Shabbir's Diary

Mindshare's annual adventure

Every year my company has a retreat.  The planning of the retreat is complicated but I'm given sole responsibility for the fun activity that precedes it.  This year it's a Crime Scene Investigation involving a robbery.  (I'm being a little cagey because I know several employees read my blog)

Every year we create the teams, and every year they try and top each other in announcing themselves and creating the team persona.  The first team to announce this year did a YouTube video (which tells you a little about the zeitgeist around here) that "channels Borat", as Sarah so aptly put it.

Check it out: YouTube - Moving picture for make introduction of team one.

Comments from Sarah about the New Yorker article

Sarah's blog is all about knitting nowadays, but she had a response to my post about the New Yorker article in an e-mail to Aaron, and she's allowed me to repost it here.  It adequately describes the issues with a C-section from the patient's point of view, something I'm not able to capture adequately.

I’d like to point out that the author assumes that the anecdote he uses is ordinary.  It is in that the woman, a doctor, went to some sort of vague “childbirth class” and then felt like a failure afterwards.  A lot of the training I did while pregnant was to do things like a) be able to figure out if my kid was in the right position in utero before going into labor.  I was 100% sure he was in exactly the right position, and I knew what that position was, that I had no fear of him turning sideways or upside down.  My midwife helped me learn that and monitored my child’s position, but my ob did not!  He said he didn’t care what position the child was in! 

Shabbir and I were shocked that he wouldn’t use his modern medical equipment to check on his position while the midwife did that on every visit in my last month with her hands pressing on my belly.

This is the difference between obs and midwives.  The ob was so very clearly confident that he would be able to rip me open (and thus go from having child making being a female activity to a male activity) that he didn’t care about preventing the rip in me at all. 

There was other training, the Bradley method class was great for this, and so was my midwife, and what she said throughout the birth is that I handled the birth of my child as if I were very experienced with childbirth. Not, “oh she had an easy labor” which is what other people said as if some how it was entirely out of my control.

The article doesn’t address the difficulties women encounter in future pregnancies after having Csections.  Once you go Csection, you can’t go back.  Well you can, it’s called VBAC, but now most insurance providers won’t pay for it.  So the first doctor to rip you open ensures either a limited reproductive life or repeated ripping. 

Also the article doesn’t address the health benefits of natural child delivery vs. Csection and epidurals, but it does point out that obs speculate that csections prevent incontinence.  There are piles upon piles of articles about the benefits of natural child delivery to both mother and child, including nursing.  Not being able to nurse is a common problem after Csection, but the article says her “milk failed” – again blaming the mother – instead of the medical staff who might not have put her child to her teat after it was born.

A thirty year longitudinal study of at home births vs. hospital births has shown that there is *NO* greater risk of dying or your child dying at home than in the hospital.  I’ve just quickly tried to look for it and can’t find it, Alice told me about it last summer.   But here’s what birthcare says:

http://www.birthcare.org/safety.html

Do we have to give up natural childbirth to save infants?

My friend Aaron Pressman recently asked me what Sarah and I thought about the October 9^th New Yorker article on the rise of the Caesarian section (C-section) as a child birthing method.  (Sarah hasn’t seen it yet)  If you’ve read the story of the birth of our first child, you know this isn’t an abstract discussion for either of us. 

The New Yorker article goes into the history of the use of C-section and it’s prevalence in modern childbirth. The C-section is not the most pleasant, least intrusive, or most effective technique of mitigating problems in childbirth. It is a medical equivalent of the concept, “every tool is a hammer”.  Easy to learn and used roughly the very same way every time.

The problem with infant mortality that created the demand for C-sections isn’t a medical one. Problem births have many non-surgical techniques, all of them doable in the hands of trained professionals. Medical researchers discovered that they require a great deal of both talent and training to apply them correctly. And when they failed, infants and mothers suffer. Hence, the C-section.

The C-section is relatively easy procedure to perform and master. It is considered low-risk and carries a much lower chance of complication than the other methods of mitigating childbirth problems. It is a perfect medical option in every way except one: it’s takes an emotional and physical toll on the mother that is considered unacceptable by many of its patients. 

The goal of medical outcome researchers is to optimize performance of a system, in this case the system of childbirth. They have done that, using the Apgar score as a metric for the health of the baby. The Apgar score, which measures the health of a birthed baby, does not contain a score for the physical or emotional health of the mother. The author rightly suggests that perhaps it should. 

The unpleasant patient experience is probably the predominant reason that medical outcome researchers haven’t called for mandatory C-sections. The problem identified by the article is that many of the basic techniques for natural childbirth are being lost as younger doctors learn that birth involves either catching a perfectly delivered child as it comes out of the birth canal or scheduling a C-section. If this trend continues, the cycle of skill entropy will simply perpetuate the predominance of C-sections.  Do we truly have to give up natural childbirth in order to mitigate childbirth mortality?

We as a civilization can’t afford to lose these other child-birthing skills. Not every woman can or wants to deliver her child in an operating theater. Those that can’t make it to the OR will not be served well by their caregivers, who will have a hole in their child-birthing knowledge because nobody remember any of those quaint ‘natural childbirth’ techniques.

The Sandbox

One of my new favorite blogs is called The Sandbox, from Doonesbury creator Gary Trudeau.  He's basically republishing blog entries from military personnel from their own blogs.  Occasionally I think he's also publishing letters.

It's an excellent, unfiltered look into the minds of the soldiers both deployed and home, and the writing is all pretty good.  (I think Trudeau has an editor lightly touching up the entries.)

Link: The Sandbox.

Starbucks to sell hot breakfast sandwiches in United States

This is a really good idea.  Starbucks' food engineers have figured out how to make a breakfast sandwich that tastes a lot better and a lot fresher than most other fast food places but whose preparation is really very little work.  (the associates just stick it in a warmer/toaster)

I've become addicted to them, and it's certainly going to create new dollars from people who only bought coffee before.  It will probably also sell coffee to people who only want to get something to eat, and now have Starbucks as an option.

Link: Starbucks to sell hot breakfast sandwiches in United States - Oct. 5, 2006.

World War Z: An Oral History of the Zombie War

I know you're not surprised to see that I'm reviewing a book in the zombie genre, you already know my love of the shambling undead.  What you probably don't know is just how good this book is, and how I really think you should read it even if you only have a passing fancy for zombies.

Max Brooks, who wrote the "Zombie Survival Guide", pens this oral history of a world wide zombie outbreak that never happened.  It's written to take place shortly in the future right after the zombie outbreak has been mostly quelled.  However what's great about this story is that Brooks is a master at two key things:

• the traumatic war anecdote, and
• understanding the impact a zombie war would have in today's context.

The first is easy enough to imagine.  War is horrible, zombie war, well, more horrible.  Stories from kids who saw their families animate and attack, pastors and parishners, soccer moms, and of course the soliders.  All of these are in there and will give you the appropriate shivers.  This is an oral history, so all stories are told in interview format as a conversation between the interviewer/author and the subject.  Among my favorite stories:

Fernando Oliveira, a surgeon in Brazil who unwittingly assisted in the black market transplant of a human heart from a recently zombie-bitten man into a healthy patient.  After violating his Hippocratic oath, he becomes a shell of a man and never picks up a scalpel again.

Saladin Kader, a Palestinian whose family decides to take part in Israel's repatriation and voluntary quarantine of any person (Israeli, Palestinian, or otherwise) who had ever lived within it's borders or the occupied territories.  His anti-Israeli rhetoric becomes immediately outmoded when he's caught in a war between zombified Orthodox settlers and an Israeli Defense soldier who puts himself between the zombies and Saladin's family.

Breckinridge Scott, an entrepreneur who made billions with his phony anti-zombie drug before the tide of undead showed demonstrably that it wasn't working.  Breckinridge ends up waiting out the zombie war in a leased facility far north near the Artic Circle, far from both the living and undead that want to kill him so badly.

Mary Jo Miller, a pre-war soccer mom that finds the incredible inner strength to physically rend zombies when they threaten her children.  After the war she becomes a successful real estate developer, building planned communities of Masada-style homes that are design to be autonomous and impenetrable in the case of a zombie invasion.

 

What Brooks is really good at though is the intersection of a zombie war and today's current political cauldron.  Zombie outbreaks don't happen in vaccums, they happen in the context of fifty years of fighting between Palestinians and Israelis.  The soldiers that you send to fight the zombies are from a military decimated from a recent, unnecessary and unpopular war in the middle east.  In South Africa the government's attempts to control the outbreak begin to sound like the oppressive actions of the former whites-only regime.

South Africa, China, the US and the middle East all have their own unique problems with fighting a zombie war in their current political context, and Brooks makes it all entertaining.  So take a moment and pick up World War Z, and remember, if you can walk, you can outrun a zombie.  (Unless they're the kind from the movie "28 Days Later", and then you're screwed.)

The problem isn't your drinking....

Can someone explain to me why Rep. Foley is checking into an alcohol rehab center when his real problem is that he's a pedophile?  (That's rhetorical, don't answer)

I think it's actually probably a pretty good tactic to confess to a lesser evil.  When someone says you're a pedophile, say "No, I'm an alcoholic!".

I suspect this will probably deflect a lot of criticism.  But tell me this, why aren't the Republican leaders that knew about this problem and tried to hush it up any different from the Catholic leadership that buried stories of pedophile activity?

 

Link: Ex-Rep. Foley Checks Into Rehab - washingtonpost.com.