I recited the symptoms again to the emergency room nurses while they were rigging me up, and then again when the ER doctor appeared. Then Moira and Ranting Spawn arrived, and we sat in the windowless room, and waited, and waited some more... eventually the ER doc. reappeared; my ECG was normal, indicating no obvious damage to the heart, and my blood tests were clean - there were none of the enzymes released by stressed or dying heart muscle present. So there was nothing obviously wrong -- but given the chest pain, the risk factors, etc., he wanted to run me through a cardiac stress test. But it was too late in the day. I would have to wait. Overnight. In the hospital. I tried to argue that we only lived 10 minutes away, I could be back in the morning in a jiffy - but he wasn't buying it, the cardiologist had a full night's worth of periodic poking, jabbing, and prodding planned for me already.
So M. & R.S. left to pack me an overnight bag. My shirt and sweater were replaced by the usual dignity-sucking hospital robe. A nurse looped an oxygen line over my ears and up my nose. I had ECG leads stuck all over my torso, and I could just see the monitoring equipment if I turned my head a little. A nurse stuck an IV into the back of my hand, not for anything in particular, but just in case. Every fifteen minutes a blood pressure cuff would automatically inflate and take my blood pressure.
After a while, the cardiologist came in, and I gave him the Litany of Symptoms again, and then the he asked the usual chain of questions, which I answered as I had before.
Moira returned with my bag, and then they wheeled me upstairs to my room. Not bad – private, (fake) wood-paneled floor, LCD TV in the corner, "room service" on demand... "Hey, can you take this thing out of my nose?" The nurse checked my oxygen saturation and shrugged. "Okay." Ahhhhhhh. Then she hooked up all the ECG electrodes that were still stuck all over my torso to a small wireless unit that attached to the gown - they could track the ECG's of all the cardiac patients on the floor from the nurses' station.
In the morning I was all ready to get tested and get it over with, but my schedule was not the hostpital's schedule. From what I could see, the hospital moved at a languid pace, with at least an hour between any sort of major event, such as me being moved to the stress lab, or being moved back to the room, or having person pop in and give me an update as to what was going on. I ate breakfast (egglike substance, bagel, low-fat "cream cheese", orange juice). I finished Flashman. I picked up Thucydides. Those Athenians sure were full of themselves, weren't they? Pericles was all, "Hey, face it, we're tyrants. Let's be the best damn tyrants we can be!"*
My regular physician came by, and I repeated the Litany of Symptoms again. A nurse came in with a Russian accent an a metal-shielded syringe. "I have to give you the tracer now," she said. She attached the syringe to the IV line sticking out of my hand and depressed the plunger. "There. Now you are radioactive." (Now you are radioactif.) More waiting. More endlessly quarrelsome Greeks. About 2 hours later, they wheeled me down to the nuclear medicine lab, and I lay very still on the gamma camera, a small table with big moving detectors clustered closely around it. I had to lie there for about 20 minutes. It was quiet, dimly-lit and not unpleasant; Paul Simon's Negotiations and Love Songs played in the background. Some of the lyrics were a bit jarring: "Now I would not give you false hope/ on this strange and awful day..." but not a bad patient experience, overall.
I watched the monitor, scintillating points of light outlining bits and pieces of my insides. My gall bladder was intensely lit up; a sign my liver was dilgently trying to scrub this strange foreign substance out of my body. The intestinal circulation was a diffuse halo, and my heart was a dim oval near the top of the image. After round one with the gamma camera, they wired me up to another ECG** and made me stress out on a treadmill, followed by another dose of tracer in the IV, followed by more waiting, followed by another session with the gamma camera (still with the Paul Simon), followed by a return to my room. Then the wait. Surely it can't take this long to interpret results, I thought. How much is all this costing, anyway? I briefly entertained a few visitors. Finally, the nurse on duty came in: My stress test results were abnormal. The cardiologist would be in with details. When?? Sometime.
I called M. and told her what I could – it didn't look like I was getting out anytime soon. Pace, pace, pace. As I was pacing, the cardiologist, a small, dapper man, fell in with me. We returned to my room. "So, what do you do for a living?"
"I'm a software programmer." (Incomplete, but the simplest answer.) He looked me over for a second, and said, "Here's the situation." He started writing on the whiteboard in my room. "There's a patient with chest pain." He wrote CP +. "Cardiac perfusion at rest is good, and exercise capacity is good." He wrote Ex. Cap -. "Blood enzymes look good." He wrote Blood en. - "But under stress, the muscle at the apex of the left ventricle showed less of a signal than the surrounding muscle, possibly implying a blockage." He drew a very credible little heart diagram, showing how the tracer didn't distribute itself as expected. Then he wrote Card. perf. + "Given this, and adding in the patient's history of hypertension –" hypert. + "– high cholesterol –" hyperch. + "– and family history –" fam. hist. +; what would you do?"
"I'd assume that there was a problem."
"Yes. The most likely explanation for you episode is that there is a partial blockage in this region of the ventricle –" he circled the apex – "and that something -- a clot, a broken-off bit of plaque -- got stuck at the blockage momentarily, resulting in the angina. It will happen again, and it will probably get worse. An angiogram will tell us definitively what the state of the arteries is in your heart; it is the gold standard. Depending on the degree of blockage, we can either prescribe medication, or perform an angioplasty, insert a stent, or (in the worst case) perform bypass surgery."***
Oh yeah, I'm lovin' this. "When would you perform the angiogram?" Can I please please please go home now?
"As soon as possible. Tomorrow."
"And could I go home, before....?"
"No. I wouldn't advise it. You need to be prepared." Oh, great. I'm never getting out of here.
* A paraphrase.
** I was still finding and removing ECG electrodes from my body the morning after I finally got back home.
*** Another paraphrase.
At 11 I have a regularly scheduled meeting where key personnel from our end of Global Megacorp interface with key personnel from another sub-sub-branch of Global Megacorp (le MegaCorpe Mondiale), ensuring the smooth and continuing delivery of our widgets to correctly function within the context of their gizmos, etc. All routine stuff. As I sat listening, it slowly dawned on me that something odd was happening in the vicinity of my sternum. Yes, a very definite odd sensation was taking hold down there, a feeling very hard to describe because of its falling outside the bounds of normal sensation; not painful, but disturbing, and distracting; the needs of the gizmo-makers and the looming necessity of buy-in, so that we'd all be on board, going forward, from yet another sub-sub-division of the business (die Grosse Weltkorp) – all began to occupy less and less of my attention as I attempted to characterize just what was going on.
Not pain, but uncomfortable; more like a feeling of compression, as though my ribcage wasn't quite big enough, as though... and then it popped into my head: as though I was passing a ham through my left ventricle.
(Let me quickly state that the phrase is not original to me. 95% of the contents of my brain derive directly or indirectly from The Simpsons, Futurama, some variant of Star Trek, or Mystery Science Theater 3000, and this one is no exception: it comes from the MST3K treatment of Overdrawn at the Memory Bank, an unsightly blemish on the late Raul Julia's acting career and a good argument for never allowing Canadians and Public Broadcasting to mix, which we had watched courtesy of Netflix just the evening before.)
But...damn, that pretty much summed up the feeling. As it progressed (it was probably around 11:10 by now), odd pulsing sensations travelled up my neck and into my jaw, making my molars ache. Wow, this is pretty weird, I thought. I wonder if I should do something about it. I didn't really feel short of breath, but on the other hand I did feel slightly less odd if I took deeper breaths than usual. Every so often I needed to interject something into the meeting, so I'd take the phone off mute and say whatever it was, then re-mute and get back to trying to figure out what was going on. After another five minutes or so, the sensation began to subside, retreating back down my neck, lessening in severity... then a mild resurgence, then resubsidence, until it faded away, leaving me cold and perspiring slightly.
The big conference call ended about the same time. I felt ok, more or less. Got up and walked around a bit, engaged in several extended conversations with co-workers. Ate a sandwich for lunch. Did some work. Starting browsing the internet, looking for something resembling my little episode. Eventually, my internettatory perambulations got me onto the Wikipedia page for angina[1]. Now, I had always thought of angina as always denoting a sharp, acute pain in the chest, but then I started reading through the description:
the discomfort is usually described as a pressure, heaviness, tightness, squeezing ... Typical locations for radiation of pain are arms (often inner left arm), shoulders, and neck into the jaw... It is exacerbated by having a full stomach and by cold temperatures. Pain may be accompanied by breathlessness, sweating...Well, dang, I thought, that sounds familiar.
Major risk factors for angina include ... high cholesterol,Check.
high blood pressure,Check.
... family history of premature heart disease.Check. Hmmm. Well, now the article had my full attention. Reading on,
Angina may further be classified as stable or unstable angina ...Typical presentations of stable angina is[2] that of ... minimal or non-existent symptoms at rest. Unstable angina ... may occur unpredictably at rest which may be a serious indicator of an impending heart attack.Well, that's a bit of kick in the old teeth, eh, what?
Mental gears officially shifted to ALARMED, I call the clinic, and describe my symptoms to the voice on the other end of the line. Should I, like, you know, do something about these symptoms, which are surely nothing serious, right?
"You should get someone to drive you to the emergency room right now," the voice said.
[1] All throughout my youth, I thought the chorus to Eric Clapton's version of Willie and the Hand Jive was "An-gina, an-gina, mumblemumble mumble an-gina". It seemed like a really weird concept for a song.
[2] Subject-verb agreement has never been a Wikipedia strong point.
The postdoc. phenomenon (or its equivalent in the humanities, the perpetual adjunct) that we saw spreading into biology then seems pretty firmly entrenched across just about all academic disciplines now. Graduate schools are cranking them out at far above replacement rate, faster than academia can absorb them, and apparently faster than industry can make use of them.
"It's not uncommon to have a disconnect like this in higher education, in which people are both concerned about the difficult career prospects being faced by recent Ph.D. graduates and concerned there aren't enough Ph.D. students," said Michael Teitelbaum, of the Alfred P. Sloan Foundation.Ahhh, but we made the connection. Schools need a large pool of (low-paid) grad students, adjuncts, and postdocs to handle a lot of the low-level work around the department – someone's gotta teach the labs, run the greenhouses, run the mundane experiments, and the schools can't very well afford to have the full-time faculty doing it. But the little buggers keep graduating, or dropping out, or getting real jobs, and so the pool must be constantly replenished with fresh blood. The unfortunate side effect is a growing population of newly-hatched Ph.D.'s, clutching their bound diplomas*, desperately yeeping at their faculty advisors and acquaintances, hoping for some morsel of relevant employment to be jammed down their throats.
The ideas, he said, "often don't get connected. It's puzzling."
In fields like history, recent numbers show the market improving, and there will be more jobs as baby boomers retire.They were peddling that particular lie when I was an undergrad. There's always a Wave of Retirements, Just Around The Corner, Really, This Time We Mean It, but it doesn't really matter, considering the size of the waiting pool of applicants.
Groups such as the Business Roundtable have grabbed headlines with urgent warnings about the need to ramp up production of American scientists. In fact, Teitelbaum testified to Congress last year, there is no evidence of a shortage of scientists and engineers — particularly on the Ph.D. track.I think the shortage the Roundtable is talking about is the shortage of scientists and engineers willing to work full-time for $20,000. But perhaps I am being too hard on them.
*I occasionally thought about having a copy of mine reduced to business card size, so I could stick it in my wallet, and at the appropriate point in some barroom argument I could whip it out and say, "Well, I have a Ph.D. in science, and I think...." but I never got around to it.
"Will voters take democracy into their own hands?"
Come now Fox News. OK, some of us do grouse quietly about our "rights" and stuff now and again, but surely we would never get that uppity.
A thought occurs – Hillary Clinton is the Windows Vista of presidential candidates. Think about it: both in the works for years, both presumed inevitable and unstoppable, and both remarkably unable to dent the marketplace.
UPDATE. Yet another beautiful analogy bites the dust. Oh, well... at least Edwards came in third.
but the triumph of word over flesh, over color, over despair."Gee, Mr. Klein, show a little more enthusiasm there, ok? But thanks for clearing up the Obama-vs.-Jesus confusion.
UPDATE: Dissention in Klein's comments: Not the Messiah, but a bodhisattva.
I joined a long line of independents waiting to change party registration. I am now a Democrat (it burns! it burns!). After undergoing the transformative operation, we joined another line, which terminated in a seated group of the elderly people who always seem to run all things electoral, waiting behind a folding metal table. I signed my name and was given a small, blank square of paper. "Hang on to that!" I was told. (We never did anything with them.) We filed in little groups into the school's auditorium – which was packed, standing room only.
The first order of business was to get an exact count of caucus-elegible people in the room (there were a number of little kids running around – I assume they didn't get counted). The whole business was run by three elderly women, who had each row stand up in succession and count off from one end to the other: "One hundred thirty! One hundred thirty-one!" Every so often someone would mess up the count; the women in charge would roll their eyes – Can't you people count? – and pause until the counter got the number right. There were 625 of us – a record-large crowd, apparently. The bizarre rules of the game stipulate that a candidate needs to get 15% of the crowd to be considered viable; less than that, and the candidate's supporters either leave or join up with a more popular candidate. So there was a momentary hush as the women on stage calculated 15% of 625 (94, rounded). Any candidate unable to drum up 94 supporters was doomed.
So now we did the famous shuffle: all the supporters of a given candidate gathered in some part of the auditorium, but it was so full that moving around was difficult. The Biden supporters had to meet out in the hall; Richardson's, Dodd's, and Kucinich's groups met up on stage. It was a festive, party atmosphere; Kucinich had all of 6 supporters, but they got a huge round of applause just for not giving up immediately. Two things were immediately obvious; (1) Obama had more support than anyone, and (2) the only contest was going to be between Clinton and Edwards for second place. After the first round of totting up supporters, it was clear that everyone besides Obama, Clinton, and Edwards was doomed.
So now came the second part of the festivities; people from the larger groups would wander over to the too-small groups, and try to talk their members into joining one of the larger groups. Obviously, I was no use in this... "Uhh, vote for Hillary because she's... well, she's not John Edwards. Yeah, that's it." Everytime someone split off and joined another group, the people in the joined group would cheer and clap wildly. During this time, I thought about the caucus system, and decided that it was probably constructed by a bunch of bored farmers who just needed something to do in the wintertime. They could have just had a straight up and down ballot, but instead, decided to construct an elaborate social event out of the process... because it is intensely social, friends, neighbors, their kids, all gathering for a big gabfest and talking, talking, talking.
For about half an hour, the doomed candidate's groups gradually shrank (except for Richardson's group – they stood in a tight block on stage, radiating a what-are-you-gonna-do-for-us vibe). Those of us without the enthusiasm to go and evangelize for our candidate sat and waited; the woman next to me alternately checked her Blackberry and her cell phone. I saw two co-workers and my next door neighbor over in the Edwards group.
Eventually, the coordinators called time, and said that all the non-viable candidate supporters had to make up their minds; the Richardson group now split, streaming people into the Clinton and Edwards groups mainly. It was time to do a second head count. From my counting, it was clear that Obama had a commanding lead, and that it was going to be a squeaker between Clinton and Edwards... 260 for Obama... 174 for Clinton... no, 177 for Clinton, they forgot the three women on stage... and 180 for Edwards. The Obama and Edwards groups went wild. The Clinton group sat quietly. The woman next to me looked up from her Blackberry, said, "Edwards??", and made a sour face.
But on the Democratic side, there is one outcome that I really don't want; I really don't want Edwards to win, or even come in second, if possible. And the race is looking very tight. If I woke up Friday morning and the blowdried pseudopopulist comes in better than third, I will hang my head in shame knowing that I didn't do my little electoral bit to stave it off. So, despite the drawn-out idiocy of the Democratic caucus process, I think that I may have to go, after all, just to try to prevent that outcome.
Whom to vote for? Obviously, it has to be either Clinton or Obama. It's not much of a choice; I don't care for either one, any more than I care for... Romney or Huckabee. But given the choice, I'm thinking of going for age and guile over youth and hope – so Clinton it is. Maybe. Until I change my mind again. Twenty-one hours to go!
"Iraqi government officials maintain that Saddam's execution ended all hope among his supporters that he might return to power..."Maybe in a coalition government, say, with Generalissimo Franco.
