Monthly Archives: May 2008

Time travel’s paradoxes

While discussing Harry Potter and the Prisoner of Azkaban with me, my roommate Jordan mentioned that there was an irreconcilable paradox presented in the book.  The story is as such: Harry is about to have the life sucked out of him by the dementors when a powerful wizard across the lake casts a hefty patronus spell to ward off the dementors.  In his fleeting moments of consciousness, Harry believes that it was his now-deceased father who appeared and cast the spell.

Later, Harry and Hermione travel back in time to save “more than one” life.  Harry of the Future eventually finds himself across the lake, watching Present Harry getting succumbing to the dementors.  He tells Hermione that his father is bound to appear any moment to invoke the patronus.  However, at the last critical moment, Future Harry himself steps up and wards off the dementors, thus saving his own life.

Up until that point, Harry had been able to produce only a very feeble patronus.  He later states that at the last minute he knew he could do it because he had seen his own patronus.  Thus, disaster is averted, and all ends well.

I might point out a few–shall we say–internal difficulties this plot presents.  Of course Future Harry knows the future of Present Harry, but in his confidence-building realization that he had seen his own patronus, we realize that Present Harry across the lake had witnessed the future of Future Harry.  In other words, in that moment of clarity, Present Harry encountered Future Harry’s future, and that gave Future Harry confidence to act.  I’m still struggling to get my mind around this, but it seems ironic to say the least that Present Harry (who had not yet time-travelled) could have any insight about the future.  This is probably why the professor wisely told Michael J. Fox to avoid himself in Back to the Future.

Another paradox arises, and this is the fact that Harry could create a powerful patronus because he had seen himself do it.  This is a classic chicken-and-egg scenario.  Which came first, Harry’s patronus or his confidence?

Lastly, and this is where things really break down, it is clear that Future Harry saved Present Harry’s life.  Future Harry could only travel back in time because Present Harry had lived.  Had Present Harry died, there would be no Future Harry.  In other words, Present Harry’s living depends on Future Harry’s acting which in turn depends on Present Harry’s living.  If this were a choose-your-own-adventure book, this branch of the plot is dependent on that very branch curving back on itself and inserting a branch point.  (Sorry for the mixed metaphor.)  I suppose this may be J.K. Rowling’s implicit argument for a divine presence, but I think it would be much more intellectually satisfying had Future Hermione saved Present Harry’s life.

For those who do not find this discussion compelling, perhaps you will be deeply moved by this Prohibition Era photograph.

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Things I don’t like

After an exceptional day in the operating room, I realize this list is definitely due, and perhaps will be added to over time.  It focuses on my dislikes at the hospital.

  • Standing on power cords.  This robs me of my sense of stability and balance.  It’s remarkably uncomfortable.
  • Trying to put a forced-air warming blanket on a patient after the surgeons have draped.  Although this causes me no direct pain, it is amazingly annoying and inconvenient, especially compared to how easy it is to put on the warming blanket before draping.
  • Pushy surgeons. Surgeons are pushy for a number of reasons, but they usually fall under the categories of 1) Shortsightedness, 2) Rudeness, and 3) Bullheadedness.  I will further explore these in proceeding bullet points.
  • 1) Shortsightedness.  Often surgeons are pushy because they want to get the case started.   They believe that the extra ten minutes it took me to get an EKG before bringing the patient in the room because their patient was not adequately prepared is somehow MY delay and this gives them the right to be pushy.  They do not realize that I am trying to HELP them take care of the patient, that it is THEIR fault the patient was not adequately prepared (Why is it so hard for a medical doctor to realize that a patient with coronary artery disease needs an EKG before surgery???), and that if something bad happens because a patient was not adequately prepared, it is MY fault legally because I succumbed to their pushiness.
  • 2) Rudeness.  This happens far less often than it used to, but I’m still amazed at how a surgeon will stroll in and INTERRUPT my interview with a patient without even acknowledging me.  I am a physician, and this shows absolutely no respect. I have a policy now of either saying, “Excuse me, you just interrupted me,” or just leaving, telling the surgeon on my way out, “I guess I’ll come back when you’re finished.”  This will usually bring an apology.
  • 3) Bullheadedness.  Please do not tell me that I need to transfuse blood or start an arterial line when any anesthesiologist would balk at exposing a patient to unnecesary risk.  If you understood the valid medical reasons for doing things that anesthesiologists do, and if you presented such a reason in a nonconfrontational way, then sure, we can talk about it and consider it.  But when you are bullheaded about wanting me to do something stupid, and I choose to be neither bullheaded nor passive-aggressive back to you, then that is not time to persist in your bullheadedness.
  • Loud noise.  Today we had jackhammers in an adjacent floor for the better part of the day.  The subway workers manage to work at night and the weekends…why can’t hospital construction workers?
  • Loud noise.  Nurses with loud voices deserve their own bullet point.
  • Loud noise.  Surgeons with loud iPods get another bullet point of their own.
  • Lack of awareness.  There are critical times in surgery.  I do my best to focus with the surgeons at these times.  From my end, induction of and emergence from general anesthesia are critical times.  This is not the time to laugh and joke and turn up your iPod.  I will ask you to turn it down.  And I notice the surgeons who stand quietly and attentively at the bedside while I induce and intubate a patient.  Often, those are the surgeons I would choose to send my family to.
  • Making a mockery of safety.  During the surgical “time-out”, I stop what I’m doing and actively listen, often voicing agreement afterward.  Surgeons who do the time-out with the attentiveness of a 6-year-old in church scare me.  They seem to think that operating on the wrong side of the body is a thing that happens to Other Surgeons.
  • Nurses who do not listen during report.  I may have just spent eight hours ensuring that a patient lives through anesthesia and surgery.  I may have even made a little extra effort to make them wake up without pain and nausea.  Sometimes I take steps to prevent untoward cardiac and pulmonary complications.  If I feel like it, I manage the patient’s fluid balance and blood counts.  I listen constantly to the beating of their heart, I watch the contours of their arterial pulsatility, I monitor the electrical activity of the heart.  I pad pressure points.  I secure arms so they don’t fall.  I paralyze patients and reverse the paralysis.  I make sure necks stay neutral.  I tape eyes closed–sometimes with lubricant inside–to make sure their are no corneal abrasions.  I suction out the stomach to prevent nausea and aspiration.  I measure urine output.  I keep my patient warm.  I comfort and assure patients immediately before surgery.  I answer questions.  I introduce myself to family members.  If after doing all these things I want to take two minutes to tell you about OUR patient, please take the time to listen closely.  After all, I might tell you something important.
  • The Emergency Department.  This is the most chaotic, most terrible place in the hospital.  I cannot imagine my hospital’s ED ever being called secure, controlled, stable, or peaceful.  There are sick bays.  There are stretchers lining the halls.  There are large families crowded around loved ones.  There are people there for marginal complaints.  One’s attention is constantly pulled from one thing to another.  Here, one will encounter that ghastly combination of ADHD physicians, type A aggressive nurses, puking patients, blunt security guards, and a constant, rumbling cacophany.
  • Lack of professionalism.  Just because you are a surgeon doesn’t mean you need to curse in every sentence.  Just because you are a surgeon doesn’t mean you need to talk about your sexual conquests in the operating room.  Just because you are a surgeon doesn’t mean you need to talk about how your patient is too fat, too hairy, too ugly, or too annoying.  I will stand up for my patient.
  • Scrubs that do not fit well.  Just because more than 50% of Americans are overweight does not mean that scrubs should be designed in “square” proportions.  (Small = small waist and short legs, XL = huge waist and long legs.)  I cannot stand bunching up my wasteband and a crotch seam that comes down to my knees; nor can I stand legs that are too short.

Wow.  This post is far longer than I intended it to be.  The feelings just kept coming!  And the picture, if you’re wondering, relates to the last bullet-point.  I thought it was worth a smile!

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Dream journal

I awoke this morning at the hospital after getting several hours’ sleep while on call.  My dream was remarkably vivid and confusing…

In it, I was taking care of patients at the hospital.  One of my next patients for surgery had an unusual physical exam.  She had another head on her shoulder (think of Steve Carell’s Halloween costume in The Office).  But the surgery was for a more mundane complaint; so mundane, in fact, that I can’t remember it.  The head was normal for her.  In fact, I realized it was another person, with her own personality.

In my dream, I remember asking if the head was her Siamese twin.  She answered no, it was her mother-in-law.

While I’m pretty certain that I didn’t make sense of it in the dream, it’s even more confusing now.  How could her mother-in-law be growing on her shoulder?  An outgrowth of one’s mother is really more plausible than than one’s mother-in-law.  There was a flash in my mind when I wondered if I would need to intubate both heads, or if the volatile anesthetic inhaled by one would be enough for both.  Sadly, I cannot remember.  In any case, they seemed content with the arrangement, and I believe the operation went uneventfully.

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Photo blog

I spent a little time yesterday browsing some photography blogs.  Here’s an image I particularly liked off http://wvs.topleftpixel.com/  It reminds me of some buildings I’ve seen here in New York, where the history of a neighboring structure can be seen on the external wall.

Addendum: I felt weird copying a photographer’s work to decorate my blog, even though I gave credit, provided a hyperlink, and couldn’t see that the photo was copyrighted.  So, in the spirit of artistic integrity, I’m removing the photo and providing a link to the one I like here. The artist is Sam Javanrouh, and he lives in Toronto.

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Understatement of the Month Award

“The plane is very seriously damaged,” said Jan Van der Cruysse, a spokesman for Brussels Airport, referring to a 747 cargo plane that crashed today while attempting to take off en route to Bahrain, CNN.com reports.  Only four of five crew members sustained minor injuries.

Here’s a picture of the damaged plane.

I was noticing that it looks like the fuselage is cracked just over a third of the way back, and yet, if you look closely, you can see that the wings are still attached to the front part.  Are these the normal proportions for 747s, or is it just a matter of perspective?  Some additional pictures might help.

This view from behind seems to have the wing about at the midpoint…

…whereas in this view (which is similar to the Brussels crash view), the wings definitely appear to be in front of the midpoint.

A view from the side might be more objective.  Don’t be confused by the space shuttle in this next photo.  That’s not a usual feature of the 747.  If one were to bisect the plane at its midpoint, the place where the wings attach to the fuselage definitely seems to be in front.  I also notice that the bulge in the front of the plane is smaller in this freighter version than in the passenger models seen above.  If I were in charge of ordering jets for an airline, when I call in an order, I hope I wouldn’t forget to specify that I want the larger upper passenger deck.

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I have no words…

http://englishfail.wordpress.com/2008/05/21/missing-cow-fail/

And yes, I have about three grammar blogs on my favorites list.  But I don’t have a problem.  People who correct others’ grammar in comments on grammar blogs are the ones who have a problem.

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Ireland, part 2

Another excerpt from my travel journal, dated Friday, April 11, 2008:

The plane is now descending into Dublin, after nearly seven hours of flight.  As much as it’s in the collective consciousness to make snide remarks about airline food, ironically I’m always happy when it comes.  Others seem more than happy to receive it too…where are the gourmets who refuse?  Breakfast was a melt-in-your-mouth scone, strawberry yogurt, orange juice, and coffee with milk and sugar because I felt like it, which I enjoyed while flipping through the final pages of last week’s Economist.

It’s overwhelming to take in the sights and sounds of the city thus far.  The energy, the hustle and bustle, the cacophonous swirl of cultures and languages…and all this without leaving the airport.

David arrived an hour or so ago, and most of our time thus far has been at the rental car booth trying to prove David’s credit card (4588-8734-0056-2897, expires April 2010) does cover insurance.  Presently we’re splitting a BLT on a baguette as we await the fax of proof.  I elected not to take a picture of David as he struggled through calling card PINs and access codes to reach MasterCard’s customer service.  A hand-drawn picture will have to suffice.

We secured the car even though the fax never came.  The agent, a fellow about our age with a friendly Irish accent and a smile which became progressively tighter, finally believed David.  Soon we were off, singing a new helpful driving song: “Stay left, stay left, wherever you go…” (to the tune of “Pop Goes the Weasel”).

After a few hours in the car, we parked in the town of Cashel, which has the main atraction of the Rock of Cashel, a fortress-like hill which was given to the church ~1000 years ago, and on which were built in succession a tower, a chapel, a cathedral, and a vicars’ building.

Tower at the Rock of CashelHere I first encountered the endearing characteristic of older men of calling us “lads.”  We skipped out early on a boring video and toured the chapel with its off-center choir (Christ’s head hung to the side) with a faded fresco ceiling.  We were pleasantly surprised by the view as we rounded the cathedral’s corner and saw the adjoining graveyard.  A light rain had stopped during our short time in the video, and now dark rainclouds hovered above the brilliantly shaded green hills and countryside, making a perfect photo opportunity.  The sun even peeked out, creating shadows which danced on the gravestones.

Diagram of the Rock of Cashel

Tombstones and hills

Rock of Cashel from below

Leaving Cashel, we back-tracked to Kilkenny and proceeded to become lost, silently cursing Rick Steves’ fun but skeletal maps and the dearth of street-signs in the town.  Our home for the night was Carriglea (Irish carrig meaning sturdy or solid [often applied to rocks or homes], and lea, field or pasture).  It was managed by a talkative proprieter, Josephine O’Reilly.  Her wrinkled skin and hair dyed with just a tint of red framed a face that was eager to talk of her four children and problems with immigration and the birth-naturalization policy in Ireland.

Carriglea

We had dinner at a pub, where I learned that “cheers” is Irish for “I’ll smile at you as I hand you back 10 euro in change rather than the 20 euro I owe you, betting you won’t notice because you’re American and probably find counting money in euros intimidating and slightly confusing.”  David had a beef and Guinness stew and a Smithwicks, and I had lamb & potatoes with a Guinness, both dinners served with warm traditional Irish brown bread.  The evening was rounded out by a bar of Toblerone from the local market, and we soon found rest as we lay our jet-lagged heads on soft feather pillows.

More pictures: As can be seen in this next photograph, the ancient tombstones are not as sturdy as they may appear.

Here is the town of Cashel, lit in the afternoon sun after a rain.

Our trusty Mistsubishi Colt.

 

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