Which brings me to my second point: why do we care so much whether or not any reads our blog anyway? For those select few who attract thousands of visitors per day and for whom blogging is a real business, the answer is obvious. Their revenue is directly tied to their readership. But, for the vast majority of us, blogging is only a hobby destined to earn us $0 over the course of our blog's lifetime. So, why do we care whether or not anyone reads us? Are we hoping to become famous? Are we hoping to gain power and influence? Are we clinging to some subconscoius notion that, if only people knew what we had to say then everyone else would see the light and agree with us and there'd be no more war, no more poverty? For me, I think the combination of all these things comprises about 15% my motivation. The other 85% is comprised roughly equal parts vanity and exhibitionism.

Why do you blog?

Learn more about pipes here.

1. Barack Obama, The Audacity of Hope


2. Steve Martin, Pure Drivel


3. The Twilight Zone, Selected Radio Dramas


4. David Sedaris, When You are Engulfed in Flames


5. Arianna Huffington, Right is Wrong

• Thomas Cathcart & Daniel Klein, Aristotle and an Aardvark go to Washington


• Great Classic Stories by authors including:
  
  
  
  • Oscar Wilde
  
  
  • Edgar Allen Poe
  
  
  • Guy de Maupassant
    
  • F. Scott Fitzgerald
    
  
  
• C.S. Lewis The Screwtape Letters


• Monty Python's Flying Circus, Greatest Hits
  

The movie Recount, which premiered on HBO on May 25, portrays the events surrounding the contested results of Florida's vote in the 2000 election. Though it tends to give me atrial flutter whenever I revisit those events, I very much enjoyed the movie. Kevin Spacey stars as Ron Klain, Gore's former chief of staff, who was largely in charge of the legal effort to get the votes in Florida recounted. On May 9, Charlie Rose talked to Kevin Spacey about his role. Although Spacey went on record as disagreeing with this assertion, the film is clearly biased in favor of those who would have liked to see the Florida recount proceed. It would be pretty poor storytelling to portray it any other way. However, there is a speech by James Baker's character towards the end (played by Tom Wilkinson) that I liked very much. His point is that, whatever you can say about the 2000 election, we followed a proper, legal process. The tension that our country experienced could have easily escalated to the level of a national crisis, perhaps even civil war. But the legal process was followed, the various Florida courts as well as the Supreme Court made their respective rulings and those rulings were respected. There were no tanks in the streets, no riots, no armed insurgency.

So, for those of you - like me - for whom the past eight years have been a perpetual nightmare, I recommend this movie. If you compare ourselves to countries like Kenya or Zimbabwe, who couldn't make a peaceful transition of power if their lives depended on it, this movie may restore some of your faith in our democracy.

Charlie's interview with Kevin Spacey can be seen here:

Top Ten reasons why PacMan would make an excellent physician:

1. Hunger - PacMan is hungry. Likewise, the excellent physician should never lose his hunger for knowledge.
2. Confidence - A physician can cause harm to his patient by second guessing himself. Sometimes, suboptimal management given in a timely manner can be better than optimal management given after a delay or hesitancy. PacMan has to be sure of his ability to eat all the dots. If he goes for all the power pellets right away, not sure of his ability to effectively evade the ghosts, he will be in trouble later on when all the power pellets are gone.
3. Risk vs. benefit - PacMan is the foremost authority on risk-benefit analysis. Each ghost he eats is worth more than the previous one. If he eats just one ghost that's 200 pts., but if he eats all four that's 3000 pts! However, each additional ghost he eats confers an added risk of getting killed or of not being able to eat all the dots. PacMan must carefully balance all of these opposing factors.
4. Self direction - PacMan must guide himself through a tricky maze. Staying in one place for too long spells certain death for PacMan as it does for the physician who is not self-directed and self-motivated in his continuing education.
5. Yellow - PacMan is bright and colorful and would nicely complement the decor in a pediatrician's office.
6. Flexibility and adaptability - PacMan, if he had them, would be constantly required to think on his feet. Just as the same management protocol is not appropriate for every patient, PacMan cannot eat all the dots and navigate the maze in the same way every time. He has to be constantly changing his plan of attack in order to avoid the ghosts.
7. Expediency - PacMan is always in a hurry! And, given today's culture of managed care and the 15 minute office visit, PacMan knows how to eat all those dots in the most efficient manner possible.
8. Two-dimensional - Ok, maybe this isn't really an advantage per se. But, hey, at least he's not one dimensional!
9. Anticipatory - PacMan must always anticipate where the ghosts might go in order to avoid them. And he must have a plan in place in case they go somewhere other than where he expects them to go.
10. Round - PacMan is circular, like the excellent, well-rounded physician who has ideas and interests and partakes of activities outside the medical world.

The action is passably good, if rather tame. Like good Christians, the Pevensey children, along with Prince Caspian, turn the other cheek, do unto their enemies as they would have done unto them and work out a diplomatic solution to the "succession to the throne" issue involving a power-sharing agreement between Caspian and Miraz that... Oh, no wait a second - nope none of that actually happened. What actually happens is that, like good Christians, Caspian and the Pevensey children preemptively attack their enemies and bravely slaughter them in battle. In fact, given that the mortality rate in this movie rivals The Lord of the Rings: The Two Towers it was quite a feat for the producers to come away with a PG rating.

Another interesting decision on the part of the producers of this movie was to give Caspian and the Telmarines Spanish accents. The back story here is that the Telmarines are descended from pirates and, many centuries ago, accidentally came upon some kind of wormhole that brought them to Narnia. Then, instead of behaving like good houseguests, they proceeded to rape and pillage everything in sight. The Telmarines are eventually undone while pursuing our heroes across a river which Aslan (the God figure) then causes to rise up and swallow them. The evil Miraz now defeated, Aslan then goes on to make an offer to the Telmarines, "You may live with us in peace or, more preferably, you may walk through this door I have made in the air and end up some place...else. Someplace where we will never have to see you again." Hmmmm, sound at all familiar? Large numbers of hispanic looking and sounding people, trying to cross a river into unwelcome territory and subsequently being deported to another realm? Does The Chronicles of Narnia: Prince Caspian have a political agenda? I'll let you decide.

22 year old pregnant female in her second trimester is brought to the emergency room by her boyfriend because she's threatening to commit suicide. On initial evaluation, she exhibits clear, unmistakable signs of a manic episode and a clear intent to kill herself. What is the appropriate management? (I'm paraphrasing to respect USMLE World copywright)
A. hospitalize and give prozac
B. ask to speak to the boyfriend privately and find out what he did to make her so crazy
C. grab her by the shoulders, shake vigorously and tell her to calm down already
D. hospitalize and give ECT (electroconvulsive therapy)
E. reassurance and discharge home

The the not-made-up, and apparently correct, answer is D - electroconvulsive (shock) therapy. Yeah, I have some misgivings about that answer. As an OB resident, we used to work very hard and even give potentially toxic medications to pregnant women in order to prevent seizures. It seems pretty counterintuitive to me that you'd want to induce a seizure in a pregnant woman. I understand that there's lots of literature on ECT. Proponents will cite its superb effectiveness. And, I have no argument there. ECT is very effective treatment. But, I always thought that "effective" kind of misses the point when your talking about ECT. I mean, a foot amputation is a pretty "effective" treatment for toenail fungus but, Jesus Christ, man - you're causing a seizure! I mean seizure - like on those medical shows when the camera starts moving around all fast, and the patient is foaming at the mouth and monitors are going off and everyone's yelling at each other; you're creating this situation intentionally.

Anyway, study time is over. I'm going to bed.

I'm not particularly hung up on whether or not bloggers are journalists - logging into their free account a few times a week in order to commit random acts of journalism. Certainly, very few of them are good journalists. And virtually none of them are engaged in anything remotely resembling real, investigative reporting - something that is slowing going the way of the dodo in today's media markets.

I do truly applaud the men and women on the ground with real jobs, earning real salaries, with real professional standards, who keep me informed about what's actually going on in the world. However, I am not one of them. We at jamesloganmd.com are not journalists. We do not report news, nor do we hold ourselves to any standards whatsoever. Anything you read here has equal chances of being either real or fictional, truth or falsehood, fact or opinion. The author of what you read here may be James Logan, M.D., or it may be someone else. Or it may be no one at all! We cannot verify any facts or claims made or not made herein; neither can we verify the existence of jamesloganmd.com nor its readers.

The point that I want to get at - and, I realize this is going to sound callous - is that I think that this is one of the best things that could have happened to Obama's campaign. Kennedy is one of Obama's most prominent supporters. And when someone that close to you, with that degree of popularity, has been diagnosed with a fatal illness...it's gold! Even McCain was chocked up today:

"I have described Ted Kennedy as the last lion in the Senate," a tearful McCain said on his campaign bus in Florida. "And I have held that view because he remains the single most effective member of the Senate."

Therefore, any concievable path to victory for John McCain includes the following two things that must necessarily happen before the election 1) Kennedy must stay alive, 2) they need to find Bin Laden.