Due to circumstances totally under my control (I screwed up) my site was down for several months and then was dormant for more than a year. I am at last making progress on restoring it. I did not stop writing during my publishing hiatus, and I have blog posts in queue starting February 19th. Please be patient while I gradually restore (most of) my 300 previous posts (I've done 80 as of 11/01/17108 as of 12/15/17, not in chronological order), add a twitter feed, create a block for noteworthy posts, rebuild the genealogy and photography sections of the site, set up registration, delete spam accounts, set up comments and a forum, and work on building or adapting a theme. If I have inadvertently deleted a REAL account along with the several hundred spam accounts, I sincerely apologize. Feel free to re-register.

Thank you.

Impressing the date

My daughter and I were standing on line in an upscale cross-country ski lodge near Sun Valley.  The man in front of us ordered for himself and then his somewhat younger and obviously starstruck female companion. Their order consisted of two hamburgers, two coffees, and two large chocolate-chip cookies, and their bill came to about $30. He handed the guy behind the counter a $100 bill and said, just a bit louder than necessary, “Keep the change.”

I caught my daughter’s eye, curious to see if she had noticed. It appeared that she had. After they had left with their order, I remarked, “It looks like he’s trying to impress her.” 

My daughter looked across the room at the two of them, where he was holding forth about something and she was sitting and drinking in every word. After a pause, my daughter said:  “I think it worked.”


Behind the curtain...

As I watched my 17 month old granddaughter decode the world, it was impossible not to marvel at the enormity of the task and wonder what was going on behind that so expressive face as she processes the flood of sights, sounds, feelings, tastes, experiences, and consequences. Some predictable, but many not.


The pause followed by the emphatic nod yes or no. The straight-line eyebrows signifying displeasure. Picking things up and fingering them, turning them over, passing from hand to hand, sometimes testing them with mouth, teeth or nose.   Dropping them to see what sound they make (or to see what the nearest grown-up would do).

What did the several second pause mean when I asked: “Do you want to go out on the porch?”  Was the time before the vigorous assent spent in decoding, processing,  or deciding?  Was she figuring out what ‘porch’ means, or pondering the risk she might miss something else?  Did she really want melon but decided that she would take the porch as an acceptable substitute.

By the time she is sufficiently articulate to discuss this, the answers to these questions will be irretrievably buried beneath mountains of useful and useless information, memories, associations. I can speculate but will never know.

Why stop there?

What does the checkout person at Willey’s General Store mean by that quick glance at the bagger after surveying my tousled hair and almost not safe for work t-shirt? What does the neighbor really think as she smiles and waves as I bike by? What does my daughter mean when she sighs at one of my insufferably bad puns? What does my wife think when I am lying on the couch with eyes closed? (Napping? Hiding? Shirking? Handsome bloke?)

What do patients really think when they smile when they ask how I am and I respond: better than I deserve.  What are they really thinking when they nod in the affirmative when I ask if my explanation makes sense?

George Bernard Shaw said it well: “"The single biggest problem in communication is the illusion that it has taken place."


Reflections on retirement

Since I retired, I have repeatedly been asked two questions. “How do you like retirement?” and “Don’t you miss practicing medicine?”

The answer to the first question has been evolving. At first I begged off with: “It’s too early to tell.”  That slowly transitioned to: “It’s a learning process.” (Often followed by a conversation about the challenge of deciding what to do every day instead of letting the schedule decide for me.) These days I talk about how much fun I am having with my grandchildren and how nice it is to have both time and energy to pursue longterm passions for Nordic skiing, hiking, woodworking, computer programming, photography, writing, reading, and guitar.

My answer to the second question hasn’t changed much. Yes, I miss practicing medicine. A lot. And, despite how busy I am and how much fun I am having, the pain of my withdrawal from practice shows no sign of abating.

There are things I don’t miss. I don’t miss the constant fatigue. I don’t miss the fear that I will make a preventable mistake and cause pain or harm, or even death. I don’t miss the stupid policies and procedures that made it harder to do the real job of helping patients. I don’t miss the sadness and anger when bad things happened to good people. I certainly don’t miss the loss of autonomy and the madness of watching a patient-centered practice become a medical business after it was acquired by a local hospital. 

Overall, though, the frustrations of practice were dwarfed by the rewards.

First and foremost, I miss my patients. They were (and presumably still are) great people, wonderful in their diversity, authenticity, engagement, and willingness to share with me. I miss being invited into their lives, and allowed to share their triumphs, trials and even tragedies. I miss their concern about me when I was ill or having a bad day (or week).  I miss them asking me questions about health and medicine, and answering my questions about their work, travel and hobbies. I miss the magic that happened multiple times a day when I entered a room, closed the door, and asked how things were going and how I could help. I miss the blessing of a thousand friends. If any of my patients are reading this - thank you for all you gave me.

I also miss solving problems. Some of the problems were medical: what could be causing this consultation of symptoms, why is it not responding to treatment, how do we manage the side effects of treatment, how can we find out more about what is going on? Some of the problems were more psychosocial: how can we help this child succeed in school, how can we make the treatment more affordable or more tolerable, how can we maximize the function and joy for this person despite their illness, how can I help this person understand without being overwhelmed by what they learn. 

I miss the constant learning. The science of medicine changes at a breakneck pace, and keeping up with everything isn’t possible. The trick was always being open to learn new things, not just about new developments but also about old problems.  Sinusitis began as ‘a thing’ I learned about in medical school and residency, but in practice it quickly became a collection of medical syndromes with different presentations and treatments, based on constantly growing and changing (and often contradictory) science.  In addition, even if the ‘sinusitis’ was the same, each patient with sinusitis was different, and different in ways that one can only learn about from the patient. It both saddened and puzzled me to hear clinicians complain about the growth in what there was to know and the impossibility of mastering it all. I saw this not as a recipe for failure but as an opportunity to learn and grow every day.

I miss the team I worked with. I was fortunate to be surrounded by a tight and supportive community of nurses, clerks, secretaries, lab techs, and clinician colleagues who shared my commitment to the patient above all else. They both had my back and refused to let me off the hook.

I even miss, at least a little bit, the demanding and often rigid structure of my life. Even while I complained that it stood between me and things I wanted to do, I took comfort in knowing I could count on being busy doing important things with a good team for appreciative patients. 

Looking back, I think of a Nietzsche quote. : “There is one thing one has to have: either a soul that is cheerful by nature, or a soul made cheerful by work, love, art, and knowledge.”


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