Geaux Tigers!

As everyone knows, this is a big weekend in college basketball, especially around here. For only the 7th time in NCAA history, a single school has placed a team in the Final Four in both the men's and women's tournaments. That school, of course, is LSU.

Unfortunately, the unexpected success of George Mason in the men's tournament has stolen some of LSU's thunder. The Tigers have great stories of their own, however. First, the women's team is led by Simone Augustus, a Baton Rouge native and unquestionably the best player in women's college basketball. Augustus, who led the NCAA in scoring this year, was the National Player of the Year as a junior, and a lock to repeat this year. She is probably the best athlete ever to come out of Louisiana in any sport. If Simone plays like she can, the Lady Tigers have an excellent shot at the championship. Even if you are not a fan of women's sports, take my advice and check out the best basketball player you have never heard of as the Tigers take on Duke on Sunday.

On the men's side, the big story is that LSU's 4th seeded Tigers are a true homegrown product. The 7 players with the most minutes this last season all grew up within 60 miles of the LSU campus. Most of the players knew and played against each other in high school. In a sport where big schools recruit nationwide, a team with such deep local roots is an anomaly. The men's team starts 3 freshmen, 1 sophmore, and 1 senior, and was not expected to make it past the second or third round. Instead, it beat the number 1 seed in the entire tournment when it dispatched Duke, and then defeated a top ten team in Texas to advance to the Final Four.

This past year has been a rough one for sports fans in Louisana. The Saints had a miserable season (the second-worst in the NFL), and the New Orleans Hornets skipped town for the entire season and now say they will not be back next year, either. LSU is our hope, and it aims to do something very special: only once (UConn, 2004) has a school won championships in both men's and women's basketball.

This weekend, forget George Mason. The real underdogs, the people of New Orleans, are pulling for LSU. We could use a ray of light down here.

Geaux Tigers!

My Cajun Story

For the interest of any gentle reader who wants to know, I have added a web page to my site that explains the origin of my last name, how to pronounce it, and a very brief history of the Cajun people and of Cajun food.

It has often struck me as of late that the term Cajun is well known but poorly understood. So I take my stand. 

You can find it here, or click on "What's in a Name?" on the menu to the right. 

The Houston Problem

The people of Houston are starting to complain about the burden of Hurricane Katrina victims.

When I read about this, my first reaction was dismay that one of the richest cities in the South could complain about the burden of evacuees. After all, Houston got so many because it had the most to give. And I do not think Houston would consider for a moment trading its problems with those of New Orleans.

However, I know New Orleans well and realize that parts of it were very violent. Even in a good year it usually stood in the top 15 American cities in murder rate. After Katrina the murder rate dropped to zero for many months, primarily because the areas with the highest crime levels were also the most devastated. I sometimes shuddered as I wondered where those people went. Some of them went to Houston, apparently.

I hope though, that Houstonians remember that good is often unrecognized as people naturally focus on the worst. When New Orleans was hit by Katrina, hundreds of businesses relocated to Houston. Some of these will never return. Houston, and Texas in general, was very aggressive about plucking away Louisiana's best and brightest, both before and after the storm. There were job fairs in Houston to recruit educated evacuees, especially teachers and medical personnel. I remember a billboard that went up within a month of the storm in New Orleans, promising jobs in Texas to New Orleans teachers. Ads for dislocated nurses to move to Texas appeared in the newspaper almost daily.

I can relate my own experience. When I was in Baton Rouge after the hurricane, trying to decide what I was going to do, the very first phone call I received in my job search was from a Texas recruiter. When I finally decided on my present location in Mississippi, I turned down 4 qualified offers from Texas cities. Texas may have qualms about accepting our poor, but it silently benefits from the influx of our well-educated. If I had accepted one of those jobs and moved to Texas, no newspaper headline would have said, "Texas Reaps Benefits of Physicians Dislocated by Hurricane Katrina." Yet I know of several quality doctors who did resettle in the Lone Star State.

Though I sympathize with Houston and its problems with evacuees, it is simply unfair to blame New Orleans for this turn of events. New Orleans is in no condition to accept its poorest citizens back, and these citizens may not want to come back, considering that Texas is far richer than New Orleans, and its public services markedly better. It may be a burden for a sick woman to ask a relative to take care of her children, but one cannot try to give the children back while the mother is still in intensive care.

The Heart Is a Shingled Dwelling

I was in my front yard, a roofer standing next to me. After a few brief words, clipboard in hand, he stepped away, then paced back and forth along the length of my lawn. His sun dried eyes squinted at every angle of my house, and he recorded each observation on a form.

“Dbl. peaked roof,” he said. “House 1800 sq. ft. 30% grade. 2 skylights. ” He spat out his words in short, tight breaths, the very tone of his voice implying that he spoke as well as wrote in abbreviations. After filling in a few blanks on the form, he punched up some numbers on a calculator, tore off part of the sheet and handed it to me. “Here’s your est.”

I glanced down at the paper, and couldn’t believe my eyes. It was the cheapest roofing estimate I had ever seen. “Are you serious? You can replace my whole roof for this price?”

“Sure can,” he said. “I just got a new shipment of roofing materials from a friend in Mexico. Cheapest stuff you’re ever gonna see.”

“Cheap? As in cheap price, you mean? This is good roofing material, right?” I asked.

“Oh, no,” he replied. “Junk. Pure junk. The shingles are a light as paper. That’s why I can put it on so cheap. So light one guy can lift 5 sq. on his back and climb up the ladder one hand free. We fasten it up there with plastic staples. Cheap, cheap stuff.”

Now I was just confused. My voice halted. “Why . . . why, would I want a cheap roof? I want a good roof.”

“Now, think about this, Mr. Hebert. I’ve been talking to a lot of people lately and selling a lot of these cheap roofs. Hear me out.” His hand moved to his breast pocket instinctively. There was a pack of cigarettes there. “Today is nice. Light wind, sunshine. You don’t need an expensive roof today.

“Consider when it rains. Most of the time the rain is light. A few 10 mph gusts. Nuthin’ much. You don’t need an expensive roof then, neither.”

“Friend,” I said, “I appreciate your concern for my financial well being. But I would like to point out that within the last year we had a hurricane. Hurricanes bring one hundred and twenty-five mile-an-hour winds.” I was in no mood to talk in abbreviations. “I am not concerned about sweet winds jostling the daffodils. I am concerned about a storm sending my roof into the swamp.”

“Yes, but, hear out, hear me out. A storm like that comes every 100 yrs. A T-storm bad enough to knock this roof off will come once a year. That’s 4 hrs. in 1 day, or only 0.04% of the time. On the flip side, that means the roof is fine 99.96% of the time. I don’t know about you, but a roof that works 99.96% of the time sounds like a great deal to me.

“You’re a doctor, aren’t you, Mr. Hebert? How would you feel about a medical treatment that worked 99.96% of the time? 99.96 . . . .99.96 . . . . 99.96 . . . .”

I blinked. My house was gone, the roofer was gone. I was in my office, in an exam room, talking to one of my patients, Mrs. Plum.

“Ninety-nine dollars and ninety-six cents. That’s what my cousin pays for one prescription of blood pressure medications. I can’t afford that.”

Rising out of my daze, I said, “Mrs. Plum, you don’t need anything as expensive as all that. I can write you a generic. The point, though, is that your pressure has been a little high the past two visits. It is a problem we ought to address.”

“Doctor Hebert,” she said nicely. I stiffened in my seat. When a Southern lady suddenly turns honey sweet, that means she does not intend to be denied. “My pressure is only high when I come into your office. When I take it at home, it is fine. I think it is just the anxiety of coming to the doctor.”

“Yes, I understand that, but . . . “

“I only come here once every few months. The rest of the time I am at home, calm and relaxed, and my blood pressure is fine. Ninety-nine percent of the time, it is fine. Why do I need to take pressure pills when my pressure is only up one percent of the time?”

I opened my mouth to answer the question, but I thought I heard tremendous roar of a hurricane gust strike my office. I looked out the window, and the view was calm and peaceful. Stalks of pine bark crowded the slopes outside, and the honest sun shone beneficently down upon it all.

It went against reason that a single hour, one twenty-fourth of one three hundred-and-sixty-fifth of one seventy-seventh of a life could make all the difference. Experience said otherwise.

That kind sun was shining on thousands of little Hurricane Katrinas at that very moment, thousands of tiny little blockages in the coronary artery system that would only last a few hours but would produce enough damage to splinter an entire life.

“Mrs. Plum,” I finally said, “you don’t take heart medicine when your heart is sick. You take it to keep your heart from getting sick. Now is the time to start taking your medicine because you are well. If you wait until the damage is done, all you will be doing is picking up the debris.”

“Debris?” she said. “Debris? We’re not talking about a tornado here, doctor. We’re taking about my heart!”

I wrote her a prescription for an antihypertensive. She said something to me as she left, but I can’t remember if she told me she was going to take it or not. I was distracted by the view in the window, the silent spring day, ever so placid.

                    The winds that will be howling at all hoours
                    And are upgathered now like sleeping flowers.

-- W. Wordsworth.

Big Brother Strikes Again

It is one of the most disturbing developments I have seen in the medical blogosphere in quite some time. GeekNurse is gone! GeekNurse was a blog about the experiences of a pediatrics RN in Auckland, New Zealand. It was also one of my favorite medical blogs, though I was a latecomer. I often enjoy reading nurses' blogs, because they offer a perspective on the medical life that is different from the physician.

GeekNurse closed down with a very cryptic and Orwellian message:

Closed

Owing to concerns raised by staff and management, GN's archive has been removed from public display.

What confounds me the most is the very bureaucratic and political nature of the statement. It is written in the passive voice ("concerns raised by staff and management" and "archive has been removed"), a stylistic ploy authoritarians use to hide the identity of the perpetrator (as in the classic Washington standby, "mistakes have been made"). The phrase "staff and management" also has that Iron Curtain-ish feel to it. GeekNurse is a lively and often humorous writer, and I have a hard time believing he could have authored that statement, at least not without a gun to his head.

The commenters on the site seem to feel "staff and management" refers to the administrators at the hospital where he works. Though GeekNurse is a pseudonym, he apparently identified himself by name in the copyright statement of his blog, so he would have been an easy target for witch hunters. Having worked in many hospitals myself, I can see how a hospital administration might apply pressure to one of its employees to prevent him from embarrassing them, or (more legitimately) from compromising patient confidentiality.

It is worth noting that if the closing of GeekNurse was the act of a hospital administration and if it was done over the concern for patient confidentiality, this does not excuse an act of censorship. Often, especially in academic or public-minded institutions, there is the belief that censorship is acceptable if the intent is benign. Unfortunately, this attitude overlooks the value of the discordant voice in any society. In my mind, there is no distinction between benificent censorship and forced homogeneity.  

GeekNurse was never offensive that I know of. And erasing an entire blog is a radical response to a conflict of interest. If there was a problem, why couldn't GN remove the few entries in question and then issue a public statement explaining what was done?

I worry about this because I too am a hospital employee, having signed on with Southwest Mississippi Regional Medical Center in McComb, Mississippi. Though Southwest has never said a word to me about my website (in truth, I do not know if they know it exists), I occasionally worry that one day I will be approached about the content of my blog. Since I am a doctor, my employment options are many, so I doubt I would take any kind of censorship lying down. Of course, one never knows until the time comes.

What I would like from GeekNurse is an explanation. I would even more dearly like to hear from "staff and management." Freedom of speech is a very precious right, and we bloggers should not let something like this pass without comment.