Gets off the floor and returns to her chair.

Me: I have no idea.  See you in two weeks.

Her little episode didn’t even make it into my note.

Numb and Numb-er

I’m happy to announce that I now drive a Mercedes-Benz.  It’s true.  A real in-the-steel-and-glass Mercedes.  The model is a C-180, which is the 4-cylinder, 4-door model.  The smallest engine they make (great gas mileage).  To boot – it’s green, my favorite color.

I’m a doctor now, people.  Apparently helping sick people entitles me to the high-life.

Truth is, here in Germany, the term “hooptie” is a known, legitimate noun.  The term is used to describe nice German cars that are (usually) bought by Americans and then run into the ground.  You can pick up BMW and Mercedes hoopties for 500 euros.

 

Mine looks just like this one...but way cooler.

My car isn’t exactly a hooptie.  In the States, it would probably have cost at least $5,000, maybe more.  I don’t really know because I’ve never been in the market for Mercedes-es.  But I got mine here for a few thousand bucks.  It’s still in good shape and as long as I take care of it (an expensive proposition in Germany), it should get me around for at least a few years.

That is…unless it takes a few years until my new monument to affluent living is allowed to take me anywhere.

Take the Army’s torrid and longstanding love affair with bureaucracy and combine it with 1000 years of rulership of the masses in Europe, you get the process I dealt with just to be allowed to drive a car.

Buying the car is easy.  But in this Germo-Americo Funkenthink, the quagmire starts there.  You first need a special driver’s license, which requires a half-day class and then a 130 question test ( which I immediately failed by about 15 questions).

You also have to have insurance on a car before you actually register it.  And, the car needs to be inspected.  But you can’t drive it to the inspector’s unless you have it registered and insured.  But if you fail the inspection, you’ve just registered and insured a car that sucks.  So, you have to de-register it (I did that – twice – before I settled on the Mercedes).  De-registering requires a trip to the local customs office (American) plus a second trip to the other customs office (German, 35 min drive), numerous forms, money, waiting and…all the while you still need the insurance.

So, I’ve been a little reticent to drive much unless I have to.  I’m always wondering if I actually have all the paperwork and proof that will allow me to stay out of jail were I to get pulled over.

Instead, I came up with an alternative (heh, heh):

Through some highly unfortunate events in my brother’s life, I ended up with his Harley motorcycle.  Now, make no mistake – I owe him for this very expensive bike.  It was a ‘take-care-of-my-hoss-for-awhile’  kind of proposition.  Of course, being a deeply loyal brother, I immediately agreed to “help out”.  But, not being a big Harley-lover, I…well, I sold it.  And I bought a BMW motorcycle instead.  Initially, I sold it to help fund out trip out here, and a portion of the Harley money was a HUGE help in getting us here.  That said, I GUESS whatever money we had left over should have been sent back to my saintly bro.  But with all these fantastic German road machines around, you sorta just get Beemer Fever.  What was I supposed to do?

And anyway, my bro is about 10,000 miles from me.  Is he really going to come get me when he realizes I sold his Harley?  I mean, c’mon, I did the guy a favor!  BMW vs. Harley is a no-brainer.

 

Mine's just a LITTLE less shiny and has panniers.

So I now fly along the German Autobahn on a R1150 RS BMW.  Riding a bike like that, in this part of the world (any part of the world if you worship BMW bikes) is an experience that is hard to replicate.  Harder to describe.  At 80 miles an hour, I blow by stunning autumn trees, taking in their blurred resplendence in shimmering hues of gold and yellow and red.  ”My” bike purrs along effortlessly.  When I lean over the gas tank and duck behind the faring, the engine sounds something like a sewing machine, but even softer, maybe more like two feathers rubbing together.

There’s only one problem…Germany is COLD.  The other day I left for work in the dark, road sparkling with frost, at a temp of -2.5 Celsius.  Buh-rrr.  And this is only OCTOBER.

The night before, I had received a notification in the mail that my car did not have the correct license plates due to a dating error in the – you guessed it – insurance policy.  So, should I be pulled over in my esteemed Mercedes for any reason, I could expect to be hog-tied, whipped and sent back to the States crisply folded into a shoe box.

Thus, while my longsuffering wife dealt with the paper-pushers in Hiedelburg, I rode the bike to work, frost and chill notwithstanding.  I do have some decent riding gear I picked up when I first got the Harley.  I have a jacket with armor in the shoulders and arms, and pants with knee and hip pads.  I have big thick gloves – also a “gift” *ahem* from my bro – and good riding boots.  All the gear is made to withstand serious wind and rain.

 

"Got a little nippy back there going through the pass, eh Har?"

But I’m not sure any gear will hold up for long when receiving a direct 80 MPH sub-freezing air blast for 40 straight minutes.  Mine didn’t.  By the time I got to work, I was so cold most of joints wouldn’t bend.  I walked into the clinic like I was in a body-cast.  I don’t think I even spoke to my first 3 patients that day because I couldn’t unclench my jaw.  I just nodded compassionately with my hands buried in my armpits and gave ‘em whatever drugs they wanted.

I probably should have just sold the Harley and given whatever money we didn’t need back to my brother.  But instead I chose to buy a Beemer with the extra cash and freeze my face off in Germany.  If you love BMW motorcycles, you’ll understand completely.  You’ll probably applaud me for such a wise and intelligent idea.

I’m cheering, anyway.