The Deconstruction of American Idol

Now in its seventh season, there is now doubt that American Idol is a powerhouse in American entertainment. Week after week, it is the most watched show on television. Millions call in to keep their favorite contestant in the show. Millions are donated to help a worthy cause. And numerous careers have been launched thanks to this little singing competition. One of the aspects that makes American Idol fun is the feeling of participation that the viewer has. We, the audience, have the power to call a phone number (as many times as we want in the 2 hour block) and do our part to support our favorites. Part of this excitement is that the show is "live", at least for those of us here on the East Coast (I've never watched it elsewhere, so I don't know how they pull it off). However, nagging the show over the years have been suggestions that it is somehow "rigged", that the results are, at the very least, manipulated by the producers through the judges and the host. As best as I can tell, though, these have never been more than vague suggestions. Rumors and whisperings. Nothing more. Until now, perhaps. Thanks to somewhat spacey judge, Paula Abdul, there have been no shortage of "Huh?" moments over the years. She has what I like to refer to as verbal diarrhea. She just sort of talks, and talks, and you hope that something coherent comes out of the mess she just spewed all over the place. Last night, though, was the most surreal moment I have witnessed. Here is the set-up: Each contestant was to sing two songs. Host RyanSeacrest made it clear they would be pressed for time and the judges were to only comment and critique after both songs had been sung. Each contestant performed their first song and, in what appeared to be a somewhat impromptu moment, Ryan has all five come out on stage and asks the judges to quickly comment on the songs so far. Randy and Simon were their normal selves. But in the middle of them we have thetrain wreck that is Paula Abdul. She first starts to comment on Jason Castro's (forgettable) first song. After a quick comment she then continues, "The second song, I felt like your usual charm wasn't...it was missing for me, it kind of left me a little empty. And the two songs made me feel like you're not fighting hard enough to get into the top four.'' What? Randy leans over and reminds her that Jason only sang one song and she acts dumbfounded. She says she thought he sang twice, then comes up with some line that she was confusing her notes with David Cook, who sang second. Only she then says that David was fantastic. Hmmm, something doesn't add up here. So, the question becomes; What was Paula talking about? As I see it, there are only two possibilities. On the one hand, she already had notes from the rehearsal and she was just going to stick to those, no matter what happened with the actual "live" performance, or on the other, she had prepared before hand the type of critique she was going to offer based on what the producers wanted to see happen. Either option seems pretty underhanded to me. The second option, well, that is nefarious enough I don't even have to discuss it further. But even the first seems wrong to me. If this is supposed to be live, and we, the American audience, are expected to judge the contestants on the live performance, what business do the judges have not doing the same? To maintain the integrity of the competition, the judges should be commenting on exactly the performance I just saw. Commentary on a previous performance, that could have been much better or much worse than the one seen on TV gives the judges an opportunity to artificially manipulate the audience. In the end, I find it quite disingenuous.

Another holiday away from home

I knew, going in to medicine, that there would be holidays that I missed, ones I just couldn't be there for. In the (not quite) 2 years I have had the initials MD after my name, this has been true on more than one occasion. Here is a brief list:

• Valentine's 2007
• My Anniversary 2006
• New Year's Eve and Day 06-07 and 07-08
• Easter 2007 and 2008

Not to mention some Memorial Days, and a few other minor holidays. However, I have been home for both Thanksgiving Days and Christmas Days the past two years. Honestly, I really can't complain. Being gone is just sort of part and parcel for the job. However, what really has impacted me is just how amazing my family has been about all of this. Today, again, my children heard their friends talking about their Easter Egg hunt, without being able to talk about their own. But they don't utter a single complaint. Birthday celebrations have had to be adjusted a day or so here and there. Other celebrations have been bumped as Daddy had to go to the hospital. But they don't seem to care. I'm sure that, at some level, they do care. I am sure it is tough at times. However, they deal with it with amazing grace and poise. They actually seem to see it as exciting that they have theirs the day after (or before, as the case may be). Most of us know (all of us should know) that there will be similar sacrifices. And our families should know this as well. But talking about it is one thing, actually starting residency and living it is another. Now, a few years in to it, I can say that, like having children, no one can tell you what it will be like. Sometimes families struggle with this. And while it hasn't always been easy on us, I am humbled to realize just how supportive my family has been through this all. They are pretty amazing.

I passed!

Please refer to the previous post to fully understand my excitement. It is sufficient to say that I passed my stone. Hooray. I just have some vague lingering discomfort in my back, but nothing like it was. Thank goodness. Carry on.

A healthy dose of empathy

The time quickly approaches. I really only have a few months left as a General Surgery resident. Then I make the transition to Urology resident. To be quite honest, I am incredibly excited. Not only am I incredibly tired of General Surgery, I look forward to focusing my time and energy on what I will be practising for the rest of my life. But yesterday I gained a whole new ability to empathize with my future patients. It was about 8:45 in the morning. I was working on writing some transfer orders for one of our patients. Getting ready to move her out of the ICU, I sat down at the desk with a pile of forms (we can't seem to do anything without forms) and started to write. Then it hit me. Pain. Pain like nothing I have ever experienced. In my right flank. It radiated down, around the side and to my left groin. Maybe that is too much information. Oh well, there it is. I couldn't sit still. Walking hurt, sitting hurt. Anything I did hurt. I knew exactly what it was. I had a kidney stone. I paged the chief resident on our service and told him I thought I had a stone. After I told him my symptoms he agreed. Time to go to the ER. About 30-40 minutes had passed and it was just getting worse. I walked down to the ER, hobbling a bit, and went to the check in desk. They gave me a funny look, here I was, in my scrubs and white coat, embroidered with "Peter J Jones MD" right there on the front. The triage nurse called my name and immediately looked at me with a quizical look. "What are you doing here?" she asked. Yeah, we know each other. See, the General Surgery resident is in the ER a lot. Seeing consults, running traumas, etc. They get to know us pretty well. "I think I have a stone," I told her. I mentioned the symptoms and she took me right to a room. I won't lie, they took really good care of me. Sort of that "care for our own" attitude. The nurse was in immediately, and IV was in my arm along with 30 mg of Toradol. They even went and got me a mobile IV pole, since I just couldn't stand to sit still. A few minutes passed, things were getting worse and I called the nurse back in. "I'm ready for the morphine," I said. He pulled the syringe out of his pocket and I had 4 mg of morphine on board. Holy crap, that is good stuff. I didn't get a buzz (I don't think you really can when you are in real pain), but I felt a lot better. All this happened before the ER doc had even seen me. Honestly, the nurses and aides were great. I gave them a urine sample, and within minutes I was on the table of the CT scanner. I walked back to my room (walking was still preferable to holding still) and grabbed a C.O.W. (computer on wheels), logged in to the medical record system, and pulled up my own CT scan. Maybe there is some HIPAA violation in there. Frankly, I didn't care. I just wanted to know if there truly was a stone or not. As I scroll down the scan, I spot one. A little 2-3 mm white kidney stone. But there was one problem. This was in the upper pole of my left kidney, no the right, where the pain was. I look over at the right side and notice that the right renal pelvis is dilated. So is the right ureter. That means there is something further down the line. I keep scrolling through the scan and sure enough, there it is. Another 2-3 mm stone in the right junction of the ureter and the bladder. Great. Well, at least I knew why I hurt so bad. At least I knew it was real. A few more doses of morphine, a prescription for ibuprofen (the 800 mg tablets) and some Percocet, and a couple of liters of IV fluid later and I was headed home. The pain continued, off and on the rest of the day and into the night. As it is right now, the pain is better, but I still haven't caught that little bugger in my strainer. I have puked a couple of times (first time since High School), and didn't really sleep at all last night. Hopefully tonight will be better. At least I don't hurt nearly as bad. Next time I have a patient with a kidney stone, now I can truly empathize with them. I suppose that is good. Right?

Christmas photo follies

As some of you should know by now, we decided to just use a picture of our little ones for our Christmas card this year. It was fast, easy and we thought they turned out well. But getting one photo that was decent enough to use, well, that was not fast or easy.

Alex would only smile for a split second, Jessica wasn't feeling well, and tried her hardest to muster a smile, but it just didn't work. And Aubrey, well, she is just Aubrey. You never quite know what you are going to get with her.

In the end, we managed to salvage one that was decent enough. Jessica still has a bit of a grimace, but she is trying.

Merry Christmas everyone!

Chuck: Our new favorite show

Years ago, I started watching Alias. My wife sat down and we were both immediately engrossed. It became our weekly show, the one we would set time aside to watch together. And if one of us couldn't be there we either taped it (in the old days), or (confession here) downloaded the episode. It was a lot of fun. We knew that, every week, we had that time set aside for a little escapism. Our enjoyment of this activity waned a bit during the third season (our least favorite), but we stuck through. After Alias went off the air, we were sort of in a void. There just wasn't anything that we both wanted to watch. My wife fell in love with Gilmore Girls, and is still enjoying catching up on past seasons on DVD. I would see the occasional episode, and while I found much of the dialog witty, it didn't really draw me. We sort of started watching Lost at the beginning of the second season. But, to be honest, it started to get a bit too weird for us. For the most part, we have not really watched too much TV together since that time. Not a huge loss, as there are better things we can do with our time. Still, we missed having a show that we sat down to watch together every week. We tried with Heroes last season, and while I enjoyed it, it was too dark for my wife's taste (and this season is too directionless and, well, just bad). Enter Chuck. I happened to catch the pilot episode and found it quite enjoyable. It managed to straddle numerous different styles. On the one hand you have an action/spy show. Similar to Alias, the main character has to hide his spy life from his friends and family. Yet the show also mixes in well the geekiness (or nerdiness) of the main character and his friends. It manages to balance humor with action nicely. To be honest, it is a very pleasant breath of fresh air. The cast is great. Each one is likable and believable (relatively) in his/her role. The interplay between the characters is handled well, not too heavy handed, but again with just enough tongue-in-cheek to keep you smiling. We have been catching up on some past episodes we missed, and are, unashamedly, big fans of this new show. The news that it was picked up for a full season (and possibly a second-it is hard to tell for sure due to the writer's strike) came as welcome news. At least thus far, they have managed to make it work well. And for the other nerds that may be watching, there are ample nerd and geek references (subtle for the most part) that keep me on my toes, watching for them. It is a lot of fun to have something that my wife and I both look forward to watching again.

Um, my brother wants to be. . .

Whew, dusting off the old keyboard here. Been a while. But I had to share, this was too ridiculous. 4:30 this morning. I was on call for General Surgery (and Pedi Surgery and Vascular Surgery and Trauma and ENT). Other than a vascular patient who decided she wanted to try to die and hemorrhage on us (she's as okay as she can be, at least not bleeding like a stuck pig anymore) it was a pretty quiet nite. One of the joys of being the junior Surgery resident on call is that you have the glory and honor of having all outside phone calls that want to talk to a Surgeon directed to you. You get a page that starts with 333** with two other numbers (the **), and when you call back, you are connected to the caller. This is usually either MDs from other hospitals calling to transfer someone to us (because they are too complicated, the patient that is, or because they are too lazy, the MD that is), or previous surgery patients who have a question about something. These calls can be a real pain. So, the pager goes off. 333**. Outside call. My guess is, at this time, a sick person has shown up at another hospital and they want to send them our way. I dial the number, hear the beep that tells me we are connected. "Hello, this is PJ with Surgery." "Um, yeah, my brother, well, he wants to be a woman." Silence. "Do you do that surgery?" "No. No, we don't do that surgery. General Surgery isn't even the right person to call for gender reassignment surgery." "Well, can I talk to the person who does it?" "No, no one here does it." "Um, can you give me the number of someone who does?" "No." Click. This has to be a prank. No one in their right mind, lest anyone who actually is considering gender reassignment, is going to have their drunk sounding brother call at 4:30 in the morning. My money is on one of the other Surgery residents who are on research this year and have the time to pull a lame prank like this. Needless to say, it made a fun story to tell the other residents this morning. What a classic line. "Um, my brother wants to be a woman." Priceless.

Blogging From Word

Being something of a tech geek, I couldn’t help but jump on the chance to download and install the beta of Office 2007. And as a blogger, I thought it might be fun to see how well it works blogging from Word.

We’ll see how this shows up on my blog. Mostly just for test purposes.

Ramble on. . .

-Writing so Dis Con Nec Ted. . . A great song, by the way. Understated, incredibly thunderous bass, and almost uncomfortably restrained vocals, it is one of my Rychian favorites. -Back from Houston. What an incredible experience. It was life altering. Okay, so I am full of crap. It was awful. Not in a really bad sort of awful way, just in a "I spent $1000, plus $500 in airfare, $160 in hotel and $35 for a car just so I could take this idiotic test?" sort of awful. Let the good times roll. -On call tonight. Got here to the ICU at 5:30 this morning, hoping to leave by 8:30 tomorrow morning, with no plans for sleep. Now that is what we call quality patient care. The drive home is always adventerous as well. -Got a new review up over at Blogcritics.org (I am now a writer over there, mostly music reviews). What makes this one fun is it is the first review I have written for a CD the band's publicity company sent me. Sort of fun to get free music. -Graduation approaches. That is a bit of a surreal thought. When I graduated from my undergraduate institution I didn't think it was a big deal. I knew I had another, much more significant hurdle before me. Now that I am there, at the cusp of that hurdle, well, it doesn't seem like that big of a deal either. My wife assures me it is. I think I am a bit blinded by my proximity to the occassion. But I have to admit, I do like the thought of actually being a doctor. In training, of course. But I will still have that MD. -Along those lines, I have had numerous people lately call me Dr. Jones. I want to correct them, it just sounds so wrong, so dirty of me. Then I remember. The only thing between me and that title is one month (from tomorrow). I would have to actively bust my hump to not actually graduate. And so I leave it alone. And secretly, I really like the sound of Dr. Jones. -I have wanted to blog numerous times in the past week, but the slate has come up blank. Hence the ramble. -It is high time to take out the contacts. They have been in since before 5:00 am, so my eyes are getting a bit tired. -It is also high time to end this entry. I have been composing it for about 5 hours now, in little spurts, sometimes not even a whole sentance at a time. D ow N (San Chonino is probably the only one who will get that)

With benefits

I have been a student for a long time. It has been a total of 22 years now. That is, obviously, the majority of my life. I am used to being a student, with all that entails. And there is one thing that being a student doesn't generally entail. Benefits. While I will still be in training, it suddenly dawned on me that I will be employed. And with employment comes benefits. And in our case, Dartmouth-Hitchcock has some pretty nice benefits. I was investigating how much it was going to cost us for our health insurance. See, last year they decided to increase the health insurance premiums for students with families by about 200%. Needless to say, we felt the hit. They sent out an email about how they are going to go ahead and raise premiums even more for students with families this year. In order to keep that increase minimum, they are also going to increase deductibles and decrease benefits. Sounds like a great deal, no? I suppose that is what happens when you are so dramatically the minority. Well, me curiosity was piqued. How much was I going to have to pay next year for health insurance? So I did a little research and found the answer. And then I called my wife to tell her the news. It is free. Yep. Dartmouth-Hitchcock pays the premium for all House Staff as well as their eligible dependents. We were thrilled. That is a huge help for the next year. So, while I was at it I thought I would look into the disability benefits. There has been a big buzz at school about disability, with the option to purchase disability through Duke if it is cheaper than where we will be going. Well, guess what. Disability is free as well. So is (limited) life insurance. This is a whole new world to me. One I look forward to entering. All at about $7.00/hr.