Thursday, June 07, 2007

End of an Era

The venerable Bob Barker is calling it quits as the host of the Price is Right after thirty five years presiding over the showcase showdown. At eighty two, Barker reportedly said he wanted to "retire while he was still young". I have fond memories of the Price is Right, not necessarily the show itself, but all that it represented; that nostalgia of the seventies. If the Price is Right was on, you were either A: Out of School for some reason or B: On Summer Break. I remember when he finally decided to embrace his age and quit dying his hair that Ricky Riccardo Black. I remember all those Cal state college girls bouncing down the aisle as the next contestant on the Price is Right. They always won the T-Topped Monte Carlo, because who knew the price of LaChoy Ramein Noodles better than a college student? Ahhh. Good Times. God's Speed Bob.

Wednesday, May 30, 2007

Pirogue History





Since I began building my Bayou Pirogue, I have become increasingly more inquisitive about the history of the watercraft and it's use in the coastal south. As it turns out, there is quite a bit of heritage attached to these flat bottomed, shallow drafting craft. In fact, according to research compiled by the Army Corp of Engineers, the boats were infamous in Louisiana waterways during the Cival War. Before attacking Confederate Fort Burton, Union troops raided the nearby basin, confiscating sugar, molasses, cotton and firearms from Bayou residents. These raids by Union troops became increasingly frequent and made life more difficult for the local residents.

Union forces defeated the Confederates at Bisland, Grand Lake and Fort Burton in the spring of 1863, giving them control of the surrounding waterways wherever they could operate armored gunboats, and the Confederates could not match the firepower of these Vessels. Even with this advantage, though, Confederate guerrilla forces, as well as jayhawkers and smugglers, constantly harassed the Union forces, especially in the summer of 1864. Jayhawkers were roaming bands of deserters, draft dodgers and criminals who infested much of the backwater Bayous of Louisiana during the last three years of the war. Confederate irregular forces used the familiar terrain of the basin to their advantage, relying upon pirogues, skiffs and horses in their hit and-run forays against the federals. To deal with these problems, the Union command decided to destroy all ferries, bridges and boats in the basin as well as confiscate all contraband goods. Anything not produced locally, including flour, salt and other staples, became unavailable to residents. These policies antagonized local Union sympathizers and hindered the collection of intelligence. In November 1864, the Union command conceded that small loyal planters in the basin could keep their pirogues if they were hidden at night from "guerrilla thieves".
I am taking my time in the construction of my Cyprus Pirogue. I have decided to include chine blocks on the interior for the added stability. I want to be able to maneuver the boat with a punt while standing. I've decided that the lower Edisto past Parkers Ferry will be where the pirogue makes her maiden voyage. Hopefully it will be completed by the time we take our annual vacation to Edisto Island in the later part of June. I'm going to add fore and aft decks as well as a keel strip to increase its stability. It is widely known that the Pirogue is a "tricky" boat, meaning one might get wet while learning to pilot it standing up. I'm experienced in a canoe, so using the eddies and current of the Edisto to my advantage is something I am fully capable of, but tossing an eight foot cast net off the bow of a flat bottom boat less that 28'' wide and 10'' deep is not a challenge for the faint at heart. Trying it out at dead low tide in June is the most prudent plan, of course my kids will video tape the whole ordeal in case the inevitable happens and I go over the side with the first cast.

Monday, May 21, 2007

Networking DICOM enabled devices

Over the last few weeks I have been working with our Radiologists' IT guy, Randy, to optimize the virtual private network (VPN) between our PACS servers. The initial configuration has been working in a pull mode, but now we finally have a true point to point secure network. Sean, a colleague of mine from SPAWAR helped design the network. He has a ton of experience designing network security systems for both ship and shore based applications. Another SPAWAR guy we know, a true old school network engineer, has been developing teleradiology solutions for Navy Medicine since the technology emerged. Actually, Navy Medicine is one of my largest sponsors, so I also have a great deal of experience with the nuances and overarching regulatory requirements for medical networks. Just as it is for a small branch medical clinic in the military, if a small civilian family practice wanted to get into telemedicine or teleradiology, there would be very few options out there without going through the big box vendors like GE or Phillips. We find that in the defense environment, even though the medical activities rely heavily on technology, they do not have the resources required to implement information assurance and security effectively. After all, Information Technology isn't their core competency; medicine is. That's where commands like SPAWAR come in. We have the experience and know-how to integrate common off the shelf products to create a layered network protection strategy. We can help the medical commands insure HIPAA compliance. We figured the same holds true for private practice in the civilian world, even for small rural hospitals. We have been kicking around the idea of doing some consulting work through SWI diagnostics, my wife’s LLC. Her customer base is heavily rural, and initial conversations with some of these folks have generated a very positive reception. Although we may initially have to drive to Georgetown to reboot a print server for fifty bucks, we will eventually open the door to an array of future support functions, including helping rural practices go digital and securely connecting them to the outside world. Second opinions from university hospital specialist are only a click away.

Friday, May 18, 2007

Wall of Mediocrity

I ran across an interesting article in Slate magazine last week about unwitting parents who lavish their offspring with praise, even at the most mundane accomplishment. It has been a pet-peeve of mine for years, ever since my son’s first tee-ball practice. All of the "Oh, your soooo Awesomes" have taken a toll on me. I have no problem giving praise when it's warranted, but I've always thought that bombarding your kids with undeserved praise was more than a disservice, but a detrimental travesty that would eventually lead to some sort of group therapy. I got a good laugh out of Greg Fockers "Wall of Gaylord" in the movie "Meet the Fockers", where the mediocrity of Ben Stillers character was celebrated as spirited achievement in a shrine-like display erected by his father. This subject has always touched a nerve with me, and unfortunately in our society the behavior has become more ubiquitous. You see it everywhere...Parents showering praise for even the most meager of efforts. I know so many people like this, it turns my stomach. Here is an excerpt from the article:

The Wall Street Journal reported last month on the travails of employers faced with twenty- and thirtysomethings who've been told how brilliant and wonderful and special they are all their lives. The article tells of a consultant who counsels a manager to praise young employees for showing up on time after a pattern of lateness. How does one conjure a compliment out of "pathetic" and "entitled"? A personality test for narcissism given to college students every year shows an inexorable rise, with today's students being on average 30 percent more narcissistic than the students of 1982. Substitute "self-esteem" for "narcissism" and the results suddenly look rosy, but you simply can't, because all the $10 trophies and the lavish praise of mediocrity, or even failure, doesn't really bolster kids' self-worth. They drink the Kool-Aid, but they also know it.

Stanford psychologist Carol Dweck concluded that it's not praise itself that's the problem, but rather the kind of praise we pile on our kids. You’ve heard it a million times, “you’re soo smart” or “you’re the best player on the team!”, when what we should be praising is the hard work and the effort. Dweck speculates that if you tell a kid he's smart , the only place he's got to go is down, thereby avoiding challenges and freezing at the thought of failure, but tell him you admire his determination and he'll keep plugging away, bettering himself in the process.

Thursday, May 17, 2007

Boat Fever

I am a huge fan of wooden boats, so the Charleston Maritime festival this weekend is definitely on my to do list, and I have my boarding passes in hand. For several years I have attended the holy city's maritime festival and watched longingly as others participated in the family boat building event. The family boat building event introduces novices to the wonderful craft of wooden boat building, where experts mentor families as they construct a small skiff from pre-cut materials. The event culminates with a launch party. I have threatened to sign up for the event every year, but as usual, we waited until the last minute to register. The family boat building event only accommodates twenty entries, and it fills pretty quickly as one might imagine. Feeling a bit overworked and disappointed that I missed the cut again this year, I vowed to build my own wooden boat. This was no overnight decision. I knew what design I wanted build and have had her plans in my head for years. So, with a bit of research and a few phone calls, my son and I are well on our way to building a classic Bayou Pirogue (pronounced pee-row). The pirogue was first introduced to the bayou in the late 1600's. It is somewhat of a mystery how the pirogue got to Louisiana, but it has been there for centuries and has become a part of the Cajun heritage. Originally the pirogue was hewn from large cypress logs, some measuring more than 12 feet in diameter. The cypress log was split down the middle. Then the outside of the log was shaped to the builders liking using only an ax and an adze. After finishing the outside, it was turned over so that the insides could be "scooped" out with an adze and other chisels. I ordered measured drawings from UncleJohns.com, and a supply of epoxy resin and wood flour from http://www.raka.com/. Larry Steeves, owner of Raka, inc. was a huge help, and has built a pirogue himself. I also spent some time researching construction techniques and found that by increasing the length and width of the vessel it would be a much more stable craft. A few of the images are of Tom Hills pirogue. Constructed in North Carolina, Tom's version is a faithful derivative of the classic bayou pirogue. I have set up the sawhorses and the tailgate tent on the patio and I can't wait to get started, I'll make sure to post plenty of step by step pictures. I haven't done much fiberglass work, so this should be fun. See you guys at the festival!


Tuesday, May 15, 2007

Final Touches

I took a couple of hours yesterday to put the finishing touches on the new office bathroom. I'm really very pleased with the results. It turned out far better than I had hoped for. Those nice corner sinks you see in the pictures were ordered from plumbingsupply.com, and I have no problems giving them a plug here. I have ordered a lot of stuff from them in the course of our remodel and have nothing but great things to say about their service as well as their prices. Overall, as a project goes I would give this one a difficulty factor of about 6 out of 10. Not overwhelming, but not for an amateur either. It took a wide array of skills to pull off - Framing, Plumbing, Electrical, Tilework, and Finish Carpentry...not to mention the architectural design, project planning and the demolition...both concrete and interior walls. The results look awesome, it is functional, and best of all, it meets the regulatory compliance we were lacking in the original bathroom. Enjoy the photos.



Friday, May 11, 2007

Finishing the office bathroom

So after a marathon weekend roughing in the new bathroom in our office, we spent Tuesday and Wednesday evening putting the finishing touches on the new space. We installed the toilet which is always fun, the sinks, wall sconces, and all of the various bathroom accouterments. Ahhhhhh...there's nothing quite like a brand new bathroom. I guess I'll be christening the throne soon enough. Enjoy the photos.


Tuesday, May 08, 2007

Rough In of the New Office Bathroom

Over the weekend, in true marathon style, we gutted and roughed in the new bathroom. When I say gutted, I mean we stripped the space down to the framing, relocated wiring, framed in a new ADA approved door, rerouted the plumbing, relocated the waste pipe (which involved busting up the slab), and drywalling the room. Quite a feat for a do-it-yourself job...mostly. I subbed out the drywall, because a mans got to know his limitations. My drywall always ends up looking amatuer. We use Martin and Sons for the drywall, they did the work a few months ago when we had the sagging drop ceiling replaced. They do an excellent job, and don't complain too bad about our not so perfect prep work. I will use them for every drywall job I do in the future and would recommend them if you're in need of drywall contractors. No job is too small, as you can see from these pictures. They completed this in a little less than four hours, and came back the following day to re-skim and sand. I defy you to find an imperfection. They make my crumby framing look great. The room wasn't square, off by about an inch in either direction. Not visible to the naked eye, but you cant rely on a t-square to score the sheetrock when the framing isn't perfect. Take a look at the first installment of pictures. I'll post the completed finish work separately later in the week.






Friday, May 04, 2007

On Simplifying Life

I’m in a miserable rut. I work constantly, and there is never enough time in the day to do what needs to be done. I'm having a terrible time getting motivated to do anything, and living in our house in the condition it's in is difficult to say the least. I haven't been able to enjoy myself in a long time. Even if I take a weekend off for some downtime, I end up doing nothing and feeling guilty for it. I keep telling myself that if we can just get through this office overhaul, I'll relax some, maybe go to the beach. We bought a family pack of splash passes this year even though I’d wager we won’t use them once. We find it difficult to grocery shop much less cook, or do laundry for that matter. We eat out often enough that even the fare from our finest local establishments is uninspiring. We irresponsibly have pets that we don't have time to care for. Not being able to see light at the end of the tunnel is weighing heavily on me. Setting priorities has become increasingly more difficult, and getting out of bed in the mornings is a challenge in itself. I filter through mountains of unkempt clothing every morning trying to find something suitable to wear to work, and it never seems to get any easier. I'm throwing down the gauntlet and making a conscious decision to simplify my life, to take time for myself and my children. Experts agree that simplifying ones life is the easiest way to become more productive. It's often suggested that we cut out activities that aren't consistent with our core values. I know I need to stop spending time to save money. Instead, I should be spending money to save time. I shouldn't spend an entire weekend putting up drywall when I can have a crew do it in six hours for less than 400 dollars. It's not worth my time. I've also decided that I'll plan for a weekend that doesn't involve work, to spend more time with my family and with folks that make some kind of positive contribution to my life. I'm going to stop spending time with people who drain what little energy I have left. If you're a needy friend or relative, sorry...I'll catch up with you later. I'm not going to focus any of my time on things I can't control. I'm not going to worry about what our contemptible competitors are up to. I'm not going to check my stock portfolio every day anymore. I'm going to cut back on the extra curricular activities my over-stimulated kids are involved with. If they need a day planner when their ten, their too damn busy. I'm going to take time for a glass of wine and an evening walk. Maybe I'll go fishing. Anybody know of a good home for a two year old border collie?

Sunday, April 29, 2007

Operation Ultrasound


Holly and I watched a moving piece on public television a few weeks ago that documented the lives of military families. The program examined how these families cope with the stress of separation and the ubiquitous fear of the unknown. It left us feeling indebted and obligated to the people who risk their lives to preserve an esoteric right for the rest of us to live ours the way we choose. We wanted to give something back, and as valuable as a care pack full of chocolate is in Kabul, we wanted to offer something that could genuinely help some of these young families to stay connected. Starting May 1st we are launching "Operation Ultrasound", a FREE service to pregnant wives of deployed US servicemen. Participants will get a CD with a digital image file of their baby that they can email to their husband oversees. Recent studies have shown that the bonding experience provided by a 3D ultrasound can help mothers improve their diets and exercise more frequently, but for military fathers, the chance to actually see the baby and create a pre-birth bond is instrumental in drawing the whole family closer together, and it can provide an important bridge connecting dad back home. Holly figured she would do something she knows, and she knows ultrasound. If you guy's know of a local military family that could use this service, feel free to pass them our way. You can see the official press release here, and there is more information about it on our website. Help us get the word out, we tentatively set this to run through June, but if the response is there and it's not overwhelming for us, we're open to extending it as long as we need to.

Thursday, April 26, 2007

Staging the New Bathroom


My to do list continues to grow at an alarming pace. I worry that I may never be able to complete all of the remodeling jobs that have made it onto the short list. I began to prioritize them last week and it has become overwhelming to say the least. What ends up happening is that I have to place business related projects on the top of the list, but in an inevitable catch-22, we can't shut down operations long enough to complete them. One of the projects on the top of the list is the lab bathroom. It must be remodeled for handicap accessibility. This is a total overhaul that includes busting up concrete to relocate waste pipes. This isn't an overnighter. I have decided that the easiest way to handle such a project is to plan it to the letter, pre-purchase all of the required material, and stage-assemble everything for fit in a mocked up work area prior to removing a single nail in the existing bathroom. I have learned from experience that what drags a project into do-it-yourself purgatory is being unprepared for the unexpected. Having to run back and forth to the hardware store for the correct plumbing fitting two or three times adds hours to the effort. Staging can eliminate a great deal of this. When I built our kitchen island, I staged it in the living room; placing painters tape on the floor to locate walls and pipes. When I moved the finished product into the new space, it was completed inside of an hour. All I had to do was tack down the shoe molding. I plan to take the same approach with the lab bathroom. As such, I have staged everything in the living room again. I have ordered everything except for the doors, which I manged to find at Maner supply on Cross County Road. I needed ADA compliant solid core prehung doors, not cheap...and not light either. They have metal frames and weigh at least a hundred pounds. I'm picking them up this afternoon. Staging has already paid off, I found that my kids had left the lid off of the plumbers putty, allowing it to harden. If I had been in the middle of the remodel, I would have had to stop to make a trip to the store. The diagram to the left shows the new layout.

Monday, April 23, 2007

Ignorance is bliss

Every once in a while those uncertain actions we take on a hunch are validated by a successful outcome. As small business owners, my wife and I make a lot of decisions from the gut. You have to. Market analysis is about 95% common sense and about 5% hunch. Several years ago when my wife started her elective ultrasound center, we did a full scale market analysis. We researched the total available market utilizing US Census data for our regional population and combined it with data pulled from South Carolina's Department of Health and Environmental Control on birth rates in our area. We divided the total available market into income level categories and analyzed the resulting cross sections. Through statistical inference we were able to quantify our projected target market. The numbers didn't lie. We knew going in that we would have to reach an abnormally high percentage of the target market in order to generate enough cash flow to remain solvent, but since there was no competition in the area, we decided to go ahead and take a leap of faith. Months into the ordeal and very near throwing in the proverbial towel, we realized that Dionysus had slain Apollo and the ensuing exuberance outweighed the rational. We ended up making significant changes to our business model out of necessity, but we emerged stronger and wiser in the end. We still offer elective 3D ultrasound, after all, being able to offer this incredible experience to women in the Lowcountry was the impetus for the business in the first place, and that hasn't changed. We spent a tremendous amount of time and energy to convert from an elective, self pay approach to a physician ordered reimbursable approach. It has already proven to be the best decision we have made to date. Last week while I was doing some research on the Internet I noticed that the owner of a well established elective 3D ultrasound center in the midlands had placed her business on the market for sale, effectively validating our hunch that an abnormally high percentage of the market is required to support these endeavors. I won't claim to know the underling reasons behind that sale, but based on her publicly disclosed financials, I'd say it was because it barely pays the rent. Been there done that. Like I said, market analysis isn't rocket science, it's common sense. Unlike other service oriented businesses, the market for elective ultrasound is finite, meaning, you can't manufacture clients --without an army of irresponsible gigolos. To be in the market for a novel 3D ultrasound, you have to be a female, be between eighteen and twenty-six weeks pregnant, and have at least some degree of disposable income. If that's not a finite market I don't know what is. A few months ago while our business was already undergoing its transformation, we received a phone call from a potential competitor who stated that they intended to open an elective 3D ultrasound center in our market. To be fair, they were returning a anonymous call we had placed to inquire about their pricing structure and service offerings. They just wanted us to know that they thought there was enough business out there for everyone, and wanted us to think of them as a partner as opposed to a competitor. Holly and I both got a good chuckle out of that...but under the circumstances, perhaps a belly laugh would have been more appropriate.

Friday, April 20, 2007

Latest from Hollyweird

Apparently yet another 'celebrity' has proven without a shadow of doubt that the land of glam is truly out of touch with reality. Listen to Alec Baldwin's absolutely disturbing rant left on his eleven year old daughter's voice mail. I think they will be postponing that family vacation to the Neverland ranch this year. Unbelievable. I never liked the Baldwins anyway, now I have a legitimate reason to despise at least one of them.

Thursday, April 12, 2007

Late Freeze Spoils SC Peach Crop

The unexpected Easter freeze seems to have devastated the palmetto states peach crop, a reported 35 million dollar annual production and the second largest peach crop in the nation. California is the first. I feel for the upstate farmers. An April freeze attacks bud growth, usually spelling disaster for their fruit. I live a block away from the farmers market in Summerville, and I frequent the market every Saturday morning with my kids. The opening of the market in April marks the perennial start of the growing season, and its close in October wraps up the local harvest with the traditional bounty of fall; squash, pumpkins, and corn. In the summer though, fresh Carolina peaches are always a favorite with my family. I'm convinced that my youngest can devour half her body weight in peaches. I may have to boycott those California Peaches this year, they're just not the same as stone fruit from the upstate. Although they vary from growing season to growing season, I find the western varieties not so appealing in the taste department, arguably the most important characteristic for fruit of any kind if you ask me. The California ones are clearly beautiful specimens to behold, but I'll take a dent or two for a Carolina peach bursting with flavor and aroma any day. Fruit is not unlike honey in that it takes on a subtle flavor distinction from its indigenous surroundings, and because this is obviously Gods country, our crops taste, well...divine. I can only pray that our berries held out, what kind of summer would it be without fresh local berries?

Monday, April 09, 2007

Moving up, Moving out

I realize that this blog was originally conceived to chronicle the restoration of a charming downtown Summerville cottage, but restoring a 100+ year old home is only one of my many duties. I have a large hat collection. Monday to Friday I wear a business systems analyst fedora for a defense contractor supporting the Space and Naval Warfare Systems Center over on the old Naval Weapons Station. In the evenings I don the IT guy derby for my wife’s diagnostic imaging center. I keep the VPN firewall up and running and make sure that the radiology and DICOM files are being processed and archived as planned. Maintaining the PACS system should be a full time job, but I squeeze it into a few hours in the evenings. On weekends and most holidays, I put the hardhat on and work on the house.

As I described in a previous post, we purchased the property primarily as a mixed use residential-professional office arrangement. We intended to convert a large detached two car garage into a home base for our mobile diagnostic ultrasound service, and that is precisely what we did. I completely renovated that outbuilding, wired it, installed a bathroom, installed central heat and air, and built out the area as office space, but as our business grew, we grew out of the building and ended up moving our offices into our residence and redesigning the converted garage to function as an outpatient exam room for vascular and prenatal ultrasound.

The CMS (Medicare) test deposit was entered into our bank account on Thursday, so it would appear that our enrollment package is nearly complete. We will be able to accept insurance any day now. Our promotional material has arrived and we will begin a comprehensive marketing campaign within the next two weeks. What that means is that our business is growing. We will soon need even more space. After many hours of contentious deliberation, Holly and I decided that we would inevitably have to convert the entire residence into an outpatient imaging center. With some work, the building would make an ideal medical practice. After all, a local attorney operated out of the space for many years. So, essentially the front two bedrooms will be converted into exam rooms, and the parlor will be converted into a waiting room. The living room will house a horseshoe administrative area, and the back bedroom will be an executive office. The kitchen, of course will become the employee break room. The converted office outside will become a vascular lab.

In order to make this space work as a state of the art imaging center, we have to take on several large projects including building a wheelchair ramp off of the front porch. We also have to remove the gorgeous claw foot tubs and replace them with urinals and ADA compliant fixtures. We have to build the horseshoe administrative area, run the appropriate communication lines, and put sinks in all of the exam room spaces. Most of the doors will have to be widened and replaced with industrial solid core flush units. We would have to replace all of the carpeting, and install vinyl composite tile in the exam rooms. We also would need to replace the windows and cover them with attractive Bermuda shutters on the exterior to limit the sunlight infiltration and create the appropriate ultrasound conditions. Of course, I will probably hire a general contractor to tackle these projects. All in all, the layout couldn't be better, and the great part is that in the end we can deed the property over to the LLC and instantly increase the asset side of the balance sheet.

A couple of weeks ago I noticed that our facility was chastised as “make-shift” on another merchant’s blog. I don’t know what this persons motivation was or even if they have ever been inside our facility. I doubt that they know the reasons behind our conscious and socially responsible decision to utilize a mixed use zone. I doubt that they know that most of the homes on our street, with the exception of one, are currently in use as professional offices. In fact, I doubt that this person knows much of anything. I have lived in Summerville my entire life with the exception of a few years while I was away in college. I was born in the old hospital, now the county services building off of Main Street. When I was in high school the US Census count said there were less than six thousand residence in Summerville. There are nearly fifty thousand now, with over half of them arriving in the last decade alone. With all these new residents comes new services, new shopping centers, and new strip malls. If there is one thing I despise more than anything else, It's seeing new strip malls detracting from our truly remarkable landscape. Don’t get me wrong, as a small business owner; I’m clearly not against growth. I just think it’s a shame to build new strip malls when so many existing ones are so anemically vacant.

In order to maintain the integrity of the town center, people need to live where they work. Otherwise you don’t have heterogeneous sustainable growth, you have sprawl. No one wants sprawl. Anyway, a note to the uninformed: Our decision to live and work from our home was not based on financial reasons, or any other reason that you might dream up for that matter, rather it was based on a humble attempt to revitalize a part of our beloved community; a community that is being threatened by the very irresponsible development you operate your own business from. Get a life. Get informed before you feel the need to comment on something you obviously know nothing about.

Friday, April 06, 2007

Thoughts on Ultrasound

With South Carolinas' proposed ultrasound bill making headlines nationally, I thought I’d chime in on the business of ultrasounds in general...while the subject was still at arms reach. I feel uniquely qualified to comment on ultrasound since my better half operates an independent diagnostic testing facility, or IDTF, specializing specifically in the modality. Her facility offers both full diagnostics as well as 3D/4D limited diagnostic/elective ultrasounds.

Elective keepsake ultrasound facilities started appearing around the country in the late 1990’s, when ultrasound technology made the leap from grainy single-slice two dimensional renderings to volumetric three dimensional images that generated incredibly life-like images of babies in utero. We’ve all seen the commercials. These keepsake ultrasound places use the new 3D and 4D technology to provide expecting parents an exciting preview of their baby with detailed graphic image quality and motion.

My wife is an ARDMS registered sonographer and registered vascular technologist(RVT). She chaired the Diagnostic Medical Sonography program at our local community college, first as its clinical coordinator and then as the Program Director. She started the 3D-4D elective center three years ago. I wont hesitate to say that perhaps we viewed the world with rose colored glasses back then. The endeavor nearly broke us. The whole starting a business thing was exhaustingly hard work, and needless to say, although it has been what one would consider successful, it did not go as well as we had imagined it would in the sense that it failed to produce that elusive sense of fulfillment often associated with an entrepreneurial spirit. If you're a professional in the medical community in the Holy City you know that the community itself is holier than thou...both tight-knit and conservative by nature. So, for every minute of positive publicity she managed to generate, it was equally matched with two minutes of the negative variety. She only saw a handful of clients her first month despite aggressive advertising and a costly professional marketing campaign. She had essentially been black-listed by the establishment.

She started this business out of sheer passion and a love for the profession, and by stripping away the bureaucracy that has become ubiquitous in our health care delivery system, she could allow women access to the latest applications and technology while still maintaining a small, patient-focused atmosphere. After all, these services wouldn’t be available if there wasn’t a demand for them, and 3D ultrasound is truly a patient driven service. 2D ultrasound on the other hand, when operated by qualified sonographers is quite sufficient for obtaining clinical indications. Interestingly enough, very few CPT codes exist for 3D procedures, which means that reimbursements are the same for 2D as they are for its more desirable 3D cousin (desirable from the parent’s perspective that is).

So, for the short term at least, these entertainment businesses will thrive, and as well they should…because there is a demand, right? Not so fast. After three agonizing years in the elective ultrasound business, all the while kicking and scratching to preserve what was left of her professional image while fighting for every client, the handwriting was quietly etched on the wall. It is only a matter of time before the elective ultrasound industry is regulated completely out of business, but before that is allowed to happen, technology will catch up with it and drive the final nails into its coffin. I used this analogy with my son: "Why would you pre-order an x-box for $600 when you have a perfectly good play-station? You don't need the x-box, you simply want the x-box...and if you're patient, you can buy it next year for $350." The same holds true for these new ultrasound machines. Right now, Doctors don't need them, but as the technology advances, the new machines will become more affordable and rapidly replace the older units currently found in every OB-GYN office, thereby eliminating the demand for boutique ultrasounds altogether. In fact, there is convincing evidence that this trend has already began to manifest itself in the Lowcountry, and if you need further proof that self-refer is a tough row to hoe, take a look at what happened to Prevecare east of the Cooper a few years back.
My wife’s own company just purchased a brand new 3D ultrasound machine that is more portable, more powerful, and cost about half of what her first unit did…Now don’t get me wrong, it was still outrageously expensive, but my point is that they are now well within the reach of most private practices. Seeing that the handwriting was indeed on the proverbial wall, she felt it was time to start transitioning out of the elective ultrasound business and into the mainstream medical market. We needed to enroll in Medicare as a certified provider, begin accepting insurance, hire a physician, and contract with a radiology service to interpret the studies. She’ll still provide 3D ultrasound, it just means that we’ll be marketing to the doctors for referrals as opposed to marketing to the general public, but it also means an ADA approved facility, wider doors, wheelchair accessible ramps; grab rails, sinks in every exam room, the whole nine yards. More overhead? Absolutely. More regulatory oversight? Absolutely. Brighter future? Undoubtedly. One thing we will miss though is the 100% reimbursement we enjoy with the self refer work…a traditional provider only collects on about sixty percent of what is billed. Now I understand why they bitch so much.

So for all the moms-to-be out there seeking those keepsake ultrasounds...Do it the right way. Do it the safe way. Let your doctor know you want to have your diagnostic exam performed in a relaxing, patient focused environment, where the 3D pictures are complementary. He'll get a full report from our board certified in-state radiologist, we'll bill your insurance, and you can invite your family to share the experience. You'll leave with reassurance instead of a kitchen magnet and a false sense of security. We’ll keep you posted on the transformation.

Friday, March 30, 2007

Happy as Clams

When I was a younger man, maybe twenty-one or so, I was working a manufacturing job at a local plant. I had spent a couple of years in college, but had failed to realize that majoring in art history didn’t typically open that job door in the Deep South. Fortunately, my best friend’s mother ran one of those temporary labor joints. They had a big van and would drive around town picking up day labor bound for a variety of odd jobs, usually loading shipping containers out at the docks or sorting tomatoes at the packing sheds on Johns Island, either way, the work was usually hard and the pay was usually lame. Because of our inside connection, it was Randy and I who landed the good jobs…or the best of the crap, depending on how you looked at it. Occasionally the jobs even had a benefits package of sorts; after all, there was that one stint with the refrigeration company where we got to service AC units in the girls dormitory at the College of Charleston.

On this particular assignment though, I was tasked with steam cleaning big diesel engines that had been shipped back in to the plant due to various warranty claims. They were from dozers, log skidders, and farm equipment of all kinds, but they always came covered with mud and grease, sometimes so thick that it was hard to tell they were engines at all. We had to clean them before the quality technicians could evaluate the claims, although many times it was quite obvious judging from those gaping holes in the core, that often the engines in question had run shy of oil and thrown a rod or two as a result. They came shipped in heavy gauge wire baskets and a forklift would drop them off every hour on the hour, lining them up for cleaning truckloads at a time; all day long. We wore rubber boots, rubber aprons, and a combination ear muff face shield thingy. Needless to say, I hated the job.

The incessant dampness had eroded away the tips of my fingers, or maybe it was the caustic solution they used to break up the grease. Either way, a couple of weeks into the work I got a liberating phone call from Randy’s mom paroling me from any further Chinese water torture. It seems that one of the larger and more sophisticated manufacturing plants in the area had several openings, and lucky for us, it was their policy to always hire temporary labor first, apparently so they could kick the tires before committing to permanent employment. The pay was much better and the benefits package consisted of much more than any sorority ogling opportunity. I would have to keep my nose clean for a few months, pass a drug screening, and of course…take a physical.

Ok, so here’s the point where you say “he thought he slipped that pass a drug screen thing on by us”. No… wrong. Guess again. It was the take a physical thing that sank me. You see, I had, and still have to some degree, a debilitating fear of needles. If this physical meant that I would have to give a blood sample, then I would surely die from inhaling industrial strength easy-off and over hydration. I didn’t apply for the job.

Now, seeing as we lived in a small town it didn’t take long for Randy’s mom to call my mother, who in turn called my dad, who practically dragged me to that office to turn in my application. I think my dad really wanted me out of the house more than he wanted me having that job. I often look back to find discomfort in the fact that my folks prodded me more to apply for that factory job than they did for me to stay in college.

Weeks went by without a word and I had completely forgotten about the job when I got a postcard in the mail informing me that I and nineteen others had been selected for employment. Randy was not one of them. To this day I’m not sure why I was selected and he wasn’t. Although he said it didn’t change anything, I could tell that he resented me for it and things were never the same between us afterwards. After a series of interviews I was told that I would start on second shift in three weeks, providing the drug test and physical came back in order.

The drug screening and physical actually took place in the same office, an industrial medicine facility that seemed to specialized in denying carpel tunnel claims, spine pain, and neck injuries of any kind presented to them by employees of the plant. These guys were hired guns, not your typical compassionate medical staff. Since I was still gainfully employed steam cleaning engines, I couldn’t take time off to go take a physical, mostly because I didn’t want to take time off to go take a physical, so I scheduled it during my lunch break. Although I only got a half hour for lunch, I was able to finagle an hour out of my foreman in order to “go to the DMV”.

I had worked myself into a knot of anxiety by noon. I had reasoned that since I had to give a urine sample, I should hold what little I had so I wouldn’t have to go through the water drinking ritual once I got to the doctors office, and since it was scheduled during my lunch break, I didn’t get to eat. On the way over I realized that I really, really had to pee. By the time I arrived I was floating, I had to go so bad that it literally hurt. Of course, the office was packed. I went straight to the sliding window at the front counter and explained my situation. I told the receptionist that I was there for an employment physical and drug screening, and that I really had to use the restroom and that if she would be so kind as to provide me with the little container I could go ahead and provide my sample.

If you can imagine what a bank teller looks like when someone slips her a note that reads “Stay Calm, Your Being Robbed”, that precisely describes the expression on the receptionist's face. Apparently some people, guilty people seeking employment that is; try to fool the drug screens in any number of unscrupulous ways. They must have had one of those hidden panic buttons like a teller too because the entire lot of ladies behind the counter sprung into action like defacto DEA agents. I was told that I would have to wait my turn. I was escorted to a seat and handed a clipboard. Every eye in the room was on me and I still had to pee like a race horse.

I waited a painful fifteen minutes, defiant at this point; I agonizingly awaited my name to be called, when alas! Glory be to God, the door open and St Peter called me back. The nurse was nice. She was tall, dark haired, and wore cute designer glasses. I immediately explained my circumstance once again, but it had appeared that the Nazis at the front counter had gotten to her as well. She said, “Just hop up here on the scale and let me get your height and weight and we’ll get right to that sample in just a minute”. I swear, I was nauseated from near bladder eruption and low blood sugar from skipping lunch, but I had come too far to turn back now. I had to stick it out. After she had my proportions recorded, I eagerly asked for my sample cup yet again. “We’re just going to draw a little blood then we’ll be all done and you can go give your sample”. Fine. Did I mention I had a needle phobia?

Ok, so at this point I could care less if they amputated my arm, just get it over with so I can pee dangit! I felt a pinch and a sharp prick. She filled a nice vial and said “Ok, All done”. She handed me my sample cup and escorted me to the bathroom at the end of the hall. I was a little lighted headed, but that was the last thing on my mind. The bathroom was a single, meaning it was just the commode and a corner sink, so I locked the door behind me like any normal person would do and I frantically began unzipping my pants. I wasn’t even thinking about reserving some for the cup, I just wanted to relieve myself at that point. Ahhhhhhhhhhhhhhhhhhhhhhhh. A warm sensation enveloped my entire body and I felt calm and peaceful. This obviously went on for some time because I think I dreamt about Josephs Technicolor coat in there. Apparently, the low blood sugar, in combination with the extreme anxiety and sudden blood loss, Oh yeah…and all that pee, caused me to pass out.

I could hear them out there beating on the door, but I couldn’t move. I was so warm and cozy down there on the floor of that bathroom. When they finally got that door open it was as if God himself had shined his flashlight on me. There I was in all of my glorious splendor…pants around my ankles and lying in what seemed to be gallons of my own urine, none of which made it into that sample cup. I had hit my head on the door so they wanted to keep me for observation, clearly out of fear of litigation.

I was certain that I had pissed away any chance of employment, but they hired me anyway. Sometimes I wish they hadn’t. Sometimes I wish I’d pissed before I left work. I took that job and spent ten unhappy years in that place. Nowadays, I get up several times a night to pee, and I’m happy as a clam.

Tuesday, March 27, 2007

16 grandchildren, 38 great-grandchildren, and 9 great-great-grandchildren

My grandmother on my father’s side passed away last week. She had been ill for several months after suffering a nasty fall in her nursing home. My brother and I picked up our younger sister, and made our way to Louisville Kentucky to pay our last respects and be with our family. Our sister had driven from Atlanta to Greenville and we met her off 385 on our way up. It was an eleven-hour trip, and one that I made with some reluctance. I have to limit exposure to my sister and I thought that spending hours in a confined space with her would make me say or do something I would surely regret, but this trip was different. We laughed, told stories about our own road trips as kids, and enjoyed each other’s company amidst the incredible vistas of the Great Smokey Mountains. We indulged ourselves in barbeque at establishments that neither of our spouses would be caught dead in. We reconnected with cousins we had not seen in many years. We exchanged phone numbers and email addresses and promised to keep in touch. For many years, way too many to count, I have avoided spending time with my family other than on the emblematic holidays, because as we all know, moderation is the key to enjoying any potentially dangerous cocktail. However, I had a profound revelation on this trip, on this sad and mournful journey I came to appreciate that the bonds of family are stronger than any petty vice, blood is indeed thicker than water, and in the absence of our kids and our significant others, we realized that we are who we are, and that it’s ok to be that way. My cousin Richard said it with the simplest eloquence; “Look around you guys, look at all these children. If it weren’t for Grandma, none of us would be here today” This man, this stranger, opened his home to us and welcomed us with open arms, because we share a common thread without which none of us would exist, because we’re family.

POE, ESTHER MAE RICE, 87, our beloved mother, passed away Thursday, March 22, 2007 at River View Village in Clarksville, IN. Formerly of Louisville, she retired from Kentucky Baptist Hospital as a nurse aid, was past president and a life member of VFW Auxiliary and Robert E. Newman Post. She was preceded in death by her husband, Hubert Edgar Poe. She is survived by two sons, Edgar Ray Poe and Charles Walter Poe; two daughters, Carol F. Egbert and Linda Sanders; 16 grandchildren; 38 great- grandchildren; and nine great-great- grandchildren. Graveside service will be held at 11 a.m. Monday, March 26, 2007 in the Evergreen Cemetery. Visitation is from 4-8 p.m. on Sunday at the Neurath and Underwood Funeral Home (between Clays and Shelby Sts.)

Thursday, March 15, 2007

The Forboding Toga Party

"The following story, too, is told by many. A certain seer warned Caesar to be on his guard against a great peril on the day of the month of March which the Romans call the Ides; and when the day had come and Caesar was on his way to the senate-house, he greeted the seer with a jest and said: "Well, the Ides of March are come," and the seer said to him softly: "Ay, they are come, but they are not gone." -- Plutarch

It seems that on this day in 44 BC, Julius Caesar's posse of homeys whacked him while he had his back turned. He was said to have been warned to "beware of the ides of March", or March 15th. Incidentally, the Latin term "Kalendrium" means "account book", and the shortened version "Kalend" (from which our term "calender" is derived), was used by the Romans to denote the first day of the Month... because just as it is a couple of thousand years later, that's when the bills are due. What? No grace period???