Stuff I've Read Since January
Harry Potter and the Order of the Phoenix, by J.K. Rowling - Good stuff, but I always feel like a need a break after the voluminous Harry Potter books. Goblet of Fire still my favorite.

Millionaire Republican, by Wayne Allyn Root - Some lightweight entertainment to cleanse the mental palate after Potter. The author is a loudmouthed conservative with an interesting personal story. Turns out he lives by my parents.

Nightfall, by Isaac Asimov - I read this at Bean's recommendation. The premise is brilliant: what happens on a populated, multi-sun planet when the lights go out.

The Know-It-All: One Man's Humble Quest to Become the Smartest Person in the World, by A.J. Jacobs - More fluff. Godby lent this book during an impromptu trivia contest. The author, an East-coast magazine editor (liberal undercurrents aplenty), describes his journey through the entire Encyclopaedia Britannica.

I Am Charlotte Simmons, by Tom Wolfe - Just as voluminous as a Harry Potter book, but I was sorry to finish it. Tom Wolfe is a great author. His characters (caricatures?) and settings are captivating. I hear that W was a big fan of this book. I just finished it a couple days ago. Now I've got to find something new. - served up by Oven @ 1:30 PM 5 comments

 
Physician Assisted Suicide
In the last week I’ve been digging through my home computer’s hard drive and I found a treasure trove of old emails that were archived there when I left my employment at Major University Department of Medicine to go into private practice. (That’s how I stumbled across Oven’s email.)

I found an email to my friends that must have been written when Dr. Kevorkian was in the news. I think it’s worth posting just because it’s a clear dissection of the legal and ethical issues involved in assisted suicide. My opinions on the matter haven’t changed. Interestingly, while I was on the “pro life” side on the Kevorkian issue (I think he should be convicted on multiple murder counts) I supported letting Terry Schiavo die, much to the disagreement of other Coffeehousers. I don’t think that’s inconsistent. I think patients have a right to refuse care, not to be killed.

Here’s the email.

Finally, a subject I know something about.

Before we can talk intelligently about doctor assisted suicide we have to make a few other terms clear that relate to death and dying.

(1) refusal of care - An informed, competent patient has the legal and ethical right to refuse any medical care, including food and fluids, even if without such care the patient will die. This is totally UNcontroversial and is well established both legally and in the medical ethics literature. Put another way, it is both illegal and unethical to impose on an informed, competent patient medical care that she has refused, even if such care would save her life and even if everyone else in the patient's family and neighborhood wants the patient to receive this care. (I don't have the slightest problem with this. Let me know if you do.)

(2) competence/informed refusal - The requirements for being informed and competent are technical. (It is purely a legal, not medical, construct.) Basically, a patient is informed and competent if he can weigh the risks and benefits of different courses of treatment (e.g. accepting food vs refusing food, or having surgery vs refusing surgery) and decide among them. The physician, the patient's family or anyone else may think that the decision is foolish or sacrillegious or stupid; that doesn't mean that the patient is not competent.

(3) surrogate decision maker - If the patient is not competent to make decisions, a surrogate decision maker is sought who best knows the patient's values and can make decisions for the patient that are hopefully as close as possible to those that the patient herself would have made if she was capable. This surrogate is typically a family member. So everywhere in this letter when I mention patient's refusing certain care or requesting certain care, you may substitute the patient's surrogate decision maker if the patient is not competent. (That's how a comatose patient, for example, can refuse fluids.)

(4) incompetent patient with no surrogate - Occasionally there is an incompetent patient for which no surrogate can be found, for example a man with no living family, or someone who has no close friends. This situation can be legally and ethically tricky, but is rare and is irrelevant to the larger questions of the "right to die". I will therefore ignore it.

(5) suicide - Suicide is the intentional taking of one's own life. Simple, huh? E.g. John shooting himself in his head or driving his car off a cliff. This is illegal in many states, so that the person who attempts it may be incarcerated and given psyciatric help. In California a few years ago, suicide was decriminalized so that the justice system is no longer involved, but people who attempt suicide can still be hosptitalized against their will to treat their injuries and get them to a psychiatrist. That's fine by me. Any voices of dissent on this?

(6) assisted suicide - This is the knowing assistance to another's suicide. If John asks Henry "Could you please bring me a gun so I can shoot myself?" and Henry complies, Henry is commiting assisted suicide. Obviously if John lies and Henry thinks that John is going to use the gun for target practice, Henry is not guilty of anything. Assisted suicide is illegal in all states. Physician assisted suicide is just a special case of assisted suicide. There are no special laws about it (as far as I know). It is simply illegal because all assisted suicide is illegal. Please note that in assisted suicide the assistant (physician or otherwise) is merely helping; the soon-to-be-dead-one is actually doing the act. I will argue farther below that assisted suicide should continue to be a crime, since it is never necessary for the alleviation of suffering. Please argue against me if you dissagree.

(7) euthenasia - The intentional taking of a life by a physician at the request of the patient. As opposed to (6), the doctor is doing the killing now, but still at the patient's request. This is also illegal. There is no specific law against this, and it is simply murder or manslaughter. Sadly it is almost never prosecuted. Since the patient and doctor are in cahoots and the whole thing is done secretly, it is a very difficult crime to discover. I think it's unambiguously evil, and would promptly report any of my esteemed colleagues who did such a thing. (Many of my colleagues have mixed feelings on the matter.)

(8) death as a side effect of appropriate medical treatment - The prolongation of life is only one of the goals of medicine. Another is the alleviation of pain. A patient may choose medical therapy which is has the risk of killing him. For example a patient who breaks a bone may choose to have it repaired surgically, rather than the alternative of a lifetime of disability, even though there is a small chance that the general anesthetic will kill him. If he in fact dies, he died as a complication of the surgery, and he is not considered to have been euthanised. Similarly, a patient in terrible pain may choose to have his pain treated with large doses of intravenous narcotics (among the most potent of analgesics) even though narcotics slow down breathing and at high enough doses may stop it. If the patient's primary goal is the alleviation of his pain and not the prolongation of his life, he may choose to have his narcotic dose escalated as high as needed to make him comfortable, with the understanding that a dose that kills him may inadvertantly be reached. This is not euthanasia because death was a side effect and not desired effect of the medicine. It is completely legal and ethical, and I've done it more than once to miserable suffering patients with terminal illnesses that wanted their suffering ended. This has been legal for a long time, so the public fear that doctors will keep suffering people in pain against their will is totally unfounded. We can, and frequently do, treat pain so aggressively that the medicine hastens the patient's death.

If, however, the patient was able to get pain relief at a certain dose of narcotic and still breathe adequately, any higher dose given to hasten death would be euthenasia. I suspect that this happens frequently - comatose comfortable patients are given morphine for their presumed pain, and it kills them. This is euthenasia, and legally it's murder.

Now that we've got some definitions under our belt, I can make my argument against euthenasia and physician assisted suicide pretty short. I don't think they are ever necessary to alleviate pain or to end the misery of someone who doesn't want to go on in his current state. I think currently accepted legal and ethical means are enough to treat everyone humanely and to end their suffering. Moreover, I think that given the ability to actively kill people, doctors (being only human) will abuse this ability as their convenience, financial interests or personalities dictate. Already in Holland where euthenasia has been legal for several years there are many reports of abuse. There are wide spread reports of old, sick people being killed without the request of the patient. (Remember, euthenasia, by definition involves killing a patient at his request. Killing someone without their request is even more clearly murder.) Some old people there fear being hospitalized, thinking that others may decide that they are too far past their prime and kill them. Some patients have actually hired guards to stand at their bedside fearing that while they sleep a nurse may "euthenize" them. Scary stuff.

Just to convince you that the current system does not force anyone to go on living in pain or in a miserable state that makes death preferable, let me show you two very typical examples:

(a) A patient who was previously healthy has a devastating car accident (or stroke, or heart attack or whatever) and is in a coma for weeks. It becomes clear that he will not ever recover, but could potentially live for decades in a coma. The patient's family make it clear that the patient has frequently told them that he would never want to live this way, and therefore refuse further medical care, including food and fluids. He is kept comfortable and expires in a few days.

This happens all the time. The right to refuse care basically allows a patient to die rather than continue in a horrible situation. Without fluids no one can survive longer than about 4 days, and frequnetly sicker patients are receiving more aggressive care, like ventilators or medicine to maintain their heart rhythm or blood pressure. When these supports are withdrawn death is very quick.

(b) A patient is dying of cancer and is fully alert but is in excruciating pain, and the cancer in her lungs makes her always short of breath. She may live for weeks or months but decides that it is more important to her to end her pain than to prolong her life. She wants her pain treated as aggressively as necessary to make her comfortable in her last days. She is given increasing doses of intravenous narcotics. These make her very comfortable and sedated, and help her not sense her shortness of breath. She sleeps comfortably and dies the next day, the narcotics having worsened her already precarious respiratory status.

So if we can already help these people, how does the legalization of euthenasia or doctor assisted suicide help? If patients are in pain or are depressed I can already treat their pain and depression as aggressively as they want me to, even if this hastens their death. Also, any patient whose life depends on medical care, including food or fluids, can kick the bucket at any time by refusing further care. Letting me commit physician assisted suicide would only help if I wanted to kill people who weren't in pain and weren't sick. How can this be defended?

I think Kevorkian is a serial murderer and should spend the rest of his life in jail. Some of his patients have not even been terminally ill, just old women whose pain was not being properly treated. I'm very worried that I have not heard an organized voice from my profession opposing his action. Doctors have become wimpy or stupid or scared.

I hope this wasn't too long. I eagerly await your questions and comments. - served up by Doctor Bean @ 6:27 PM 22 comments

 
Mr. Jellypants
About a decade ago, I received the following email from Oven.

Hello Mr. Jellypants,

Badgrass got you down? Well, it takes more than a whistle to keep the leaves off a chestnut tree, if you know what I mean. Say, how about those Hooters? Now ain't that a cracker! I was talking to Derry just the a few weeks ago, and I says to him, "I think the Hooters have more muscle and greater mental powers than any team since the Cinncinati Buffaloes of 1963." And wouldn't you know it, they start breaking records and shattering chandeliers from Seattle to St. Augustine (which, by the way, is the oldest city in the United States). Friend of mine, Jerry McSwordfish, got me a couple of tickets to see them play in the Cobblestone Cup just two weeks from last Thursday. Of course I'll have to quit my job, but it's worth it. I can't tell you how excited I am --- oh yes I can, I just wet myself!

Well, see you later Old Sassyflaps. Don't take any wooden pickles.

The following was my response.

Dear Sir,

I am surprised and disappointed to learn that your constant requests to the warden for internet access from your rubber room have apparently been granted. I don't know how you've managed to track down my address, but I swear I won't allow your lunacy to shatter my life again. I've finally got my credit cleaned up and all the dental work finished and the nightmares are down to every other night, so I have no intention of having anything to do with a midnight-hollering toothpaste-snorting forehead-stapling whacking-off-in-public freak like you. If you have any reason left in your misshapen skull, you'll leave me alone. I am forwarding a copy of your insane ramblings to your psychiatrist; I hope he'll finally decide to medicate you into a harmless drooling vegetable.

Julius "Jellypants" Sassyflaps

- served up by Doctor Bean @ 7:35 PM 14 comments

 
Venn Master
Rivka, 4 1/2, is running towards me holding a piece of paper.

"Daddy, I made you a Venn diagram."

That's weird. Sounds like she said "Venn diagram," of all things.

"A what, Honey?"

"A Venn diagram. It's matzah and challah."

And indeed it is:

The exclusive Matzah section (left "circle") is passover, obviously. The shared area is "all other nights." I don't know what the exclusive Challah section (right), unless it's just our default mode. She can't quite explain it.

(cross-posted on Our Kids Speak) - served up by Ralphie @ 10:52 PM 3 comments

 
Office Space
Moved offices this weekend. I don't want to say that the new space is labyrinthine, but while trying to find the bathroom I ran into a half-man, half-bull.

I don't want to say that the new space is dry, but I've been using more lotion than a Jane Gumb victim. - served up by Ralphie @ 10:49 PM 0 comments

 
Vendetta in Your Pants
Vendetta in Your Pants

Resting in my bedroom
Free from any cares
I hear my happy family
As they shuffle 'bout downstairs
When the noise stops I get lonely
And I go to join the pack
But I find they've moved and left me
And are never coming back

Anger at the beasts
Anger at the plants
Anger at Rice Krispies
Vendetta in Your Pants

Working in my homeroom
Trying to do my best
To process all the lessons
So I'll ace tomorrow's test
I go home self-assured
But like a stupid ass
I sleep too long next morning
Miss the test and fail the class

Anger at the beasts
Anger at the plants
Anger at Rice Krispies
Vendetta in Your Pants

Running through the guy's gym
Dribbling down the court
I make a thirty-footer
I'm a master of the sport
I've worked my life to get here
I want to be Kareem
But I slam dunk on the coach's head
And get kicked off the team

Anger at the beasts
Anger at the plants
Anger at Rice Krispies
Vendetta in Your Pants

Sitting in my Datsun
Cruising down the street
I see an awesome blond chick
That I'd really like to meet
Being so distracted
I miss a traffic light
I slam into a semi
And the day turns into night

Anger at the beasts
Anger at the plants
Anger at Rice Krispies
Vendetta in Your Pants

There's nothing you can do
You never had a chance
The fates are stacked against you
Venddetta in Your Pants - served up by Oven @ 9:44 PM 1 comments

 
Another Reason to Move to Texas
Kosher-for-Passover Dr. Pepper - served up by Ralphie @ 2:08 PM 0 comments

 
Movie Review: Crash
Crash is supposed to be a movie about racists in Los Angeles. What it is really about is a bunch of jerks in Los Angeles. This doesn't mean that the jerks aren't racists or that the racists aren't jerks. But, for a movie, there's no there there.

I don't know how many Best Picture films I've seen, but I can't remember any previous Oscar winners that did not have a story. That's right - Crash has no plot. The movie is made up of incidents that happen to some people, but none of the recurring slices of life contain a storyline. It's just a bunch of scenes. Something happens to someone, and then, Hey! - something else happens that makes what happened previously seem somewhat ironic!

So, no, this movie isn't really about anything in the classic sense of story, as in, Little Red Riding hood is about a girls who goes to visit her grandmother and finds that Grandma's been eaten by the Big Bad Wolf. But it strives to be "about" something - the closest I can come to figuring it out is that you might do something wrong that puts you in a bad situation, but that doesn't give someone else the right to something worse to you.

Robert Fulghum, call your office, because we all learned this in kindergarten: Two wrongs don't make a right. Great. Got it.

I'll give it this - the performances are excellent. If you want to see an ensemble acting workshop, rent Crash. If you want to see a deep rumination on race relations in our fair city, you'll need to look elsewhere. - served up by Ralphie @ 10:36 PM 25 comments

 
Ray "Bubba" Sorensen
Once a year since 1999, Ray "Bubba" Sorensen paints patriotic images on a boulder in rural Iowa. A sample of his fine artwork is shown here. We Americans are blessed to have Bubba as one of our fellow citizens. His talent and his heart are an inspiration. Thanks, Bubba. - served up by Oven @ 2:56 PM 5 comments

 
Passoverdoing it
I guess I went a little overboard preparing my cubicle for pesach.

Have a happy, kosher passover. - served up by Ralphie @ 1:01 PM 5 comments

 
Passover Yuks
Did you hear about the Shmurah Matzah Bandits?

They were roundly condemned.

They're now serving time at Leavenworth.

Thank you! I'll be here all week. Please try the paschal lamb. - served up by Ralphie @ 12:34 PM 2 comments

 
Three thoughts
Isn't every ingredient in any recipe "optional"?

Don't we all live in voluntary evacuation zones?

Aren't we all pre-op transsexuals? - served up by Ralphie @ 12:01 PM 0 comments

 
Synchronous – An Introduction
I wrote a science fiction short story.

Most science fiction isn’t really about science; it’s about technology – spaceships and blasters and transporters and triquarters. But some science fiction is actually about science – about people asking smart questions and making important discoveries about their complex universe. My favorite such stories is Asimov’s Nightfall. If you can get it in an anthology, read it.

I decided to bury the story in the archives because it’s much longer than even a long blog post and I didn’t want to take up that much room on the front page. It’s not long for a short story – 13 pages on MS Word with typical settings, just under 7,000 words. I also didn’t want to publish it in fragments because I didn’t want to decide when you had to stop reading it. You may wish to read it in one sitting or interrupt whenever you’d like. I also think that it will not be of general interest, but that’s OK. I’ll leave it to you decide if you’d like to read it or not.

I’ll value your comments, both positive and critical. Leave them here. I’m closing the comments for the story itself so that I don’t have to keep checking there for comments.

Finally, I’m reserving all rights to it, so please don’t copy any of it. Feel free to link.

(Click on the title of this introduction to go to the story.) - served up by Doctor Bean @ 11:08 PM 23 comments

 
Home of the Homeless
Friday morning I went to a Starbucks near my office in Santa Monica. Outside, at one of the tables, sat a homeless man. His look was straight out of Central Casting: fingerless gloves, tattered jacket, scraggly wool cap, filthy skin, large sores on his hands and face. One detail was different, however.

He had a laptop.

When I asked him if he had wireless Internet access, he said "yes" in a way that sounded more like, "Of course, you idiot, this is the 21st century." And then his cell phone went off and, well, he had to take the call.

I wish I were making this up. - served up by Ralphie @ 4:05 PM 24 comments

 
Best. Correction. Evah.
From this week's Jewish Journal of Greater Los Angeles:

An advertisement for Classique Raphy kosher catering contained an unfortunate, obvious typo. Raphy offers Cornish Hen in a Wine Sauce for Passover, not Cornish Ham. - served up by Ralphie @ 11:42 PM 1 comments

 
On Leaving Egypt
...and prepackaged haroset. A similar experience to the generation who saw gefilte fish move from a carp in the bathtub to a jar in the fridge. - served up by Ralphie @ 12:47 PM 1 comments

 
Hot Chicks - Are They Funny?
Sad item: Hot chicks aren't fairing well in Hollywood these days. - served up by Ralphie @ 11:05 AM 3 comments

 
Old News, but Worth Mentioning
Jack Abramoff was sentenced to five years, ten months. Duke Cunningham was sentenced to eight years, four months. Matthew Lee Cloyd, Russell DeBusk, and Ben Moseley (the church burners) will probably get at least five years each. All I can think is - What a bunch of scumbags. I still get riled when I think about their crimes.

Jill Carroll was freed after 82 days of captivity. This is wonderful... and surprising. I've come to expect the worst from Iraqi kidnappers. As bad as Jill's captors were, they stopped short of the ultimate evil. Thank God.

Cynthia McKinney smacked a D.C. cop. I don't know what her story is, but I don't have a lot of sympathy for her. - served up by Oven @ 7:45 PM 2 comments

 
PM Says New Hamas Government Is Broke
(Or: Why Can’t Other People Pay for My Stuff? – Part II)

GAZA CITY, Gaza Strip Apr 5, 2006 (AP)— The new Hamas-led government is broke and missed the April 1 monthly pay date for tens of thousands of Palestinian public workers, Prime Minister Ismail Haniyeh said Wednesday.

It was the Islamic militants' first admission they will have difficulty running the West Bank and Gaza without massive foreign aid.

Well, yeah. Given that they have absolutely no productive economy, that might be a problem. The tragedy is that before intifada 2, the Palestinian economy was doing well from trade and tourism from Israel. Looks like unbridled Jew murder, while no doubt emotionally satisfying, has some financial downsides.

So now the Palestinians’ main problem is: Our economy is shot and we’re unproductive. Why can’t other people pay for our stuff?

The Palestinian Authority is the largest employer in the West Bank and Gaza Strip, providing salaries for 140,000 people that sustain about one-third of the Palestinians. Haniyeh said it was unclear how the government will meet its payroll.

Swell! We’ve commented on this before. The government being the largest employer is not a good sign.

At least the U.S., Canada, and Israel are sticking to their guns and refusing to turn the cash faucets back on. We’ll see. Maybe the European Union will decide to pay for their stuff. - served up by Doctor Bean @ 2:52 PM 0 comments

 
Online DVD Rental Service smackdown. - served up by Ralphie @ 1:08 PM 2 comments

 
Quick Capsule Movie Reviews
Walk the Line
Pretty much what Jon Stewart said about this movie at the Oscars: It's Ray with white people. And I feel the same way about both biopics: their subjects weren't exactly great people. I didn't know anything about Johnny Cash before I saw the movie. Now I know that he was a philandering rocker who glorified crime. The gangsta rapper of his day, if you will. I was not impressed.

Pride & Prejudice (2005)
I have not read the book (Robert Avrech, please don't shoot me), but I enjoyed the film's understated wit. Mrs. Ralphie didn't like it because it was basically just about marrying off a bunch of chicks. Fair enough. But I did learn one thing: the difference between the rich and the poor is the servants. Rich people in England had servants who wore wigs. The poor people's servants had no wigs. And there you have it.

Also: Keira Knightly, Winona Ryder called and she wants her face back (and her career, while you're at it).

The Squid and the Whale
This movie could use less squid, more whale.

I have no idea what that means. The Squid and the Whale is a tale of divorce in Brooklyn in the 80s. Its performances are superb. Jeff Daniels' arrogant, manipulative novelist is heartbreaking in his inability for true introspection. Laura Linney, one of the best actresses out there, doesn't have a lot to do but wins you over, even though she (at first) seems to be the bad guy.

The film is more the story of the family's two sons, however, each of whom sides with one of the parents. The story is ultimately disappointing, with an ending that is just too subtle for my taste. But for some reason the film is captivating - maybe it's the abovementioned performances - to the point that Mrs. R & I forced ourselves to stay up and watch it late into the night, even though we were exhausted and the DVD has no due date.

Warning: some of the behavior in the movie is highly disgusting and disturbing. I was a little embarassed to be watching it with my wife. If my parents had been there I probably would have eaten my own lips. If you don't watch movies on principle, this is probably not the one you should start with.

The Prize Winner of Defiance, Ohio
The best of this lot. Julianne Moore stars as a woman who must eke out an existence for her 10-member family by winning 60s-era jingle contests. Woody Harrelson is superb as her sad-sack husband, an alcoholic with a dead-end job. He knows he's a loser, the kids know he's a loser, and he knows that they know that he's a loser. But, aside from sporadic outbursts, they must all behave like no one knows anything. The movie is filmed in a unique style that evokes the feel-good kitsch of the era while depicting the dire straits that this family often finds itself in. - served up by Ralphie @ 3:07 PM 18 comments

 
Doctors tell Blair NHS doesn't work
(Or: Why Can’t Other People Pay for My Stuff?)

England’s nationalized health care system can’t sustain the levels of spending needed to deliver care to its citizens. When costs are redistributed away from the beneficiary of the service utilization and costs skyrocket and quality suffers. This should not be startling. They’re thinking about supplementing revenue by having patients (gasp!) pay for some of their care. Radical reform! That method of distribution seems to work pretty well for potatoes and socks and lawn-mowing. Maybe we should try it for healthcare, too.

Here’s the system I suggest. It’s very very technical so I beg your indulgence. Stick with me. Here goes: Have people pretty much pay for their own stuff. Have people who can’t afford any stuff get care through private charities or a marginal government sponsored safety net for the indigent. That’s it. - served up by Doctor Bean @ 4:11 PM 45 comments

 
The Jews Control Everything
...even UCLA Basketball. - served up by Ralphie @ 1:10 PM 5 comments

 
Iranian missiles can be tracked
Well, duh, especially when they're on television. - served up by Ralphie @ 11:52 AM 0 comments