After about ten years, 37 dusty woodworking magazines, eight books, and lots of fantasies, I finally have a workshop. For a long time, I have been intrigued with woodworking. Like most attractions, it’s hard to explain. Perhaps it’s the manual aspect, working with my hands, from which there’s a certain indefinable pleasure. Certainly the craftsmanship of a well-contstructed item exhibits a strength and beauty of its own. And wood itself is a pleasure-the grain, the color, the way it works. Now I need to become a student again, starting at the beginning as a novice who knows next to nothing about the hobby but is willing to learn and be patient in the learning.

And here is my classroom. I converted a 24 x 26 ft irregularly shaped garage into a pretty spacious woodshop like so . One of my main considerations was adequate lighting-and there is lots, with 42 and 105 watt CFL bulbs laid out in a alternating grid on the ceiling .
Each size of light has its own circuit so that I can turn on one size only or both at once for maximum light output. I also wanted plenty of electricity capacity including 220 volt outlets for possible future energy needful machines like a big jointer or central dust collection system. I had an electrical subpanel installed for that purpose . The top part of the walls is drywall and the bottom is exterior grade beadboard sheeting. To allow safe use of the vertical studs I made sure the electrical runs were only in the bottom half of the walls so I can nail or screw into the studs without risk of electrocution.

And so the adventure begins.

One of our friends who is a former educator gave our family a jigsaw puzzle for Christmas. No one else seemed all that interested, so I decided to tackle the project. I have a quirky interest in maps and geography anyway, and I thought it might stimulate the children to get involved. Alas, working on the jigsaw puzzle simply got added to the list of “wacky things Dad gets interested in.”


You can see that this was a global puzzle. In addition to the standard jigsaw construction, there were several interesting characteristics. First of all , each country (also individual states and provinces in the United States and Canada) was its own correct geographically shaped piece. Some large countries were broken up into more than one piece. The ocean pieces were the usual random jigsaw shapes. Helping to place the ocean pieces was lettering on the pieces describing each country, its capital, population, and area, all arranged in alphabetical progression across the globe. So instead of a large area of featureless blue one could actually get some sense of where ocean pieces belonged from the lettering on the piece--but many pieces had only fragments of text.


In all, there were 600 pieces. I worked on it in spurts, whenever I needed to be still, but not thinking or talking, solving or planning, reading or figuring. Total time was about three to four weeks. I learned several interesting facts in the process. For example, did you know there was a Canadian province named “Nunavut?” Or that South Georgia Island is nowhere near the state of Georgia? Madagascar and Mauritius are both islands off the southeastern coast of Africa. Kazakhstan is a huge country formed from the former Soviet republic located south of Russia. Burkina Faso is a landlocked country between Mali and Ghana.

This was a “pseudo-cylindrical” projection of the earth’s surface in two dimensions. Some distortions are obvious, which made the puzzle a little difficult at times. Nonetheless, when I was done, I felt an embarrassing sense of accomplishment about the project. Sometimes little goals are better than big one.

Tags: Puzzles

I have posted a couple of new book reviews. These aren’t all of the books I’ve read, just the ones I’ve managed to write a review for in these hectic holiday times. Enjoy!

It’s a little hard to plan wonderful experiences. Mostly, they just happen and the trick is, when they do, savor them in the present moment. Kevin, my brother, is very good in this practice. But, if one simply sits around waiting for peak experiences the odds are probably against encountering a lot of them. Hence, my plans for a father/sons outing: the 2008 Music City Football Bowl.

First of all, you can’t plan the weather. It was cold, 39 degrees at game time, with a steady 10-15 mph wind out of the (cold) north. Second, you can’t outwit viruses, either; they have their own ways of working around human desires. I contracted my first head cold of the season two days before the game and dragged myself through work duties, then committed myself to the game despite the way I felt. Third, the two teams playing in the bowl were of course unknown at the time I bought the tickets. When the selection was made, hometown team Vanderbilt was one of the contestants. The Commodores traveled about three miles to their first bowl game in over 20 years. Boston College was Vandy’s opponent, and seemed the favorite as they had gone the ACC Championship game this season and had a much better record.

So Andrew, Greg, and Greg’s friend Jorge piled into the car and off we went. I tried to tell the boys that they didn’t have enough clothes to keep warm, but being thirteen years old they know lots more than parents do about such things. It was pretty chilly, and it didn’t help that we were in the shaded section of the stadium as the sun went down. Nonetheless, I didn’t get cold. Here’s the list of what I used to stay warm:

• Hiking Boots
• Inner wool socks
• Electric wool socks
• Polyethylene long johns
• Ski pants
• Polyethylene top
• Wool Top
• Windstopper hunting sweater
• Neck gaiter
• Ski Parka
• Biking skull cap
• Sock cap
• Neoprene hunting gloves

I also brought three extra pairs of gloves (all of which got used) and a large bandana (for my nose).

Well, to make a long story short, we left after the third quarter. The temperature had dropped to 34 degrees. The gameplay was pretty poor and the boys were cold. But I wasn't! Being prepared makes a difference, and reinforces the principle that there isn't really any weather one can't be outside in with the proper clothing. The best part of the game might have been the hot chocolate, as seen above. Why does hot liquid taste so much better when you're cold?

As a father-sons experience it might have been less than ideal, but I'm glad we went. As Clint Eastwood has been quoted: "We've come this far, why ruin it by thinking?"

By the way, Vanderbilt won.

Tags: football, weather

After five and a half weeks, I finally got back on my bicycle. I had left my sling behind the week before and my shoulder was feeling pretty good. The weather was Indian summer perfect with bright sun and temperatures in the low 70s. So I went. It felt good to be back on the bike. The drive chain hummed, the pavement sushed by, the gears clicked, and I reveled in the pleasure of exertion. As I passed the spot where I had crashed, I spit on the pavement as a gesture of defiance. A little childish maybe, but if we don’t defy our ghosts, maybe they chase us back inside to the recliner, or to the grave.

Tags: injuries

Well, for those who want the full picture, so to speak, here it is, a fracture of the right clavicle. My right clavicle, that is, the injury I described in the last blog post. Now this particular image accentuates the appearance of the break in the bone because my arm has been externally rotated, that is, my elbow is touching my torso and my right hand has its palm facing forward with the forearm at a ninety degree angle to the rest of the body. Not too surprisingly, that was the position where it hurt the most.

Now compare this image on the left, with my right arm across my chest, palm facing my body. One can just appreciate the break in the upper border of the bone. Looks better, doesn’t it? Looks like it might even heal decently, if I can just keep it in that position. And that’s the problem, since a right-handed person such as myself can’t do much productive work with his dominant hand continuously folded across his chest. Even the simplest of tasks can be a challenge. Have you ever tried to put on a sock with one hand? Even typing this short post causes my shoulder to ache a little. It’s also hard to write notes, sign prescriptions, or mark worksheets without the hand coming off the chest at least a little. Implanting a pacemaker is well beyond the possible.

But at least my fracture is non-displaced. It can heal if I can keep it immobilized (relatively). Uh, I think that means I can’t ride a bicycle for a while. So I’m going to do a lot of hiking in Vermont, it seems . . .

For those who want more details of collarbone fractures, see this article.

Tags: injuries, fractures

Well, it finally happened. Here I am at age 49 and I’ve never broken a bone in my body-until today. I still don’t know how it happened. My wife and I decided to go out for a bike ride together. We were pedaling along at an easy pace when I suddenly found myself pitched sideways in an instant, on the ground, my left foot still clipped in to the pedal. I remember hitting my right shoulder on the pavement. A woman in a car stopped next to us on the shoulder as I sat upright and assessed my injury. I was briefly nauseated but it passed quickly. I had some ugly “road rash” on my arm and leg. I could move my arm but the shoulder didn’t feel too good. The good samaritan in the car (thank you, Julie S.) piled our bikes and us into her vehicle and took us home. Vikki found me a large bag of cold ice and I drank a beer and went to bed. There was a pretty good lump at the top of my right shoulder but I thought it might just be a hematoma. Nonetheless I went for an Xray and sure enough I had fractured my collarbone distally just before the joint at the shoulder. Luckily I got ahold of one of the local orthopedic surgeons who was on his way home but graciously agreed to come review the film, then went back to his office and rummaged around for a shoulder sling.

Fortunately I don’t need any surgery. Unfortunately, Vikki and I are scheduled for a husband-and-wife getaway trip to Vermont in a couple of weeks in order to-you guessed it-go biking. Oh, well, I may have to pull a “Tyler” a la’ Tyler Hamilton who in 2003 won a stage of the Tour de France about two weeks after breaking his clavicle in a bike crash. It’s too late to get a refund of the payment for the trip and I didn’t take out travel insurance so it’s grin and bear it or lose the money.

Tags: injuries

On a typical work day, I head out the door between 7:30 and 8 am. After arriving at the hospital I usually start my inpatient rounds in the ICU. The physician’s assistant or nurse practitioner who helps us in the hospital will see some of the patients first, but I’ll just pick up a chart of someone on the list and dive in. I’m pretty fast making rounds now because I’ve learned the routine at each hospital: where to find the charts, and where to find the information in the charts. I’ll start to fill in some of the relevant information for my chart note. Every patient gets a “progress note” (even if there’s not much progress) which contains certain information meant to enhance inter-provider communication, supply advice between consultants and attendings, and provide a medical-legal record. A progress note on an established patient consists of a heading with the date and the identity of the particular note-writer e.g. “Cardiology”, and then several categories of content: Subjective (the patient’s symptoms), Objective (blood pressure, pulse, examination findings, lab results, test results), and then Impression and Plan-or for consultants “Recommendations.”

So I’ll fill in some of the note with data from reports on the chart, and then go see the patient. Sometimes the visit is brief (patient comatose, or demented, or feeling well) and sometimes it takes a while (new patients, family present with lots of questions, etc.). Then I’ll fill in the exam findings and formulate a plan. [I’ll try to attach a typical note below for illustration.] Somewhat archaically these notes are hand written. That’s a subject for a separate post, but for now let’s just say that some doctors really do have the proverbial terrible handwriting that makes their notes in the chart next to useless.

At some point, usually before rounds are completed, the office calls saying that I have patients waiting. I’ll go and see anywhere from three to 12 patients in a row before taking a break, usually to go back to the hospital to see more patients or interpret some “studies”. These are diagnostic cardiac tests. While I’m in the office, I will interpret studies such as echocardiograms, nuclear stress tests, EKGs, 24 hour rhythm monitors, carotid artery ultrasounds, or computed tomographic angiograms (CTAs) in between seeing patients. There are often phone calls, too, from ER physicians wanting to admit or transfer a patient or from other physicians with questions or concerns.

At lunchtime I usually go back to the hospital to see more patients on rounds or interpret similar diagnostic studies which have been generated at the hospital. Often there will be more involved diagnostic procedures to be performed at the hospital such as coronary angiograms. Sometimes there will be a pacemaker to insert. Each of these activities is accompanied by its own arcane set of paperwork to be completed and placed in the chart. I probably sign my name and attach the date about 50 to 100 times a day between office and hospital.

Finally, by the end of the day the last patient has been seen in the office and hospital, the last chart signed, the last EKG read, and it’s time to go home. Usually I try to leave by 6:15 pm or so. By staying efficient and keeping up during the day, this goal is usually accomplished.

I typically will see 15 to 25 office patients and 8 to 15 hospital patients a day. I will probably read 5 to 10 CTAs, 10 to 15 echocardiograms, 50 EKGs, 5 to 10 rhythm monitors, and perform 2 or three arteriograms.

This is my typical day’s work. Some days are busier, some a little slower. Some are downright crazy usually due to emergencies or a sudden deluge of new consultation requests, often in the context of one of my colleagues being away on vacation. I’ve managed to adjust my work style to get it all done, but at some cost to patient relationships. All in all, my days are usually full and rarely boring. There are some routine elements to the work with infinite variations. More on those in a later post.

Well I tried it again. This time I located a shower I could use in my office building, so when I got to work I showered off which felt much better. Unfortunately somewhere along the way to work I lost my air pump which must have worked itself loose and fallen off. There were no major car-cyclist mishaps but the traffic was heavy. Anyway I still feel good about getting some exercise while traveling back and forth to work. Here’s my route, about six miles one way:

Tags: commuting

Which is the greater good: to serve more people or to serve fewer ones better? To be more specific, in my current medical practice, I see a far greater number of patients than I did previously. Consequently, in a given day, I spend less time with each patient. I now can pretty much classify any new patient and their symptoms into one of a relatively small number of categories within the few couple of minutes of the encounter. Rapidly I can begin to triage their workup and select what diagnostic or therapeutic options I will employ. There is a limited number of clarifying questions I will ask. I try to do a little patient education regarding new drugs or unfamiliar diagnostic tests. If the patient has any questions I try to answer them. Then I speak some “transitioning” language so as to prepare the patient to be checked out by my staff. And I move on . . .

Many of our patients are poor or indigent. Many don’t have a lot of formal education. There’s a high incidence of smoking, obesity, diabetes, and sedentary lifestyles. It’s difficult to explain complex concepts of cardiac anatomy and disease pathophysiology to them. Usually if I try to engage them in the decision making process they just shrug and say “whatever you think, doc”. The most worrisome disorder - coronary artery disease - is highly prevalent and dangerous when undiagnosed. Yet the symptoms are often misleading or non-specific. The physical exam is nearly useless. But with a ten second CT scan that I might order, I can instantly see a “snapshot” of their cardiac risk that creates immediate direction for their therapy-or major reassurance when negative.

So what’s better? Should I spend more time establishing a relationship with these patients (most of whom, if new patients to the practice,are referred anyway by the primary providers for a consultation) or should I attempt to see a larger number so as to provide more of them with useful even potentially life-saving information and advice? I wonder . . .

Tags: obesity, technology, smoking

Recently I’ve become interested in learning a little about HTML and CSS. I started with a reasonable desire: make a family web site. Its purpose: share thoughts, family news, photographs, and links to other projects (my boat-building endeavor) and hobbies (cycling). There was a web design program (iWeb) included in the iLife suite packaged with every Mac. I played around with it some but decided I wanted a little more flexibility. That led to a lot of web research and eventually I selected RapidWeaver because it seemed to have a good balance between ease of use and options in page layout. Or so I thought.

I also picked up a well-written intro textbook on HTML and CSS (Head First HTML published by O’Reilly) which was a perfect level of simple and useful for a semi-intelligent newbie like myself. As I began actually constructing the content of the site, I became dissatisfied with the built in themes of Rapidweaver and so I looked for additional themes. I started with research into free themes available on the web and there are quite a few. People have done a lot of work to put these themes together and provide the code underlying them. I selected one but rapidly learned it also had some elements that were sub-optimal (primarily due to color conflicts between fonts and page backgrounds). So I tried to use my newly-found meager HTML skills to pick new colors. That lead to more conflicts, more research, more web time, more confusion, with a slow slide into frustration and a gradually increasing obsession to get the thing right. I solicited help from my computer-savvy brother-who tried to help-but eventually I realized the whole project was out of kilter.
That is, the effort involved had outstripped the original purpose: enhance the family life. Now my little obsession was becoming detrimental to the greater good. It was time to re-balance.

So I ditched the original theme because it was too much work (even if it was free) and paid $12 for a commercial theme I liked just as well and was better designed. And I told myself to relax and let it go. The darn thing can evolve over time--doesn’t have to be perfect the first week. So the lessons:

• Free is great but sometimes means more work
• Projects must be re-assessed for harmony with their original purpose
• Don’t create pressure to finish something that’s really open-ended-or, in other words: enjoy the journey instead of anticipating the destination

Tags: balance, web

There are a lot of complications that result from obesity. Here are some that I observe on almost a daily basis:

• Obese people can’t exercise easily, which only compounds the difficulty in losing weight, since most studies have shown that exercise is a requisite for permanent successful weight control.
• It may prevent needed diagnostic studies--there are weight limits for the tables used in medical imaging, for example. Even if one is under the weight limit, the bigger the patient the worse the quality of the study--fat scatters X-rays and exacerbates artifacts.
• High blood pressure is difficult or impossible to control
• Diabetes is difficult or impossible to control
• Cholesterol levels are difficult or impossible to control
• Obese patients wind up taking lots of medicines, sometimes ten or fifteen or even twenty different agents-expensive!
• It promotes blood clots in the legs and lungs--potentially fatal
• Obesity increases the risk of heart disease independently of other risk factors
• It increases the risk of arthritis and early joint replacement
• Chronic low back pain and accelerated arthritis can lead to painkiller addiction

We live in a food toxic environment with many people never doing more than going from car to house and back to car--a recipe for ever-expanding waistlines and more of the above.

Tags: obesity

I finally did it. For weeks I had been meaning to get up some weekend morning and go for a longer ride on my bike. But laziness intruded, other pleasures beckoned, and I procrastinated. This past Saturday I made myself get up and get out on the road before 7 am to beat the Tennessee heat. My plan was to start slowly in pace and then build up. After an hour on a course of gently rolling hills, my average was about 16.3 mph-faster than I had intended. So I slowed down and took a break, stopping by a babbling stream in the shade, where I got off the bike, stretched, and re-hydrated. Then I got back on the bike and felt much better. The remainder of the ride was pleasant (after one short but gut-wrenching steep hill) and I returned home a bout 9 am after 28+ miles. I savored my sense of accomplishment. My ride didn’t interfere with the rest of the family’s activities because save one they were all still asleep when I returned. So the lesson (learned again and again): start your day with something you want to accomplish, get it done, move on with your day. The key is to start early. Getting the lazy butt out of bed is the biggest hurdle, but it’s worth it.

July 31

Some recent observations and sights while cyling:

* A flock of at least 25 turkey chicks scrambling behind Mom Turkey around a pond near Hendersonville
* A woman at 6 am walking one small dog and pushing a 1950s style baby carriage with her other small dog in the carriage!
* A beautiful sequence of irrigation sprinklers spewing misty spray by the side of the road
* A quick red brown fox carrying breakfast back to her kits in the den
* Large man in large truck pulls up next to me at a traffic light, leans out the window while we’re waiting and says “Yeah, you might as well bring your shavin’ kit to this light cuz’ it takes so long . . .”

July 21
Today I commuted on my bicycle to work for the first time. I had been meaning to try it for some time, but just finally got motivated enough to begin. The process required me to leave a change of clothes beforehand at my local office, the only one close enough to home (six miles) to make this commuting idea practical. Then I had to remember to take all of my little tools to work with me on the bike: beeper, cell phone, ink pens, patient census cards, eyeglasses, and hospital ID. I wondered how I would get all of them into my jersey pockets until I remembered my Camelbak hydration pack hanging up in the closet. After taking out the bladder, I had plenty of room for these items in a convenient on-my-back solution.

So I was ready. I figured it would take between 20 and 30 minutes to get to work, but I was worried about the traffic, since for most of my other bike rides I am going at non-peak hours, either earlier in the day before driving to work or on the weekend.


Thus I started. Traffic was manageable and I had a pretty good shoulder to ride on for most of the commute until I got to the last mile or so when the road narrowed. There weren't any problems, though, and I pulled up at my office building ready for the transition to the work day.

Unfortunately I had picked one of the hottest most humid Tennessee summer days to begin this venture. After I wheeled my bike into the office and parked it in the server closet, I went into the bathroom to change clothes. There the sweating began. When you're on the bike you don't notice sweat too much because the wind is flowing past. Once you stop, however, perspiration pours out. Did I mention that there wasn't any shower at the office? I thought I could just wash off with a wet cloth. I didn't smell too bad, but even after 20 minutes I was still soaked. The day was getting on, though, and I had to go to work. So I disgustingly pulled on my pants, shirt, socks and proceeded to work. At the very first nurses station, someone asked me what happened--that's when I realized the back of my shirt was soaked through with sweat. On I went, and it was an hour at least before my perspiration output returned to normal levels. I just had to keep the shirt on until it dried. The trip home in the afternoon was fine, but when I got home and just pulled off my jersey, socks and shoes before jumping into the pool with the kids.

Two days later I did it again, only it was cooler and I didn't sweat quite as much.

I felt great not driving for two work days out of the week. Now I just need to figure out a better system of hygiene!