The Last Word On Nothing

Outdoors After Dark

By: Christie Aschwanden | November 11, 2014

It’s 6 am on an early November morning, and I am tiptoeing up a juniper hillside with a rifle slung over my shoulder. I’m following Adam, my friend and guide, when suddenly he stops. “Listen.”

It’s still completely dark, except for the sea of stars above us, which I gaze up at as I stop and listen to the elk, my mind focused on pinpointing its whereabouts. He’s just west of us, and now we’re sneaking through the darkness toward his call.

If you’re a regular LWON reader, you already know how this story ends, and you also know how my three outings earlier this month fanned my passion for elk hunting. As I tried to explain my new obsession to a friend, I realized that one of the most enjoyable parts of elk hunting was the time I spent outdoors in the dark.

Something magic happens in the woods when the sun goes down. Without sight as a guide, the other senses become more vivid, in the way that I imagine a blind person must become more attuned to sound or touch. The sounds of a forest contain so much information, but these signals can become drowned out among the textures of sight. Tracking elk without vision for reference, I became hyper-aware of the auditory cues all around me. As I focused on locating elk calls, I also noticed an owl hooting in a nearby tree and the sound of a racoon, scurrying through the brush.

I’d never really thought about it before, but some of my fondest memories in the outdoors have happened in the dark. Continue reading →

Guest Post: Affair of the Heart: VI. An Incident in the Pancreas:

By: Colin Norman | November 10, 2014

In early February this year, a few days after a magnetic resonance image confirmed that an aneurysm at the root of my aorta had reached a worrisome size, I received a phone call from the office of my primary care physician. The MRI had picked up an “incidental” finding, unrelated to the aneurysm; could I come into the office to discuss it?

The incidental finding turned out to be a type of pancreatic cyst called, ominously, an intraductal papillary mucinous neoplasm (IPMN). It’s probably nothing to worry about, my doctor assured me, but it would be prudent to have a high-resolution MRI of the abdomen and the pancreas to get a better look at what we’re dealing with. The MRI confirmed that the cyst was an IPMN, about 2 centimeters (almost an inch) long. The recommendation: repeat the MRI in 3 months to make sure nothing has changed.

At that point, I was in full reporter mode, having just learned that my aortic aneurysm, which I had basically dismissed for 12 years, could no longer be ignored. I set out to learn all I could about IPMNs. It’s an interesting story that raises hopes of early detection of more cases of pancreatic cancer—one of the deadliest cancers—and some tricky questions about the benefits and costs of screening for these and similar lesions. It would be an even better story for me if I were not in the middle of it. Continue reading →

The Last Word: November 3-7, 2014

By: Erik Vance | November 8, 2014

As with the four previous, we kicked off the week with Colin Norman’s tale of undergoing heart surgery. He’s feeling good but has turned his thoughts to the genetic nature of heart disease. He perused his family album in his mind and fretted for his daughters’ future.

Then Erik made several connections between the institutional capacity of countries when it comes to science and, say, not killing their own people. He also bragged about how much he is traveling these days, which many of us here at LWON find pretentious.

Helen officially joined the rest of the world’s population by announcing her deep loathing for daylight savings time, along with a brief review of its history.

Then Ann took us back to the doctor’s office by saying that beauty of medicine is that it follows a narrative. And like writers, doctors are at their best when they feel involved with the story, such as at conferences where they swap tricky cases.

Cassie batted cleanup by taking on ebola quarantines. She’s a little tired of the national panic and is not convinced we should lock up every darned person who perhaps maybe thought about possibly coming in contact with an ebola patient.

* * *

Abundance of Caution

By: Cassandra Willyard | November 7, 2014

A little over a month ago, Liberian Thomas Eric Duncan became the first person in the US to deve Mary_Mallon_in_hospital lop ebola. In the days before he died, Duncan infected two nurses. Last month, a New York doctor who had been working with Doctors without Borders in Guinea was diagnosed with the disease, becoming the fourth person to develop the disease in the US. The case count is vanishingly small, yet the infections have sparked a highly contagious epidemic of fear and prompted some states to adopt draconian quarantine policies.

In New Jersey and New York, anyone who has come into contact with an Ebola patient will now have to serve a mandatory 21-day quarantine period whether or not they have symptoms of the disease. Other states have passed restrictive rules too. In Connecticut, Ryan Boyko, a graduate student who worked with the Liberian Ministry of Health and never came into contact with anyone infected with Ebola, had to stay in his apartment even after he tested negative for the disease. These policies go well beyond what public health officials recommend. Continue reading →

Inputting Narratives

By: Ann Finkbeiner | November 6, 2014

You’ve probably done this already or if you haven’t, you will: you sit in your doctor’s office and look at your doctor, your doctor sits at a desk and types on a computer. Your doctor apologizes for the lack of eye contact and explains something about health records now being electronic and tied to reimbursement. You hear “Electronic Health Records” and stop listening; it’s like “Health Policy” — who knows who makes that stuff or why.

Your doctor complains about the non-intuitiveness and frustrating illogic of the program’s interface. You yourself know those bossy sites that force you through useless steps, sites on which you click five times on meaningless words to get one thing done; and you begin to sympathize, but it’s hard to express that without eye contact. Your doctor says these programs aren’t even interoperable, and then you remember the time you and your husband showed up for (minor but serious) surgery before dawn at the famous hospital and the hospital had no such surgery scheduled and had to call a surgeon out of bed; and later on, explained that your doctor’s computer and the hospital’s computer don’t talk to each other.

Your doctor, who is seriously pissed-off, winds up the office visit; she says she’s using an excellent medical education to do data entry and she’s spending more goddam time looking at the screen than at the patient. If you happen to have gone to more than one doctor in the past year or so, you’ll have heard this more than once. Everybody agrees that electronic health records are necessary and inevitable but a website devoted to them, reporting on a RAND study, says they’re causing the medical profession to have “high levels of disgruntlement.” No kidding. Continue reading →

Dear Time: Would You Please Stop Being So Stupid?

By: Helen Fields | November 5, 2014

It doesn’t seem right that something as basic as time should be so annoying.

No, it’s not time itself that’s annoying. I’ve more or less made peace with the fact that it’s marching on. The thing that’s annoying is when the stupid time keeps changing.

In college, I appreciated that extra hour of sleep in the fall, even if I lost an hour in the spring. The longer it goes on, though, the more ridiculous it seems, this whole business of switching clocks twice a year.

Last week I left work in daylight; this week it’s pitch black at quitting time. I hear that the change is even more annoying when you’re working with children or animals who keep soldiering on, waking up at ungodly hours expecting breakfast. Even for those of us who can read clocks, it can take a bit of time to adjust. Giving billions of people jet lag twice a year is just silly. And, darn it, I like my evening light.

Time zones make it even worse. Sometimes I call people in the UK or Europe to interview them. They do daylight savings, too, but they don’t switch at the same time as us. For a week in the fall and a week in the spring, we’re only four hours apart behind Britain instead of the usual five. Great if you remember to check or if you let computers schedule your meetings for you. Less great if you don’t.

Continue reading →

Gotta Have Faith

By: Erik Vance | November 4, 2014

I’ve been traveling a lot recently. I spent the month of August in China and Vienam, I went to Sweden in October, and of course I’ve been bouncing between my home in Mexico City and the good ol’ US of A. And you know what all this travel has gotten me thinking about? Institutions.

I assume that since I didn’t say beaches, cartels, or communism I just lost about half my readers. That’s fine, for those of you who stayed, let me lay out what experts call the “Vance Paradox.” I mean, they don’t yet, but they will by the end of this post.

Continue reading →

Guest Post: Affair of the Heart: V. A Family Matter?

By: Colin Norman | November 3, 2014

Six weeks after intricate surgery to replace an aneurysm at the juncture of my heart and aorta with a polyester graft, I’m almost back to normal. I’m walking a lot, about to start biking again, and I’m well on my way to a complete recovery. But there is still a nagging question: Does my family history of aortic catastrophes have implications for the next generations of the Norman family?

My paternal grandmother died from an aortic rupture. My father was felled at the age of 67 by what was diagnosed as a heart attack, but some of the symptoms sounded like an aortic dissection—an aneurysm that eventually resulted in a breakdown of the aortic wall. And in 2002, my brother survived an aortic dissection, thanks to an astute diagnosis and skillful surgery at the Karolinska Institute in Stockholm. It sounds like a family affliction, but it could all be coincidental. Continue reading →