Overheard in a New York Comedy Club

The scene: a faded, half-filled comedy club, still clinging to its Seinfeld-era glory. A spotlight shines on a brick wall, a black painted wooden floor, and a lone microphone. A pathetic MC is trying to work the crowd.

MC: And how about these home defibrillators, huh?

The Crowd does not respond.

MC: I mean, do you really want Grandma shocking Grandpa? She can't even program a VCR!

Someone in the crowd chuckles softly, for a few seconds. Then, silence. A doctor, sitting amongst his fellow interns, raises his hand. The MC seizes upon the opportunity.

MC: You, sir?

Doctor: Yeah, so, those defibrillators detect whether it's okay to shock or not. The only thing people have to do is put the paddles on the chest and listen for instructions.

MC pauses for a moment, stunned. Thanks for interrupting my set!

Doctor: Just trying to help.

The MC introduces the next comic, and another teaching moment comes to a close.

Convergence

I have observed a striking correlation between blogging, interest in emergency medicine, and geocaching. First in myself, then Doc Shazam, and now Jaime Marks from the Differential went on a GPS hunt with her EM attending and a nurse.

OK, my n is 3. Still, it seems like these are naturally overlapping interests, and I can't offer an explanation why. It's worth noting, however, that none of these activities were possible until very recently.

Lightning in a Bottle

There is no better way to start your workweek than listening to "Bottle Rocket" by The Go! Team. It starts abruptly with a bright, heralding trumpets, crisp drums, a bouncy keyboard, and a fast-paced, almost indecipherable rap.

The first ninety seconds leave you breathless. Then, just when you think the song will start to get repetitive, the trumpets blare and give way to a most unexpected harmonica solo.

"This harmonica solo will not be topped," I thought, on first listen.

But then the cheerleaders started chanting, and I knew I was wrong.

I smiled all the way to work.

Reflecting Absence

Lately I've had the opportunity to spend some time in in northern New Jersey. Oddly enough, it's here where I've encountered the most raw emotion about 9-11. Maybe because it's the way the Manhattan skyline dominates the view here -- despite its own new construction, Jersey City and Hoboken are very much in New York's shadow. Or maybe it's because I'm working with EMT's, who have more than their share of stories from that terrible day.

Within a few minutes responding to a call near Liberty Park, or driving along the banks of the Hudson River, the tales come rushing forth: The paramedics they knew that died that day, the mutilated patients coming across the river on the ferry, the explosion in the WTC PATH station that nearly suffocated rescue workers across the tunnel.

While they're recounting these stories, their eyes invariably settle on a point above the southwest corner of lower Manhattan, where the twin towers once stood.

"As beautiful as the city looks tonight," one paramedic explains, "those towers, you have no idea how tall they were... They were bigger than everything."

In the late sixties and early seventies, Manhattan added 8-12 million cubic feet of office space to its skyline -- the equivalent of downtown Pittsburgh -- every year. Then, in 1973, the World Trade Center was dedicated, itself sporting over 13 million square feet.

So colossal, so incongruous with the genteel buildings around them, one could understand how some disapproved of the massive structures. Columnist George F. Will, calling the twin towers both hopeless and pointless, shared his objection to their aesthetic, in 1977:

"I have a recurring nightmare - if that is the word - in which two Concorde super-sonic airliners, one British and one French, slice the towers in half, a collision of modern achievements."

But the brash bulk of the buildings could also inspire. The WTC was a source of breathtaking photos and copycat architecture. A band even named itself "I am the World Trade Center" (their first album was released in July of 2001. Track 11 is called "September").

Stark, minimalist, utterly dwarfing everything around it, the twin towers were hard to get used to. But their absence is even harder to accept.

You can sense the loss when you look at the World Financial Center complex. The twin towers were originally at the edge of the island, but the dirt from the WTC excavation gave rise, in the mid-80's, to the World Financial Center buildings. Now those four buildings look like orphans, and in a sense, they are.

No view is as powerful to me, however, as the experience passing through the temporary WTC transit hub.

Making my way from the MTA to the PATH trains, along the vast concrete floor, I can see through the open air to Ground Zero to my left. The rebuilt WTC 7 is also visible to the west, and from this vantage point below, the protective metal plating along the base catches the sun, and doesn't look quite so repellent.

The bare station -- which will someday be home to one of Calatrava's sweeping white roofs -- is now decorated only with oversized arial photos of lower Manhattan, and large white banners featuring quotations about the city.

At first I thought the effect was Orwellian. But after a few trips among the energy and purpose of the commuters, the juxtaposition of the cheery signage with the bleak emptiness of Ground Zero, gives me a feeling of optimism I wouldn't have believed I could associate with this site.

My favorite banner bears an old quotation from journalist and author John Gunther. The banner ends before the third comma, but I find the complete quote to be entirely appropriate:

New York City, the incomparable, the brilliant star city of cities, the forty-ninth state, a law unto itself, the Cyclopean Paradox, the inferno with no-out-of bounds, the supreme expression of both the miseries and the splendors of contemporary civilization, the Macedonia of the United States. It meets the most severe test that may be applied to the definition of a metropolis: it stays up all night. But also it becomes a small town when it rains.

'Because the world is backward'

There's a masterful piece in today's New York Times about the Mini-Mental Status exam. Adapted from Bernard Cooper's book, it's the story of a doctor administering a battery of questions to an aging man, while his son looks on:

First she asked my father to tell her the date. I silently answered along. He got it right. I was off by a couple of days. I scooted my chair closer. Now I had something to prove. I felt as if my father and I were opponents on a quiz show.

"What state are we in?" "City?" "Hospital?" "Floor?"

Not until she whispered "Bernard" did I realize that I'd been muttering answers under my breath. But I was sure my father hadn't heard me. And anyway, I got them right. Dad, on the other hand, didn't know what floor we were on. But he probably would have known it was the third if he had been the one to push the elevator button instead of me. The mechanics of recall are delicate, so iffy and contingent.

My father lowered his head and laced his fingers together in his lap. He had the shamed, inward look of a man who knows he has blundered but doesn't know how.

"Mr. Cooper?" she asked. "Are you ready to continue?"

My father nodded. His head seemed heavy, as if with answers that would soon elude him.

"Spell 'world' backward," the doctor said.

"Why 'world'?" Dad asked, peering over his glasses.

Because the world is backward, I said to myself. Laws are repealed. Iron rusts. Logic unravels.

The trio continues processing the questions, only to get hung up by on a pen. Cooper captures the horror of forgetfulness, the absurdity of this test, and also its strange appeal.

These days I'm riding along with EMT's in ambulances. The crews are very efficient and well trained, and I've learned a lot about their jobs. To return the favor, I try to help out around the truck, or expand upon part of a patient's workup -- EKG interpretation, the differential for syncope, etc.

Just recently we were called for an assault on a young man, it turns out he was hit over the head by "some dude", at the bus station. He couldn't recall much about it, and had had a few drinks -- but there was something odd about his affect, on top of it. Aside from a small head laceration, his physical exam was unremarkable. But when the cops disclosed to us that the patient didn't know where he was, I launched into the Folstein (another name for the above-mentioned mini mental status exam).

The EMT's, and even the patient, were thrilled with the questions:

"Holy crap, doc!" one paramedic exclaimed. "I had the wrong date today."

"So I can say 'No ifs, ands, or buts', huh? Is grammar really that important?"

I sensed the test was not fulfilling its diagnostic usefulness. So I ditched the rest of the Folstein exam, and, egged on by my audience, went for broke:

"Okay, one last question. You know the expression, 'people in glass houses shouldn't throw stones' -- what does that mean to you?"

The group was stunned. Here was something not pondered in many bus stations. After a moment, the patient abstracted the meaning of the maxim.

The excitement faded, and the crew returned to their paperwork. Perhaps they had a new appreciation of how brain function can be assessed with a few simple questions. At the very least, they'd found a new diversion to challenge each other, and the patients they'd encounter that night.

A Bleat from The Bleat

Even Lileks gets the blues:

Well, I went off on a rant tonight; didn’t mean to, but it’s been building. I blame myself; I am feeling particularly small and useless these days. For God’s sake, my primary contribution to the world today was a 300-word piece on pretentious bath towels. Seventeen more years of this, then the gold watch? How exactly is it possible that I love my job, love my life, feel extraordinarily lucky and grateful, and still want to bang my head into the kitchen counter at night.

If you'd told me, a year ago, the size of our audience on Medgadget or Pre-Rounds, I wouldn't believe you. But sometimes, late at night, by the kitchen counter, it all seems like pretentious bath towels. Thank goodness for the privilege of my day job, for times like those and really for all times.