Nothing But Iron:  The Beets Go On August 24, 2009 By Steven R. Lagman, M.D., C.A.S.W. Deprived readers, you probably think I have neglected you because my agrarian (oh, go look it up, Bruce) lifestyle demands it, but that is only part of the reason I have let my sportswriter status lapse almost into oblivion, wherever that is.  True, it is hard to justify sitting at a desk when it is sunny and 76 degrees, with weeds to pull, lettuce to pick and wood chucks and Japanese beetles to battle, but other noble pursuits compete with my almost-overpowering-but-suppressible need to entertain you.   There is, for example, my day-job board recertification.  Because I was initially board certified back in the days when anesthesiologists administered whiskey and traveled from saloon to hospital on horseback, mine is a lifetime certification.  Recertification for me was voluntary, but I chose to do it, not because I could find nothing else on which to spend $700, and not to acquire another piece of competency-corroborating paper to toss into the closeted cardboard box that contains all the others, but to force myself from the ranks of complacency.  In other words, it is not difficult, especially given the obligations of the modern-day multitasking renaissance guy, to spend considerable amounts of time not learning a damn thing about my profession.  Taking the board recertification forced me to study, which, because all of the study is pertinent to the well being of my patients, is not the drudgery of learning histology as a medical student or Architecture in Early 18th Century European Literature as an undergrad.  In my pursuit of enough knowledge to correctly answer 80% of questions on a 200-question test, I came across many interesting bits of information that either have potential to change the way I practice or to reaffirm that my current practice is indeed current.  My goal was to become the equivalent of a fresh-off-the-assembly-line anesthesiologist by August 6, when I took the test, except that now I also possess the experience to know when not to be too fancy or too high tech.  After all, simplicity continues to be underrated.     While on the subject of my day job, I might as well tell you about propofol, since everyone wants to know about it in the aftermath of Michael Jackson’s death.  I know you are expecting a punch line, and Jackson’s apparent weirdness lends itself to that, but I don’t feel like joking about a guy who just died.  I do want to offer, before we talk pharmacology and medical ethics, that Jackson was an amazing musician and that his triumphant-turned-tragic example makes me treasure my anonymity more than you can know.  Propofol is a fantastic drug.  It has been around for about two decades.  It works fast, feels good (so I am told), wears off quickly, leaves no hangover and won’t make you vomit.  It’s big downside, however, is that the dose that makes you sleep, is very close to the dose that makes you stop breathing.  In fact, when we use it in amounts to start general anesthesia, patients almost always stop breathing, which is why it is best used by anesthesiologists, a.k.a. people who can breathe for you if you stop.  Though it wears off pretty fast on its own, propofol has no specific reversal drug.  Most of us anesthesiologists don’t even recommend its use by other (non-anesthesiologist) doctors, or at least those without advanced airway skills.  I qualify this entire discussion by reminding you that I don’t have any idea what really happened at Never Land Ranch the night Jackson died.  If, as many stories have suggested, he was given propofol by a doctor, and that doctor failed to monitor him appropriately, that would be, as they say in both the music and medical industries, bad, as in lose-your-license bad, or maybe even go to jail bad.  It will be interesting to see how that plays out.   As a further confounding non-literary diversion, I have been deeply invested in a high-profile legal battle.  You might have even seen the minute-by-minute developments scrolling across the bottom of the CNN screen, or in the inset box in the upper right corner or on the information bar on the screen’s left margin.  It all started when I realized during the board recertification that the test is discriminatory against people who do not know the answers.  I vowed to do what it takes to remove this bias against ignorance, so I initiated a class action law suit against the American Board of Anesthesiology.  I am motivated not only by self-righteousness, but also my the prospect of winning, as a member of the class, a coupon for 15% off anesthesia drugs and supplies, and a nine-figure settlement for the seven really nice attorneys managing the lawsuit.    In between dramatic made-for-surreality-TV court battles my time was occupied by five tournaments and a weekly league that I managed in my dual appointment as a summer varsity basketball coach and summer team coordinator.  Coaching is the fun part, and by contrast, the easy part.  The job of the coordinator is to coordinate schedules, send e-mails and text messages, pay fees, stockpile and sometimes wash uniforms, and figure out who will play when and where, cultivating rosters that are at times too full and other times too empty.  You might assume the job of coordinator is a thankless job, but not in my case.  I have, in fact, been thanked countless times, by parents, players and by the team’s real coach.   I reply each time that it’s a labor of love or at least, so my wife does not get jealous, one of intense affinity.  Besides that I realize that the organizational challenges are a good exercise for the mind.  I even learned how to set up spread sheets that can track player availability, record games played and automatically calculate individual fees.  If that sounds like bragging, you caught me; spreadsheets are pretty close to the boundary of my comfort zone.  I would guess that most doctors, coaches and amateur farmers wouldn’t know the COUNTA formula (oh, look it up, Bruce) from a Formula One race car.  I have learned during the forty-eight-year process of becoming a lot older than a young person that one never knows which acquired skills may be of value.  And with government-managed universal health care (not to be confused with universal health, a more politically-tenuous endeavor) looming, I may well find that my command of spreadsheets was a springboard for an unexpected replacement career.  In other words, everything is an opportunity.   My greatest coaching satisfaction comes not from the role of cunning chess master or conqueror of great rivals.  In fact, this was as much a summer of strategic conquests as it was a summer of stifling heat and humidity.  (For you desert dwellers, this is one of our coolest summers in the history of looking at thermometers.)  My greatest satisfaction is derived from my role as teacher.  Nobody likes losing, but it has been my observation that the lessons available to the players of the losing team are plentiful and potent if properly revealed.  After three wins (one by forfeit) in our last tournament, we advanced to the championship side of the bracket.  I suspected that the fourth game of our last tournament might present some match up problems.  I had no returning starters and our opponent was an AAU team from Minnesota.  As a rule, teams taking the initiative to travel outside of their home states are made up of large, fast, single-sport athletes highly committed to playing basketball.  My suspicions were right, and after a barrage of steals and transition baskets, we were down by twenty early in the half.  One kid asked the score, which was displayed on a portable scoreboard not visible from the bench.  I lied that I didn’t know, and told him that I preferred instead to focus only on the play in progress.  It seemed that approach.   As the game went on, and the margin widened, I noticed the Minnesota players slowing.  I motioned to the other coach and told him it would be better if his players kept attacking.  I did not entice him to run up the score to embarrass us, but I wanted my kids, for their own benefit, to see the best challenge they could see.  With about five minutes left I asked the other coach if he would press us.  “You want us to press?” he clarified.  “If you don’t mind,” I replied.  He called time out and I told my guys to be ready with their press break.  The pressure was heavy, but my guys did a pretty good job with it.  After the game, which we lost by 40 or so, I explained why I wanted the other team to keep playing hard, but I could tell by the looks on my players’ faces–none of which were sullen or downcast–that they needed no explanation.  Like I said, everything is an opportunity.        When I wasn’t coaching and suing and thinking about how bad I felt about not updating my slog, I was practicing for the Adult Text Messaging Championships, held last weekend in Long Beach, California.  I took second place in the 40-49 year-old men’s division cranking out an impressive 8 words per minute.  I would have taken the gold but instead of spelling car I spelled aafvrzzr, which did not impress the judges, a group of five 13-year-olds who were themselves texting during the entire competition, which might explain how I did as well as second place.  LOL. This didn’t detract a lot from my writing, but I did take several minutes to ponder things that interest me more than a South Carolina governor’s extramarital affair.  In no specific order, they are:  gravy boats, Twitter, moss (not the football player), the hard plastic parts of shoe strings, antique thimbles, crepe paper, salad forks, thumb tacks, and chain-link fences.    And, because we are friends and friends don’t let friends read lies and half-truths, I really have spent a compost-load of time in the garden, which is now the size of some of the farms I didn’t grow up on when I was a kid.  It is possible that gardening is a addiction for me, but more likely it is merely a compulsion.  The big news from the fields is that the tomatoes have finally begun to ripen, and this makes me very happy because I like to eat ripe tomatoes.  I have 14 plants of 8 different varieties.  I know you thought there were only two kinds of tomatoes, Early Girl and Better Boy, but these are not really tomatoes, at least from the perspective of us tomato cultivating purists.  The latter are just hybridized concoctions of major seed companies bred for the purposes of making money for the seed companies.  Unlike the sterile fruits of these hybrids, my heirlooms provide plantable seeds for the next and subsequent seasons.  In the next permutation of my web site (coming soon, maybe by 2010 or 2017), you will be able to follow the progress of my garden with on-line photos and text.  If you want to, that is. NBI Reader Dave Rolnick asked for a definition of heirloom.  In simple terms, an heirloom is one of hundreds of varieties of the best damn tomato you ever ate.  Heirlooms have been around for decades and have often been passed down in families from generation to generation like stuff you might see on Antique Road Show.  In complex terms, well, who really cares about complexities, if the maters are so good and eventually don’t cost anything, except for sweat, time and a little pruritis to grow?  Pruritis, by the way is the $109 ($20 co-pay) medical term for what you get when a mosquito bites you.  You know it as itching.   I share this from read Kurt Rongstad because it amuses me:  Kurt calls me the Unabomber because, like my bomb-mailing predecessor, I tend to disappear during the growing season.  Apparently, Theodore Kaczynski, who lived in a shack far from his local grocer, grew his own food, so he could not be troubled to kill and maim until after the crops were harvested.  Of course there is one major difference between the Unabomber and me: I don’t have a beard.  Oh, yeah, and I am not a lunatic, or at least my lunacy doesn’t compel me to send bombs to people.  Maybe I can just be the Unawriter.    I close with a story of customer service excellence and why it matters, as told to me by my brother Mike.  Mike lives in Arizona and owns a pool repair business.  He is also a professional photographer [link to Mike’s amazing photos].  Last year he worked for College Affair Magazine [link to magazine site], a campus magazine that didn’t pay much, but did offer regular media credentials to Arizona State athletic events–including football and basketball games–and to the local college bowl games.  Pro photography is highly competitive and good-paying jobs are hard to come by, which is why Mike still services pools.  Last week Mike called his editor asking why he had not yet received media credentials for the coming season.  The editor apologized; she was busy shutting down the magazine.  Suddenly his access to major sporting events was gone.  He suspected is options would be limited so close to the start of football season, but a search soon led him to another popular, but financially viable, ASU-based publication (the name escapes me) geared more toward alumni than students.  While preparing an inquiry it occurred to Mike that the publisher’s name was familiar.  It turns out that Mike had repaired the same guy’s pool about two weeks ago.  The needed part was not in stock, and, if not for creative thinking, the pool would have been out of service for weeks.  We northerners don’t appreciate this, but Arizona people really need their pools in August.  Instead of making his customer wait, Mike decided to buy a filter that contained the repair part, which I believe might have been the bleeder valve, but maybe it was the air-relief strainer.  I don’t know a bleeder valve from a blood clot, but I do know how to search for names of pool filter parts using Google.  Anyway, Mike removed the bleeder valve from the filter and finished the repair.  When the new valve arrives he will replace it and return the filter for credit.  It was clear that the pool owner-publisher was impressed with Mike’s go-the-extra-filter resourcefulness.  Mike still had his cell phone number so he sent a text message that resulted in a prompt call back.  The publisher liked Mike’s photo work as much as his pool work and agreed to take him on and supply media credentials.  Even better, the magazine’s (former?) main photographer is now working in California, so Mike’s role with the publication could rapidly expand.  Did I mention that everything is an opportunity?   Preview of coming subjects: Brett Favre, Michael Vick, The Packers, The Badgers, Plaxico Burress, proposed division changes in WIAA basketball, the stimulus package and more! ___________         Nothing But Iron is an amateur sports and other stuff column written at the convenience of its author, who is really pretty busy, but it’s a dry busy.  This issue is dedicated to Bruce Lagman, who suffered a birthday on Saturday and to Cameron Lagman, who tore his ACL last week during a football scrimmage.  The staff at NBI wishes both a speedy recovery.  ©2009 DrTM Enterprises.  All rights reserved.