Why Social Media?

The voice on other other end of the phone shook with volume and power. I could envision her fists shaking, her brow sweating, and her eyes bulging as if I was watching a bad reality show on TV. She was not just insinuating. She was outright accusing me of doctoring her medical record for my own personal gain.

I calmly listened to her fowl mouthed diatribe and waited for a moment to interrupt as she caught her breath. Should I tell her it was a hard day in the office? Explain that a patient was dying in the hospital? Would she have understood that I was just trying to follow government mandates and had been distracted by my first attempt at eprescribe?

So Yes...I did miss that my front desk employee had placed the wrong chart on my schedule. The names were so close. And I asked about her insurance status not to profile her but to decide whether to use eprescrbe or not.

In my heart I realized that she didn't want explanations. She was convinced that I was trying to harm her and I wasn't going to change her mind. It didn't matter that I correctly diagnosed her with pneumonia. She, in fact, got her antibiotic a few hours late but was feeling perfectly well now. But none of that mattered.

The truth is as physicians we are suffering from poor PR. Between the loss o faith from To Err is Human and the political wrangling of the PPACA we have gone from knights to knaves.

In the public eye the empathic physician has been replaced by the miserly clod who clumsily dances through doctoring in order to drive home in his BMW and trade stocks online.

We are looked at as greedy. We spend to much. We order too many tests. We make to many errors.

If those darn doctors would just do what they were trained to do!

Many physicians who struggle on the front lines see a very different picture. We are consumed by our career. We fight for our patent's well being as if they were family members. And we get burned over and over again by the oversimplification purveyed by catchy headlines and enthusiastic politicians.

In order to reverse the egregious harm done to our profession we have but one choice. We have to take our fight to the people.

Why do I use social media? I see it as a profound and effective way to communicate to our patients who we are. To re brand us back to the knights we strive to be.

Only then will they know our commitment. Only then will they have a window into our souls. Only then will they know that although we may not be lying with them on the operating table.....

we still bleed.

What Do You Want?

I sat uneasily staring at the young man sitting across from me. He winced and painstakingly adjusted in his seat to find a comfortable position. His face gray and withered had taken on the look of the nursing home surrounding us. Drabness pervaded.

At thirty eight he was much too young to be incarcerated in such a manner. He was a victim of biology's cruel misfortune. He had usurped the privileges of age prematurely. He was dying of cancer.

His legs were paralyzed since undergoing surgery to remove tumor from his spine. His lungs, stifled by nodules, gurgled and sputtered with every breath. His hands clenched with each movement. The pain was debilitating.

His doctor discharged him from the hospital with instructions to get stronger. A few weeks of therapy and you'll be ready for your next round of chemo...your next back surgery.

I listened to his explanations and begrudgingly hid the doubt and disgust that percolated through my brain. What kind of physician encourages his dying patient to waste his last hours of life doing physical therapy?

I focused my thoughts for a moment. If I impose my will on him am I any better then the doctor who exhorted physical therapy? Could I recommend hospice with a clear conscience?

So what do you think of all this?

As I waited I searched him for direction. He paused. He closed his eyes and took a deep breath. A tear formed and rolled down his cheek.

I think I'm dying!

I reached over to the desk and handed him a tissue. I thought of my wife and children. How would I handle his situation? Would I except the harshness of reality or would I fight impossible odds?

What do you want?

His eyes, which had been focusing on the floor, shot up to meet mine.

I want this to be over. I want to be out of pain.

His face brightened. The grayness disappeared and he smiled and started to laugh. I asked what was so amusing.

What I want?

No one has ever asked me that before!

The Kind Of Doctor Who Takes Care Of Colds

It was my favorite kind of gathering. The room was filled with young attractive non medical people. Most carried a cocktail effortlessly as they stood in their best Friday night apparel. The tempo of the conversations rose and fell.

I caught a glimpse of my wife standing across the room with a small group of friends. I watched her hand gestures and the shift in her posture. I had just enough alcohol to amuse myself by conjuring up mock details of their conversation. Boy Sally I love that purse but those shoes are just dreadful!

I cradled a Corona in my right hand as a distant acquaintance wandered forward in my direction. He was well dressed. A business type if I remembered correctly. He was a friend of a friend.

We chatted amiably for a few moments. Quickly running through our list of polite conversational topics before a look of excitement flashed across his face. Hey...your a doctor right? What do you practice?

I felt a twinge of disappointment and embarrassment. I really didn't like talking about my profession in public. I paused for a moment and then explained that I am an Internist.

An Internist? Like a primary care doctor? The kind of doctor who takes care of colds right?

I probably would have taken offense to his comment if his words hadn't transported me back to the struggles of the last week. My eyes glazed over.

I signed four death certificates last week. Each patient was in hospice. One in the hospital. One at home, and two in a hospice unit. Three I had known for years. The fourth was a young man who I just met. I spent hours counseling each one of them.

I admitted ten people to the hospital. Some got better. Some got worse. A few ended up in the ICU.

I was on call half the week and hadn't slept most of those nights. I returned each morning dutifully to see patients in clinic. I struggled as always to sort out the bio-psycho-social causes of illness. I diagnosed a case or two of gout. Saw a patient with erythema chronica migrans whose Lyme titers were markedly positive. I told a young woman she has cancer.

I worried. I paced. I stressed. I ignored my children nagging at my feet as I returned the deluge of phone calls from the nursing home.

I held hands. I teared up several times. And I laughed...in the hospital, in the exam room, at home. I laughed even when sometimes I felt like I wanted to cry.

I woke up from my haze to see that my companion was now waving his hand in front of my face. For a moment I focused on him before I purposefully walked in the direction of my wife.

Yes. The kind of doctor who takes care of colds.

For Safe Keeping

He skated into my room with his hair disheveled and his hands waving wildly. For a moment I thought he was Kramer from an old a Seinfeld episode. His lips moved erratically as he gasped for breath.

Doc...doc you got a help me!

I motioned him into a chair. As his backside was about to touch the seat he bolted upright. He stood with one arm resting on his hip and the other holding him steady against the desk. His eyes squinted in pain. A drop of sweat formed at his hairline.

What happened to you?

As I asked his face turned from pain to humiliation. His voice lowered and he strained to lean closer. He looked up at the door cautiously to make sure that it was closed.

Doc I got a chicken bone!

He must of recognized the confusion in my facial expression because his eyebrows furrowed in frustration. He looked like a poor school teacher forced to explain yet again to his substandard students the difference between a noun and a verb.

Jeeeeeez, I got a chicken bone stuck up my ass.

I almost fell off my chair. I turned my head and bit my lip. Anything to avoid breaking into peels of laughter.

Upon regaining composure I turned back toward him again.

Surely your wrong! A hemorrhoid? An abscess? Some left over toilet paper?

He was losing patience quickly. He gritted his teeth in a last effort to control his emotions.

I know what I know. Last night I ate chicken and this morning I got a chicken bone stuck up my ass. Are you going to take it out or what?

With that he dropped his pants, turned around, and leaned forward against the exam table. I cleared my throat and took a step backwards.

Um...Um....I better get some gloves for this one.

I adjusted the exam light over his behind and pulled my stool closer to take a peak. Apparently he enjoyed the warmth because he moved his torso from side to side in mock pleasure.

And there it was. A minuscule shaft of pearly bone with a forking arm wedged perfectly in his rectum. With forceps in hand I gently coaxed the obstruction free. I could hear the sigh of relief escape form the other side of of my precariously perched patient.

I laid the product of my excavation indignantly on the tray and turned to leave the exam room.

No more chicken for you I called over my shoulder as I gathered my computer and raced toward the door. Out of the corner of my eye I could see him grab a tissue and grasp the bone between two fingers.

He then put it into his pocket...

for safe keeping.

Why I Write And Some Medical Blogosphere History

It was the sitemeter. The damn sitemeter. I couldn't take my mind off of it as I sped down the highway to the hospital. The sun inched over the horizon and a blur of headlights swarmed and then passed my car.

I should have never put a sitemeter on my blog. I didn't need to stare down the barrel of cold incontrovertible proof. I already knew that my posts disappeared into the ether as fast as I pushed the publish button. But I sure didn't need confirmation.

*

I remember back to when I started blogging. I built a web site selling artwork. I called it Fine Art Doctor. It was a hobby to fulfill the emptiness from those early years of practice.

The blog was a companion to the web site. I wrote about various art related topics. But I was flat. Uninflamed by the controversies of the art world I searched the Internet for more.

What I came across was a well known blogger named Gruntdoc. When I surfed his site I knew I was onto something. I left a comment on one of his posts and started to change the direction of my blog to focus on medical topics.

It was 2006 and the Grand Dame of the medical blogosphere was a woman named Moof (I know your lurking out there somewhere!). Moof followed from Gruntdoc and introduced me along with Doctor Anonymous (Mike Sevilla) to the community.

It was an inspiring time. I remember reading the likes of Charity Doc and Doctor Charles (before he left and then came back). TBTAM was on hiatus. KevinMD still rained supreme but in a slightly lesser way.

*

I turned the radio up as Adele was playing in the background. Her voice, sweet and soft, was becoming bigger and more powerful each second.

In the beginning I had quite a following. I started with medical narratives and poetry. Eventually I graduated to writing fictional stories. I celebrated with each comment. Sometimes I got as many as ten per post.

I felt creative and liberated. Like part of a community. I even got some face time on KevinMD. Sure I would sometimes fall off the bandwagon and go days without posting. Maybe even weeks. But I would always come back.

That is until the morning I had a car accident. I wasn't hurt but I was shaken. And then I arrived at my office to turn on the computer and find that my blog was gone. A word press glitch.

I finally got the content back weeks later but it was imported to a new web address.

With the snap of a finger I lost my blog. I lost my community. I lost my voice.

*

Adele is now barely audible. Her voice vibrates with charisma but soft...emotional.

I migrated over to blogger with little fanfare and little following. I would have loved to be able to brag about my stamina but I couldn't. My blog had been mute for weeks or sometimes months at a time. Posts came and went. Sometimes barely audible.

So why did I do it. Why did I keep writing in such a public way to an audience that had all but disappeared?

*

My mind slowed. My shoulders relaxed and I listened to the music:

I hate to turn up out of the blue uninvited.
But I couldn't stay away I couldn't fight it.
I'd hoped you'd see my face & that you'd be reminded
That for me it isn't over.

As I listened to the lyrics my emotions swelled. A few words masterfully twisted and tangled with a little melody brought up such vivid feelings. Snapshots. Memories. It reminded me why.

*

I write because I envy people like Adele. I envy the master craftsman who with a twist and flourish can reach down deep into our souls and produce something different in each and every one of us.

I yearn to use a few words to paint a million pictures on each reader's private canvas. To pull out from them that which they secretly want to expose but hold fiercely close to their hearts. To teach. To learn.

I would write if there was no blog, or paper, or pen. I would scrawl my awkward musings in the sand with a stick.

I would write because I have to.

Even if no one is listening.

A Hospice Story

If cats have nine lives surely Paul had at least two. There was the one he led for his first thirty years. Lonely and introspective he struggled with a secret that was far too large for his conservative Catholic upbringing. So he closeted his feelings. He closeted his hopes and dreams. And he closeted his sexual orientation.

His second life began on his thirty first birthday when he confessed his heart to his parents and sister. A heated argument ensued which caught Paul completely by surprise. He left his childhood home in the tony Chicago suburbs and never looked back.

A decade later I stood next to his bed my body shading the stream of light pouring in from the east facing window of his room. I fidgeted uncomfortably as I asked if there was something I could do. It was my first day on the hospice unit. His partner nodded slowly. They wanted to see the chaplain.

*

My earliest clinical experiences occurred during the first year of medical school as a hospice volunteer. Each week I would leave the cloistered environment of the library and anatomy lab and wend my way through the hospital to the hospice ward. It was the mid nineties and people were still dying of AIDS.

Paul had withstood every cruel manifestation of an emotionally and physically disfiguring disease. Lymphoma, Kaposi's Sarcoma, pneumocystis pneumonia. He was tired. And for the most part he was ready to die.

As dying people go, Paul had it all. A caring partner. A slew of friends that visited him constantly, and a kind and generous demeanor. He rarely complained of physical pain. He, however, could not overcome the internal unrest that snatched the dream of a peaceful death from his frail clutches.

Paul had not spoken to his family in over ten years. They had no idea that he was sick or dying in the hospital. He called once six months prior. But his father hung up before he could explain his situation. He yearned to see his father and mother once more...to hug his baby sister.

*

On a sunny October morning the chaplain sat down at the nurses station to call Paul's parents. His mother answered the phone cheerily. The chaplain gently explained who he was and why he was calling.

A barricade that took a decade to traverse emotionally melted away in minutes as his family rushed the short distance from the suburbs to the city hospital. By the time they entered his room, he was unconscious.

I watched as Paul's father, mother, and sister sat attentively at the bedside for a few minutes. Then they would leave and his partner and friends would enter to take their rightful place. This back and forth continued for hours.

As Paul's breathing slowed the chaplain approached his family and beckoned them to come. They joined the others standing in his room. Each family member jockeyed amongst the crowd to get one last look. Touch his body one last time.

The chaplain asked that they hold hands to say a prayer. And there stood Paul's loves ones. His father holding his partner's hand. His mother and sister interspersed among his friends.

Paul's eyes opened briefly before he took his last breath. As he looked up a faint smile formed at the corner of his lips.

He had found peace. He could die now.

The two parts of his life...

had finally come together.

Sexual Dysfunction And Hearing Loss..A Story

As I barged into the exam room I could feel my cape catching on the door knob as the few strands of hair left on my balding head blew luxuriously in the wind. I halted a moment to catch my breath.

Doctor....doctor you must help me.

My thoughts raced. Could it be a heart attack. A stroke. Hemorrhoids? I strode through the door and sat down on the edge of the chair. I was prepared for anything.

You see doctor....it's an emergency. I went to sleep three days ago and when I woke I couldn't hear out of my left ear.

His mouth twisted as he chocked out the last sentence. My keen medical mind surveyed the situation. He was in moderate distress. His head swayed back and forth with each word as if trying to position his right ear for better volume control. His brow was damp. His hands shook with excitement and fear.

He began to explain the dilemma further but I lifted my hand dismissively. Quiet man...I don't need to know such insignificant details.

I propped him up on the exam table with one hand as I pulled my trusty otoscope of the wall. I agiley placed the tip in his left ear.

First line: AECD. Second: QSTR

He waited for a moment and confusedly blurted out: what...what are you saying?

Oh nothing. I replied nonchalantly. I was just reading the eye chart on the other side of your head. Just as I expected! Even through the otoscope I have perfect vision!

He swayed in his chair as I finished the exam.

It appears you have an obstruction. Nurse...nurse...get me the irrigation tray.

I filled the syringe with scalding water and draped his shoulders with a gown. After five or six vigorous sprays a small blue pill fell out of his ear and onto the exam table.

I picked it up and examined it. Why it's a Viagra pill!

His eyes grew big and his jaw dropped. So that's where it went...I've been looking for that all over.

My eyebrows rose quizzically as he fidgeted and blurted out an explanation.

You see doc....my wife was trying to be all sexy like and leave a pill on my pillow. But I got so tired I didn't even see it. I laid down on my left side as usual to take a nap...

By then I had turned to leave the exam room. There was another life to save the next door over. Hearing loss as a side effect of Viagra. You better believe I was going to report that adverse event to the FDA.

Doc...Doc...one more thing. He thrust his hand toward me. Can I have the pill back.

Those things are expensive.