It was a bitterly cold day, and my birthday to boot when I had a stray thought about the word "Kaputt". It is of course a bit of German slang, one that has crossed over into English. I must have been feeling a little run down and defunct.
It does not exactly have the feel of a proper German word, and I got to wondering if it was one of those words that drop in from another language. It seemed just a little familiar to me, being teasingly similar to an occasionally used Latin word.
Caput is the Latin word for head. We still encounter it in medicine from time to time. A fungal infection of the scalp is Tinea Capitus. The sinister tangle of dilated veins around the umbilicus that is seen in end stage liver cirrhosis is colorfully called Caput Medusum. The word is less recognizable but more widely used in its form Capitol in the sense of a nation's "headquarters".
Caput is a most archaic word, so it is not clear exactly how it relates to the Capitoline Hill where we recently heard the faint echo of Monetas and her honking geese.
Like so many forerunner words Caput has a lot of modern descendants including Chief, Chef and Chapter.
And the hop over into French?
Evidently there is an ancient French card game called Piquet. Rarely played in modern times it was once very popular. To wander even further off topic a Piquet hand with no face cards was called Carte Blanche. Games always are a fertile source for slang and the phrase faire capot (literally, "making a bonnet") was used to indicate that one had won all the tricks in a game of Piquet. And where one side wins all, the other loses all.
In the early months of World War I, when German troops surged to within sight of the Eifel Tower they joked, apparently getting it backwards, that the French were faire capot, with the sauerkraut tinged linquistic abilities of the common soldier corrupting and shortening the phrase to kaputt!
-------------
(As with most etymological expeditions I am simplifying a bit. faire capot also was used as nautical term for tipping over a boat, and capot could serve as either a word for bonnet or as a general term for over garments of a nautical or military nature. All these shades of meaning probably went into the generation of a new and rather specific term for military defeat)
Friday, January 31, 2014
Wednesday, January 29, 2014
Script Doctor
I don't have a future as a Hollywood script writer. Mostly because I do not write dialog well. I also would probably have difficulty with explosions and glittery vampires. So I am not about to "quit the day job". But I think I would do very well indeed as a script doctor.
No, not the anonymous drudge who takes a half baked bit of writing from an entirely baked established Hollywood writer and then beats it into comprehensible shape. No, I think my niche would be adding little bits of medical detail.
I can't begin to tell you just how "fake" illness generally is portrayed on TV and in movies. With a few notable exceptions such as "ER" and "House" it is considered just fine to have the buxom starlet linger at death's door, delivering her final lines with nothing more than a tiny bit of oxygen whispering past her perky plastic surgerized nose. No endotracheal tube. No pallor. One lousy bag of sugar water hanging on the IV pole.
And of course she has been stricken by some ailment, undiscovered by medical science to date, that progresses from radiant goddess-like beauty, through a few seconds of feeling dizzy, and on to a theatrical demise before the last commercial break.
I think I could write better stuff. I know I could write more realistic stuff.
There is a lot of great material to work with. I'm keeping a few to myself, just in case Spielberg calls for a meeting. But here's one that has been around the block once or twice:
Alien Hand Syndrome.
This happens when a very specific part of the brain gets damaged, usually through a stroke. The patients so afflicted have a hand that moves and has normal sensation. But they can't entirely control it. And more to the point, their brain does not recognize it as "theirs".
The Alien Hand appears to have a will of its own, and tends to reach out to grab things in the immediate environment. Obviously Hollywood has been using this one for quite a while now!
And of course......
In fact an alternate name for Alien Hand Syndrome is Dr. Strangelove Syndrome!
Ok, so the existing pool of TV/Movie writers get one right on rare occasion. But lets not give them too much credit. They were just cribbing from the New Testament:
And if thy right hand offend thee, cut it off, and cast it from thee: for it is profitable for thee that one of thy members should perish, and not that thy whole body should be cast into hell.
Matthew 5:30
No, not the anonymous drudge who takes a half baked bit of writing from an entirely baked established Hollywood writer and then beats it into comprehensible shape. No, I think my niche would be adding little bits of medical detail.
I can't begin to tell you just how "fake" illness generally is portrayed on TV and in movies. With a few notable exceptions such as "ER" and "House" it is considered just fine to have the buxom starlet linger at death's door, delivering her final lines with nothing more than a tiny bit of oxygen whispering past her perky plastic surgerized nose. No endotracheal tube. No pallor. One lousy bag of sugar water hanging on the IV pole.
And of course she has been stricken by some ailment, undiscovered by medical science to date, that progresses from radiant goddess-like beauty, through a few seconds of feeling dizzy, and on to a theatrical demise before the last commercial break.
I think I could write better stuff. I know I could write more realistic stuff.
There is a lot of great material to work with. I'm keeping a few to myself, just in case Spielberg calls for a meeting. But here's one that has been around the block once or twice:
Alien Hand Syndrome.
This happens when a very specific part of the brain gets damaged, usually through a stroke. The patients so afflicted have a hand that moves and has normal sensation. But they can't entirely control it. And more to the point, their brain does not recognize it as "theirs".
The Alien Hand appears to have a will of its own, and tends to reach out to grab things in the immediate environment. Obviously Hollywood has been using this one for quite a while now!
And of course......
In fact an alternate name for Alien Hand Syndrome is Dr. Strangelove Syndrome!
Ok, so the existing pool of TV/Movie writers get one right on rare occasion. But lets not give them too much credit. They were just cribbing from the New Testament:
And if thy right hand offend thee, cut it off, and cast it from thee: for it is profitable for thee that one of thy members should perish, and not that thy whole body should be cast into hell.
Matthew 5:30
Monday, January 27, 2014
Motivating the Healthcare Peasants, January 2014
For those joining the story late I should explain that I was once a Family Practice doctor. Oh, philosophically I still am of course, but my work the last six years has been primarily in a rural Emergency Room.
My paperwork burden is much less these days as I do not have to get involved with decisions regarding staffing, "Strategic Planning", or more to the point, billing.
But once in a while something official turns up in my work mail slot. Here, have a look:
Yesiree Bob, it is a check written out to me by a gigantic health insurance company. And for the princely sum of Zero Dollars And 17 Cents.
I thought this was pretty funny so I took it down to administration. I figured that since I was working for them that any money that came in for my care was rightfully theirs. My thought was that I could sign it over and tell them to buy, well not a cup of coffee but maybe a little container of non-dairy cream to put into the cup of coffee.
But as it turns out this actually is money for me. Caught up as I was in a moment of Scrooge McDuck enthusiasm it took a little explaining for me to understand how this windfall was possible.
I was told that part of reforming health care involves making the primary care drudges at the base of the food chain happier. Maybe they will work harder, refer less routine stuff to the Apex Specialists. Heck, perhaps better pay will even cause them to be fruitful and multiply.
This is good, worthy and to be encouraged. But if the Powers that Be had asked my opinion I would have just said cut the humble (FP/Peds/Internists) a check. "Here's a couple grand, thanks for all you do."
But no. Via some complex system a few pennies of positive reinforcement are calculated from the charges you submit. I suppose in a large group practice or over the course of a year this could add up to something more than the rather insulting manifestation of approval that I got in the mail. I guess this program has been around for a year now and so far this is the first check I have seen.
But perhaps I am being unfair. What I am not showing for reasons of privacy is my name and address on the check. They got the name right, but the address was a puzzler. It was in another state. But it did seem vaguely familiar and after a while it occurred to me....
Folks, the highly efficient, well oiled machinery that is health care financing in the Year of Our Lord 2013/4 has decided that my mailing address is at the hospital where my father practiced up until his retirement........a quarter century ago.
Obviously no human brain was involved in this. Some deep archive of computer data made the link between my father and I based on our shared last name. (For the record we do not have the same first name, nor have I practiced in his state after a brief moonlighting stint in 1985!).
It is very much like being a passenger on a trans Atlantic flight and seeing the pilot's cabin door swing open....and there being no living, thinking people up there at all.
It makes me wonder how many other tiny checks are being mailed out at 38 cents a pop. And how much staff time and expense goes into doing so? How many end up in the wrong state? This one found its way to me somehow, but how many other little bits of financial detritus are swirling about in the drafty, ramshackle edifice that is our health care system?
Well, maybe I am over reacting a bit. Perhaps I should close with a hearty "Rest Assured Citizens!". Clearly the wise and sapient beings that are reforming America's Health Care System have not only your best interests at heart but mine also. As a hard working Family Doctor (albeit presently working hard in the ER) I bask in the esteem of the Exalted Ones. I know how much they appreciate what I do.
-----------
Addendum: A few days later I got another check from a different insurance company. It went to the proper address. And while I do not feel substantially motivated it will cover my pub tabs on the spring trip to England.
My paperwork burden is much less these days as I do not have to get involved with decisions regarding staffing, "Strategic Planning", or more to the point, billing.
But once in a while something official turns up in my work mail slot. Here, have a look:
Yesiree Bob, it is a check written out to me by a gigantic health insurance company. And for the princely sum of Zero Dollars And 17 Cents.
I thought this was pretty funny so I took it down to administration. I figured that since I was working for them that any money that came in for my care was rightfully theirs. My thought was that I could sign it over and tell them to buy, well not a cup of coffee but maybe a little container of non-dairy cream to put into the cup of coffee.
But as it turns out this actually is money for me. Caught up as I was in a moment of Scrooge McDuck enthusiasm it took a little explaining for me to understand how this windfall was possible.
I was told that part of reforming health care involves making the primary care drudges at the base of the food chain happier. Maybe they will work harder, refer less routine stuff to the Apex Specialists. Heck, perhaps better pay will even cause them to be fruitful and multiply.
This is good, worthy and to be encouraged. But if the Powers that Be had asked my opinion I would have just said cut the humble (FP/Peds/Internists) a check. "Here's a couple grand, thanks for all you do."
But no. Via some complex system a few pennies of positive reinforcement are calculated from the charges you submit. I suppose in a large group practice or over the course of a year this could add up to something more than the rather insulting manifestation of approval that I got in the mail. I guess this program has been around for a year now and so far this is the first check I have seen.
But perhaps I am being unfair. What I am not showing for reasons of privacy is my name and address on the check. They got the name right, but the address was a puzzler. It was in another state. But it did seem vaguely familiar and after a while it occurred to me....
Folks, the highly efficient, well oiled machinery that is health care financing in the Year of Our Lord 2013/4 has decided that my mailing address is at the hospital where my father practiced up until his retirement........a quarter century ago.
Obviously no human brain was involved in this. Some deep archive of computer data made the link between my father and I based on our shared last name. (For the record we do not have the same first name, nor have I practiced in his state after a brief moonlighting stint in 1985!).
It is very much like being a passenger on a trans Atlantic flight and seeing the pilot's cabin door swing open....and there being no living, thinking people up there at all.
It makes me wonder how many other tiny checks are being mailed out at 38 cents a pop. And how much staff time and expense goes into doing so? How many end up in the wrong state? This one found its way to me somehow, but how many other little bits of financial detritus are swirling about in the drafty, ramshackle edifice that is our health care system?
Well, maybe I am over reacting a bit. Perhaps I should close with a hearty "Rest Assured Citizens!". Clearly the wise and sapient beings that are reforming America's Health Care System have not only your best interests at heart but mine also. As a hard working Family Doctor (albeit presently working hard in the ER) I bask in the esteem of the Exalted Ones. I know how much they appreciate what I do.
-----------
Addendum: A few days later I got another check from a different insurance company. It went to the proper address. And while I do not feel substantially motivated it will cover my pub tabs on the spring trip to England.
Saturday, January 25, 2014
American Health Care 2014...a shortage of WHAT?!
Continuing for a few days my musings on the current state of the US health care system...
I arrived in the ER for my Friday shift only to be met with a note announcing that there was a nationwide shortage of "normal saline".
WTH!!!!!
Normal saline for those not in the trade, is a commonly used IV fluid. Very handy stuff if you need to quickly re-hydrate somebody or as initial fluid resuscitation in trauma. It is made of:
Water.
Salt.
That's it. Not exactly a complex, hard to manufacture, 21st Century Wonder Drug.
It seems that we are not short of water. And we have plenty of plain old NaCl. Apparently the problem is that a large number of bags of the stuff were found to have dubious plastic connectors, making it difficult to be sure that the stuff is actually sterile.
Primitive technology. But still lifesaving stuff. And unavailable because somebody (I figure in some third world manufacturing system) did not pay attention to some stupid but critical step in manufacturing a bazillion little plastic do dads to be shipped off to the United States.
We can still administer IV fluids of course, but have been reduced to using an alternative IV juice called Lactated Ringers. Nobody likes it except surgeons. They love the stuff, which is sufficient reason in my book to be suspicious of it.
I arrived in the ER for my Friday shift only to be met with a note announcing that there was a nationwide shortage of "normal saline".
WTH!!!!!
Normal saline for those not in the trade, is a commonly used IV fluid. Very handy stuff if you need to quickly re-hydrate somebody or as initial fluid resuscitation in trauma. It is made of:
Water.
Salt.
That's it. Not exactly a complex, hard to manufacture, 21st Century Wonder Drug.
It seems that we are not short of water. And we have plenty of plain old NaCl. Apparently the problem is that a large number of bags of the stuff were found to have dubious plastic connectors, making it difficult to be sure that the stuff is actually sterile.
Primitive technology. But still lifesaving stuff. And unavailable because somebody (I figure in some third world manufacturing system) did not pay attention to some stupid but critical step in manufacturing a bazillion little plastic do dads to be shipped off to the United States.
We can still administer IV fluids of course, but have been reduced to using an alternative IV juice called Lactated Ringers. Nobody likes it except surgeons. They love the stuff, which is sufficient reason in my book to be suspicious of it.
Friday, January 24, 2014
Medical Record Software gone Wild
Coming to computerization later in my medical career I think
I have a better perspective on it than most.
Doctors older than I just ignored it until retirement. Young cubs had to grow up with this stuff and
seem to accept all manner of indignities without the ability to complain.
Anyway, I recently had to learn something new. Not a complete medical record system, just
the little slice of it that allows patients to be transitioned from the ER to
the inpatient area. My trainer was
appalled that I had never bothered to learn this system and in fact had
forgotten my passwords. In my defense, I
have been happily hand writing transition orders that up until now seem to do just fine.
But now we have a Federal Regulation that all transitions
from ER to inpatient need to use a certain software. I guess it applies everywhere in our galaxy,
or so I have been advised.
Here are a few gems from the “Physician Training Checklist”
“Searching – wildcard dash”
“Shopping Cart”
“…if using half words always add a dash”
“Transaction lines = Select (bank of answers) Enter
(free-text) Choose (buttons).
All pretty mundane.
But this bit of bureaucratic nonsense made it into my personal Hall of
Infamy with a special gem:
“Duplicate balls – already ordered but can continue”
Wednesday, January 22, 2014
A Mystery Coin - Ancient Low End Bling
Today's Mystery Coin is about as ugly as they get. The top view is the reverse. The bottom view is the "heads" or obverse. It looks so flat and clean that it almost appears to have had the Emperor/King/Shah scraped off in a purposeful defacement. But what I found initially fascinating about this coin was the hole near the top.
Ancient coins often turn up with holes in them. In fact I have another one in better shape:
This is a common low value coin from one of Constantine's squabbling descendants. A rather inexpertly drilled hole near the top looks like where you would place a loop, so that this could be worn as a pendant.
When researching the question of ancient coins with holes in them I ran across this very thoughtful discussion that also has some photo galleries that put my examples to shame holed ancient coins.
But getting back to the coin of the day, note that it is not a nicely drilled/punched hole as in my second example. Zooming in closer...
This has been crudely punched through with a knife blade or something akin to it. There is corrosion on the edges so this is not recent damage from being excavated clumsily. The hole was made in such a fashion that the side with lettering was preserved, so we have to assume that it was of greater importance to whoever was altering this coin for display purposes.
This is one of those coins that is really too far gone to identify. My best guess is that it is something like this:
My example is similar in style but clearly a different Emperor. By playing with magnification and squinting I "think" I can make out just a few letters...
??
AR???OS
?BIRTD??
D?VR?x
??
At this point a responsible historian would just say, "who knows?". But a frivolous sort such as I can imagine that the coin actually says:
??
ARTORIOS
BRITD?
D?VRex
??
So there you have it, all you need is a plausible mint transposition of the I and R to give us a nonsensical identification of a coin from King Arthur!
Oh, and if anyone has an actual sane identification I would love to hear from you.
Monday, January 20, 2014
A Mystery Coin - Allegory or "Selfie"?
Our coin of the day:
A few things were clear from the onset. This coin is bronze, but too small to be of standard Roman denomination. This would suggest either a Greek coin or more probably based on style, a local coin minted in the formerly Greek lands under Roman rule. This was quite common during most of the time that the Romans ruled the Eastern Mediterranean. Perhaps they did not find micro managing the local economies worth while. Perhaps it was a tip of the hat to former Greek greatness and autonomy. The Romans always admired their Greek mentors. But for one reason or another it was common practice for several centuries to allow cities in the Eastern part of the Roman Empire to make their own low value coins. They were encouraged to put the current Emperor on the "heads" side.
I think my coin is a very beaten up version of this:
A few things were clear from the onset. This coin is bronze, but too small to be of standard Roman denomination. This would suggest either a Greek coin or more probably based on style, a local coin minted in the formerly Greek lands under Roman rule. This was quite common during most of the time that the Romans ruled the Eastern Mediterranean. Perhaps they did not find micro managing the local economies worth while. Perhaps it was a tip of the hat to former Greek greatness and autonomy. The Romans always admired their Greek mentors. But for one reason or another it was common practice for several centuries to allow cities in the Eastern part of the Roman Empire to make their own low value coins. They were encouraged to put the current Emperor on the "heads" side.
I think my coin is a very beaten up version of this:
It is described as being a coin from the reign of the Emperor Trajan, from 98 to 117 AD. It is said to be from Phoenicia/Tyrus and to depict "veiled and turreted head of Tyche" on one side and a date palm on the other.
This appears on first glace to make sense. Most of the coins from this era showing a palm tree are quite logically from places where they grew and were an important food source. North Africa, modern day Israel and Syria, less often Sicily. And Tyche was a very common figure on coinage of this sort.
Tyche was the equivalent to the Roman goddess "Fortuna". In fact Tyche derives from the Greek word for luck. She was felt to govern over the fortune and prosperity of a city. And, because your fortune and prosperity would be much more secure behind fortifications, she is often shown with a headdress that depicts city walls and turrets!
So far so good. But sometimes the interplay between traditions can be interesting. And it got me wondering if the female figure on today's mystery coin was intended to be a straight up depiction of Tyche, or perhaps a portrait that intentionally resembled a close relative of Emperor Trajan.
Check out the similar looking hair styles and face on these candidates:
Plotina, wife of Trajan.
Marciana, sister of Trajan.
Matilda, niece of Trajan and mother in law to the Emperor Hadrian.
From coins and sculptures we think we have a decent understanding of Roman hairstyles, and this over the top "turret head" coiffure only seems to turn up in these female relatives of Trajan.
Of course this begs the question. Was my mystery coin trying to resemble an Imperial lady? Or were said ladies trying to affect the looks of "Fortune"? If the latter it is hard to imagine an Emperor for whom this is less logical, Trajan did not hail from the Eastern Provinces. He came from modern day Spain, clear at the far end of the Empire.
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