Sunday, May 13, 2012

Doctors and Magic




Doctors and Magic


Do you believe in magic?  Sure, no, yes, maybe, it depends on how you define magic are all acceptable answers.  But for the most part I think we, as physicians, tend to be skeptical.  It comes from a lifetime of requiring proof in making the decisions that affect our patient’s lives I suspect.  I wrote about my own personal loss of magic some time ago, and yes I believe in the magic of love.  I believe in the magic of innocence and beauty of the tenderness of Christmas mornings, and tooth fairy nights.  But I don’t much worry about wizards, or witches, or vampires, or evil magicians pitted in old feuds from Arthurian times.  Maybe I’m just obtuse.
I have a group of e-friends I enjoy very much.  I don’t know any one of them personally, but if I have the opportunity on M-W-F from 3-4 pm CST I log into #LitChat and share with other writers and readers from around the globe.   Last week we had begun discussing the book The Night Circus by Erin Morganstern and one of the participants allowed that in her book club, which was primarily composed of physicians, no one seemed to get it.  I felt bad.  I’d started the book when it was first published, and here it was three months later and I still hadn’t gotten a third of the way through it.  The problem was, I didn’t know why. 
Why had I stalled out?  It was beautifully written with luxurious description that creates a magical world straight out of a Tim Burton movie.  The plot revolves around two children selected as participants in an ancient feud and bound to one another in a battle to the death; no matter how long the contest takes.  They both receive different arcane training in the ways of magic until they are grown and then set on a collision course in the contest venue of the night circus, a magical circus that appears and disappears from place to place around the world.  That’s about as far as I got.  It was kind of like surgeons and internal medicine residents on night call appearing mysteriously in the various wards of the hospital to battle with one another over the true manner of healing.
I can hear the voices thundering through those cold gray green halls.
Zanziber, resplendent in his blue scrubs with contrasting Betadyne stains cascading down his thighs declares. “The only way to heal is with cold steel.  Surgery is the only way.  He has a perforated ulcer.”
And then Mortimer, rheumy eyes dull, places his stethoscope in the pocket of his yellowed white coat and responds to the challenge; “You wouldn’t know healing if it bit you on the ass.  It’s pancreatitis.  Look at his blood chemistries.”
Fire flies from Zanzibar’s eyes.  “Chemistries be damned, there is rebound, and where there is rebound is a surgical abdomen.”
And that was my problem with the book.  While it might have been magic for some, it was learned ritual for me, the IV or the blade.  You want arcane magic get a psychiatry resident involved in a case.  A life and death struggle that involves death by exhaustion is nothing to and old-school surgery resident.  The book didn’t take me anywhere that I hadn’t already been intellectually, but now that I had been called out I was damned and determined that I was going to finish it.  I will spare you any further plot details, to keep from ruining the plot for you, but suffice it to say that in the end it all returned to my own personal viewpoint on magic, that it exists in the relationships we pursue and the love we share with one another along the way.  All in all, it was worth the read.  It is a triumph of descriptive writing with a plot worthy of Shakespeare.  Perhaps a plot derived from Shakespeare, but that doesn’t detract from the writing.   

Thursday, May 3, 2012

Bloggy Stuff

This isn't so much about as around,
A boat that doesn't float lies aground
Useless for what it's meant for
less than more then before

Take a walk, feed the dog
Neither spinning gear or whirring cog.
The world passes floating spin
And all I do is walk home again.


- Posted using BlogPress from my iPad

Saturday, April 28, 2012

Year Six

Three new pieces on the evolution of a golfing obsession, the thirty- foot snake, truck box surprises, a sample of Terrence and the Toilet Fairy, ghosts in my pick-up (three pieces), a Christmas piece from the 1930's, and two other's. How's that sound for next season?


- Posted using BlogPress from my iPad

Thursday, April 19, 2012


More and Less


Let me let you in on one of the basic facts of life, and no, you don’t have to be a doctor to know this one.  Everybody wants more!

“More what?”

Who knows? More money for some, more fulfillment for others, or perhaps just more love, a lot of times it varies.  It may be one thing one day and another thing the next. What we want more of is variable.  The feeling that we need more of something is universal. For me what I need more of depends on the season and what mood I’m in.  In the fall I need more jackets.  In the spring I feel like I have a shortage of golf clubs.  Never mind that I have closets overflowing with both and I have more of either than I can ever reasonably use.  I don’t have the one I need now.

 And I’m not unique to this affliction.   Need proof?   Just look in the self-improvement section at your local bookstore, or turn on a little daytime television.   Flip through the channels any day of the week and two thirds of what you’re going to see pouring out at you is how to get more ________.  The blank may change from one channel to the other, but the quest, the need to get more, remains  universal.

Why do we need more?  Well, we need more money so we can get more stuff.  For two decades the U.S. economy has been based on a simple principle…consume, consume, consume.  When our economy hit a bump and consumer spending dropped the first domino fell, setting off a chain reaction that reverberated around the world.

I hate to admit it, but I’m no different from anybody else.  I fall hook, line, and sinker for the lure of the consumer advertisement.  I know that they’re just shallow manipulations of my individual gullibility.  And while I know this intellectually, at some deep basic level, for some reason, I believe what the commercials are telling me.  I need a new Lexus.  That three-year-old bomb I’m driving isn’t cool anymore.  I need the new one.  And yes…yes…yes Lord knows I need that new I-pad.  I can download three million songs and a thousand movies and…and…and, who knows what else? All I’m sure of is, I'm sure I need one.

 Unfortunately, as much as I delude myself into believing it is, my need isn’t real.  I don’t have time to download a hundred movies, much less a thousand.  I have three movies on my current tablet, and yet I’m coerced into believing I need a newer, more technically sophisticated model.  With the rapidity of technological evolution in the modern world, this cycle of need and fulfillment is never ending.  As soon as I buy the new Lexus or I-pad they’ll start advertising a newer model.  One that fuses both of them and comes with a thought activated cell phone in it.  And as soon as I get that, there’ll be an even newer model with both the cell phone and a miniature teleportation device, so I can teleport myself, my Lexus, and my I-pad to Tahiti to drive around for only a nominal fee.  And so it goes ad infinitum.

In a lot of ways medicine is the same way, but instead of ego and vanity being the primary driving forces, it is our very lives that are at stake.  We want more and we want better, the heck with better, we want the best.  Who doesn’t feel like they deserve the best health care?  America is nothing, if not an egalitarian society, in this regard.  Everybody deserves the best health care, right?

Well, I don’t know.  Let me pose a hypothetical scenario.  What if there was a drug that was ninety-nine percent effective in preventing osteoporosis in post-menopausal women?  And, what if it had no identifiable side effects?  Shouldn’t we give it to everyone that could benefit from it?
  
That seems like a “no brainer”.  And it would be, until you find out that it costs twenty thousand dollars a dose?  Ok, well, that does seem a bit steep.  But it really would make so many lives better.  I guess we still should.

The problem is, at that cost, for that many women, most of which will be sixty-five years old or older, the cost of the drug will bankrupt Medicare in a single year.

Now, should we make this wonder drug available to our Medicare beneficiaries?  By the way, I hate the term beneficiaries, almost as much as I hate the term, health care provider.   These are patients; sweet little grandmothers and mamas, wonderful women, and you’re their doctor and you have this wonder drug that will make their lives so much better. No longer will they have to face the chronic back pain and the debility of nerve root compressions that are associated with the pathologic fractures of osteoporosis.  Should you give it to them?  And, if you do who should pay for it?
This isn’t a medical decision.  Medically, the answer is obvious.  From a risk-benefit standpoint the drug is amazingly effective, so it’s all benefit with no risk.  The only risk is to the solvency of the largest health care provider in the United States, Medicare, and by extension the viability of our government as a source for health care coverage for those that have no other way to afford it.

So, this decision becomes not a medical decision but a social decision, a governmental decision, a legal decision, even a moral decision.  It is a decision that will reverberate through the years.

If the recent financial downturn has shown us anything, it’s that consumption has it’s limits, and those limits are imposed by the availability of funds.   Deficit spending and debt are only sustainable so long as there is someone willing to lend us the money that we don’t have. We are currently in a position that requires that we make a decision on how we will impose spending limits because we’re running out of credit.

Because our economy is, to say the least, less robust than it was a few years ago and the increasing number of folks becoming Medicare eligible due to the baby-boomers pouring into the over-65 population like water from a busted dam, things can’t work like they used to.

We need a better system.  Not one dominated by partisan politics, and we need to do it soon.  The system we have now is failing and its loss will effect, not just ourselves, but what kind of future we leave for our children.


Saw Levon passed on today. I don't know where he's gone, but he left a trail where he's been.  He was a part of a culture that is and was a rare time in the world.  See you neighbor.

Tuesday, April 3, 2012

Working on

Am working on the final run through on The Uncommon Thread. The cover is finished, just need the final graphic layout. Need to done by Monday, that means no more distractions.


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Location:Home

Looka'here

I've decided to change the name of the blog. Apparently a rap song called Looka here was released and anything even close to that is innundated. So since rap isn't something I care to blog about I've retooled. I will go back and import some of the old stuff over so it can vein the archives. Maybe I'll get back to posting more regularly with the new site. Off we go!