Leaving Las Vegas… Hopefully

Notes on the human condition, the laws of thermodynamics, and spandex.

Travel to medical training venues is becoming more painful. People in line to check-in at hotels want to comment openly on my column. Recently in Las Vegas at the Paris Hotel – in the private check-in lounge no less – one of the PAs registering for the emergency medicine boot camp course I was teaching at wanted to vent her spleen and give me editorial direction. Enough already. I’ve heard the message that since March I’ve been a little too political, and serious to the point of being morose. As one of my regular readers said, “Greg, I liked you better when you were funny.” And to all of you – or should I both of you – who thought I was too hard on the ACEP Council, let me remind you that shooting the messenger is a bad tactic and an even worse strategy.

But it’s OK. You get a break this month from EM politics, attacks on drug ads and ED overcrowding. Tragedy tomorrow; comedy tonight.

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Let’s return to Las Vegas, where if you are not teaching a course or taking one due to the rock bottom room rates, I can’t imagine why you would be there in the middle of the summer. When I left Detroit to head to Vegas the temperature was 63 degrees Fahrenheit. As we landed, the well-intentioned pilot announced that the Las Vegas-McCarran County airport temperature was 111 degrees… in the shade. And by the way, there is no shade. It’s the desert. Since the invention of the internet (thanks, Al Gore) and the further degradation of Native peoples with Indian reservation casino gambling, the need for visits to Las Vegas in the middle of the summer has been eliminated. You can ruin your credit and your reputation at the Indian casino in Travers City, Michigan for half the cost while enjoying a temperate climate.

So it’s 111 degrees and we have established that there is no shade. This is where the third law of thermodynamics kicks in. I am certain that most of you studied physics about the time I did, when there were only two such laws. First, there’s the continuation of the conservation of energy – you know, energy can’t be created or destroyed. And if that hospital transporter who you’ve yelled at is in the union, no extent of energy you expend will ever convert it to work! Go ahead, try it. I dare you. All emergency doctors remember the second law because, like the first, we live it every day. A system is always moving toward maximum entropy. Life devolves into chaos. This is particularly true at shift change.

The third law states: You can never reach absolute zero: -273.15 degrees Celsius. Las Vegas – specifically the front doors of the Paris Hotel – challenges this assumption. They have a super conductor air conditioning system hooked to a hundred-mile-per-hour blower. As you step from the 111-degree street into their entryway you are frozen nearly solid. I believe that the physical shock of entering too many casinos could actually kill you. It’s an amazing phenomenon. The entire City of Las Vegas is based on the improvements in air conditioning.

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After checking in and assuring the gal at the desk that I did not need or want gambling lessons, I proceeded to my room where I steamed my suits. I realize this is a strange practice but I have always done so and old habits die hard – even if the Vegas heat renders my work an exercise in futility.

Having settled in, I can now proceed to my favorite pastime: people watching. Vegas as a concept is a very difficult proposition to explain to anyone unaware of American culture. If an alien landed on Las Vegas Boulevard, they would radio back to the mother ship that there is no intelligent life on this planet. I am neither a prude nor a snob, having been raised by immigrant parents who never went to college and having come of age in the open hearth steel mills of Detroit. But there are limits. God will handle judgment.

First observation: clothing is optional but tattoos are not. And if you have to adorn yourself with embedded ink, it must be shown to the entire world. As emergency physicians we know the sentiments expressed on skin better than most… and know the regrets they’ll bring. Seventeen-year-old girls who got Justin Bieber inked on their backs two years ago are oh so regretting it now.

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Number two, skip the spandex. I’m a live-and-let-live person. But there are people who should be forced to get a license before buying spandex clothing. A muffin top is one thing, but a spare tire fit for a Caterpillar front end-loader is something else entirely. I’d like to enlist in the Las Vegas fashion police and sentence these folks to look at themselves in a mirror. They must have one. Some of the hotel rooms even have them on the ceiling.

Third, if I ever get to the point where I start dressing myself, my wife and my children in matching outfits, just shoot me. Haul me out and do what you need to do. I’m not talking about family reunion T-shirts here. I mean the whole enchilada, from shoes to sunglasses. It makes Disney World look tasteful.

Observation number four: if you’ve ever wondered why we seem to have more health problems in America than in the rest of the world, just take a look at the BMI on display in Vegas. Last April I was in Sweden to speak. Virtually nobody there looks like us. We have the waddle down to an art form. I’m no poster boy for health. The only real exercise I get these days is jumping to conclusions and running other people down. But we have as a country lost control of the fat issue. When your waist exceeds your inseam by ten inches, you have a problem which no pill, pilates or physical therapist can solve. As these people turn and walk away, it reminds me of two piggies fighting in a gunny sack.

Number five: does your mother know what you’re wearing? Call it my Midwest upbringing but should gold lamé dresses really be cut just south of Munchkin Land? As Dorothy said: “We’re not in Kansas any more.” Maybe I’m wrong here but sensuality is only effective when used sparingly. It is unnecessary that I be assaulted by every implant that semi-bounces by me in the hallways.

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Number six: pay back is hell. This one isn’t so funny. An endless stream of movies have put Vegas on display as the town that invented the escape. But I didn’t see Mike Tyson or a tiger romping with overgrown adolescents on a fun-filled holiday weekend. Since the Second World War when Vegas was an 8,000-person way station for transient GIs on their way to fight in the Pacific, the city has always seemed a pornographic, sun-baked Shangri-La; where we enter into a Nietzchean irrationality and all problems are left behind. What happens in Vegas stays in Vegas, right? Not in this universe.

I’ll tell you what I did see in front of the Paris Hotel was a limo driver ordering eight heavily intoxicated twenty something white males out of his vehicle. As one last young man was pulled out, presumably the groom, the bachelor party got into a confrontation with the Las Vegas police. (I have never figured out why heavily intoxicated young males think that ten or twelve drinks will allow them to successfully fight with big, strong, sober cops who do it every day for a living.)

The final person to emerge from the limo was a scantily clad – and calling it clad is being generous – young woman, who I’m certain was not related to any of the young men. She looked down at the “groom” while putting on her cover-up. He stopped crying for a moment as her eyes found his. She bent down and wiped the vomitus from his face with her cloak, like Saint Veronica wiping the brow of Christ at the Sixth Station of the Cross. Vegas the myth and Vegas the reality look at each other across this divide. If I never see this place again, it wouldn’t bother me a bit.

But I will come back. Not for the strip, and certainly not for the spandex, but for the students. Regardless of the venue (they’re all the same after all; slides come up and lights go down) I never cease to be encouraged when I interact with the men and women who come to learn. They really care about what we have to say. They want to be better at rendering care. They want to know how to take away pain. These students didn’t come here to contemplate the intellectual inconsistencies of Vegas or the black holes of American culture. The beauty of teaching those involved in emergency medicine is that they already get it. They deal with the least glamorous aspects of the world every single day. It’s their vocation and their calling. They understand there is no Xanadu and that the Promised Land is in your heart, your mind and your soul. They came not so much for the city but for the science. They came because the need is great and their opportunities are endless. I’ll go back to Las Vegas in December, not for the city, but for them.