Vanguard: A Miscellany

Thursday

Thursday. Have to kill time. It's my half day, and I'd scheduled a dentist appointment at 2:00. I grind my teeth, so I need to get fitted for a night guard. The fitting done, I get financially raped by my dentist in Beverly Hills. Serves me right. Who needs a dentist in Beverly Hills? Especially one who's kind of a perv. I finish in fifteen minutes, but I can't go home. The traffic between my apartment and OBar sucks. Any time after noon it sucks. And Beverly Hills is so much closer. And I have to meet people at OBar at 7:00.

So I go to Shorty's to get my hair cut. I met the owner at a friend's birthday party over the summer. It was a pool party and he was hot. So I've been going there ever since. I finish there a little past 3:00. And even more, I can't go home. So what do I do?

The Theory store on Melrose. I love Theory. Besides Boss, nothing fits me as well. And I've been dying to go to their flagship store, so there I go. And I get helped by Mitch--cute Mitch, so attentive, so complimentary, so...straight. I leave.

Next stop is across the street...the Diesel store. I think I buy more than I should because Callow the salesperson who helps me is cute-in an unconventional kind of way. And by unconventional I mean not really all that attractive, but he is flirting with me, so that helps. I think about leaving a business card with some stupid little whatever written on it...except his name is Callow. I can't really see yelling "Callow" out in the middle of who knows what. And there is the issue of the unconventionality of his, er, beauty.

Still it is only 4:30 by the time I finish purchasing my necklace and shirt. No one would show up at OBar for another two and a half hours. Dinner at Hamburger Mary's kills another forty minutes or so. I shouldn't have the two margaritas with my naked Mary burger. If I have two margaritas by myself, does that qualify as alcoholism?

Anyway, a little past 5:00 and I still hav time to kill. But I did think ahead. I accounted for just such an event. I brought my handy dandy MacBook Pro. Have I ever mentioned how much I love, love, love Apple products. So I head into Marco's Cafe to write a post...this post without a clue in the world of what it was I was going to write about. The day has been kind of boring, except for the fabulous shopping (and "fabulous" is there for gay dramatic effect). But I can't just write about that.

I walk in, stumped about what it is I should write about. Then our eyes meet. As soon as I walk into the coffee shop, he sees me. And I stare back. Only for a second. I didn't want to be all creepy, but he looks so fucking familiar, not to mention kind of hot. Where the fuck do I know him from?

I order my coffee still trying to piece together where I know him from. And it hits. Like a ton of bricks. I see him almost every day. In the hospital hallways when I get my breakfast every weekday morning, I see him. And honestly, I've had a little bit of a crush on him for the three years I've seen him. He's cute. So my type--well at least one of my types. My height, lean, dark hair and eyes with very angular features. I've tried to work up the courage to say something to him. I thought about commenting on his hair when he got it drastically cut. Couldn't do it. Or maybe just say "I see you every day. Thought I'd just introduce myself." Couldn't do it. Besides, I just wasn't sure if he was gay or not.

Well, I've made a little pact with myself (and another friend of mine) to be more assertive. Tonight I am going to introduce myself. I am going to say, "Hey, you look really familiar." No ifs, and, or buts. I am going to take life by the horns instead of letting it pass me by. And even if it turns out badly, I still win. I've done what I would not have done otherwise. It will be tonight's Pyrrhic victory.

So I set my bag and computer down and turn to go to the table where he sits.

He's gone. God damn it.

GODDAMIT!!!!

And then there's a tap on my shoulder: "From _____ Hospital, right?"

His name's Kevin.

Wicked

I asked him what it was about musicals that he enjoyed. It was simple. For a few hours, if it is good, he forgets everything else; he gets lost in the play. All the stress and worry of day to day life is suspended for three hours if the play is good.

Wicked was good. It was really good. The story was clever--a revisionist bent to the well known tale of Oz, one that casts a favorable light on the previously one dimensional Wicked Witch of the West. I've always loved stories like that, one that tells a well-known tale from the perspective of a previously voiceless character(s), like the women of Camelot Gwnhwyfar, Morgaine, and Igraine in Marion Zimmer Bradley's Mists of Avalon or the jealous queen in Neil Gailman's Snow White interpretation Snow, Glass, Apples. It gave her a raison d'etre and also helped shed light on most of the other supporting characters. The story was peppered with allusions to spin doctoring and governmental eavesdropping and suppression of truth, but it wasn't heavy-handed in its approach. The clever writing and solid acting mixed humor with drama.

The music, as far as the genre is concerned, is also good. "Popular" is fun and witty, while "I'm Not That Girl" is sad and pensive, and "No Good Deed" is anthemic. All with enough of a hook that makes it impossible to not have it loop several times in the iPod in your mind.

And the play was every bit as strong visually with its impeccable set and lighting design. The costumes were fun--distinct, yet not a complete departure from those we've become familiar with from the movie. It didn't hurt that there was also some eye candy in the form of the blonde ensemble guy dressed in a skin tight flying monkey costume. Hellooooo nurse (does anyone remember the Animaniacs?).

So it was a great play, a great escape. Most everyone was completely engaged in the story and the music. And for those few hours, despite having had little sleep, everything else for me seemed to fall away which really is impressive considering the assholes who sat behind us, feeling no need to stop their conversation just because they were supposed to be watching a play.

Anyway, see it if you get a chance. You won't regret it. And let me know if you agree with the blonde flying monkey.

On the Town

I picked him up at his apartment. He looked good. Hair done just so. Good choice of cologne. And a three piece suit. He looked good in a suit. Frankly, I'm glad he insisted that we dress up. "What are you wearing tomorrow?" he'd asked. He was disappointed when I told him I'd just planned on wearing slacks and a dress shirt. It's L.A. after all. No one really dresses up...for anything. "No, we're both going totally dressed up," he demanded.

So there I sat in his apartment in a new pair of black pinstriped pants, a white French cuffed shirt with a tone on tone pattern, a deep plum/almost black velvet tuxedo jacket, and patent leather spats. If anyone asks me to dress up, I'm going all the way. We chatted a bit over a cocktail before heading out.

Since I suggested the night's activity, he selected the restaurant. It was Thai, and it was perfect. The food was amazing and the conversation equally so. But we ate quickly to ensure that we got down to Hollywood by 7:45. He insisted we get there early. From his experience in New York, if we didn't get there on time, there was a good chance we'd not get in at all.

As we got closer, it was clear that we were both excited. After all, neither of us had been to a play in a long time. His last play may have been Miss Saigon, actually. And we were both really looking forward to Wicked. Really. He actually read the book and loved it. And I could see his eyes light up as we entered the Pantages Theater.

We took our seats and both got completely lost in it. It was a fantastic musical, and even better than I had expected. What I loved was that I would occassionally look over at him, and see that he was totally into it. His eyes were fixed by the spectacle of the play. And even after it ended and we drove back to his place, he kept talking about it.

But that was it. The night was over. We exited the car, and he gave me a hug, "Thanks dude, I really appreciated that." Funny thing about that night is that it wasn't a date.

It was a night out with one of my Straights.

Context

The toughest thing about what I do is recognizing patients for more than what they are. Or rather, recognizing them for more than what they are to me. On a daily basis, I talk about my 9 o'clocks or my 10:30's. I talk about my diabetics or cardiac patients. Patients--that's the only context in which I know them, at least the vast majority of them. I know their medical history. I know their medications. I know if they smoke or drink. I know their family history.

Just like I know Ms. Beam. She's been under my care for the last three years, and frankly, I'm surprised. Honestly, if I were to have taken bets for who was not long for this world, it would have been her. She's a wraith of a woman, nothing but a ninety-seven pound skeletal scaffolding wrapped by a suit of skin wrinkled and leathered by the years of nicotine. It was easy to picture her pucker as she inhaled a drag by the clearly defined crevasses that radiated in perpendicular lines from the outlines of her thin lips. She had quit years ago, after she was diagnosed with lung cancer. After she had part of her lung resected. Besides which, the cigarette would have been dangerous with the oxygen tank that she rolled behind her everywhere she went. It is almost unbelievable to see this seventy year old woman who frankly looked no less than eighty five get about so adeptly with her oxygen tank in tow, particularly since she did so using a walker. Her strength was poor; it had been so since she was treated for colon cancer two years ago. And yet, she went on, my emphysematous, double cancer patient.

More than that, I really didn't know. When we meet, I'm pleasant. At least I think so. But with the knowledge of a full day's docket still ahead, we get down to brass tacks fairly quickly. And I feel badly about it. I'd like to have more time to make a more human connection. Unfortunately, it's impossible when I have to question her about her symptoms, recheck and revise her medications, review her previous labs, order lab tests, write the prescriptions and write the clinic note. And that's when everything goes off without a hitch.

Last week, there was a hitch. A big hitch. She didn't want narcotics. I just didn't understand. She had rated her pain a ten on a ten point scale; it didn't surprise me with the number of vertebral fractures she had sustained. With osteoporosis, the bones crumble like stale crackers with any amount of trauma. And vertebral fractures hurt. They hurt like a bitch. Still, no narcotics.

"I don't know if you know [I didn't], but I'm a recovering alcoholic. I'm in AA. Haven't touched a drop in twenty-three years. And I also don't like the other stuff. I have an addictive personality. When I was younger I did it all. I worked for the studios. I smoked. I drank. Gin and tonics; they were my favorite. And I did speed. It kept me thin, you know. I was kind of a party girl."

And in that minute or two of exposition, the fragile, dottering old patient changed for me. Who she was now was part of a larger, more vibrant picture of a life led fully, regardless of whether or not it had been led wisely.

I think it's sad that we come into contact with so many people and are unable or unwilling to learn the stories of their lives. Everyone has stories. And I think what I want to do is make a point to sit down an extra ten minutes with at least one patient a day to learn at least one story a day. I've recently become more stressed and angry at work, and I think by doing this, it will help me to not only become a better doctor, but a better person.

Week In Review '07.47

11/17 - Still in New York. We woke up late. Around noon. Then just walked around the city, me and my buddies. Went into a couple of stores, lunch in Little Italy, opened the door to Coyote Ugly only to turn right back around with disgusted looks on our faces. I guess we had all thought it, but as soon as Razor Burn said it we shit our pants laughing in mutual agreement: "I feel like we got nutted on as soon as you opened the door." Now I think it was probably just dirty mopwater, but as God is my witness, the place had such the overwhelming stench of semen--and not semen after eating pineapples, semen after eating broccoli! If you don't get it, just move on.

Anyway, we found a little bar, the kind of Cheers type bar that you never find in L.A. I need to open one here. It had dark wood walls, a dart board, and pool table. It was such a nice mellow way to spend a cold ass afternoon.

That evening, we went out with the Greek girls again. They took us to a Greek restaurant in Queens that eventually turned into a really crowded club. We got trashed. Again. But I swear that there were three 8 month pregnant women dancing around in the club. WTF?

11/18 - Got up after two hours of sleep so I could catch my 8:30 flight back. Treated a girl who had passed out on the flight and got paid in cheese. Went home for like two seconds, then out to WeHo to hang out with this guy. I know. I'm a loser, but what can you do. Then had dinner with Dutch and Fishering at Boulevard Lounge. I love that place. And if you go there, ask for Eliza's table; she's the best waitress...EVER! And cute as hell. Then went back to the airport to pick up Razor Burn and Guido because they took a later flight.

11/19 - Went up to the new business after work. Wasn't supposed to work Mondays, but there was a client there that only I could handle. So tag more hours to my nine hour day. We closed up shop, we being Sunshine, Razor Burn and I then grabbed a quick bite before calling it the end of a very long day.

11/20 - My back has been killing me. I have two herniated disks and they started to act up. So it was a perfect excuse not to work out. So what did I do? Nothing. Went home, built a fire, watched some TV and had a great, great night.

11/21 - On call...that's it.

11/22 - So call really sucked. I had to go into the hospital three times, the last time being at 6:45. Fifteen minutes before the end of my shift. And just late enough for me to not be able to make it to Dutch's by the 8:15 predesignated meeting time. We were going to go down to skid row to help feed the mentally handicapped homeless. Oh well.

As for Thanksgiving. Well my family is retarded. My sisters, parents and I were thankful not to have to cook. My uncle offered to do Thanksgiving dinner this year. So when I called earlier in the week and said "So I guess I'll see you on Thursday" and he responded "Oh, no Thanksgiving dinner is on Friday" in my head, I was all "um...no...no, Thanksgiving is on Thursday. Just like last year. And the year before that. And like it's been for fucking ever!" Turns out, my aunt and cousin were working Thursday so he pushed dinner back a day without remembering to tell me.

So what did I do? My sister Virna, her fiance, and I went to...drumroll please...Boulevard. And I got to see Eliza again. Honestly, it was a great Thanksgiving, and we talked about just doing restaurants from here on out. No cooking, no cleaning. It was just enjoying a meal and company. That's what Thanksgiving should be about anyway.

11/23 - Had Thanksgiving dinner at my uncle's.

"Hey who brought the wine?" says my uncle, holding a bottle of pinot noir.

"Oh, we did," says my sister Vanessa.

"Great. I'll go chill it," says my uncle.

"Oh, actually it's a red wine," says by sister Vanessa.

"Great," says my uncle without missing a beat. "I'll go chill it."

That's my retarded family.

Anyway, afterwards, I did some stuff with Razor Burn and Sunshine for the business which then spiralled into meeting up with Guido and drinking way too much (surprise) which resulted in being kicked out of one bar 30 seconds after entering, being told by the bouncer at another that he shouldn't even let us in, and then having to call Sunshine's wife to pick us up even though she specifically told Sunshine earlier in the evening "Don't drink too much."

Honestly, I'm not an alcoholic. I'm just soberly challenged.

I Remember When

I think people remember their friendships by the big events. You know. Like I remember when we were in the stairwell at the L.A. train station. We were in there trying to be all cloak and dagger about mixing champagne and orange juice so we’d have mimosas on the train ride down to San Juan Capistrano, only the champagne had been shaken so much that I left the stairwell doused. And that was just the beginning of that trip with those guys.

Or I remember standing with him and the girl he was hitting on in the clear, bathwater warm Caribbean when, out of the blue, he produces a pair of board shorts from underneath the water, hands them to the girl with a matter-of-fact “Can you hold on to these for me” before diving into the water, ass in full view. After a second of shock and disbelief, she runs off with his shorts, leaving him completely naked in the ocean, forcing me to take chase, weaving in between a beachful of cheering onlookers. And that was just the beginning of that trip with those guys.

Or I remember going to concerts with that friend—Scissor Sisters, Fischerspooner, LCD Soundsystem, Stars, Deathcab for Cutie, Air, Esthero, etc.

It’s the big things usually. Sunday night was going to be one of those big things. For as long as I’d known him, Guido had raved about Clutch, a band he’d followed since his high school days in the east coast and they were a local band. He was psyched. And he was psyched to have Razor burn and I check them out, so much so that he bought us tickets.

And it was memorable. They were great musicians. Honestly, I don’t know that I’ve ever been more mesmerized by a drummer. That man was mad talented! And we all had a great time. We even talked about how that concert was going to be memorable, something we will look upon fondly, adding to our list of “I remember when” stories.

The funny thing is that it was the dinner we had beforehand that, for now, stands out more. The restaurant was nothing special. No interior designers had been consulted in the choice to put up the decades dated wood veneer paneling or to set the bud vases that carried silk flowers to adorn the tables. In this city where every restaurant has to be the new “it” restaurant, it was kind of refreshing and quaint. Apparently, quaint cut it for no one except for our party of three and one other couple who were oddly seated at the table adjacent to ours even though the remainder of the room was completely empty.

There was nothing particularly memorable. We caught up on how each other’s families were doing. Guido and I talked about working at a soup kitchen for Thanksgiving. Razor Burn invited the two of us to Christmas at his brother’s: “You guys know you’re family, right?” At one point, Razor Burn disappeared to answer a phone call. After ten minutes Guido excused himself to check up on him and assure that everything was OK. Again, it was a dinner of really nothing special. No grandiose Summer of Fun plans. No talk of opening up another business. No scheduling appointments to check out houses. Just a run of the mill dinner with run of the mill conversation.

And even though it may be a dinner that won’t be remembered by anyone but me, it is just that kind of dinner that, for me, truly defines what friendships are all about.

Happy Thanksgiving

That's it.

Noggin

I've sorta gotten addicted to an online game. It's called noggin. It's an online version of the classic game called Boggle. And if you know what Boggle is, then you know the extent of just how big a geek I truly am. And if you don't know what Boggle is, ignore what I just said cuz it's extreme! EXTREME! Cause I don't do anything unless it is X-TREME motherfuckers! Like Red Bull and Pop Rocks extreme.

Here's the skinny. There are sixteen dice, each with a single letter on each side (except for Q because Q is pathologically co-dependent, unable to function without its 'u'. U's bitch you might say.) In any case, the dice are shuffled until they land in appropriately sized holes in a 4 x 4 grid. The point of the game is to come up with the most number of words spelled out by the adjacent letters, not including proper nouns, until one minute runs out.

There are a couple of tricks I've learned: Look for "s" or "es" that way you can get points for a singular noun and then pluralize it for even more points. Or find "est" or "iest" to turn a noun into an adjective. Tons of points with that trick.

Anyway, it's fun. Well in a loser, I have no friends kind of way, but still fun.

So last night I met up with Dr. Faux and his wife for dinner. It was a work thing. He had been assigned to review my charts and assess if they were appropriately coded. I did pretty well, making sure I coded not only for diabetes, but diabetic neuropathy. And/or diabetic foot ulcers. And/or diabetic retinopathy. And if the diabetic was on dialysis, extra bonus points because you can also code for chronic treatment with dialysis, diabetic nephropathy, chronic kidney disease, long term use of insulin, and so on. Extra bonus points. And if they are amputated and on dialysis? EXTREME mega bonus points.

I did learn a few new tricks, though. If I code for diabetic neuropathy, I can also code for neuropathy in diabetes. See what I did there? It's the same fucking thing in real life, but in coding life, two completely different entities. Booyah! Mo money! Also if a patient has hypertension and heart disease and kidney disease, you clearly can code separately for each of these, but then magic...you can also code separately for hypertensive heart and renal disease. Three turns into four. Just. Like. That.

So now, with all the extra time I have in between seeing 26 or so patients a day and being on call and reviewing labs and returning phone calls and writing letters, I can now also play the coding game.

Sometimes, a lot of the time, I hate my job. Extremely.

Hubris

I pushed the button overhead as instructed, and within seconds the tall blonde with impeccable skin and impossibly long, stilettoed legs appeared.

"Yes sir," she said curtly, obviously trying to deal with something more important than whatever it was that I was bothering her with. "What can I do for you."

"I, uh, well. It sounded like someone needed some help."

"Oh, I'm sorry. Are you a...?"

"Yes I am."

Yes I was, damn skippy. Yes, I was a doctor. The call went out, and I responded. Seconds before I had pushed the button, some woman was on the PA system asked for me, "If there is a doctor on the flight, would you please push the flight attendant call button. Again, if there is a doctor on the flight, please push the flight attendant call button."

They had called for my services twice. And as I walked past the rows and rows of passengers, led back by the flight attendants, I actually felt somewhat proud. I walked straight, my chest puffed out. I felt goddamned important.

My ego was already at a peak from the weekend in New York. It was a fucking total rock and roll trip, with amazing accomodations, crazy shopping, unrestricted partying. It left me feeling pretty good about my life and myself. I was the mother fucking shit, and now here I was the sole physician on a fully packed flight whose services were required. Oh yeah, I was the shit.

I went to the back of the plane and started barking orders, "Go get me a blood pressure cuff and a stethoscope. Also get me some orange juice and a cool towel. If there is a tank of oxygen on the plane, I need that too. And get those people out of here!"

I was referring to the looky-loos standing in the aisle to look at the girl who had passed out and the doctor who was evaluating her, although I think they were there primarily for the latter.

She was a little dehydrated, likely from the fever from her viral infection. It was no big deal, medically. I made her drink more water and started an IV. She'd be fine. But the flight attendants kept asking, "Will she be all right? I mean, if it's an emergency, we can land the plane.

Holy shit! On my command I could've forced the pilots to fucking land the plane. How awesome is that for power? Except that I'd look like a jackass when they found out that I'd forced the landing for the sake of a run of the mill viral infection. That would not have been rock star, not rock star at all.

She felt better by the time I was done.

It was pretty damn cool.

It was so cool that I told one of colleagues when she asked how my trip was.

"Did they give you anything," she asked.

No, not really. I mean I ordered a cheese platter and tried to pay the $5 for it, and the flight attendant said, "After all you've done, don't worry about paying for this. It's the least we could do."

Yeah I actually got a freebie. And I definitely was a rock star!

Until my colleague said, "Yeah it's funny how the airlines are so cheap nowadays. A couple of years ago, I got a hundred bucks for the same thing. And the time after that, I got $200.

And all I got was a cheese platter. It's funny how life puts you in your place. Totally not a rock star.

Week In Review '07.46

11/10 – I’m starting to think that weekends are really no different than the weekdays. Turns out I’m just as busy, and sleeping in isn’t much of an option. I had stuff scheduled from noon on, so I did a bunch of random crap including the requisite gym time early on.

Ok maybe I am exaggerating a little, the weekends are different—a different kind of busy, a fun kind of busy. Sunshine’s wife Cheerleader had wanted a (groan) girls’ day out. With me. I figured I’d humor her for the day just cause punching a business partner’s wife in the face probably isn’t the best way to get a business off on a good note. Actually, it was fun. Shopping at Bloomingdale’s and scored an awesome pair of Theory slacks. Then picking out dresses for her. Although I gotta say, there’s something a little odd when my friend’s wife asked me, “So do you think this is sexy enough for the places we go to?” as she paraded around in a smoking hot dress that was designed to showcase cleavage. We finished up the afternoon in true girls’ day fashion with a few hours at a day spa.

The night was left for me to get my gay on. I met with Blue Eyed Dan, the Greek and Manfriend for a couple of glasses of wine before heading to Green Lantern’s birthday party. During that party, I sort of realized that aside from volleyball, I didn’t have much in common with the volleyball guys. We bailed early.

11/11 – Nothing. Oh my God, the whole day I did nothing except catch up on some TiVo. Didn’t even go to the gym, I finally got off my ass at 4:00 to get ready. As per what has come to be protocol, Razor Burn and I met at Guido’s for a glass or five of vodka Red Bulls before getting the evening started. That night, it was once again the Wiltern. This time for Clutch. Since they were one of the opening bands, we were able to get home at a decent hour.

11/12 – I actually had Veteran’s Day off, surprisingly. But again only sort of. Gym at 9:00. Then I met up with G Squared for my photo shoot with him. Only I wasn’t behind the camera. Eeeek!

Then I was on call starting at 10:00 p.m. It sucked. What’s new?

11/13 – What’s worse than a clinic day after a holiday, when three days’ worth of patients have build up all demanding to be seen for emergency non-emergencies? A clinic day after a holiday after being on call and only getting three hours of sleep. What’s worse? Having to dinner meeting during which you’re told you’re not doing enough because I could make the company more money if only I knew how to create more diagnoses for patients that I can bill for. It wasn’t that bad. At least it was Dr. Faux who had been assigned to review my charts.

11/14 – I got out of work at 6:00 on Tuesday. On Wednesday? 7:00 p.m. What the fuck? I thought it was supposed to get easier. Unfortunately on that day, it was the sickest of the sick coming in. Afterwards, I ran for an hour to blow off steam, then stayed up till 2:00 a.m. Sadly, it was nothing interesting…just reading up on pre-operative evaluation of the pulmonary patient and treatment of metabolic syndrome. Woo hoo. Do I know how to live it up or what?

11/15 – Didn’t go to work. Took the day off. I had to do a bunch of shit. Bunch of shit included getting a much needed massage before packing up and hopping on a plane to New York City…all on the company dime. Oh and Razor Burn and Guido came with. When the temperature in L.A. is in the 80’s, it still counts as part of Summer of Fun!

11/16 – We got into JFK early. Once we landed, we took that fucking city by storm, spending the day shopping, eating, drinking. Interesting thing was checking in to the W Hotel. As soon as we got our keys, I heard someone call my name. Had to be a mistake, so I ignored it. “Van!” Turns out Whore Bitch a friend from L.A. was also staying at the hotel. Small world, right?

Anyway, shopping, eating and drinking. Then we took a little disco nap before meeting up with girls we had met earlier in the summer at the W Hotel in Los Angeles where they had been vacationing. We started out at the hotel bar before moving on to a bar called Rooftop. Whore Bitch met up with us at which point, I got a little taste of gay New York. The two of us left the Straights to go to Splash. Turns out gay bars in New York, not too different from gay bars in L.A. Same people, different city.