As an emergency room physician who works many different shifts at all hours of the day, I have learned a little about sleep and exhaustion over the years.

These are the sleepy categories of my life. For me there are four different kinds of tired ranging from mostly alert and ready to go, to exhausted to the point of not being any good to anybody. These are arranged from most awake to most exhausted. Converting from day shifts to night shifts puts me through the whole range.

The most awake is when I have had enough sleep and I am awake during a time that I am normally awake. A good example of this would be normal nine to fivers who sleep nights and work days. If they got a good night sleep and they are normally awake during the day, they are about as awake as you get.

Second on the scale of sleepiness is when I did not get enough sleep the night before but I am awake at a time that I am usually awake. For example a nine to fiver who did not get to bed until 2:30am. He is tired from not enough sleep, however, he is still doing his job then next day during hours that he is used to being awake.

Third sleepiest is when I slept well but I am being required to be awake during time I am not used to being awake. An example of this would be a nine to fiver who took a nap all afternoon and then had to stay up until 4am in the morning working on a presentation for work. The sleep would help, but the fact that he is usually asleep by 11pm would make him very sleepy in the middle of the am while working on his project.

The most exhausted times come when I did not get enough sleep and I am forced to stay awake during a time that I would normally be sleeping. For a nine to fiver it would be getting up at 7am, working all day and then working all night until four am on a presentation. Not only are they working at a time they should be sleeping, they have already been up all day.

For medical shift work it usually manifests itself like this. I have been working day or early evening shifts for weeks and it is time to work my first night shift. I don’t get any sleep during the day because I am not tired enough. Then I stay up all night long seeing patients. I am not used to nights and I havent been to bed in 20 hours. I am mentally and physically wiped. By day two, I have gotten a little bit of sleep before my night shift. I still stay up all night when I feel like I should be sleeping, but at least I have gotten a little sleep before my shift. Next day I sleep a little more and feel a little less like I should be asleep at four am in the morning. By my fourth shift, I sleep eight hours during the day and I feel at four am like I SHOULD be up at four am. I have succesfully converted to night schedule. Then my nights are over and it is time to switch back and go through the whole exhausting process again. All of this while making life or death decisions in a busy emergency room.

Mark Miner

Mardi Gras is a lot of things, but funny, like laughing so hard you can’t breathe funny, it’s not. Most of the time….

Last night was fat tuesday. The official end of Mardi Gras season. I was walking up Bourbon street. It was crazy packed and there was barely room to move. I was walking in the road right along the curb and I stepped in a puddle with my left foot. The pool of cruddy water mixed with New Orleans street debris was eight or ten inches deep. My shoe went completely underwater and it drenched up my pantleg. I stepped over to the side and shook my leg off. I was about ready to keep walking back to my hotel, when I realized how absurdly funny this was.

A lot of people are staggering drunk at Mardi Gras. Some are barely able to walk on even ground, let alone navigate a deep hole in the road. Instead of moving on, I picked a spot right in front of this murky lagoon and watched the next three or four hundred drunk people step into (and some of them fall into) it. Sometimes there would be a train of ten people in a row who would all step into it. I was laughing my ass off. I was seriously enthralled by this display. Over an hour later I continued on toward my hotel after some of the funniest stuff I have seen at Mardi Gras.

I was also drunk 🙂
Mark

Me! My favorite day of the whole year!

This is part of a series of posts describing what it is like to ride in the biggest parade at Mardi Gras.

The fun starts long before the parade!

Endymion is a Saturday parade. The actual parade starts around five pm, takes in a bunch of New Orleans, and finally hits the Superdome at around eleven pm. This IS Endymion to the hundreds of thousands of spectators who come to see this “super parade” in action. For Krewe of Endymion, it is a wonderful all day Saturday affair that starts at ten am and ends at three the next morning. The events of this wonderful day both before and after the parade itself make it my favorite day of the whole year.

For Krewe of Endymion the fun actually starts months before the parade with various activities, dinners, and balls that help plan the event and elect leaders.

Your dues are paid, beads and other “throws” are selected and purchased. If you are out of town, arrangements are made to stay in New Orleans for this wonderful party.

On the Saturday morning of the parade, we all meet at a good restaurant.

The last two years it has been Burboun House on Bourbon Street. The food there is fantastic and it is an open bar for us. Starting at ten am, we meet up with all of the riders of our float and have a great lunch, catch up with what is going on and laugh, curse, drink and share in some great guy comradery.

We usually roll out of the restaurant at noon with bellies and brains full of food and booze.

We walk out onto Bourbon street wearing our parade costumes. This is where Rock Star for a day actually begins. Walking Bourbon, costumed for Endymion, is like being royalty. Everyone along Bourbon wants a picture with us. Old men and women, great families, and oh yes, the ladies. It is very cool to get your picture taken with parade Krewe (lucky us). We meander down Bourbon causing commotion the whole way, wandering into establishments to stay boozed up lest the wonderful buzz of the day come to a premature end.

Float Captain James Moises Recaps the Rules

Next on the bus to our floats.

Here we get a last minute recap of rules that we have heard so many times before. It would not be Mardi Gras without this re-hashing of what not to do! A couple of the rules that get emphatically mentioned every year are; One, once the parade starts do not throw your first beads until the float captain does, thus signaling the beginning of the parade for your particular float. Two, and very, very important, do not at any time during the parade take your mask off! The charm and mystique of Endymion dictates that the riders are officially anonymous. Friends and family of riders can easily pick out their rider on the float though. After the rules recap, distribution of sandwiches, and other last minute details, we arrive at the parade site.

Instead of the bus dropping us all off at our floats, which are at City Park, we are dropped five or six blocks away.

This is one of my favorite parts. We walk in costume, beads in hand, mildly intoxicated through a wonderful neighborhood near the park. There are thousands of people lining the streets. Some have been there overnight to get a good spot just to watch Endymion Krewe walk to their floats. There is music and tents and barbecues. It is easy to find an encampment of folks that you don’t even know, sit and have a sandwich and beer with them. Everyone is so friendly. After partying on the walk with families, beer and fun, it is off to our floats. Just as you hit the edge of the park, you suddenly get a feel for how HUGE Endymion actually is. The floats line up from one end of the park to the other and wrap around back to the beginning. They are behomoths and very colorful. The whole park is a sea of riders, marching bands, mounted police and droves of spectators.

Once you find your float, nineteen B in our case, you climb aboard and start prepping your area.

The spot you stand in is approximately four feet by four feet. At the beginning of the ride most of this space is taken up with beads beads beads. If you stack them very carefully, you can make yourself a small foxhole to stand in. There are hooks at head level in your cubicle so that you can have some beads pegged and ready to throw. Even though there are many pegs, they will hold maybe one percent of your beads at a time. As you are making ready, families and friends of riders are constantly making their way to the floats to wish us well. We drink, smoke cigars hang out and wait until finally the word is out, the parade has started! Due to its large size and number of floats, it may be an hour before your float starts moving.

coming soon part three
see also Pics from Mardi Gras 2009

After a long look at my low light candids from the last several years, I decided to make a project out of getting the best pictures possible using only the available light.

Available light is a great way to convey the mood of a scene.

The light that is present on your subject and in the background of a scene is a very important to how your brain sees the image. The color of light is also very important. The only way to capture this ‘message’ is get a picture that reflects the feeling. A flash changes the color of the light, kills the background and slays the mood. Step back, shut your flash off, hold your breath and take a great image.

High ISO turns up the sensitivity of the digital sensor.

Taking pictures in low light usually results in a more grainy look to the digital image. This digital noise comes from the sensor making an image with less than an ideal amount of light. High ISO noise can be removed using software meant for this purpose. The results can be phenomenal. Do a google search for high ISO noise and you will find several progams that will help.

Shutter speeds are longer when there is less light.

Shutter speed is how long the sensor is exposed to the light. When you take a photo in low light, the shutter stays open longer. You must take this into consideration. Find a way to brace your camera when you are taking the picture. Using a monopod can help tremendously. Hold your breath and gently squeeze the shutter. It is a very good idea to take two or three shots when you have a long shutter speed. This gives you two or three chances to get it exactly right!

Aperature is how wide the lens opens up to let in light.

All lenses have a maximum aperature that is part of the characteristics of the lens. The wider the aperature the better that it does in low light. The trade-off here is that the wider a lens opens up, the less depth of field that you get. This is good and bad. If you are taking a portrait of a single person, you focus on the closest eye and shoot the pic. The eye is sharp, the other eye is mostly sharp and the background goes out of focus. This is a good look for a single person portrait or candid. The problem lies when you have more than one subject. Whatever face you focus on will get sharp treatment, even faces three inches farther away from camera may not be acceptable. If you make the facial distances from the camera equal you will get excellent results.

Even with its problems, available light photography will reward you with some excellent pictures that the flash would have killed.

Mark

Both of the photo sets below feature available light photos.
Cedar Rapids Night Life
St Lukes Christmas Party

Mark Miner

Saturday night was the Endymion parade and the Extravaganza at the Superdome. Kid Rock kicked the doors out. Second best concert I have ever attended. (Green Day was number one). Until I get the whole article written, please enjoy these pics from the last few days at Mardi Gras.

Mark

Mardi Gras 2009 Pics

Amazon.com and Itunes both offer a huge selection of downloadable MP3’s. Both services charge 99 cents or less per song. They are both very easy to use and are constantly availabe when you get the itch to hear something new. There is, however, one huge difference between them.

Itunes songs all contain DRM, digital rights management. All of the songs you download from Itunes have a lock on them. They will play on your ipod, (if you go through the right steps to make your ipod official with Apple). But lets say you make a family movie and want to add an MP3 that you downloaded from Itunes to it, you can’t. If you want to put the music on your memory stick and play it in your car, you can’t. If your device doesn’t support DRM, then you can’t play the song that YOU PAID FOR.

Amazon.com mp3’s cost the same and come WITHOUT digital rights management. There is much more sense of ownership when you buy an MP3 on Amazon. It is an MP3 that will play on any device that will play MP3’s. If you want to bring the song into your video software and make a movie of Grandma’s 90th birthday party you can. If you want to play it in your car’s MP3 player, you can.

Keep in mind that the Artist retains the same rights when you buy the MP3 from either service, ITUNES just holds a billy club over your head to remind you.

Go to Amazon.com mp3’s section and do a search for your favorite music. When you download your music here you won’t find a cigarette butt in your drink to kill your buzz.

Mark

See CNET’s recent head to head between Amazon and ITUNES. Spoiler, Amazon wins!

Slideshows are a great way to showcase your photography. The Ken Burns effect adds an extra dimension and music rounds out the presentation nicely.
Mark

This winter has been long and COLD. Several all time low temperature records were set in a winter that has left most people in perpetual shiver. The video is a shot of the neighbors decoration blown down by the wind. The second two shots are of a huge blowing drift in my backyard. Both shots were through my window. (way too cold outside). The wind noise is from a sound effect that I downloaded from the net.

Mark

Video edit that starts with some shots from St Thomas, US Virgin Islands, plays through to some Mardi Gras from last year then ends with more St Thomas and a little bit of Jost Van Dyke in the British Virgin Islands. It is a year old. It has never been posted here so from that standpoint it is still new!

Look for more HD video in the coming weeks.

Mark

Audible.com is an excellent source for audio books that are easily loaded onto your IPOD or other MP3 player.

Audible was founded in 1999 as a service to provide audio books to its then fledgling audio player. Since then, Audible has grown to over 50,000 titles. It has support for almost every audio player out there including Apple’s venerable IPOD. Audible was purchased by Amazon.com in March 2008 for 300 million dollars.

Why audio books rock

Books are downloaded to your mp3 player directly from the Audible.com site. The recordings come with album art and are chapter tabbed. A lot of the books are read by the actual authors and the selections that are not are read by professionals. The audio quality is usually excellent. Most of them are done very well and are a joy to listen to. The audio books are reviewed by readers on a five point evaluation system. Some books have two or three HUNDRED reviews with well written commentary.

I listen to an audio book in my car constantly. My commute to work is only 20 minutes each way, but in about two weeks I get through a six hour audio book using time that would have been wasted just driving. Long car trips become a joy when listening to a qood audio book. I usually leave my front door open while I am pumping gas and let it play even then.

Cost

There are several different plans availabe at audible and they also have monthly specials. There is a two credits a month plan for $22.95 that works very well for me. Almost all books are 1 credit. I have been on audible.com for 5 years and I have listened to 140 books. I have yet to download a book that takes two credits. The books that you download are on your computer. They also stay in a ‘library’ on audible.com’s site so that you can re-download them at any time if you need to.

Some of my Favorites

Blink by Malcolm Gladwell read by the author
Tipping Point by Malcolm Gladwell read by the author
Outliers by Malcolm Gladwell read by the author

Life of Pi by Yann Martel- Excellent book with a great narrator.
A Short History of Nearly Everything by Bill Bryson – It is a great easy to listen to primer on all of science from the beginning of time until now.
The Four Hour Work Week by Timothy Ferriss – Excellent book and part of the reason that I am writing this blogsite.
Time Travelers Wife by Audrey Niffenegger – Excellent book with an excellent reading.

Other books that were great on Audible in no particular order:
Cold Mountain by Charles Frazier
Einstein a biography by Walter Isaacson- excellent
Extremely Loud and Incredibly Close by Jonathan Safran Foer

Audible already has an amazing collection of books available to download. Just about all of the best-sellers are there and they are constantly adding new titles. If I had to give up cable OR audible.com, I would give up cable (but not my high speed internet 🙂 )

Visit audible today and LISTEN.

Visit Audible.com

Few things in life deserve the title “Rock Star for a Day”. Being on Krewe of Endymion is one of those things.

Once a year, New Orleans, Lousiana hosts the biggest US Mardi Gras Party. This annual celebration triples the population of N’awlins from 500,000 people to 1,500,000 people. Mardi Gras or “Carnival”, as it is called, is one giant outdoor blowout. New Orleans measures the success of Mardi Gras each year by the tonnage of trash that is produced.

An essential part of the MG experience are the parades. These exhibitions range in size from a single flat panel truck with a dixieland band, to a super-parade with more than a thousand riders or Krewe. Endymion was founded in 1974 and is one of the two parades at Mardi Gras that has earned the category of Super Parade. Endymion has over 2400 Krewe. A quarter of a million people line up the along the route of Endymion, some families setting up their annual ‘spot’ 18 hours before the parade. Endymion draws the largest crowd at Mardi Gras.

Now a little about the Rock Star part

Perspective from the crowd

Watching a parade at Mardi Gras, the crowd chills along the route and watches as marching bands, baton twirlers, mounted police and other parade participants go by. When a float goes by everything changes. Suddenly the mob goes wild. People are screaming at the top of their lungs and waving their arms madly. All the while trying to entice beads from the riders on the float. They are jumping up and down and trying to make eye contact with the riders to collect all important beads, doubloons, cups, frisbees, teddy bears and footballs. After the float has passed, the revelers go back to chillin with their friends. Patiently waiting for the next chance for treasure….

Perspective from the float

If you are on Krewe of Endymion, the whole perspective is from the float. You stand in a four foot by four foot cubicle. Your beads stacked up around you to your waist, leaving a small foxhole you can barely stand in, let alone move. There are thousands of people constantly in your field of view as your behemoth ride meanders through the streets of New Orleans. The crowd is ever changing. they are whipped into a frenzy, yelling at the top of their lungs, waving ther arms wildly and trying to get you to throw beads. Even though there may be a thousand people in front of you at any one time, you can pick anybody from the crowd and make eye contact with them. You can easily pick any one person from the crowd and reward them with beads or other throws

see part two of the article

It has been ten years since I have written anything. These years have been spent practicing Emergency Medicine in a couple of very busy emergency rooms, which does not lend itself to much writing. Doctors orders and prescriptions rarely require matching tense or action verbs. Because of this even a three paragraph story is taking a few rewrites just to get the tense to match. Trying to impart the feelings that I had at the time using words is both frustrating and rewarding. The things is, I can tell a good story person to person. I get very animated, use different voices and facial expressions that really punch up the story. Trying to get this into words is very different. It gives me new respect for people who do it well. The people with a site that you read daily just to see what is next. My promise is to work and work until I get that good.

There are many resources available on the net that can make my writing better. Over the next few months I am going to do at least one thing daily that improves my writing. If you are here, I hope the positive changes will be evident.

Mark

It was a middle of the winter, slow night shift. A 90 year old woman from an outlying rural town was brought to our ED by their local ambulance service, 45 minutes away. She had called 911 because her carbon monoxide detector was going off. Paramedics and firefighters responded to her home only to find that the noise was coming from an alarm clock that she had forgotten about in a spare bedroom.

Paramedics checked her over and found her blood pressure to be high. They brought her 45 minutes to the hospital. By the time she arrived it was 6am and it was time for her morning blood pressure pill.  We gave her her 6am medications  (which she had brought with her) and in 30 minutes her pressure was normal again.   We notified her hometown ambulance service (which was now 30 minutes away) and they came back to the ER and took our patient home.

The Royal Mile, Des Moines, IA

Certainly the urge is there… You have something on your chest that you have wanted to say for months. You are SURE that it is relevant, pithy, and certainly worth putting up right now. Instead write it, save it as a draft, (after all it might actually be great) and take a look at it again after the fun wears off.

M

It was a wonderful day for driving and I was on my way home from Vincennes, Indiana to Chicago after working an overnight shift.

I was three hours into a seven hour drive. I was driving through a small town in rural Indiana and I fell asleep while driving. I woke up with a start when I hit the back end of a car at a stop light. Approx speed 25 mph. My airbag deployed, my sunroof was completely ejected from the roof and came to rest in front of the car that I had hit. I got out, dusted myself off and checked to see if anyone in the other car was hurt. They were fine. In the process I had done about 12k worth of damage to their car and totaled mine. It was towed to a local junkyard and I secured another ride to Chicago….. Fast forward 6 weeks. I got a call from the junkyard. They said they were selling the car for scrap and that I might want some things that were in the trunk. I had a fedex account number so I gave the goofs at the junkyard my shipper number and told them to send me the contents of my trunk by FEDEX GROUND, (the LEAST expensive fedex option). Bright and early the very next morning I get an oversized EXPRESS OVERNIGHT package, (the MOST expensive fedex option) from Fedex. I signed for it and brought it inside. Inside the box were two rolls of toilet paper, a rusty screwdriver and two 25lb bags of sand. What the hell? Total cost from fedex was 270 dollars………

It was the middle of a crazy weekend night shift in the ER in Iowa.  I had just finished my residency in emergency medicine in Chicago   The night was stupid busy.  There were patients everywhere.  Sick ones, mad ones, drunk ones blue ones.  They called me into a room with a twenty-ish male patient who was accompanied by police.  Evidently he had been stealing his parents stuff, pawning it and buying whatever drugs he can get his hands on.   That night he had been drinking/druggin and was so sleepy he could barely keep his eyes open.   When he did open his eyes he was profane to officers and nursing staff.  I entered the room at the tail end of a slew of cursing…  He could barely keep his eyes open and then he started cussing me too.   He was obviously very intoxicated and high on illicit drugs.  I said “Dude, why don’t you move to Chicago, there are a BUNCH of drug addicts THERE?”  

The patient barely opened one eye and said, “Why don’t YOU move to Chicago, there are a bunch of DOCTORS there too!”.