Your Daily Douchebaggery

Yesterday in our post-shift wrap-up (because supervisor Cormac is awesome to the 10th power) we got into a discussion over the increasing prevalence of the terms "Traditional Asian Medicine" and its acronym "TAM" being used as synonyms for Traditional Chinese Medicine" and TCM respectively, and who is doing this and why? Now, it's not that TAM is a nonsense term; it's just that since Asia≠China therefore TAM≠TCM. Sort of like Latin America≠Mexico--Mexico is part of Latin America, and has cultural, linguistic and historical roots and overlaps and commonalities with other Latin American countries, but Mexico is specific, as is Cuba or Venezuela or Peru--none of them are exactly like the others. China is also specific, as are Japan, Korea, Thailand, Laos, and India which all include themselves as part of Asia and in the descriptor "Asian"

Thus, using "Asian Medicine" as a term of general reference to encompass all the medical traditions of various Asian cultures is fine. But what we do is specifically Chinese, and has its roots squarely in Chinese language and culture and philosophy, even as those things may share commonalities or at least parallels with those of other Asian cultures. To call our medicine Asian and not Chinese obscures its origins and is sloppy and imprecise.


And why this change? The term "Traditional Oriental Medicine" is still around even though on top of having the same issues "Oriental" is an extremely loaded and imperialist term, and that its introduction with acupuncture to the United States likely came about as much because in the 1970's Chinese was tantamount to being "Oriental", or that since the Chinese were evil communists it wouldn't be politic to trumpet the medicine's Chinese origins too loudly when its proponents already faced an uphill battle to get it into the statutes here. Plus ça change, plus c'est la même chose. It seems that with the bad press China has been getting lately there are some in our profession who are afraid that calling our medicine Chinese will go badly for us. Could I have some Freedom Fries and a side of Liberty Cabbage with that?

Off to the Races

Tour of California,that is. I'm pretty tired right now, and I'm still not sure what all I can and can't say, but let me just say this: as with any race, (so far) the worst part is getting to the start line. Jumping jeebus on a pogo stick.

Weekend Roundup

This was my last weekend of freedom for a while, so I tried hard to make the most of it. Steven couldn't make our snowshoe trek, but I decided to do it anyway even if I had to go by myself. Which is usually what ends up happening. Which is exactly what happened. And I had a fine time, even though it would have been cool to share the awesome with someone too.

I got a late start, made even later by trying to call the rangers up at Angeles and find out what the deal was. The recording said the road was closed east of Islip Saddle, though--that seemed like a good sign. So I headed over to A16 to replace my frontcountry map and because I owed my classmate an Adventure Pass and book. I expected mass quantities of traffic up Angeles Crest, since it was a balmy and clear 70º and the roads were completely dry. I realized the reason why when I got up to about Charleton Flat--the traffic was already arrived and parked, people everywhere playing in the snow with saucers and sleds and tobogans. I drove up the road as far as they would let me to Glenwood Dad's Camp about 3 miles east of Newcomb's Ranch.

Once I got on the PCT and started heading north I didn't see another human the entire time I was out. I saw ski tracks that looked fresh, especially on my way back, and occasionally I could hear people from way across the drainage, but I saw no one. The bright sun burned warm on my bare arms and shoulders and I almost wished I had brought shorts instead of tights. No wind either--it was perfect. The snow was a little old, a little slushy in spots; sometimes in shady sections I punched through the thin hard crust to the soft slush underneath like it was crème brûlee. When I came to the first road crossing I got to break trail all the way up to Cloudburst--I even lost it for a short time in the same spot G and I did when we came up here a few years ago. Once at the top, I never realized how close I was to Waterman--if I had started earlier I could have hiked up the road 1/4 mile and done some of those trails too. I thought about continuing on PCT too, but it was 4PM and I opted to turn around. Maybe there will still be something left in March, and maybe the road will be closed higher up...

Sunday's feature was Episode V of The Sunset Chronicles, a sort of serial marionette rock opera starring Jen's coworker Monica as the principal singer. It was an impressive and creative show, with all hand-made puppets and sets, performed at the tiny Union theater near USC. One of LACBC's board members played violin with her cellist husband after the show in the gazebo behind the theater amidst what will someday be a stunning garden. As it was, we were impressed by the carnivorous plant collection in the gazebo. On our way out of the theater, Jen and I spied a narrow, dimly lit hallway with stairs at the end--ooh! Of course we couldn't resist, so we didn't! We climbed up the narrow tight spiral and came up into a small, circular room that was painted all around with ice floe scenes behind a 360º diorama of more iceburgs and formations. There was a subtle soundtrack too--when we went back down we discovered the exhibition was called Effulgence of the North, and that the Velaslavasay Panorama Enthusiast Society put it up for all to enjoy--I wonder what the next one will be like?

Apples and Oranges

Or so it would seem, when you ride with pros. Via Kevin, who thought it was interesting. I don't disagree!

A River Runs Through It

Ok, maybe not a river exactly, at least not at this point. A stream then, usually no more then 3 or 4 feet wide. But it braided itself with the trail most of the way up the canyon, even becoming the trail at one point, and just about everyone's feet were wet by the time we got to the top. Good thing it wasn't too cold last night, even in places where the coldest air normally sinks down and gathers.

I prepared for a typical Wednesday Night Ride, especially since the last ride Cyril emailed everyone promising some pub time at the end. So I packed a change of clothes into my little Jack Wolfskin, and warm riding clothes, water, etc. and headed out on the Love Goat to time-trial up to 26th and San V since I was running late and was afraid they might actually leave on time.

As it turns out, I needn't have worried--at the projected ride time most people were still putting on clothes and getting bikes out of cars. I found Cyril, introduced myself and he set me up with a sweet little Light & Motion setup that lit my way all night but since it was mounted to my helmet I had trouble adjusting to light far enough up the trail to find it in a lot of places in the canyon. Now I understand why the WNR guys always have a helmet AND bike setup...

We gathered everyone and debated routes: Westridge to the hug and down Backbone? Sully Canyon over to Westridge and down? I suggested either the canyon or Westridge and over to the Whoops--I knew a "secret" backyard trail that routed around the closed fence at the bottom, even though they locked up OJ's Escape at the very bottom which was part of the fun of taking that trail. Sigh. In the end we elected to test Sully Canyon since no one had been up it since the last round of storms. It wasn't bad compared to other times I've been there--like with 10-foot drop-offs or the raging river that literally carried my teammate Albi's bike so far downstream after he crashed that he never found it. I like the canyon because up or down it's technically challenging without being scary and steep. Even still, I haven't been on the mtb in a while, and I haven't ridden anything other than fireroad in a VERY long time, so I found that my skills and comfort level were definitely lower than they have been. But, it was good nonetheless to get out and start pushing 'em back up--I was happy that I would come to a stream crossing or some other problem I wasn't sure I could clear and I felt that familiar knot of anxiety in my gut but I breathed it down and went for it anyway, and I'm equally happy to report that most of the time I made it--only tipped over a couple of times. There were other problems I could have tried and elected not to that night, but all in good time. And I was at least climbing well even over some of the more technical sections--I even got some kudos from Christian.

Since the canyon took longer than expected, we elected to split at the top: one group would go on the Backbone, the other would ride as far as Dead Car/Cliffside and then return down Sully Ridge. Yes, I elected to go the short route with Christian and Larry from REI (btw Jamie, when you read this he says an enthusiastic "hi!")--I was tired! Larry was cool--on the ride down I learned that he's only been riding for a year (mostly road) and is just now getting into dirt, but he runs a lot. He recently spent four years as a combat medic, and now he's putting application packages together for PA school.

Turns out there were no concrete plans to go for beers afterward like at WNR, and since the ride split we didn't. But I got some laughs and scored some points with a couple of the guys who asked my what all I had in my large and full pack when I explained that it was mostly a change of clothes for when (not if!) we went for beers after the ride, since that was our WNR ritual, even if the ride took so long we missed last call we would just pack up coolers and bring them with to enjoy at the trailhead.

All in all a fun ride and fun night--I won't be able to make the next couple of weeks since apparently we are heading up for ToC on the 14th, but I can't wait for March--they are a really fun group of people and it feels good to be reconnecting to my beloved AR community after being away for so long!

In Lighter News...

I picked up my graduation invitations/tix today--yay!!

In weirder news, there was a note on my car as I rode by it today on my way to clinic. It was in an envelope with my name written on it. I opened it up, and I think it was from one of my former students (I can't quite remember the name...I've been racking my brain all day) who (apparently?) lives on my street and saw me getting out of my car one day, because I didn't buy Lars until after I'd quit teaching. He was just saying hi, and wanting to know if I'd be interested getting a drink or a workout or a walk around the park since "we live so close".

Too. weird. It will take all the dirt-ride awesomeness of the Dart-Nuun boys tonight (and maybe a beer afterward), a much-anticipated PCT snowshoe trek on Saturday and a rock marionette "concert" on Sunday to reverse all the yucky-heavy of this week. I guess like Bessie Smith says, it jus' be dat way sometimes.

Appearances Are Revealing, Even As They Are Deceiving

Patients often seem to come in themed waves. One day it will be low back pain, another day it will be allergies, the next might be digestive problems. Yesterday was dedicated to shen disharmonies, or at least odd people.

My first one of the day was an older man who grunted through his new patient paperwork for about 15 minutes. He seemed a little crotchety, but we get a lot of pain patients, and pain can make you pretty grumpy and not-your-usual-sunshiny self, so ok. I came back out to get him after going through his intake forms and transferring the information to mine, and he was gone. The receptionist pulled me aside and told me quietly to be sure and gather as much info as possible about prior treatments because apparently he has been to the clinic before but used different names. So I took him back to my room, and did the workup/history which yielded your basic garden-variety neck/shoulder tension, but it did give me a chance to practice some of the history-taking techniques I learned in Fred's class last weekend. I'm feeling better and better about those. But he had a strange, reticent kind of energy--like he just wanted to cut to the chase or something. I went back and presented the case to my attending, and told him about the prior visits. We looked compared the files: same SSN, same address, but he was 4 years older this time, identical handwriting, etc. Even the chief complaint was the same. What was interesting to me was that on his first file he signed the arbitration agreement but put the word "duress" in parentheses (he is a retired lawyer--does that trick actually work?) and then initially refused to sign the current agreement until the receptionist told him we couldn't treat him without it. We had a good discussion about how if this patient had come into our private practices we likely would have referred him out right away for that reason--everyone knows the profile of patients who become huge, litigious headaches.

After his treatment my attending and I went in with his files and set them side by side in front of him, and asked what was going on. And it was just a question of money, it turns out--he wanted to make sure he got the senior discount, even though he was technically a couple of years shy. We ended up giving it to him anyway, and explained that we were happy to try to work with him and make sure he got the care he needed, but that we needed him to deal honestly with us, and he agreed. So that's a story to file away for the next time it comes up.

My next patient was a woman I remembered from when I was an observation intern, who was still wrestling with the same issues of consolidating her mental energy and concentration and making a commitment to end a relationship with a much younger man whose company she enjoyed but who made it clear that he was not ready to settle down with anyone for a long time. Which is a sucky situation, and I've been in a version of it, and I totally get it 'cuz making clean cuts is still painful even though in the long run it ends up being better than the alternative.

Segue to my afternoon, where Steph and I have been co-treating a 45Y woman who initially was trying to get pregnant even though her life and emotional state are such that the last thing she needs is another child right now. So that dialogue has been ongoing, trying to approach her from the standpoint that she needs to be healthy physically and otherwise in order to give optimal chances to a new child or the 4-year-old daughter she already has. She's so invested in and identified with the drama she creates however that it's slow and uneven progress. I want to just ask point-blank why she wants another child, and see what she says. My attending is much more patient with her than I am--she is the perfect sort of person for me to challenge my practice of tonglen, I guess. I want to write another post exploring what happens or doesn't happen when patients become so attached to the identity of being sick or in pain or whatever that they don't really want to move on and get better, and what to do about that, how best to help them. Is being too patient enabling? Is it better to be compassionate but straight-up look-here's-what-you-gotta-do-no-matter-how-painful-to-look-at? Obviously, it depends on the patient and what they can take in, but still. How to evaluate even that?

Fast forward to my last patient of the night. A beautiful woman who is used to being a beautiful woman, but who is aging and has (at least temporarily) lost her mojo so to speak and is having a hard time mustering the will to get back up on top of it and impose disciplined structures like diet and exercise. And the thing is, she's totally identified those things not with health and feeling good from the inside, but with vanity and looking conventionally sexeh hawt. I was asked for a facelift and lipo a few times (joking but kind of not). Underneath it all were undercurrents of livery, livery energy because she's frustrated by her job, relationship, etc. How true that underneath every excess lurks deficiency, that underneath brash confidence underlies cringing insecurity. It is so easy for me to take people who seem so sure of themselves at face value, when really I should be wondering: what is this hiding, and why?