Sunday, March 6, 2011
Tuesday, January 25, 2011
Touch:The Journal Of Healing
Check out the January 2011 edition of the Touch: The Journal of Healing. Two of my poems were selected.
Sunday, January 9, 2011
Why I Feel Shame
In response to commenters on my last post. Why I feel shame (from KevinMD):
Are physicians motivated by virtue or are they passive victims?: "Often the individual likes their physicians and thinks of him or her as a “knight.” This is the belief that the physician has the patient’s best interests in mind at all times and takes the needed steps to be sure that the patient is always placed first. But society overall does not think this way of physicians. To most, physicians have long ago lost their “Marcus Welby” status and instead are driven by the desire for a high income, reduced work load and less attention to the patient and the patient’s needs. With this sort of attitude, society through its elected officials and through the insurance apparatus erects many polices and procedures to guard against the “knave” doing harm, reaping too much income, etc"
Are physicians motivated by virtue or are they passive victims?: "Often the individual likes their physicians and thinks of him or her as a “knight.” This is the belief that the physician has the patient’s best interests in mind at all times and takes the needed steps to be sure that the patient is always placed first. But society overall does not think this way of physicians. To most, physicians have long ago lost their “Marcus Welby” status and instead are driven by the desire for a high income, reduced work load and less attention to the patient and the patient’s needs. With this sort of attitude, society through its elected officials and through the insurance apparatus erects many polices and procedures to guard against the “knave” doing harm, reaping too much income, etc"
Wednesday, January 5, 2011
On Being A Doctor
Dr Wes said a few words and then we settled in for the movie. A documentary. the crowd was about one third physicians. The others undoubtedly physician supporters. Family, friends, nurses, hospital staff.
Of course it was preaching to the crowd. A story of a physician who found doctoring much less then expected. Stressful, time consuming, frustrating. So rarely did he feel like he was doing what he went to medical school to do...helping his fellow man.
Some in the crowd shook their head in agreement. Others nodded vigorously in disapproval.
And the lights came up. Dr Wes said a few more words. Then Nancy Pando asked the physicians in the room to stand. Reluctantly men and woman arose and looked around. Then something unexpected happened. The crowd started to applause. Loudly and with exuberance.
And briefly I felt profound pride in myself and my profession.
Sadly this gratifying moment was quickly overshadowed by a sobering realization.
Although I cant explain why......lately I feel something completely different in relation to being a physician...
overwhelming shame.
Of course it was preaching to the crowd. A story of a physician who found doctoring much less then expected. Stressful, time consuming, frustrating. So rarely did he feel like he was doing what he went to medical school to do...helping his fellow man.
Some in the crowd shook their head in agreement. Others nodded vigorously in disapproval.
And the lights came up. Dr Wes said a few more words. Then Nancy Pando asked the physicians in the room to stand. Reluctantly men and woman arose and looked around. Then something unexpected happened. The crowd started to applause. Loudly and with exuberance.
And briefly I felt profound pride in myself and my profession.
Sadly this gratifying moment was quickly overshadowed by a sobering realization.
Although I cant explain why......lately I feel something completely different in relation to being a physician...
overwhelming shame.
Saturday, December 18, 2010
Time Waits For No One
We sold it. Katie and I. Leila's Crib.
It had been sitting. Stuffed in the corner. For the last year. After Leila got her "big girl bed" and learned how to awake in the middle of the night and wreak havoc on the household.
At first it was just laziness. We kept planning to sell but never got around to it. Then finally the add was placed on Craigslist. And the days passed and no interest. It was a beautiful crib. Pristine condition. Stylish.
So eventually we dropped the price and re listed a few times. Nothing for days....and then an email. They wanted to see it. They would be right over.
A young couple. First child. Last few months of pregnancy. They eyed the crib up and down as Leila tried to initiate conversation and Cameron ran to get his pottery. But it only took a minute to decide. They would take it.
Quickly I got the tools and started to disassemble. Leila's home. For the first two years of life. There was a flurry of activity. Unscrewing....lifting...carrying. Money was exchanged and we wished the couple well.
As they amble slowly through our front door carrying various pieces of furniture it hits me. We sold Leila's crib! My mind flashes forward to a much later time. Nursing home bound my addled brain struggling through dementia's cobwebs. I become agitated from time to time and the nursing staff hands me a baby doll. The studies show that it calms demented people to care for a pretend child.
I will hold the doll thinking that it is Leila and wander aimlessly through the nursing home. Searching for a crib to lay her down for her afternoon nap. Except that I won't find it....because I sold it. On Craigslist.
And as I stare out the window at the young pregnant women carefully placing the deconstructed crib in the back of her truck I feel great regret.
Because even now before my brain ages and becomes entombed in the plaques and tangles of senility I can't escape the basic fact:
No matter how bad I want it to....
time waits for no one.
It had been sitting. Stuffed in the corner. For the last year. After Leila got her "big girl bed" and learned how to awake in the middle of the night and wreak havoc on the household.
At first it was just laziness. We kept planning to sell but never got around to it. Then finally the add was placed on Craigslist. And the days passed and no interest. It was a beautiful crib. Pristine condition. Stylish.
So eventually we dropped the price and re listed a few times. Nothing for days....and then an email. They wanted to see it. They would be right over.
A young couple. First child. Last few months of pregnancy. They eyed the crib up and down as Leila tried to initiate conversation and Cameron ran to get his pottery. But it only took a minute to decide. They would take it.
Quickly I got the tools and started to disassemble. Leila's home. For the first two years of life. There was a flurry of activity. Unscrewing....lifting...carrying. Money was exchanged and we wished the couple well.
As they amble slowly through our front door carrying various pieces of furniture it hits me. We sold Leila's crib! My mind flashes forward to a much later time. Nursing home bound my addled brain struggling through dementia's cobwebs. I become agitated from time to time and the nursing staff hands me a baby doll. The studies show that it calms demented people to care for a pretend child.
I will hold the doll thinking that it is Leila and wander aimlessly through the nursing home. Searching for a crib to lay her down for her afternoon nap. Except that I won't find it....because I sold it. On Craigslist.
And as I stare out the window at the young pregnant women carefully placing the deconstructed crib in the back of her truck I feel great regret.
Because even now before my brain ages and becomes entombed in the plaques and tangles of senility I can't escape the basic fact:
No matter how bad I want it to....
time waits for no one.
Friday, December 17, 2010
Memories of College
I gently brushed the moisture from my brow and relaxed happily in the grassy field. The campus was barren during the summer and only a handful of students were living in the circle of dorms that surrounded the athletic center and adjacent track and soccer fields.
I just finished working out. My muscles twitching and the sweat causing my shirt sleeves to stick to my arms. As I cooled down I gently laid in the grass and allowed the sun to wash over me. Out of the corner of my eye I noticed a figure approaching.
He appeared in his forties. Wearing old tattered shorts and a t-shirt. His facial hair overgrown and unkempt in distinct contrast to his balding head. He walked without particular haste or direction. His eyes glassy. His gait unsteady.
I may have noticed the distinct odor of alcohol. Or maybe it was my preconceived notion of the homeless people in the area. The mind is highly suggestible.
Hey buddy...can you help me out?
I paused, calculating...How about something to eat?
He nodded and I beckoned him to follow. We walked down the hill to a convenience store. I only had a few dollars. We agreed on a turkey sandwich and a few drinks. I handed him the change at the register.
And then we walked back to the field and sat down. I unwrapped the turkey sandwich...giving him one half and keeping the other for myself.
We ate. Silently. Enjoying the summer day. The sweaty college student and the unkempt homeless man. We exchanged some pleasantries. Nothing too deep. Eventually he finished...thanked me...and walked off.
Years have since passed and I am a doctor. Now I spend most of my day "helping" people. But for some reason it doesn't feel quite the same.
It was like something magical happened that day.
And for a moment I felt a sense of oneness.
Humanity
Peace
I find it so hard to recapture those feelings nowadays.
I just finished working out. My muscles twitching and the sweat causing my shirt sleeves to stick to my arms. As I cooled down I gently laid in the grass and allowed the sun to wash over me. Out of the corner of my eye I noticed a figure approaching.
He appeared in his forties. Wearing old tattered shorts and a t-shirt. His facial hair overgrown and unkempt in distinct contrast to his balding head. He walked without particular haste or direction. His eyes glassy. His gait unsteady.
I may have noticed the distinct odor of alcohol. Or maybe it was my preconceived notion of the homeless people in the area. The mind is highly suggestible.
Hey buddy...can you help me out?
I paused, calculating...How about something to eat?
He nodded and I beckoned him to follow. We walked down the hill to a convenience store. I only had a few dollars. We agreed on a turkey sandwich and a few drinks. I handed him the change at the register.
And then we walked back to the field and sat down. I unwrapped the turkey sandwich...giving him one half and keeping the other for myself.
We ate. Silently. Enjoying the summer day. The sweaty college student and the unkempt homeless man. We exchanged some pleasantries. Nothing too deep. Eventually he finished...thanked me...and walked off.
Years have since passed and I am a doctor. Now I spend most of my day "helping" people. But for some reason it doesn't feel quite the same.
It was like something magical happened that day.
And for a moment I felt a sense of oneness.
Humanity
Peace
I find it so hard to recapture those feelings nowadays.
Monday, December 13, 2010
No Respect I tell Ya
Sometimes I wonder....do non primary care physicians respect our opinions? Do they believe in us? Are we piers or inferiors? And in general....what do we deserve.
I was rounding in the hospital on my partners patients when I came upon Mrs. S. She was having progressive hip pain and her rheumatologist ordered and MRI which showed a joint effusion. The patient developed low grade fevers and anemia and was sent to the hospital to rule out infection.
A quick review of the labs showed the esr and crp were moderately elevated. She was anemic. Her rheumatoid factor and lupus testing were normal. The joint fluid from the hip was tapped and was not consistent with infection.
So I sat down with Mrs S and started to take a history. Upon further review she had also developed bilatteral shoulder pain. Worse in the morning upon waking. Better with activity. She had moderate fatigue.
Based on the clinical history, labs, and radiology findings, I felt the growing suspicion that this was Polymyalgia Rheumatica. So I called the rheumatologist and discussed with her my findings. I felt pretty certain. The conversation went like this...
This looks like polymyalgia....
No I doubt it...probably viral!
But what about the story doesn't fit for PMR?
It just doesn't...lets keep her off steroids and see what happens!
The patient was discharged from the hospital and later followed up with my partner and the rheumatologist.
A few weeks later I ran into her in my office. Upon asking her how she was doing I got this response:
Wonderful Dr. Rheumatology realized that instead of an infection I have Polymyalgia Rheumatica...I am doing so much better now on steroids!
No respect I tell ya....no respect.
I was rounding in the hospital on my partners patients when I came upon Mrs. S. She was having progressive hip pain and her rheumatologist ordered and MRI which showed a joint effusion. The patient developed low grade fevers and anemia and was sent to the hospital to rule out infection.
A quick review of the labs showed the esr and crp were moderately elevated. She was anemic. Her rheumatoid factor and lupus testing were normal. The joint fluid from the hip was tapped and was not consistent with infection.
So I sat down with Mrs S and started to take a history. Upon further review she had also developed bilatteral shoulder pain. Worse in the morning upon waking. Better with activity. She had moderate fatigue.
Based on the clinical history, labs, and radiology findings, I felt the growing suspicion that this was Polymyalgia Rheumatica. So I called the rheumatologist and discussed with her my findings. I felt pretty certain. The conversation went like this...
This looks like polymyalgia....
No I doubt it...probably viral!
But what about the story doesn't fit for PMR?
It just doesn't...lets keep her off steroids and see what happens!
The patient was discharged from the hospital and later followed up with my partner and the rheumatologist.
A few weeks later I ran into her in my office. Upon asking her how she was doing I got this response:
Wonderful Dr. Rheumatology realized that instead of an infection I have Polymyalgia Rheumatica...I am doing so much better now on steroids!
No respect I tell ya....no respect.
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