Sunday, November 21, 2010

Electronics, Part 3

This so far doesn't have so much to do with medicine. When my birthday came around this year I suggested to my wife a Kindle, and she agreed, no doubt happy to be off the hook figuring out what to get me. It took a while to get it, since they were on back order.

Now I've had it for a couple of months and it's cool. It's the Kindle 3, with just the wireless capability, good enough for me. Although I've used it a fair amount, I haven't bought much, just a German-English dictionary (two English dictionaries come with it), and one other book. So am I a slow reader?

Amazon has some free ebooks you can download, but they aren't so easy to find – takes a bit of searching. What I've found out is that you can download Kindle-compatible ebooks from Project Gutenberg, which is a project in the process of making available for free a large number of out-of-copyright books.

I've read Samuel Johnson's "A Tour of the Hebrides" (along with Boswell's "Journal of a Tour of the Hebrides"), written in the 18th century, and "Moby Dick" by Herman Melville. The latter was quite a surprise, as someone who had never read it, but thought I knew the story from the Hollywood version with Gregory Peck. For one thing, the book is BIG, and it takes quite a long time indeed to actually get to Moby Dick, with variably interesting diversions into whaling (a pretty gruesome thing in the 19th century). It occurred to me that if this book just came out, there might be compliments, but overall it would probably be panned as being bloated, with some contrasting styles of narration that don't necessarily go together. It's also said to be written by this Ishmael character, who alleges to have little education, but somehow spins a complex linguistic yarn with all sorts of references to classical and other literature.

I can recall from the movie version the scene where Ahab is pulled into the water by Moby, then resurfaces attached to the whale, his arm flapping as if beckoning the ship. Great scene, but not a part of the book – Ahab gets rather ignominiously yanked into the water, and that's the end of him. There are also very detailed descriptions of Queequeg's appearance and behavior that are nothing short of amazing.

Interestingly it was quite easier to read and understand Johnson's 18th century British English than Melville's 19th century American English. To say that it is flowery and obtuse is an understatement.

I took my Kindle on a trip lately, and tried out the idea of putting various reservation information on it, and it worked quite well, and so I had all of that in one place. When you don't need it anymore you just delete it.

I like the lightweight feel of it, and the physical size is about right. The battery life is great. They have what is said to be an "experimental" feature of a browser, but rather difficult to use, and legibility can be a problem, but browsing is not why I bought it, so for me not a big issue – after all, I have my smartphone now.

Sunday, November 14, 2010

Electronics, Part 2

On a more positive note than Part 1 is that I finally got a smartphone. It's not like I was just itching to get one for the longest time, I actually didn't feel I needed one until recently. What I had gotten by with was a simple phone, which most of the time was off, and some of the time wasn't even with me. The other part was having a beeper, yes the age-old beeper.

The reason for this was that, as I go through my day, I do not want to spend time answering the phone, to get messages, to answer questions about something or other. Even though some people had my cell number, it generally didn't do them any good, since I might not get a voice mail message for a week or two. Many doctors go on and on about not wanting patients to have their cellphones on when they're being seen, but at the same time, I've seen doctors interrupt conversations with patients to answer their phones.

Thus the beeper. Sends me a passive message, which might be about needing to call, but mostly not, but at any rate there isn't this expectation that I, personally, will be available to talk 24/7. The only bad thing about the beeper was the sound, which could be changed to one thing or another, but what couldn't be changed was the volume. The basic volume was Ok most of the time, but in a quiet room as you're resting, in the middle of the night sleeping, it was very annoying.

What finally happened was that, as part of the new world order of our group being bought up by the hospital, they agreed to continue our phone and beeper contracts until they were up, after which they would pay me $50 per month to get "whatever I wanted." There was no way that I was going to get a phone and beeper service, and hard to imagine I could pay only $50 in the process, so time to move on.

I had plenty of time to wait, see what's new with phones, with services. I had thought that surely I would want something with a keyboard, such as a Blackberry. But then there were iPhones, and later Android phones, which at first seemed not so good imitations of iPhones. But I'm not a fan of Apple and their business model, so I waited.

And then it becomes clear that the Android OS is rapidly evolving, and with the competition heating up between hardware manufacturers, things are getting better. Then this year as the switch comes nearer, Samsung comes out with their Galaxy S phones, and now I can see some sense in it.

Even so, I waited until I could figure out the transition from beeper-phone to smartphone. Finally I figure it out. I had already been having my office send an email about messages in addition to pages on the beeper, since there are missed pages, and missed pages are just missed.

The answer is smartphone and email, having a dedicated address for this phone, and dedicated just to office/answering service messages. Dedicated to keep the noise level down, noise being spam, and unimportant messages. And thankfully, when the email comes in, my phone chirps, just once, and I have control over the volume -- perfect!

It's been a little over a month now, and it's going well. I hadn't realized that my answering service could email as opposed to call or page (but they won't do more than one kind at a time), so that came as a great asset here. Meanwhile, I have gotten more familiar with other things like Epocrates, famous in the ranks of smartphone users. I'm also able to take advantage of other things, like the BMI calculator on my website.

The next thing I want to do is decide how to cut back on services. I started out with unlimited internet, but it's already clear I don't need that much, so we'll see.

Electronics, Part 1

This is going to be a series of posts on electronics as I use them in practice.
First, a sad report on the netbook I blogged about last year. It looked promising, and at least for a time its promise seemed fulfilled. It did all the things I needed to get done, making EMG reports, tracking my patient charges, keeping up on messages and emails, and because of its light weight, was very easy to carry around everywhere.

Durability has always been the main long term problem with laptops I have owned. Usually, it's the screen - flaky connection, or in one way or another the LCD display just failing. One laptop still at home collecting dust has a failed CD-ROM drive, a killer when combined with the absence of any other way of upgrading the OS, since it was made before one could ask the computer to boot from a USB drive. I tried switching out the drive, but this didn't help, so it must be the drive controller.

So what happened to this Dell Latitude 2100? Not quite sure, but it seems to be a motherboard issue. Most often, I try to start it up, lights flash, and then the Caps lock key is blinking and blinking and blinking. After various shaking maneuvers were tried, it seemed for a while that lightly tapping the case on the counter would allow it to boot. But then, putting it into sleep mode, carrying it somewhere, and it would be frozen. Sometimes freeze up while I'm using it (grrrrr!).

With time, it took more "aggressive" tapping (aided by frustration), but somewhere along the way, I noticed that twisting the case could be enough to work sometimes, but anything that worked only worked sometimes. Obviously, surgery, or at least internal investigation was in order.

Comment: Sending one of these things back to Dell is of course an option. However, I was now in post-warranty land, and past experience tells me that a trip to Dell costs $150 (probably more now) just to have them take a look at your computer. So for a computer that brand-new cost me $400+, spending half of its brand-new cost is stupidity in action.

Next stop, Dell's website. I've bought a number of Dell products over the years, and while I am always game to trying to get useful info once again, they did not fail to change my bias that there is little if any useful support on the Dell website. What I was looking for was some help with understanding how to dismantle the 2100. I did find a site from a Dell employee about changing the SDD drive, but he gave no clue as to how to open up the case.

No help? No problem. After all, what I had in my hands was an electric-power-consuming paperweight. What good is a laptop that you might be able to get working by hammering on the counter, might quit in the middle of what you're doing, and will almost certainly not maintain its usefulness when you suspend and carry to some other place?

So I fumbled my way through opening the case by removing all identifiable screws, still found it impenetrable, and managed to eventually snap off some internal posts. VoilĂ ! Case opened!

It would have been great to say that I found some loose part, some errant piece of metal debris shorting out some circuit, some obviously sick connection somewhere to instantly fix and resurrect this failed netbook. Alas and alack! No such luck. I mashed down on all he ICs I could see, brushed the motherboard from any unseen debris, no effect. And yet, twisting the motherboard could manage to allow this thing to fire up. [Disclaimer: you will see numerous warnings about disarming things you are taking apart, dire consequences of electrical shock, transmitting currents to various electronic components without adequate grounding. I'm careful, but I ignore such warnings. After all, to me this is a dead piece of electronics. Zapping the processor to some state of complete inoperability would actually do me a favor, allowing me to comfortably toss this amalgam of silicon and solder in the trash.]

Yesterday, I managed through googling to find some Dell information on disassembling the 2100. Still lacking in some important details, I was able to figure out that, as I had actually suspected, that the "key" to getting this sucker apart somehow rested in getting the keyboard dislodged. However, even after this revelation, I have learned nothing further. I can say that the motherboard problem lies somewhere in the region of the WLAN device, which seemed to be suspiciously loose, yet various maneuvers attempting to improve the WLAN card connection made no difference, even though some localized mashing down in that area could affect the ability to boot.

So, all of this internal investigation, and I remain in the same place. So it's now kind of an extra computer, has a way of being useful, but this laptop bought for its great portability only is useful by smacking it around to get it to boot, then must be treated ever-so-gingerly to not upset the delicate connections you have resurrected for a time.

OMG! What am I doing in the meantime? While I keep getting a steady stream of emails from Dell about "deals" on laptops or whatever, the deals seem to all be in $500-600 dollar land, at least, and most are more. Oh yes, I'd love to send you $600 for a laptop that I might need to replace in 18 months, conveniently after the warranty expires. What I found was a demo Lenovo laptop at Office Depot, for which I paid $360, having a dual-core processor and a 250MB hard drive, 4GB RAM. Its main issue was that some kid had shoved something across the keyboard so that the F10 key no longer would stay in place. (I can't recall any software that really needs or uses the F10 key, and besides the mechanism works, it's just that there is no key on top of it)

So, it's heavier to be sure. But now I have a faster computer. I can set up a virtual machine running Windows so I can interact with the hospital's software. Not such a bad trade. But it's still a laptop, subject to all the physical breakdown problems I've seen before.

Sunday, November 07, 2010

"You have a brain tumor"

You might think that for neurologists this is something we say "all the time", but it's surprisingly and thankfully infrequent. My guess is that even neurosurgeons don't even have to break the news very often, since they are seeing someone who has been referred because of the knowledge of a tumor.

A capsule of a recent event went something like this – I'm asked to see someone for some intermittent weird sensations in a hand and later also in his face. This comes and goes. Exam is quite normal in all respects, even for any signs that there is any loss of sensation in his hand. So, what is this? A stroke or TIA? I recently saw a woman with a similar story, also negative exam, and she had a thalamic stroke.

This time, a very obvious tumor. Keep in mind that, as far as medical terminology is concerned, "tumor" just means "some kind of mass". A blood clot in the brain is a tumor. A fatty deposit somewhere is a tumor. The tumor that most people think about medically would be called a "neoplasm".

At any rate, this man's MRI very strongly suggested a neoplasm. So now it comes down to breaking the news. I confess to some tossing and turning that night. I learned about the finding by phone in the evening, but there was no point in calling him on the phone, rushing into the hospital to spill the beans. How will he take it? Be upset? Be upset at me? Break down into inconsolable sobbing? You never know.

Like so many things that you cogitate about, worry about, feel your stomach churn about, it was something of a nonevent. Nonevent to me, but there can be no doubt it was an important event to him regardless.

My experience-based advice is this:

  • Do not shy away from this.
  • You must have control of your faculties when you break this news. You cannot be involved in your own internal conversation with yourself while you are divulging this kind of news.
  • Be attentive to body language and every other sign of severe distress. Many people simply clamp down emotionally when this sort of news comes, so the only sign of an intense problem may come from the involuntary things they do as you explain what you know.
  • Be in no rush to leave. Wait for a sense of how they are handling it. Wait for verbal reactions. Wait some more. Ask for some feedback, especially if you're not getting much.
  • Regardless of how complete you think your interaction was, you must plan to come back to ask if there are more questions. You have just hit this person with what amounts to a stun gun.
  • There is no reason to explain much of anything in detail. There is no value in sketching out the range of what this "might be". It is what it is, and what you need at this point is something definitive that will only come from the pathologist after a biopsy or resection.
Like so many of these things, it was not as bad as I had envisioned it could be in my ruminations, but nonetheless I needed those ruminations to prepare myself mentally.