Dr. Sour Puss

The chronicle of a lonely do-gooder family doctor who survived.

Monday, March 6, 2017

The Family Doctor Manifesto

Here's something I wrote somewhere on the Inter-hoo after a day that was too damn long. I don't even remember what it was the got me ranting so hard.

Here's the deal. I'm a motherfucking family doctor. I am a leader in the community in which I live. People come to me for medical care when they are in moments of crisis in their lives. I prescribe the pills, but more importantly, I provide the comfort, the wisdom, and the support they need to weather the crisis. I make a human connection in 15 minutes, whether you are an airline pilot, a grocery store clerk, a college student that smokes too much pot, or a delusional homeless person that thinks all white people except me are out to get you. I am the grease that eliminates the grinding of the gears of society. I am the person that can make a multimillionaire neurosurgeon see the reason why he/she should donate their time to help a struggling addict with a risky surgery because I believe with enough support this person has value and can be better. I am not a technician, I am an artist who practices with the whole of the heart every day, 24 hours a day. I've seen things you people wouldn't believe. Attack ships on fire off the shoulder of Orion. I'm the person who treats your drug addiction and mental illness and realizes the greatest proof of your struggle is the fact that your daughter is thriving in her freshman year in college. I delivered your baby and understood that those first few hours when I was writing orders at the hospital afterward were the most important hours of your life. I skewed the results of your Montreal Cognitive Assessment so that you were excused from a citizenship test you'd never pass so you could stay here with your children and grandchildren because I know you and I've seen you at the park and our children have played together, and you are welcome with me in my community regardless of how you arrived here. Of course I'll spend some time with you right now because I see that this is important, but if I can't spend time with you right now, I'll find the right words to convey that I understand and I know I should spend time with you but I can't because there is a world of need competing for my time, but you are still important. I am a family doctor and I walk down the street in my neighborhood and homeless people, firemen, shop owners, and software executives talk to me because I am the glue that binds all of these people together. And I proudly carry my children with me to watch and understand the power of human connection and because I am oh so proud of them.

There is one president who did things to help me maintain my position in my community and there is one president who is threatening my ability to continue to do this. I don't know if I can withstand the assaults on my job, but I will never succumb to practicing for money, or medical tourism, or to being a well paid technician.

This is what I've always wanted to be. And, yes, I am full of myself, aren't we all?

Monday, October 27, 2014

Some practical advice about ghosts

In honor of Halloween, I'm re-publishing something I wrote elsewhere on the interweb.

The older I get in life, the more it is plainly obvious to me that ghosts exist and one would be well advised to conduct one's affairs presupposing the existence of otherworldly beings in our presence. When we bought our house, it was in an older part of town, and as we all know, older buildings are far more likely to house apparitions and spirits. Candidate houses were researched in crime data bases, and were evaluated for things like creaky floors, scary trees outside the windows, and architectural style (A Victorian home over a hundred years old in the United States is so likely to be haunted that I would never consider living or even staying overnight in one).

It is a total misconception that keeping ones body parts under the covers is protective. I think this notion came from the "monster under the bed" tradition of night terrors which is of course silly. There are no such thing as monsters. I think it is plausible that hiding under the covers does afford some protection from Aliens spying on you from outside the window, something that also plainly exists. (Ie you are much less likely to be abducted and probed if you are not easily spotted under the covers.) So yes, when I hear strange noises in the middle of the night, I do hide under the covers until I have a better sense of what I'm dealing with. But this should really only be the first step in your approach to an Unknown Nocturnal Supernatural Being. YMMV.

I leave a small light on if there is a chance I could be visited by an UNSB. It doesn't keep them away but I like to see what I'm dealing with. Ghosts will often give you clues to how threatening or scary they are likely to be, it might be their age, there dress, something and you're gonna want a good look at your ghost. It is important to keep in mind that a ghost will never inflict direct bodily harm but a more menacing ghost will still spook the bejesus out of you and is more likely to cause others in the home to act out irrationally and dangerously ("Heeeere's Johnny!").

Cats help. I keep a guard cat on the bed every night and I think everyone should. It is very unlikely that a being passing into our universe from the Spectral Plain will escape a cats attention. The problem is there's a lot of non-significant ghost activity going on all the time. Souls conducting normal after life activity, contacting relatives, etc that I don't need to know about. Some cats will pick up and freak out about it, meowing in a corner at nothing in the middle of the night. Our current guard cat is really reliable.

Ever vigilant

The ultimate last line of defense, your impenetrable fortress against ghosts -- and this is the big mistake made by characters in most horror movies -- is safety in numbers. Everyone in the house should be piling into the same bed, or at least pairing up. Spirits know that groups of humans are much more likely to rationalize and normalize a supernatural event when they are talking it out with each other, and they don't even try. There is serious academic research postulating that human family structures were evolved and shaped by the threat of ghost harassment.
Our house is a hundred years old and located not on, but near an ancient Indian burial ground. Interestingly, we also discovered that the architect of the house died while it was being built. The pre-existing Haunting Risk Assessment Scale II score is really quite high, 18 out of a possible 24 and we certainly would not have bought the house had the previous owners disclosed this information. But I have to say -- with relatively simple interventions, a nightlight, a faithful guard cat, and both boys climbing into my wife and I's bed in the middle of the night, we've remained completely free of ghost activity for over ten years.

Thursday, May 16, 2013

Sometimes, when all the hateful narcissists of the world want to spread the misery in their lives all over you, you just need to come home for a rousing game of Belly Buttons on the carpet with your two boys.

My life is great and I'm thankful for it every day.

Saturday, September 15, 2012

Lia Lee 1982-2012

To say that Anne Fadiman's book The Spirit Catches You and You Fall Down was hugely influential on my life would be an understatement. It's pretty cliche for a doctor to say this about her book (akin to someone saying To Kill a Mockingbird is their favorite book, simply because they haven't read much since high school). I admit that I am not a particularly well read person, mostly because a busy life in medicine doesn't afford much down time for reading. However, for many of us in health care, the revelations in the book are profound and true.

Before my life as a doctor, I started out as an activist for homeless people. When deciding a career path, I realized the most important contribution I could make to help disenfranchised people at the margins of society was to become their physician. Before I was interested in anatomy, physiology, and biochemistry, I was interested in the stories people had to tell. How they got where they were, what their lives were like, and how they viewed their current plight. If you let people speak freely, they will eventually tell you what they need, even if they don't consciously realize what they need themselves. And often what they need is medicine. Often what they need is counseling. Often what they need is someone from within the system to hear them. I would be that person.

Flash forward about eight years. 

I've been a good little med student, surrounded by old men in white coats, and classmates on their way to bright futures as subspecialists with German sports cars. My brain only thinks in terms of cranial nerves, generations of cephalosporins, and the DSM IV. I find myself an intern at the county hospital in Seattle. As it happens, this hospital is a pioneer in cross cultural medicine, with interpreters on staff for every language and culturally appropriate educational materials and seminars. The hospital is the primary source of medical care for refugees from all over the world, Latinos, Somalis, Ethiopians, Iraqis, Sudanese, Vietnamese. When a cargo container at the port is found to contain 30 emaciated Chinese immigrants, they come here to be cared for by a young, still somewhat idealistic, but obviously quite green intern.  This intern is mystified why his patients don't understand they need to take their medicine every day or they will get sick and need to be hospitalized, or why a woman who watched her family get murdered in a war doesn't grasp that her unexplainable somatic symptoms are the result of PTSD.

It's about 1999, and in this crucible, a social worker gives the intern a copy of When The Spirit Catches You and You Fall Down. The book takes place in the California central valley in the early 90s where a community of Hmong refugees, escaping war and famine find themselves resettled. Lia Lee is a young woman born with a seizure disorder and is brought to a teaching hospital by her family. The drama in the story centers around the miscommunication between how Lee's family sees her illness and how the residents treat her. Lee's family believes that she's been touched by a healing spirit, and can be made well by appeals to other spirits, sacrifice, and atonement. The doctors who treat her become frustrated by her family's refusal to give medications or pursue radical treatments for what they see is a severe neurologic condition. As outlined, probably for the first time, by Fadiman, the Hmong mistrust many of  western medicine's treatments, horrified by things like surgery and blood transfusions which may upset the individual's balance and wholeness, allowing evil spirits to enter their body. Lee's condition deteriorates, she loses the ability to speak, to walk. The Hmong further mistrust the doctors because their treatments, incorrectly applied by the family, aren't working. The doctors perceive abuse and neglect. Child protective services get involved. The story doesn't provide a happy resolution, except as a cautionary tale for others.

You can know everything there is to know about anti-epileptic drugs, antimicrobial mechanisms of resistance to antibiotics, or how to prevent surgical complications, but it means nothing at all if you don't listen to your patients.

In my career, this has not only been an important realization to make when I am trying to heal someone, it has been richly rewarding. In intimate settings, I have had the privilege to hear stories of pain, suffering, survival, and belief systems that run the entire gamut of the human experience. I hear it every day, and I am so honored to witness it. I realize that these truths that patients hold are usually no less true than those which medicine seeks to impose on them. 

Shortly after being given this book, I found myself taking over in the ICU at the county hospital. There, I assume care of a relative young Hmong woman who has been in the hospital for weeks, dying of progressive liver failure for which no physician in the hospital has been able to diagnose or treat. All known infectious pathogens, autoimmune causes, or toxic agents have been ruled out. Each day, we replenish her fluids and electrolytes, adjust her feeding tube nutrition, but her condition is only deteriorating slowly while her husband and family never leave her side, in devoted emotional torture.

One morning, I am rounding and come to her room to find her surrounded by Buddhist monks in full regalia chanting prayers around her bed and it gives me chills. I've been up all night and am eager to go home but I decide not to interrupt them, holding back outside the room with the Hmong interpreter I have arranged to meet me every morning to update the family. She tells me a story that hit me in the gut and literally makes me find a private room to break down and sob.

20 years earlier, when this woman was 15 years old, she lived in a village, the daughter of a fairly prosperous farmer and local government official. It has been decided that she will marry the educated son of another family in the village. But one day she meets an older peasant from another, rival, village who makes her laugh and they fall in love. Against the family's wishes, and in secret, they flee the village together and get married. For their transgression, both the man and the woman are ostracized by their villages and before all contact with their families ceases, they are told that their love is cursed and will destroy them. With no place to go, they wander as refugees and when war hits, they eventually are evacuated, ending up in the United States. Still, they are happy together, they build a life and a business  and have 6 beautiful children. But the price they have paid for their love weighs heavy over the years, knowing nothing of their home or their families. 

"He thinks he has brought this upon his wife," the interpreter tells me, looking over at the husband.

Weeks later, after daily prayers, bedside vigils, even a pig sacrifice, and the best ICU level supportive care the American medical system has to offer, the woman dies of fulminant liver failure when the family decides, on the advice of the doctors, to withdraw care.

Many times I don't have answers or explanations for things that fit within a medical paradigm, but the world is richer when we understand people and their stories.

Lia Lee, the little girl born who served as the inspiration for The Spirit Catches You and You Fall Down, died two weeks ago on August 31, from complications of pneumonia, after living most of her life in a persistently vegetative state, for 30 years lovingly attended by her family. I have no idea if her outcome would have been better if the family had blindly followed doctor's orders, probably not. But I do know that she lived much longer and gave much more meaning to her family than most people in her condition. And her story has helped and inspired literally thousands of health care workers and probably hundreds of thousands of the families they care for.

Monday, December 26, 2011

My Boeufcake side project

Ravi and rock out most every night together and honestly I didn't think much of it until we accidentally got caught on video by my sister tonight.

Friday, November 11, 2011

Sashi Carl 11.11.11

It's true, he looks exactly like his older brother.

I was a little worried I'd be jaded by the time the Two-dle was delivered, but thankfully I'm just as over the moon as I was when the Doodle was born 2 years ago. After Ravi's intrauterine growth restriction and crash c-section for a 5 minute decel down to 70, we chickened out and decided to skip the drama, scheduling our repeat c-section well in advance. I have to say leaving the chaos of several consecutive 60 hour work weeks at the CHC and a 2 year old who literally bounces off the walls at home, I appreciated the calm control of an electively scheduled c-section, it was the least stressful 45 minutes I'd had in months. Overmedicalization of child birth be damned, this was civilized.

I think our prep work with Ravi paid off big time. Within 2 minutes of meeting the baby, Ravi says, "I want to hold my baby brother!" Within 5 minutes, he was stroking his hair, kissing his face, then honked his nose.

"Ravi, do you think we should take your baby brother home with us?"

"Yeah! He can live in the Green Room!"

Saturday, September 11, 2010

Courtesy of Wilson...

Probably the only people in the world who think this is funny are in the picture.