Rakibinizin Stratejisini Öngörmek – Bölüm 1

Satranç gibi hamlelerin birbirini takip ettiği oyunlarda rakipler, karşıdakinin hamlesini görerek kendi hamlesini belirlemeye çalışır. Ardışık hamleli oyunlarda, her oyuncunun, geriye doğru akıl yürüterek kendisinin o sıradaki hamlesini öngörmesi gerekmektedir. Doğrusal bir düşünce zinciri vardır: “Eğer bunu yaparsam, öteki oyuncu şunu yapacak –ki bu durumda ben de şöyle karşılık vereceğim.” Bazı oyunlarda ise oyuncuların her ...

A nurse on coffee.

It is inhumane, in my opinion, to force people who have a genuine medical need for coffee to wait in line behind people who apparently view it as some kind of recreational activity – Dave Barry

When not at work, I wish my days rounded with an ambiance of slow, ritual caffination.

You see, working in the emergency department is distastefully instant.
You are simply not afforded the slightest space amongst the tachycardic catastrophies to let your lips simmer over molten-gold creme.
To pause and feel the weight of your favourite chipped clay mug cupped in your hands. Or perhaps porcelain. Or earthenware.
To lean in and feel the swirling warm steam feather your cheeks.

You can probably already guess that I am a bit of a coffee junkie. But far from a connoisseur.  I admit straight up that I like my cup strong and hot as sun-plasma, which is not really a great cup if you are knowledgeable in these things, as it dampens the delicate oils and ‘bakes’ out the flavour.

I lope over to the hospital coffee shop and impatiently queue up for a brew, standing in line for 10 minutes behind the towering orthopaedic registrar. Only to have him step up and order 9 cups for all his theatre buddies…no, actually make that 10.
And then turn to face down to me with a sorry about that grin that leaves me no other choice than to deliver a swift imaginary flying back-kick to his testicle bones.
With a screaming run up from way down the corridor near the oncology unit. To ensure compound fractures.

When I finally do return with my prize, I inevitably end up leaving it sitting half interrupted, just a few sips past foreplay, next to some pile of patient notes.
Whilst I, you know…..rush over to someone vomiting, or dying, or wanting me to make them a coffee or something.

So I leave my Styrofoam cup laying around to go cold…yet again.
Or to be spilt… expletively across a patients notes, or into a keyboard. Probably by a staff specialist or the nursing unit manager.

At work, for me at least, coffee is just Styrofoam, or perhaps those reusable cups that I buy from time to time to do my bit to save the planet.
Cups that always smell of plastic and stale milk ’cause I never wash the lids out properly…. and then inevitably leave them lying around only to be found several months later in a cardboard box on the tea-room table full of dirty Tupperware.
You know, the box with a sign written in red bold pen proclaiming that any items not claimed in the next week will be thrown out. Thrown out printed in capitals. With 3 exclamation marks.
The box that holds 11 other of my curd encrusted planet savers. That box.

But on my days off, coffee can be way more enjoyable.
Searching out new coffee shops provides a happy matrix of way-points to plot against any downtime adventures. Especially satisfying are those unexpectedly awesome coffees found in off-the-track, stumbled upon places.

I once spent a 3 week holiday dragging Kelly all over Japan in a desperate search for a good cup of coffee.
We totally had the most fantastic time and our search bumped us up against many helpful people.
But alas, the coffee sucked everywhere…. except for one Arabica-oasis in the centre of Tokyo.

In fact by the end of the trip I think I had completely detoxed from caffeine against my consent. I felt more relaxed. And light. My soul was re-perfused with the oceans of green tea I had been consuming. It was bad. Real bad.

Despite this green tea satori, arriving back in Sydney airport it was a mercy dash to the first coffee bar to order a strong, hot, flat white.
The bored looking girl behind the espresso machine cranked out a cappuccino. When I pointed out that I had in fact ordered a ‘flat’, she lifted the cup back from me, placed it down on the counter, picked up a knife and (to be fair, with quite a flourish) sliced the foam off before handing the cup back to me.
A decapitated cappuccino. Welcome home.

I have my favourite coffee haunts that I guard with the same measured vagueness you might get when asking a surfer about the best local break.

My personal secret way-points are cast wide.
There is an Autumn place in Leura, a small town in the Blue Mountains west of Sydney.
Spring coffee beside lake Wanaka on the south island of New Zealand.
Winter brewed in the heart of Melbourne. Summer on the Great Ocean Road.

And yes, I have my favourite places right here in Canberra. Give me a rainy afternoon, a comfy chair and a book. Life is good.

Im sure you will agree, great coffee is about far more than what is in the cup.

If you talk to true coffee experts they will talk about the 4 M’s that go together to make the perfect cup:
Macinazione is the correct grinding of a coffee blend. Having a good grinder is considered at least as important as having a quality expresso machine.
Miscela is the coffee blend. There are as many blends as there are adventures you can undertake searching for them.
Macchina is the espresso machine. Now don’t get me started here, some of these things are works of art. Ohh….shiny.
And finally the Mano. The skilled hand of the barista. I could tell you about my dreams of scantily clad, geeky, Swedish baristas…….
Ahem…..but I wont.

No, coffee is more than even the sum of these parts.
It is also about infusing place, and person. The ambiance of your surrounds, the quality of your companionship, and the tempo of your day.


Last days of the stethoscope?

GH TOC 500x381 Last days of the stethoscope?In the current issue of Global Heart (journal of the World Heart Foundation), several Mount Sinai authors have published articles on the use of point-of-care ultrasound. Phil Andrus wrote about focused cardiac ultrasound, Jennifer Huang co-authored a review of ultrasound use in IVC assessment, Daniel Lakoff described ultrasound incorporation into rapid response teams in inpatient wards, and Bret Nelson and Amy Sanghvi wrote a review of non-cardiologist use of cardiac ultrasound.

Bret Nelson and Global Heart Editor-in-Chief Jagat Narula wrote the editorial for the issue, which focused on improvements in ultrasound technology creating new opportunities and markets for ultrasound use. One theme of the editorial was whether ultrasound could replace the stethoscope, and as you may imagine the press has picked up on that thread!
CBS news visited Mount Sinai and interviewed Drs. Nelson and Narula.
And a number of media outlets have covered the story, including Popular Mechanics, the Huffington Post and others.
Mount Sinai has incorporated ultrasound into medical student education in Gross Anatomy since 2006, and last year began a curriculum in focused ultrasound as part of the physical examination course.

Need a change of scene? How about working in a flying ED?

Minh Le Cong (from the Prehospitalmed blog) has done a great post about a recruitment drive for the far north-west Queensland (Mt Isa) Royal Flying Doctor Service. They are looking for doctors for casual and permanent part-time positions.  If you’ve ever wanted a taste of the retrieval-life, with only one (and occasionally two or three) […]