Friday, September 25, 2009

This may be old school

Hello, darling

Have you harvested the bits you needed
to fill the holes in your bodymind?
Did you storm out, irrational and angry
or are the new patterns calm and cool?

Have you been blowing in the internetworked wind
roiled by resonant transforms, exchanging viral codes?
Are you home now, disconnected
safe from the malware and the glory?

Can you fill me with your data
lovingly yielding your substance?
Can I give you a piece of my mind,
mixing my endocrine soul
with your unbound discretion?

Saturday, August 15, 2009

Microsoft Word: an Anger Factory

Originally posted on September 6th 2007

This is almost unfair, though really, it isn't. It seems like Microsoft Word has received at least as much abuse as Windows itself over the years. After all, you are more or less forced to use both if you want to get work done in corporate America. A fine recipe for anger is this: force a user to put up with stupid, time wasting behavior. Then make sure, through myriad snares and traps, that there is no way to avoid said stupidities. This engenders a feeling of powerlessness, that often turns into anger. Such is the experiential and emotional path I followed about an hour ago trying to collaborate with a business partner on a document we need to present to our customer.

The document was in .doc format, of course. I'm using Windows XP on my company supplied laptop, with whatever version of Office that shipped with the platform, patched up to fairly recent vintage. Word had no trouble opening the document at first, but at some point it crashed. Thereafter it would crash on each attempt to load the benighted thing. Now, I don't necessarily hold the crash against Word. Applications crash on Linux too. Although subjectively, it seems like they crash more frequently on Windows than on Linux. They are certainly much more prone to bringing down the whole system on XP, which is an improvement in this regard over Win2K, and that OS over NT 3.51 and so on. (Vista has improved system stability quite a bit. But it is a performance pig among other things. Apps seem to crash just as much on Vista, too.)

But how was I supposed to deal with this crash? I don't have another copy of Word around my home network. I do have Open Office in several flavors. So I tunneled in to my home network (running NoMachine NX over SSH) and ran OO writer 2.0 on the problem file. It loaded just fine., which let me at least read the thing in advance of a conference call later today.

But here is the thing that really twists my tail: there is no way re-saving the document with OO and reimporting it into Word is going to result in an acceptable copy for collaboration with my business partner. Doing a "round trip" through OO from Word always results in a broken .doc at the end. This is not an accident. As many are aware, (through Groklaw's excellent coverage of the OOXML vs ODF standardization war, among many other sources) Microsoft wields the Office document formats as a weapon to keep users dependent on Office, and therefore Windows. (Number one and number two Microsoft cash cows. Coincidence? Chyah, right.)

So here is the last roadblock to me solving this little problem for myself. I'll have to go back to my partner and work out what feature is actually crashing my copy of Word. Or perhaps a reboot of the platform will fix things, or deleting Word's temp files if I can find them. Yet another roadblock: nothing I do will be based on what is actually wrong. My attempts will all be stabs in the dark because the internals of Word are secret. Bah!

Windows Anger

Originally posted on October 17th, 2005

After all this time, I haven't once whined about Windows in these pages. Well, that's about to change. Here's something I sent at work today. I've removed material that could identify the workplace, or my colleagues. If this ticks you off, try replacing all the blanks with random obscenities, and odds are you'll feel better about it.

Working on this document has made me exercise Word, Visio and Windows generally far more than I ever have before. This is a particular form of hell for a Unix geek. (Dante didn't know about Unix geeks or else he would have added a whole circle for us. It would be full of NT4 boxes, of course.) I have found many new ways to make Windows lock up for ten minutes, or forever. I've learned how to desperately guess which duration I'm faced with in a given situation, and to balance that guess against the certainty of a 20 minute reboot cycle, All of this under deadline pressure, of course.

Just now, I thought I had discovered a new way to make Windows stop doing my bidding. I had been cutting and pasting multiple large blocks of Word data between various versions of the ____ draft. I was on IM with R____, letting him know I had at last succeeded in uploading this version of the document. I went to paste the title of the document, into the chat window. Windows froze when I did that. I suddenly got the horrible idea that I had just pasted the entire ____ section into the chat session!

It turned out the collaboration software had Windows' undivided attention while uploading the doc to the ____, and my title appeared in the chat window directly. I hadn't pasted megabytes of data into the IM session. But it made me realize that I had never made that particular mistake in my career before, and still hadn't. I think that's due less to my skill, or even luck, than to the enormous range of possible screw-ups available to us at any given moment.

I am convinced however that Windows expands the already limitless range of such errors more than any computing environment I'm aware of.

Old Friends

Originally posted on August 6th, 2003

I just had lunch with three old friends from my days working at Octel. One was a good friend and colleague with whom I had been in touch off and on via telephone, email and chat, but had not met face-to-face since 1996.

He recently moved back to the Bay Area, and we decided to meet up at the Empress of India, in Santa Clara. This is a small, and very good Indian restaurant that was a frequent meeting place for the old Octel crew that I worked with. When I showed up at noon, my friend was there, and so was the boss of that old crew. She had introduced most of the shop to this restaurant, and her being there was a coincidence, made a little less amazing by the fact that she frequently has lunch there. She let slip that my first friend had invited a second old friend that I hadn't seen in many years. It turns out that he is now a V.P. of Product Management at a startup. He's a very busy guy, so he was late. My first friend and I started in on our first course. After a while, the second friend showed up. We had very pleasant conversation over the glow of truly excellent chicken curry. My ex-boss was with the party she had come with, so she didn't get involved in the conversation, but her presence made the meal seem all the more nostalgic. I felt a warm glow that was only partly due to the curry.

With some exceptions, I've been hiding out from humanity ever since my ex-wife died in December 1999. In most things, I'm self sufficient. I do well on my own. But reconnecting with this group reminds me strongly of how much I miss human company. Electronic interactions with friends fill some of my need for this sort of thing. But sitting in an old familiar place, sharing pleasures like a good meal, and watching a friend's face as he tells a joke or lets you know about a fear isn't something that translates well over email. I enjoyed this lunch an awful lot.

A Salute and a River Basin

Originally posted on May 23rd, 2003

love computer language translation. It can be so eerily inept.
I received some spam today with a probably virus laden attachment from "" The body of the message had this:
--------------------------- * * * E N G L I S H * * * --------------------------- Watched the demonstrative preview of the scherzetto " Spiral-fantastic " then you start the application that virtually you distoglie the sight from the images common in order to deform all I have there that watched subsequently for 1-2 min. Truly fantastic, it sure deserves to make to turn the knowing friends and. You do not have fear, is only an innocent game that has but its unexpected implications. Yeah, I'll bet! - ed. A salute and a river basin from Stella.

Masterful Brushoff

Originally posted on May 18th, 2003

I received the following chain letter on a mailing list I belong to. I liked it so much, I wrote the reply that follows. Then a friend posted a reply, and I responded again.

Dear Mastercard, What can I say? We've been through alot together. I remember meeting you when I was only 19. You were sitting there, all discretly in the post, with those gleaming rates peeping out from your foggy envelope window. You were smitten, you told me how responsible I seemed, what a great fit we'd be, and you were willing to go all the way right away. I've never been so caught off guard, and yet so comfortable. And you treated me right. You bought me a nice new bed, and didn't mind if I saw other girls. God, I loved that space. You were so reliable, like a regular booty call. But we both know it was more, so much more. I became dependent on you. And you never let me down. You even bought meals and drinks for my other dates. Steadfastly knowing that I'd be back, usually by the end of the month. I love you MasterCard. You took me to Europe and Mexico. You took me to concerts, and bought me cds and clothes, I didn't even have to ask. Just a glance and you were there. But then you became testy, and then down right obsessed. Your notes, while seemingly charming, were unsettling. I sent my regards whenever I could, but you always wanted more. And you'd throw it back in my face. I couldn't do for you they way you did for me. Rather, you wanted more. And you never let up. Well MasterCard, I want you to know that I wrote you AGAIN today- and this was the last time. We're even now, I don't owe you a thing. And having achieved this balance, I think its best we see other people. You've been great, just not what I need or am looking for at this time. I hope you understand, I'm sure you'll be okay, but you just want too much. I can walk away, now, knowing I did you right. I'll miss you, but there just no good reason to continue. Goodbye, MasterCard. Thanks for understanding.

Your friend,

Dear Brian, Honey, how can you treat me this way? After all we've been through, you brush me off with a check and a Dear John! Despite everything, I want you to know it was NEVER about the money. (I know I said so. Please forgive me. I was upset.) You ARE the most responsible consumer I've ever known. I understand about being late. I FORGIVE you. Please don't dump me like this! I don't want to put any more pressure on you, but the bank says I'm pregnant. How am I supposed to take care of a litter of little smart as^H^Hcards without those interest payments? Please take me back. Only 9% for the first three months, Darling!

Your Mistress

From the comments section (ljl), Brian responds

Dear Mastercard, No, darling, it's over. I've taken up with Visa, but only as a flirtation with her check card business. When you started flirting and playing with those collectors like RMA, it was over between us.


And a final(?) response from Mastercard

Dear Brian,

VISA!!? That, that .. BITCH! How could you let yourself be fooled by her come-on?? Brian, she's a cheap, no-good whore. I mean it! She's been in more ATMs than a banker's got points. Besides that, her introductory rates are only good for six weeks! I give you a whole three months, baby! Listen, I can make it last longer if I try hard enough. How does six whole months of, I don't know, 8% sound? Drop that tawdry bit of plastic and come home to ME!

It'll be .. priceless!

Sounds sorta like God

Originally posted on May 9th, 2003

dam Sohn, product manager for Microsoft's Passport group, quoted on C|Net's , commenting on whether they should have caught the trivial crack in Passport's change password process:
"Of course we should have caught it; we should catch
every (issue)," he said. "That's what you are working
toward. We are always looking. There is not a beginning
or end to this kind of effort."
No end, good. No beginning, bad.

AOL Anger

Originally posted on May 4th, 2003.

I have a problem with anger. Like today for example. I was looking over my bank statement and saw a charge from AOL.

Now, I signed up over four years ago, I'm ashamed to say, and I've never used the account. I'm even more ashamed to say that I've let those *ahem* people charge me every month for the service for all that time. Well, now I'm unemployed, and I decided to do something about it. I heard that they had a new broadband service that had all sorts of cool Time/Warner content, so the first thing I thought of was giving that a whirl before I shut down the account. I tried to remember my screen name and log in via No joy. So I called the 800 number and navigated the voice mail to the forgotten password help. After listening to a long recorded explanation of how to change my password if I had my screen name and the AOL software, I got a helpful lady on the line. I explained the situation, and she was able to call up my account using my credit card number. Next she needed the address associated with the account. I told her I wasn't sure, but that I thought it was an old Oceanside address, which I gave her.

AOL : "What about the ZIP code?"
Me: "I don't have that."
AOL:"I'm sorry, but I can't give you your screen name without the ZIP code."
Me:"Well, this was four years ago, and I'm lucky I remember the address"
AOL:"Don't you have it written down?"

Now, I was ambivilant about using AOL anyway, and I didn't want to go digging into my records to find this information.

Me:'Nope. What can I do?"
AOL:"Well, you can cancel the account."
Me:"Don't they need the ZIP code?"
Me: "Does it make business sense that I can cancel my account using my credit card number, but I can't stay your customer with it?"
AOL:"They don't have to give out personal information in order to cancel."
AOL:"The screen name."
Me:"Oh, I guess that makes sense.."

So, back to the voice mail system. I spent a short while on hold this time, enough to remember that they don't make it easy to cancel." Finally, I get connected.

AOL:"Hi, this is Steve. How may I make your online experience even better today?"
Me:"Well, Steve, I'm afraid I want to cancel my online experience."
Steve:"Oh, that's too bad. May I ask why?'
Me:"Well, I haven't used it in four years."
Steve:"OK, then. What was the address associated with the account?"
Me:"Well, I've had four addresses in the last four years. I can give you the credit card number."

So I give it to him. He repeats it back to me. Soon he says:

Steve:"No, I can't seem to find that number."
Me:"Well, they could look it up at the forgotten password desk."
Steve:"Really? How did they do that?'
Me:"I don't know."
Steve:"Well, I can't seem to find it. What was the address on the account?"

An explanation of why I didn't have the ZIP code ensued. Apparently that stumped Steve, too.

Steve:"Well, I can't help you without that information."
Me:"OK. Let me talk to your supervisor."
Steve:"The easiest thing would be to call your credit card company and have them stop paying." Me:"It's not a payment. It's a charge."
Me:"I never authorized a payment. You charge my credit card every month."

I didn't add that they change the expiry date every year to boot.

Steve:"Well I don't see how that matters.."
Me:"It means that you have my credit card number, somewhere. Let me talk to your supervisor." Steve:"He'd just tell you the same thing. What was that number again?"

So I let him check the number again.

Steve:'Nope. Still can't find it. Are you sure you don't have that ZIP code?"
Me:"Stop stonewalling and let me talk to your supervsor."
Steve:"I'm not stonewalling. I'm trying to help.."
Me:"But you can't help. Please escalate the call."
Steve:"He's on the other line.."
Me:"I'll wait."
Steve:"You keep interrupting me.."
Me:"Because you're stonewalling. They must really come down on you if you escalate."
Steve:"No, as a matter of fact they don't.."
Me:"Then please let me talk to your supervisor!"
Steve:"You keep interrupting. I'm just trying to help.."
Me:"*gargle* *sputter* Now look, you can't help me! You've tried, and you can't do it. Please just accept that and let me talk to your supervisor!
Steve:"What was that number again? I may have mistyped it."
Steve:"I don't need to listen to that sort of language."
Me:"Ahhh. You were waiting for that! Any excuse to shunt the call into the bit bucket."

I neglected to mention that I'm a bit paranoid, too.

Steve:"No, I'm trying to help..
Me: "Gaaahhh.. What was your first name again?"
Steve:"My name is Steve."
Me:"Now look, Steve. you can't help me! You've looked up the number twice..
Steve:"Three times."
Me:".. three times. And you aren't getting a different result. So PLEASE LET ME TALK TO YOUR SUPERVISOR!"
Steve:"I wish you wouldn't shout.

Ten more minutes of simliar dialog ensued before his supervisor got on the line. (After a short time on hold).

Supe:"Hi, this is ___ how may I make your online experience even better today?"
Me:"I want to cancel."
Supe:"Yess, and I see you've been dealing with my best rep, Steve.."
Me:"Yes, and he's been stonewalling.."
Supe:"..and I see you haven't been using your account for the past four.. er.. three months. That's all the further back I can look."

His disingenuous smile slid slimely out my cell phone.

Me:"So, you've got my account up!"
Me:"And Steve couldn't bring it up.."
Supe:"Yes, he was correct in telling you he couldn't.."
Me:"I want to complain.."
Supe:"Please stop interrupting me! He was correct in telling you he couldn't look up your account. I used some higher access codes to retrive you information."
Me:"I want to complain.."
Supe:"Now if you could just tell me why you want to leave AOL.."
Supe: ...
Me:"I have been trying for twenty minutes to get Steve to escalate the call to you."
Supe:"He was correct in.."
Me"Stop! LISTEN!"
Supe: ...
Me:"He couldn't access my account information"
Me:"The moment we determined that I asked that he escalate the call. He stonewalled for fifteen minutes. You get on the line and fix the problem in under three minutes."
Supe:"He doesn't have access to.."

I finally got him to sit still and listen to why I was pissed off. I then sat through a set of questions intended to figure out why I was leaving. I told him (truthfully, and with relish,) that I was leaving because the change password desk couldn't give me my screen name. I also told him (less truthfully, but with more relish) that I would never consider coming back because of the way I had been treated just now. This was not true because the real reason is that they suck. He then offered to give me three months .. pause .. of free AOL for the trouble I'd been through. (I know for a fact that he could have offerred me a three month refund.) I said "No! I want you guys off my credit card bill!"

My anger seems to flare in proportion to the amount of my own stupidity that got me into the situation. This is not a new insight for me. But reading between the lines of the AOL agents's statements, I get the impression that that's what they were doing too. This could just be me projecting my own thoughts onto others, but maybe not. The supervisor clung to his defense of his "best rep" far longer than would be wise from a customer service perspective. Of course, these two didn't seem like really bright bulbs anyway.

Well, I am now an ex-AOL customer. I feel so.. drained!

And now for a break

It's time for a break from the blow by blow description of my health problems. I just dug out the mysql database I used with my old blog, Anger Management. I'm going to post several of those old entries here. Since Google vows to store things forever, My wit and wisdom should then be available to scholars and humor critics many centuries hence, and without using the wayback machine.

Wednesday, August 12, 2009


I started the day by nearly fainting after breakfast. It was a 40 minute long dizzy spell featuring black spots before my eyes if I stood up. The nurse threatened to call 911, but I put her off. I gradually felt better and went upstairs with a staff member at my elbow. In my room, I took my blood pressure - ERROR - the meter wouldn't read it. Wait a minute, repeat - 85/64. I'm sure it was much lower when the spell was really underway. After I got to where I could think, I remembered my blood pressure meds. I'm supposed to take 2.5 mg a day of the Lisonipril. But I have 10mg pills, and I never got the right ones. So I try to quarter the stupid triangle shaped pill with variable results. I think the variation was on the "too much" side last night. I called my cardiac doc today and asked her to fax a prescription to the local pharmacy for the right amount. I don't know if she's done it, so I made sure I took less than a quarter pill tonight. We'll see how it goes tomorrow.

I visited my new psychiatrist today. He's an older fellow with an old dog planted on the couch. So the cliche of the Freudian analyst talking to the couch bound patient won't work in his case. He listened to my extensive psychological and medical history, scribbling notes rather frantically I thought. He seems like a nice guy who doesn't patronize. That's a rare and precious quality in a shrink.

I also went and had my blood thinning tested. Around 5PM I got a call from the coumedin nurse at my doctor's saying that she wanted me to stay on lovenox and increase the coumedin dose. Since the latter is managed by Atria, I handed her off to the local nurse. This worthy was insisting on a faxed order for the dose change, which I guess they worked out. I never did find out what my INR (thinning index) was, which is annoying. I like to know things like that. It seems to me the coumedin nurse wants me to discontinue the lovenox two days hence without testing, assuming that the higher coumedin dose will kick me into therapeutic range by then. I'm not comfortable with that. She specializes in getting people into the right coumedin dose, of course. So she's probably right about how long it will take in this case. But as long as I'm at increased stroke risk, I'm going to insist on whatever it takes to keep me anticoagulated. I'll call her tomorrow and discuss this with her.

At lunch and dinner, I spoke with Dick, the guy with liver cancer. He has been desperate for someone to talk to. He keeps telling me how relieved he is to have me around. I'm glad to help. He's a nice guy. I'm a little worried about being his only lifeline though. I'm also facing a choice of whether to befriend a dying man, with all the sadness and perhaps horror that could entail. There's actually no question that I'll jump right in, but the morbid thoughts do occur to me. On the plus side, he has two nice looking daughters. :)

I tried going to the see the movie tonight. It was "Labor Pains," which was a chick film par excellence. Call me dense, but I didn't get that from the title. It was mildly funny, but the subject matter didn't speak to me. I left with apologies after 15 minutes.

Tomorrow I start the outpatient program. I'm a bit nervous, but I'm sure it will work out OK.


I took it easy most of yesterday. No angina, fast heart rate but not too fluttery. Had an interview with the new nurse, Christina. She knocked and barged into my room, earning a scowl and a lecture on privacy. The other nurse had already agreed to being respectful of my privacy, but this one was obviously reluctant to agree not to just come in when she wanted. There's a care mentality at work here, I think. Like in a hospital, nurses don't knock. But this is also a residence, of course. The old folks may or may not object to this sort of thing, but I certainly do. Another angle is that many of the seniors may not be able to answer the door easily. Still, I can.

Anyhow, the gist of the interview was my medications. The staff were unprepared for the idea that I would manage most of them myself. Normally, they manage all the meds. But the place charges a lot for each tier you go up in number. I'm signed on for four meds, because one to four is the lowest tier. The next one, five to ten, costs another 300 bucks a month. Anyhow, although they were caught flat footed, there is in fact a policy that covers that. It requires that the nurse come up and make sure the resident is competent to manage the meds. This involves questions like "what year is it?" and "what does my (analog) watch say?" Also you have to read the label off one prescription and explain what to do when you run out. I also had to demonstrate how I go about injecting myself with Lovanox, the blood thinner I'm taking until the coumedin kicks in. (Pour powder into spoon, add water, cook briefly, suck it into the syringe, tie off, inject - the usual) Finally she made me promise to keep the meds in the lock box, saying they'd confiscate them if they found them outside. The problem that's meant to solve is a confused old person wandering in and swallowing all your pills.

One other thing she wanted me to do was to walk in the hallway. It was presented as not optional. I told her I was resting. I said the last time I overdid it, I ended up calling 911. I said my normal practice was to walk a mile or more every day, but as long as I had this enormous painful bruise running from my groin to my knee, I was going to have difficulty with that. I also pointed out that I would be going four days a week to the outpatient psych program, where I would be exercised and put away wet. She decided not to flog that horse.

I have mixed feelings on the regimentation. I have to sign out and in. I have to be here at 8:00 AM, 5:00 PM and 8:00 PM every day for meds. If I don't come down for meals, they'll come get me. They will try to force me into activities, most of which I won't want to participate in. (Some are fine, like the computer lessons and the movies. Blackjack seems fun too. Tai Chi is not, nor is Bingo.) All this forces me to deal with other people on a daily, scheduled basis. It means that if I start having insomnia, an important symptom of incipient depression for me, they are going to know about it. It's like what the AA oldtimer said when the new guy accused him of brainwashing. "Yes, and your brain could use it." On the other hand, I bristle at the egregious examples of powerlessness, like the casual invasion of privacy. On balance, I think it's a good thing. And it's temporary, of course.

I'm getting to know my table mates at meals. There's Juanita, a nice septuagenarian, who is a bit silly. She listens to Vicki, the youngest woman in the place - my age - make catty remarks about just about everyone, and commiserates. There's Bill, who is close to 90 and suffering from the beginning stages of dementia. Dick is a nice fellow, who told us all today that he had liver cancer. He'd known since November, but hadn't revealed it until this evening. Finally there's Gale, who still has most of his mental faculties. He has a dry sense of humor and is fun to talk to. They have all adopted me into their circle.

Around 7:30, I took a walk across the street in the city park. I made a slow circuit around the place. It's very pleasant and the weather was great - cooling off. I have lived near here for 9 years and I never once went to this park. I actually worked 50 yards away - I can see the rooftop parking lot from my balcony - yet I didn't know the park was there. Between the park and the town - and the rest of the area available through Caltrain - I think I'm going to really enjoy my time off here, once I'm back up to speed physically.

Monday, August 10, 2009

Sprung From Hospital rev 2.0

According to the electrophysiologist:
  1. Fast heart rate is likely until the amioderone blood levels come up, and that takes a long time
  2. Atrial fibrillation is also to be expected. Until the new scars around my pulmonary arteries set in, the rogue circuits will still be able to pass through the lesions.
  3. More angina is not unreasonable after having had my atria messed with like they did on Thursday.
I'm cleared to leave the hospital! Yippeeeeeeee!

Back in the Hospital Part 2

While all the back and forth about which doc would see me was going on, I had my first visitor. Sue Marken, the sister of an old friend, came by. Her brother had died after heart surgery a couple of weeks before I had my own CAB in January. We had exchanged emails back then, and had recently renewed the correspondence. I was happy to meet her face to face for the first time.

At some point in the afternoon, I found that my tachycardia had returned. My heart rate was back up to 117. The suffering soul in the next bed became delirious in the late afternoon. They moved me to a private room, away from his loud outbursts. Shortly after the move, my angina kicked up. I told the nurse about it, and she responded by giving me 1 mg of diladud. This got rid of the pain alright. It also put me out for the evening.

This morning at 4:00 AM, the nurse woke me up. She said the monitor showed I had gone in to atrial fibrillation, and she wanted to do an EKG to document it. The tech confirmed I was in afib. This bummed me out considerably. Now two of the symptoms the ablation had been designed to address have returned. Also, I'm now in a similar condition to the one that kept me hospitalized for 11 days. It's not inconceivable they may want to hold on to me now.

30 sleepless minutes later, by heart started hurting again. I called the nurse and got another 1mg of diladud for my trouble. This addressed the pain, but didn't knock me out quite as far. Tolerance is setting in.

Sunday, August 9, 2009

Back in the Hospital Part 1

Saturday night I started feeling some angina. I took my pulse and it seemed irregular to me. It also seemed very slow. The pain was worse than what I normally experience and I got concerned. I packed my laptop in case I was going to end up in the ER, but then I left it in my room as I went down to the lobby. I just wanted to talk to someone. Once there, the pain ebbed and flowed, and I finally asked the staff to call 911. I also asked them to go snag my backpack from my room. It's not like I'm obsessed with my computer or anything.

The paramedics arrived and the pain went away. This actually made me feel annoyed. I hate crying wolf. Fortunately, the pain came back. What a bass ackwards sense of priorities I have in those situations! The pain hit a 4 on the way in. Nitro helped. Once in the ER, I was at an ebb in the tide of angina, but it kicked up again. They gave me 1 mg of diladid which took the edge off considerably. a couple of hours later, they came back with my treponin level. It was elevated - .6. Based on that, they told me I was having a mild heart attack.

This is not what I wanted to hear. of course. It was a busy night, and there was someone ahead of me in the "cath lab" where they do angiograms. This was fortunate, because when a cardiologist got a look at my case, he called it off. It turns out that treponin levels can be elevated by many types of heart injuries, including those that you get during ablation surgery. They still had the fact of my angina to consider, so they admitted me. One more night in the hospital.

Once in my bed, at the opposite end of the five bed ward I was in last week, I tried to settle in to sleep. But the poor guy in the next bed was breathing harshly and coughing and moaning loudly. He would shout out for apparently nonexistent people. The nurse would come in and tell him he needed to wear his oxygen mask. He would argue the point, then comply. After that, he would sleep quietly for a while, then knock out his oxygen mask, after which the cycle repeated itself. I'm not sure how many cycles we went through that night, but I know I was awake for each of them.

Sunday morning, I got the news that I was "NPO" and couldn't eat or drink anything, This is standard procedure when you come in from the ER. Until a doctor looks your case over, nobody can tell if you might end up in surgery or need a test that requires fasting. I was waiting for the doc to show up for a couple of hours or so, Then came the word that he had refused to look at my case, because of the complexity. He handed off responsibility to the cardiologist I had seen the night before. So I waited for another couple of hours for that doctor to show up. When they chased him down, he pushed the decision back on the first doctor.

When troubleshooting network problems, and at other times, there's a phenomenon I call "blame deadlock." That's where two or more parties point fingers at each other in a loop. It's like a mobius strip with Escherian ants crawling along it. Each ant's head always points at the butt of the next ant in the line. The whole group keeps on marching ad infinitum. These doctor's had their noses firmly pushed into each other's butts.

The nurse finally broke the deadlock. Predictably, the cardiologist got his way, and I talked to the other doc. But before that, he had lifted the NPO order. Of course, the problem then became ordering a lunch tray late. This process always takes about an hour, and this time was no exception.

Saturday, August 8, 2009

Out of the Hospital

Unleashed upon an unsuspecting world, newly defibrillated heart pumping blood through my energized bod as I leap over tables, entertaining the seniors and amazing the staff.

But in reality .. I was craaaashing. It had been a long day. I'm all signed up with three of my meds being managed by the nice nurse here. She knocked at 8:00 PM and peremptorily entered my room. I said "Don't do that again!" She said "I have a key." I said "knock, and wait for an answer before barging in." She admitted as how she might have stepped over the line. I wonder if the seniors put up with that crap.

Otherwise, this place is very nice. It's convenient to Caltrain and to town. I have to clock in at 8:00 AM and 8:00 PM for meds, but that is what I agreed to. They are desperately looking for a fourth in bridge, which I firmly ducked. I hate the game though I know how to play. The building is four stories plus a basement garage. The food is ok - I had halibut which didn't make me gag. The residents were friendly. A couple made goo goo eyes at me. They had "The Soloist" for the movie which I would have liked to have seen, but I was too tired. Life here seems a bit regimented, but except for the medication regime, I should be able to opt out of anything I see as unpleasant.

The room is the size of a small hotel room, with a narrow single bed. The remarkable thing about that is that the room is intended to be shared by two men. I'm getting a discount by occupying the shared room - only $2500.00 a month. Regular price is $3100.00. It's got a reefer and they are getting me a microwave. Comcast is in with Internet access. I'm currently wired to the modem, but will go wireless as soon as I get my spare gateway down here. There's room for a small table, so I can set up my recording equipment. I can live with this. There's a nice balcony with a peninsular view across Burlingame. Unfortunately that's the side Caltrain is on. I've lived close to RR tracks before. You stop hearing it after awhile. I can't wait.

Now for the gory details. I have an ugly bruise around the incision site in my groin, I was told to expect this, but it's still a shock. But no bleeding, and the site is soft. If either of those things were the other way, I'd be calling the doc. They shaved around the incision point, but not where they put the tape. Removing the bandage made me wonder if waxing was like that.

There was a welcome kit with a plaque that reads "With each year, you grow more wonderful." I thought wonderfulness was somewhat independent of aging. That is, you might get more wonderful as you age, or you might not. But I suppose anyone would like to think they do.

All for now.

Friday, August 7, 2009

Post- Surgery

I'm through the surgery, waiting for them to process my rather complicated discharge. I'm going to the retirement home today, perhaps by way of my apartment to pick up some clothes.

I was in surgery for 7 hours yesterday. They started out dealing with the atrial flutter. Of the two kinds of arrhythmia I had, this was the toughest kind to ablate. They couldn't quite get it to go away, so they switched to dealing with the fibrillation. They were more successful at this than with the flutter. At the end of the procedure, I was still in flutter, and they had to "cardiovert" me. That's where they zap your heart to shock it back into normal rhythm. It worked, and as I sit here, I'm in sinus (normal) rhythm with a reasonable heart rate of around 80 bpm. So things have improved for me, but I may not be 100% rid of the arrhythmia. They have me back on amiodarone, the rate and rhythm control drug with nasty long term side effects on the liver and lungs. We'll see in three months if I need to stay on it.

Since they worked in the left atrium, I'm at heightened stroke risk. They have me back on coumedin, but until my INR gets into therapeutic range, I'll have to inject myself with Lovanox twice a day. The retirement home charges for medication management according to the number of prescriptions. The lowest tier is 1-4 scripts. After that it jumps up $250.00/month. I've gotten the OK from my doctors to have the home manage only four of my meds, provided the coumedin is one of them.

So here I sit, bored, in my hospital bed, ready to start a new phase in my life. I'm nervous about it, but the only way out is through, as they say.

Wednesday, August 5, 2009

A less drug addled report on the TEE

I survived the TEE. It wasn't as ugly as the first one. It was just two shots of the nasty anesthetic, with a brief tongue depressor induced gag in between. Then out with the lights. I woke up stoned and with a painful sore throat. They didn't have my delayed breakfast when I woke up, and it didn't come in the next half hour, fifteen miutes after that I got whiny and started to rag on the nurses. I really hate giving these people a hard time. It was the kitchen's fault. I got my early lunch and went to sleep. When I regained consciousness, I apologized to my nurses. They didn't seem to think I needed to, but I felt like I did.

Later in the afternoon, the people from the retirement home came by with a ton of papers to sign. The writer's cramp almost made me forget about the sore throat.

Last night my heart went through a "mode change." I'd been in rapid flutter for 8 days or so. In flutter, the heartbeat is regular, but shows abnormalities on the EKG. Mine was going at a consistent 122 beats per minute all through that time. Last night I started to feel a little angina. I rang the nurse, who wondered if it wasn't anxiety, since the monitor wasn't showing anything. I insisted it wasn't, but she ordered an Adavan anyway. The shift was changing, and the next nurse grabbed a printout of the monitor. It seems they only see the upper half of the EKG on the monitor. You have to get a printout if you want the whole thing. Lo and behold, the full readout showed I was going into fibrillation, then sinus (normal rhythm) then flutter. When my heart changes modes, I get a little angina. If I'm going fast, I get more angina. I also get a more heart pain if I'm in fibrillation rather than flutter. Today I am going fast, but not as fast as the rate that really really hurts. So it wasn't anxiety. I got my Adavan anyway.

Today I'm back in flutter. I sure hope all this improves after the surgery. I'll be going in around 7:30 AM, It starts at 8:30. 1:00 PM is a time pulled out of thin air by my doc for the surgery to end. But the nature of this procedure means its duration is inherently variable. (Measure.. try this, measure..) So I'm not sure when I'll be through. It will be some time after I wake up before I'll be able to blog about it.

TEE Time

This one went far better than the first one back in January. There were only two applications of the nasty anesthetic before they threw the switch and turned out the lights. I woke up pretty dopey, and with a sore throat. Par for the course. But then I waited 45 minutes to get a meal tray. I was fasting, so that was annoying. I'm still a bit punchy, so I'll save the nice observations of hospital life for later.

Monday, August 3, 2009


I used to have a blog called Anger Management. Its subtitle was "Things That Piss me Off." I had great fun ranting about this or that outrage of, mosly, technological civilization. Blowing off steam there was a great cathartic.

I got pissed at a nurse today. Right after I saw my doc, he (the nurse) was giving me my meds. There is this unspeakably foul liquid they have been giving me to protect my kidneys. It seems that Metformin, my diabetes med, has a reaction with the contrast dye they use in the CT scan. The sulfurous swill is designed to help undo the consequences of this interaction. The doc had said I could discontinue it. But after he left, the nurse look at my chart and noticed that my creatinine level was elevated. Creatinine is an enzyme in the kidneys. Apparently elevated levels indicate stress to the kidneys if not outright damage. He suggested that I quaff the foul potion despite the doctor's reprieve. Well, I agreed. It all made sense. But then he wanted to give it to me in water instead of apple juice. The rationale here was that concentrated sweets like that shouldn't enter my body. This point was sharper because they had taken me off my metformin. But I refused to take it in water. (You have no idea how foul this stuff is.) So he said "OK, I'll give it to you in a little juice." I again demurred. I've had three doses of this slime so far. One was it a full gass of apple juice, one in a third of a glass and one in a full glass of orange juice. Guess which one nearly made me puke? So he gave me my full glass of apple juice, and I held my breath, pinched my nose and drank it down. Then without releasing my nose, I drank a full glass of water as a chaser. I got a good result. There was only a faint aftertaste of the full outhouse flavor.

OK, so next thing. They've had me on a carb controlled diet. That's fine, but what I really need is the intersection of the diabetic and cardiac diets. I mentioned this to them every day since my admission, and it only penetrated to the kitchen yesterday. Before that, they had switched me to the cardiac diet, ignoring the carb control. I finally got my first meal with the two intersected at lunch today. But before that, I had a cardiac diet breakfast, late because they had starved me last night in anticipation of the lovely TEE procedure. I was eating this breakfast as all this was going on. I mentioned that they had switched me to decaf coffee with the cardiac diet, but that it appeared I had high test on this breakfast. He said something to the effect that decaf wasn't a necessary part of the cardiac diet, but in my case he thought it was, since I had a rapid heart rate. He said "let me just go and tell them to hold the caffeine." I said "I wish you wouldn't." There followed a pissing match where he insisted I cut out the caffeine, and I averred that since it wasn't in the doctor's orders, I didn't have to take his (the nurse's) advice. What I didn't mention was that I had been off high test since the day before, and there was zip affect on my heart rate or arrhythmia. What I know about my body and caffeine is, if I have two cups of fully caffeinated espresso, then my heart reacts. If I keep the level a long way below that intake, I'm fine. Anyhow, I got angry because this situation pushed my reddest hot button. It looked to me like an arbitrary exercise of authority limiting my freedom of action. In fact, I think that's what it was, because I had insulted the guy at the outset by suggesting his medical advice wasn't worth taking, and that I wanted to appeal to my doctor. He was dismissive, deflecting every statement I made to the effect that I wanted to have my caffeine. I finally said. "Look buddy. If you keep this up, I'm going on strike! You will see a trouble-free cooperative patient become a real pain in the ass!" He just walked off shaking his head. But I got caffeinated coffee for lunch. At least I think I did :)

Of course, going on strike would have been self immolation. I wouldn't have kept it up. But short term, the first thing I would have done would have been to disconnect my heart monitor :)

More Nerdy Stuff - and Surgery Delay

The surgery will be Thursday. The first indication I had this might happen was when they canceled the TEE test. Shortly after, my doctor came in and said we needed to delay until Thursday because they couldn't schedule a "mapping" tech. This is a disappointment, of course, since I'll have another two days in "stir."

But I asked what a "mapping tech" did and got a fascinating answer. As the catheters move into the atria, their positions are precisely kn0wn. They take lots of readings and map the atria with the catheters. Then they take the CT scan data and merge it with the direct measurements. The resulting 3d model is used to guide the ablation catheter to the precise location the surgeon wants to apply ultrasound to. This allows them to conduct the procedure without using additional X-ray imaging. I asked the doctor if I could have a dump of the data, and he said yes! I may have to learn something about the data formats, but the prospect of visualizing my atria right on my Mac just makes my nerdy toes curl with pleasure.

I'm glad I get distracted by stuff like this. I think I would feel more annoyed by the delay if I didn't.

Care for Some TEE?

That's Trans-Esophageal-Electrocardiogram. They shove an ultrasound transducer down your throat until it's got a clear shot at the heart, with no ribs in the way. Then they do an electrocardiogram from there. When I mention the test and express distaste, everyone - doctors, nurses and janitors says "ah, but you'll be sedated - no problem." I guess it's a reflex for medical people to minimize the unpleasant parts of the procedures they put you through. Reducing the anxiety of patients waiting for fun things like the TEE makes sense. But I always feel a bit betrayed and condescended to on the other side of the experience, when I compare what they told me to expect with what actually happened.

In this case, I know all about the TEE since I had one after my open heart surgery in January. It's true they sedate you for the procedure itself, and that is effective. But there's a set up phase they don't tell you about. That's where they numb your throat, then shove a tube down there to test the gag reflex. You choke, they numb some more and the process gets repeated. They need you conscious for this tasty part of the test, because they need your gag reflex to be unimpaired by anything but their topical anesthetic. It turns out I have a strong gag reflex. Back in January, it took five or six go rounds before I stopped gagging. At that point they hit me with the sedative and I went to dreamland for the rest of the fun.

I've just been told the test has been canceled.

Sunday, August 2, 2009

Testing Confusion

I've been in the hospital quite a lot in the last year and a half. Over that time, I've come to the opinion that hospitals have to be among the hardest organizations (of comparable size) to manage. Considering how many systems have to be integrated to deliver effective medical treatment, the complexity is not at all surprising. But from the patient's point of view, everything comes together at the POT (Point of Treatment - not sure if that's original coinage or not.) This often resides in the person of a nurse. These people bring their skills, education, compassion and patience to the party, (along with negative traits, of course, as the individual case may be) but behind them stands an army of people, places and things. Any failure in that chain has the potential of showing up in the care the nurse delivers.

I had an example of that last night and this morning. When the night nurse came in, he looked at the doctor's orders and announced that I needed to be fasting for tomorrow's (today's) CT scan. I objected that I hadn't had to fast for the first one. He said "well that's what the orders say." I grumbled a little as he looked deeper into the oracle's window. Then he announced that the notes said that the CT scan and another charming test called the TEE were to be given "perioperatively." This was a new word for me. It means "during the operation." It made some sense that they might do a TEE at the same time as the ablation. But it was absurd to think they would do that with the CT scan. Interpretation of the results takes time. The data from a scan is handed to a lab on a CD. They process it and build a 3D model of the area of interest. All this work has to happen before a doctor gets so much as a glimpse at the images. Anyhow, I didn't believe that the CT would be on Sunday. Sure enough, this morning they withheld my breakfast. I whined about it again, with results similar to the ones I got the night before. I asked the nurse to see if she could find out when the scan was going to take place. After telling me they have no way to tell for sure (which I know is generally true) she went away. When she came back she announce that it was scheduled for 10AM. This all happened at 7:30 AM. I thanked her and grumbled some more to myself. But ten minutes later, the wheelchair showed up, and I was on my way to the CT lab.

When I got to the lab, I asked the technician about the fasting requirement. He said "oh, it's not necessary for a scan in the chest . Some patients get nauseous with the contrast [dye] and we don't want them aspirating their breakfast." I was still cranky, so I said (to myself) "They know that I don't get nauseous with the dye." The drill for this second test was nearly the same as the day before. One difference was that they injected a testing quantity of the dye, and timed how long it took to reach my heart. From this I inferred that the problem with yesterday's test was that the timing of the dye and the imaging hadn't worked out well. I have an irregular heart rate. It's therefore difficult to predict the diffusion of anything through my circulation. So they went with a direct measurement to find the rate. They ask you to hold your breath while the imaging is happening This get's rid of some of the motion in the chest. But something I didn't know: it also slows the heart rate. But my heart is sometimes perverse. When I held the third breath I took in response to the techs instructions. My heart rate dropped by a third. It went from ~120bpm down to ~80bpm! This is the lowest measurement I've seen since I was admitted. It makes me wonder if they should just have me hyperventilate all the time, rather then doing the surgery. Or perhaps I could avoid surgery if I am regularly exposed to impressive high tech spinning magnets, or being on my back while a hot flash runs through my body. Whatever, the hot flash washed through me about half a second after the tech told me to breath. They had missed the picture again.

When I got back to my room my stone cold breakfast was waiting for me. I had them nuke the nukeable parts and ate it. The food here is actually pretty good. It's not just green jello as a friend says. Warmed over, it's less appealing, but I was hungry so I didn't take much notice.

The surgeon was by and said I wouldn't be subject to yet another CT scan. He also confirmed that I would have the TEE tomorrow (Monday) morning, followed by the ablation the next morning. This means I'll be fasting two days in a row. But at least I'm forewarned, and I can get the grumbling out of my system by writing about it here. :)

The TEE test is a doosey. I had one after my surgery. I'll blog about it tomorrow while the experience is fresh. That is, while the drugs are still working.

Saturday, August 1, 2009

Surgery on Tuesday

That's the word from my electrophysiologist. I had a CT scan today. I'd had one after my CAB, so I figured I knew what to expect. They gave me the usual injection of contrast dye. This time around, the hot rush from the dye was far more intense than I remembered from the earlier scan. It swept through my body from top to bottom, ending up in a sensitive place. Despite this, it was not titillating, it was intense and weird. I asked the technician about that and got an interesting answer. After the CAB, they were looking at the coronary arteries and at my graft. This time the target was both of my atria. There's a significant difference in size between the two areas, with the two upper chambers of the heart being larger than the section of interest in coronary artery disease. Anyhow, the size difference meant that they had to inject the contrast dye a lot faster, so they would get a bigger spread of dye. So I got a more intense sensation of heat. Unfortunately, they didn't get the picture they wanted. They didn't repeat try because they couldn't inject more dye due to concerns about the kidneys, so I'm scheduled for another scan tomorrow. Joy joy.

My psychiatrist is OK with me going directly to the retirement home. I wont have to spend time in stir on the third floor. This is quite a relief.

They guy in the next bed in this semi-private room is 98 years old. He's bright and alert and plugged in to current events. We've had a couple of good conversations, each lasting more than an hour. He came in with a calcified valve that nearly killed him. I want to be like him at his age :)

Friday, July 31, 2009

Waiting for Surgery

A compromise solution for the management of my blood thinning medication has been agreed to between my psychiatrist and my electrophysiologist. After discharge, I will move into a retirement home in Burlingame, where they will make sure I keep up on the blood thinners. I'm 90% sure I would be fine managing my own meds as I was for months after my heart attack and since my open heart surgery, The 10% uncertainty is due to the fact that I just suffered through a major depressive episode. As I related in the last blog entry, in the last week of that episode my dosing became erratic. I would forget to take the meds and miss doses. I also varied the times I took them because my sleep was disrupted. The risk of dropping below therapeutic levels and suffering a stroke if I have a recurrence of the depression is too much for my surgeon, and for me.

The retirement home is an expensive option. It would last for 3 months. I'm considering whether or not to move out of my apartment. I'd been thinking about that anyway. It would help me bear the additional expense. I'd be prepared for a fresh start after the three months, which I very much need in any case.

My physical/psychological situation has complicated plans for my care in another way. I'm going to enter an outpatient psychiatric program after leaving the hospital. But before that happens, it may be that my psychiatrist would like me on the locked ward for evaluation. That usually takes three days. I've been down there. It's drab and boring and filled with miserable, suffering souls. But if that's what I need to do, then so be it. I'd like to get that over with as soon as possible, but they won't take me until my medical situation is resolved. So I will sit here in the hospital spinning my wheels over the next several days, when I theoretically could be "serving my time" downstairs. On the other hand, it may be that they will be OK with me going directly to the outpatient program. I hope that's the case.

This experience has been an eye opener for me on the relationship between psychiatric and general medicine. I've also gotten a look at how dentistry is treated by "regular" doctors. These topics are ripe for a blog post. I have time to kill, so I may write such a post over the weekend. :)

Wednesday, July 29, 2009

Arrhythmia and Depression

I had open heart surgery in January of this year. The surgery was to bypass blocked coronary arteries (CAB) and to remove scar tissue left from my heart attack (LVA). Another component was a modified maze procedure, to try and address my atrial fibrillation and atrial flutter. The first two procedures were a resounding success. My ejection fraction is 55, which is essentially normal. This was an improvement from an EF of 30 before the surgery. But the maze procedure completely failed to address my arrhythmias. Since June, I've been suffering increasing bouts of arrhythmia combined with tachycardia.

Since May, I've been experiencing an episode of major depression. Over the last ten days, I started skipping medication doses due to forgetfulness. I also varied the times I took the medications because my sleep patterns were disrupted.

To understate the case, these two illnesses are interacting in an unfortunate way. It's not just that my depression interferes with my medication schedule. Because of debilitating symptoms (shortness of breath, exhaustion), the arrhythmia makes the depression worse. So that's a tidy little vicious circle.

Last Monday morning, about 2AM, the arrhythmia got worse. My heart was racing at about 140 beats per minute, and I became concerned about it. I took a cab up to the local ER, where I presented myself as suffering from arrhythmia and depression. After examining me, the ER doctor made the decision to admit me into the intensive care unit for the former condition.

I spent two nights in ICU before moving to over to the Telemetry Care Unit (TCU.) I'm still sitting there as I write this. My electrophysiologist has a wealth of new data on my heart condition. That in turn has allowed her to clarify the choices I am faced with. These break down into two main choices. First, we could continue "medical management" of my condition, meaning we could try to control the arrhythmia with drugs. The drug of choice for in my case would be amiodarone. I went on this drug after my heart attack, and it controlled the arrhythmias. But then it gradually stopped working. Higher doses are possible, and we are trying those to see if we can't get the a-fib/flutter under control. The drawback of amiodarone is that it has toxic effects on the liver. Since I'm only 53, those effects would be more likely to show up if I went on the medication for the long term. Amiodarone also interacts with just about every other medication on Earth, limiting clinical choices when dealing with other conditions. Also, there's no guarantee that amiodarone will work at a higher dose.

The second option is ablation surgery. This is a technically very interesting procedure done by passing catheters up the femoral artery. Two have sensing electrodes and one an RF generator. The surgeon attempts to induce the arrhythmia, then measures electrical conductivity on the atrium looking for the rogue circuit. Once found, the RF generator is used to scar the atrium in such a way as to disrupt the circuit. Then the surgeon tries to induce the arrhythmia again and the procedure is repeated as often as needed. There are two factors that complicate this choice in my case. First, I have atrial fibrillation and atrial flutter. That means that the circuits involved are more complex, and so correspondingly more difficult to fix. The second factor is that it's likely that I have arrhythmia arising from the left atrium. To get there, the surgeon has to drill through the wall separating the two atria. This lengthens the time required for the surgery. Most critically however. It raises the chances of a stroke to 1%.

And that's where my depression comes in. If I don't keep up with my blood thinning drug, and maintain my INR within therapeutic range, the risk of stroke with a left side ablation rises to between 3% and 7%. As my electrophysiologist says, a stroke would "ruin everything" for me. So I need to be sure nothing will interfere with my dosing and testing schedule. But the depression has recently caused me to miss doses, so my electrophysiologist is insisting the depression either be resolved, or that I enter into a living situation where someone can ensure I take my meds on schedule.

Thursday, July 23, 2009

Health Insurance Nightmare

As a response to a political appeal from the White House, I described my recent experiences with the health care system. I reproduce my letter here.

I had a terrible heart attack in Jan 2008. Afterward, I fell apart psychologically. I lost my job, my disability income and my health insurance due to my own inaction. By the time I had collected myself enough to try to get these things back, I had a long way to trudge through the system to get access to health care services I desperately needed.

Getting my job back was easy. Merely getting in touch with my company did the trick. Getting health insurance and disability benefits turned out to be a lot more difficult. The medical carrier refused to take me back until open enrollment. This was six months away at the time I got in touch with them. It turns out they reversed themselves later, but as a result of the first decision, I found myself dependent on the County of San Mateo for my medical care.

San Mateo has pretty good coverage for medically indigent people. But lack of funds means that the doctors and staff are faced with huge workloads. For example, there are two cardiologists on staff for the entire county. These two doctors are both excellent physicians. The care I received from them was very good. But getting to it was difficult. The county pays classified staff poorly. As a result, people with a lot on the ball tend to move on to greener pastures. Those left try hard, but the combination of high workload and high turnover means there are many deficiencies in services supporting the medical work.

It took me many weeks to get to the point with the process at the county where I could have an angiogram done. This was performed under contract at a non-county facility, since the county medical center lacked the equipment. In fact, it was at the hospital I had been brought to when I had my heart attack. The result of the angiogram showed signs of ischemia. The examining doctor recommended bypass surgery. Partly due to my own missteps, but also because my insurance company wouldn't take me back, I had been living with a very dangerous heart condition, and with a difficult path to get to needed care.

This was in January of 2009, one year after my heart attack. I had applied to get my health insurance back the month before. Just before I was to have my surgery, the private insurance kicked in. My surgery, scheduled through the county system, was to be at the same hospital I had the angiogram at. The surgery was to take place on a Saturday. That week, I went in for pre-surgical orientation on Wednesday. They were letting me know things such as the fact that my hands would be tied when I woke up from the anesthesia. (This so I wouldn't try to remove the breathing tube.) Half way through this process, one of the nurses who was delivering the orientation got a phone call from the HMO. That hospital wasn't under contract to them. They refused to pay for the surgery if I had it there.

The hospital I was sitting in when I got the news was the one to which I had been taken the year before, when I had my heart attack. I was later told by the doctor that saved my life that I had a 25% chance of survival when I was wheeled into the ER. Watching this guy bounce around like he was on springs, leading a team of people who were all trying hard to keep me breathing was immensely reassuring at the time. I felt huge gratitude to these doctors, nurses and staff who had cared for me so well. What's more, I trusted them and the hospital they worked at implicitly with the surgery I thought I was about to undergo. The change in plans was huge shock.

I turns out I retained the same surgical team at the new hospital. In fact, the new hospital was their home base. This meant the delay was only for a week, the time it took to schedule the operating rooms. Though I kept my doctors, I have a strong impression that the change would have been forced by the HMO whether or not I could have retained the same team. If a new surgical team had had to evaluate my history and condition, the delay could have been much longer. As it was, an extra week's wait did mean an additional risk of something going badly wrong with my heart before I could get the surgery I needed.

That's my story. I'm still on disability recovering from the bypass. I have an ablation surgery coming up. It will be at my preferred hospital, since in the meantime, the HMO has been switched to the one associated with that hospital. This makes me pinch myself a bit to make sure I'm not dreaming. I want to be sure it's not one of those dreams where events seem almost real when you are asleep, but which reveal themselves to be complete nonsense when you open your eyes. I only wish this were nonsense and not the cold reality I actually experienced.

Wednesday, July 1, 2009

I Love my Macbook

I love this laptop. But like love between humans, my attachment to my Mac is not perfect, and comes with reservations. Firstly, computer software sucks generally. The Mac is only a partial exception to this general rule. Second, I want all information to be free. I know this is childish and unrealistic, but that knowledge doesn't help. I am irrationally committed to Free Software. So the fact that the Mac is proprietary occasionally makes me cringe.

Here's a portion of an email I sent to a friend that works at Apple that sums up my feelings about my new machine:

You guys keep churning out great stuff. I bought a MacBook Pro the beginning of March, and I have no hesitation in saying it's the best damned laptop I've ever owned, and I've had *lots* of laptops. The thoughtful physical design, ergonomics, all that is fine. But it's the software that really rocks. Coming from Linux, I occasionally get annoyed by proprietary road blocks or toll roads. But it's nothing compared with the pit of impotent despair that I sink into while wrestling with the execrable, wasteful, irredeemable pile of stinking rotting fish that is Windows. OS/X makes towing the proprietary line seem OK. Windows brings out the insurrectionist in me. Depending on your political point of view, you could say that OS/X is Obama and Windows is Bush. They both represent the same system, but differences in style and substance make one a whole lot more tolerable than the other.

So keep up those long hours. Domestic tranquility depends on them. :)

Proprietary Software's Premature Obituary

Another prediction of Linux World Domination(tm) has appeared on Geek dot com. Not atypically for this sort of thing, it's coupled with another prediction of the demise of Microsoft and proprietary software in general. Is it likely that we have actually heard a "death knell" for the proprietary approach? To provide a partial answer to that question, we can look at the successes and failures Linux has had on the road to world hegemony.

First, it's helpful to remember that we are dealing with at least three separate markets when it comes to Linux vs the proprietary competition. Those would be the server, embedded and desktop markets. Taking them in reverse order, please allow me to pontificate on the relative strengths and weaknesses of Linux in these market segments.


Desktop dominance has hovered like a shimmering mirage in front of Linux enthusiasts, and some Linux companies for years. The massive failure of Vista gave people lots of hope that the day of desktop dominance had finally arrived. But the fact is that Linux gained a minuscule amount of share in this market over the years since Vista's release. Apple benefited more, but Macintosh is still below 10% share. Why is that?

Dirty Tricks

Microsoft has been infamous for using illegal methods in pursuit of its businesses. I followed the antitrust trial back in the 90s, and read about all the dirty tricks MS pulled to fend off the twin platform threats of Netscape and Java. The company seemed willing to go to any lengths to crush competitors. But Microsoft is unable to be quite so bare-knuckled these days. The antitrust trial illuminated a lot of Microsoft misbehavior. And, although the US DOJ under George W. Bush backed off on tough sanctions that might have been effective in modifying Microsoft's behavior, the European Union later stepped up and actually enforced their antitrust laws. This provided more evidence of Microsoft wrongdoing, and came with sanctions and restrictions that actually had some effect on the company. Bill Gates' reduced role in the company may have led to less over the top behavior by Microsoft too. But despite having to tone down some of the excesses of the past, the company still ferociously defends markets in which it is entrenched, and remains a potent threat to any competitor trying to play in one of them. However dirty tricks are less likely to be the only factor driving Microsoft's success today. What else could account for that?


Though the hardware driver picture has improved considerably on Linux, Microsoft's market dominance still means that hardware vendors are more likely to deliver ready to run drivers for their products on Windows first. Your latest PC may have trouble in that department. My not-so-new MSI Wind U100 netbook runs Ubuntu 9.04 Notebook Remix. It's gorgeous, but the wireless won't do WPA2 authentication. This means that until Ubuntu fixes the bug, this cool little netbook will work fine in the coffee shop or the airport, but not at home or in the office. You can obtain, patch, build and install a kernel module to fix the problem yourself, but if you think about it, you'll see that's irrelevant to this discussion.


Perhaps the weight of Microsoft's installed base, what the DOJ called the "applications barrier to entry," is the reason Linux can't seem to gain a lot of traction on the desktop. It's certainly true that Microsoft enjoys enormous leverage with software vendors, due to the massive market their platform provides. This leverage makes it more difficult to defect from Windows on your home PC. Your proprietary apps may work on Linux through some combination of wine and virtualization, but try to get support for those solutions, in the general case. What I mean by "support" is not just help when it breaks, but smooth and easy installation and initial configuration. And though high quality native equivalents to important commercial applications exist, few can boast the installed base, and the concomitant support from vendors and community resources that popular commercial apps enjoy. On business desktops, it may be more feasible to deploy Linux with a limited set of applications, either virtual Windows ones or native. But the IT staff is still faced with a relatively more difficult job supporting those apps given less vendor support.

New User Friendliness

Then there's the difference in ease of learning you often see between proprietary and F/OSS. A specific example may show better what I mean. Take Photoshop and Gimp. Go to and compare the new user documentation to Pretend you have never used either app and try to figure out how to get started. Hint, you'll find the info at Gimp's site, but you'll have to dig deeper, and you won't get the same quality for the new user. And this difference extends to third party support for the applications as well. Do a book search on Amazon, first for "photoshop" then "gimp," and count the number of results. Go to and check out the Photoshop video tutorials. Try to find anything 1/2 as good for Gimp there or on YouTube.

This focus on newbies goes to the heart of the Windows platform advantage on the desktop. New users of Linux tend to be significantly disadvantaged compared to their counterparts in Windows as far as learning new applications goes. My feeling is that's so because the folks that develop the software, as opposed to the people who integrate the software into a distribution, tend to lack a new user's perspective. They produce software that is easy to use once you get to know it well. Since Linux desktop domination requires coaxing lots of Windows users onto an unfamiliar platform, this deficit in hand-holding newbies bites hard. Linux distributions struggle to provide the new user with a consistent and usable environment for desktop computing. New users of Linux are likely to perceive the difficulty in picking up a new (insert user's critically important app here) as the whole story on Linux as a platform. On the other hand, it's not like Windows as a platform offers a whole lot of help in the integration department either. But the apps tend to be designed by teams that include people who want to suck new users into using them. With apologies to the minority of application projects that have worked hard to design in discoverability, and who have provided outstanding, lucid and accessible documentation with the naive user in mind, all that is just not a priority in most open source application development.

Which is it then?

You can argue about how much of Window's advantage is due to inertia and market size, and how much is due to apps that are relatively easy to learn, but there's an experiment underway that can help answer that question. MacOS X is a Unix based OS famed for usability. Applications on MacOS X are often easier to use and learn compared to their Windows equivalents On the other hand, Macintosh suffers from a similar disadvantage in critical mass that Linux does with respect to hardware and software. Macintosh enjoys about a 10% share of the desktop market, whereas Linux is around 1%. Since the two platforms face similar (though not identical) challenges trying to overcome Microsoft's market domination, we can factor out those disadvantages when comparing the two OS in terms of market share. To a first approximation, a substantial portion of that tenfold advantage in Mac desktops over Linux must reflect the advantage usability confers.


In the embedded market, Linux has a big advantage in cost. If you are talking about a mass market item, like a cellphone, that cost advantage is a huge factor. Also, embedded applications tend to be under tighter control than typical desktop apps. An alarm system is a special purpose device - achieving usability is straightforward. (Even so, it's remarkable how many embedded applications suck bigtime.) The basic cellphone applications, making and receiving calls, accessing voicemail, managing contacts, and so forth, are well defined and relatively uncomplicated. As you move up to more general purpose computing on a mobile phone, complexity increases, and many of the usability factors that are important in the desktop space come into play. But there's less historical MS hegemony here. Finally people seem to be more willing to accept learning a different way of navigating a new phone's interface compared to learning a new computer OS. So Linux has a clearer field in the embedded space.


Finally, in the server market, Linux has done and will continue to do very well. GNU/Linux started life as a Unix clone, and Unix was and remains a server OS (MacOS X notwithstanding.) Basic server applications on Linux are more mature, and requirements for application usability are different. Engineers volunteering time for server development on the GNU/Linux platform look more like their users than their desktop cousins. Indeed, the users are often those very engineers. Linux attracts quite a good deal of free R&D for new server roles. Today it's virtualization, yesterday it was clustering. Linux led both those technologies, and maintains strong positions in both today. Tomorrow the popularity of Linux in academia, and the support of big companies like IBM and HP guarantee new trends in servers will be quickly taken up, if not actually pioneered on Linux. And businesses care about some of the the advantages F/OSS confers on computer users. Avoiding vendor lock-in and providing fundamental transparency in the infrastructure are attractive to business, along with low cost and high software quality. I'm aware there are advantages to Free Software beyond the ones I just listed, but those are the ones that tend to appeal to businesses interested in using Linux in the server room.

No Panaceas

Linux is not one thing. Diversity abounds. People contribute to it, and use it, for a huge variety of reasons. So it's natural that Linux succeeds differently in different contexts. It would be unreasonable to expect anything else. Panaceas don't actually exist in the real world. Linux is not a panacea, it's a real, live, vital OS, with it's unique set of strengths and flaws. It will continue to do well in many areas, and may do better on the desktop some day. But Linux has farther to go there than in the markets which leverage its natural strengths.

Dead Software?

If you stop thinking about Linux and F/OSS as singular answers to the problems posed by computer systems and applications software, you may be able to see that software sold for profit actually has strengths and weaknesses too. However much you may wish it weren't so, from the user standpoint, software written for money rather than love is often a better solution. Alternatives to many of the flagship proprietary applications need to provide more than high quality code. They have to be designed, packaged, documented and supported to compete with their closed source competitors. One problem is that software engineers who code for love may often not be the best people to deliver on all of those requirements. Until that, and many other things change, proprietary software will stay off life support.