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

Saturday, September 11, 2010

Courtesy of Wilson...


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

Thursday, July 15, 2010

ug

At the risk of sounding self-important, there are times when my job feels like I'm staring all the pain, suffering, injustice, and inhumanity in the world straight in the face, alone, and yelling ineffectually as hard as I can at it.

Today was probably the hardest day I've had since residency and I didn't even go in to the hospital.

Tuesday, April 20, 2010

Just another heart warming story from the front line...

She was 16 and unexpectedly pregnant. She had been randomly assigned to me by our Maternal Support Services nurse and I had never met her or her family before. During those first few visits with me, she was an emotional pancake, completely flat. Silent except for the most basic responses.

Have you felt the baby move yet?
"Yes."

Are you having any more morning sickness?
"No."

Adopting my best sensitive doctor bedside manner, I would gently but repeatedly try to get inside her head, but she would give up nothing.

How are you feeling about the pregnancy?
"Fine."

Are you anxious about it?
"No."

Is your family supporting you?
"Yeah, I guess."

Is there anything else you want to talk about?
"No."

I would later discover that she, her mother, and her younger brother became patients of our clinic after her alcoholic abusive father had finally driven their car through the front room of their house and they had fled to a nearby domestic violence shelter. One of our outreach nurses had identified them as a high risk family and had them establish care with us. Now that she was pregnant, she would have to leave the shelter and the support of her mother to find a new place to live. That new place turned out to be the home of her baby's father, someone she hardly knew.

I was really concerned about this woman's affect and had talked several times with our MSS nurse about what might happen with this new mother and child. I continued to see her and she remained unengaged and withdrawn until her 20 week ultrasound. The day of the test, I got a call from the ultrasound technologist; she was pretty sure this baby had a cleft lip, maybe worse and we should probably do a more detailed evaluation. "Do you want us to tell the patient?" She asked. Concerned that I hadn't been able to read my patient's emotional state for the entire first half of the pregnancy , I told them to send her back to my office.


In my job, you have to be comfortable breaking bad news, but there are times when it is especially difficult. When a patient isn't able to understand the medical issues, for example. Or when someone doesn't have the social support to handle the burden they are given. Or when that person has already had to deal with a string of emotional traumas. I braced myself for the perfect storm.

I spent 45 minutes explaining what was going on. Your baby isn't going to look normal. You are going to need a much more detailed evaluation because your baby might have other birth defects. You should see a genetics counselor. Your baby is going to need surgery, probably several, actually. Your baby won't be able to breast feed; yes, if it's really serious there could be a feeding tube, it depends how it goes. I sorry. I know, this is bad news, but we'll be able to deal with it. Don't worry I will be here with you the entire time.

Somehow, and I don't understand from where she summoned it, this sudden news seemed to bring things into sharp focus for her. She came out of her shell. She was emotionally invested in what was going on. Now during her visits, she was the one asking all of the questions. She did everything we asked; she met with the genetics counselor, she went to the Craniofacial surgery clinic, she learned all about feeding a child with a facial malformation. She toured the hospital and took birthing classes. She created a place in her life for a special needs child. When I'd walk into the room to see her, she always greeted me with a smile.

Fortunately, this did appear to be an isolated malformation and her pregnancy proceeded without other events. We still couldn't say exactly how serious the cleft was, whether this child would need one or two surgeries or six or seven. But I did know I had a mother who was going to be confidently prepared as much as is possible. When I gave her the same advice I give to all my pregnant patients nearing their due date, it took on a special significance. "I know you're a little nervous about this, but don't worry. When the time comes, you will know instinctively exactly what you need to do."

When she did go into labor, it was midnight, and unfortunately I wasn't on call until the next morning so I didn't get the word until I arrived at the hospital, just after she had delivered. In the hallway I ran into AF, the doc on call, and she was beaming. She had been up all night with my patient and couldn't say enough about how wonderfully she did and what a beautiful family they made. "It's like pierced Madonna and Child," referring to my patient's multiple facial piercings. "When I told her you'd be here in an hour, her face lit up."

I walked into the room and her face did light up. It is always amazing to see that blissed-out look of love in a mother's eyes as she holds her new baby but to see it in this woman's eyes was honestly a career highlight, a rare reward for years of slogging it out in the urban underserved primary care trenches where most stories seem to end badly. If there was anything wrong with this baby, you would never know it looking at his mother.

As she handed the baby to me, I could see that his cleft was actually pretty serious, probably the worst case scenario, involving the entire palate and extending through the nose. He's going to need several surgeries over several years. Now the work really begins. First order of business: figure out how to feed the baby.

Mom listened closely as we brought in lactation consultants and speech therapists during those first days in the hospital. She became increasingly confident with the special bottles and nipples we gave her and she firmly committed to giving her baby only breast milk, even if it meant having to pump all of it and gently using the special squeeze bottles that worked with her baby.

The baby is now one week old. Mom is still completely in love and the baby has nearly regained his birth weight. He looks great.

A lot of times, you look back in awe at the history you have with certain patients, honored to share in those intimate moments of crisis. You witness them take terrible, overwhelming news and summon all their stregnth to try and create something positive. It's the most basic human struggle and it's the reason why I chose medicine. The situation with this baby is unique in that I'm able to look ahead; this kid is going to go through a lot of medical care over the years, and I'll get to be a part of it. I choose to believe he's going to have a great life and I have the privledge and responsibility to do what I can to make that a reality.

Sunday, April 4, 2010

First show!

video

So we survived. We were pretty stiff but it was a fun experience, no major screw ups, and we had a great turnout, somewhere between 100-200 I would guess. Muchas gracias to Brad Kosel for putting this all together. We are so lucky to have friends that do these kinds of things.

We also learned that people from Walla Walla are really nice. The Table of Contents are fantastic and have a great CD. Go get it on iTunes right now.

Thanks to everyone who showed up and humored us at our first gig. We're totally psyched for the next one.

Monday, March 22, 2010

The Health Care Bill

Dear Tea-Bagger,

It's going to be alright.

I know you are scared.

The Cold War was very frightening and we thought Communists were going to kill us all, or at least destroy our freedom-loving way of life. I remember it too.

And I know you don't understand the health care bill. To be fair, it is very confusing and complicated. And the only information your side has given you amounts to "your money is going to kill unborn babies" "the government is going to unplug grandma from life support" and "we can't afford it." It's a shame that in an information-laden society, ignorance is so fashionable, but try to consider who has the most to gain by your ignorance?

I have spent the last 12 years on the front lines of the failing American health care system. Shit, I have seen dozens of people literally die from it. I spend my free time reading medical economics journals and watch lectures by health policy experts. I consider myself fairly well informed about the current state of things, which is to say, sometimes even I am overwhelmed and confused and frustrated. But I think you can trust me when I say, this is going to be a good thing.

And I say this as one of the people who is going to foot a large part of the bill for the rest of you.

No it's not got going to fix everything. Those who called even the option for citizens to band together and buy group insurance policies "Socialism" saw to that. But consider, for the first time, this bill acknowledges, codifies, and plans realistically around a principle that has already been in effect in this country for decades: in the richest country in the world, with the best hospitals, best medical schools, and best technology, we all deserve some kind of access.

Now, I understand, the libertarian streak in you wants to say "Well I pay for my access, everyone else needs to man up and pay for theirs." Yes. Yes, you are absolutely right. And this bill takes us much closer that idea than we've ever been.

You see, whether you like it or not, no one is turning uninsured pregnant women onto the street to deliver their babies in gutters. No one is going to let a man bleed to death in front of a hospital. And the check you write to your hospital or your doctor or your insurance company already includes the cost of not turning those folks away. Now, you can stand in front of my clinic and try to prevent those who can't pay me from walking in, but most of us who got in to health care choose to help people and we're not comfortable doing that.

Thanks to Smart Liberals at Elite Academic Institutions, we have a pretty good idea of what it costs to deliver this emergency, last chance medicine that you and I already pay for. What this bill does is creates a line item for this care, separates it out from the bill you are getting from your doctor, and then figures out a more rational system to pay for this where the uninsured pay more of their fair share. Yes, some of the freeloaders (and I am fully aware this includes some of you right leaning libertarians who don't carry insurance because you consider yourself healthy; until you show me your notarized affidavit announcing you will not seek any future medical care that you cannot afford, I'm going to lump you in with the freeloaders, okay) will be required to pay a bit more into the system they already benefit from. Some of the money will come from tanning parlors. And some will come from rich people like me who can afford it.

Again: This is money that rich people like me are already paying for the emergency care of the uninsured.

Ok, Mr. Rich Conservative who doesn't believe in welfare or helping people, can you at least acknowledge that a simple idea like this sounds like it could be in your own economic best interest? I mean, if nothing else, this bill says that you won't get stuck with the hidden costs of taking care of these welfare moms and illegal immigrants, now, instead of your hospital, your elected representatives can debate directly how much of your hard earned money these low-lifes deserve. This is exactly what happens every year in such right-wing strongholds as Canada.

But if you've made it this far, let me clue you in on a little secret. Doctors, those modern day pill peddling sorcerers, have actually figured out how to make caring for these people (the ones you are already paying for, the ones who now are going to foot more of the bill for themselves) cost less. In fact, most new therapies have to prove that they save money and prolong productive work life before they are approved or paid for. Every day, hundreds of untreated diabetics walk into the hospital and are newly started on kidney dialysis (on your dime); we would only need to prevent a few of those cases to provide insulin to all of the rest of them.

I will grant that your leaders, Mr. Tea Party, are correct that the key to reform is to drive down costs. I don't need to tell you that the status quo isn't an option. $1200 a month for a family of four? For insurance that does less and less. Let's put it in a way that you might understand: you haven't gotten a raise in ten years because of health care. And if we do nothing, you may never get a raise again, with all of your increased wages going to health care costs. So of course, even you recognize the need to do something.

It is impossible to know if this bill really will drive down costs; it seems likely at least, and there is a whole lot of Research from Smart People and Evidence from Other Countries (even some Friends and Allies) that this will happen. Consider though, that insurance companies currently have very little impetus to control costs and indeed in the three decades they've run things they haven't done so. Once you get sick enough (or old enough) to stop working, you are dumped onto a public system to foot the bill for your hemodialysis or your motorized wheelchair. And that's assuming they haven't already succeeded in denying coverage for your pre-existing condition. And guess what? This bill addresses all of these issues as well: preventing denials of coverage, or life time caps on medical coverage, or preventing them from dropping groups of enrollees simply because one of the members suffered a catastrophic medical problem. Insurance companies will, for the first time, be accountable for the cost and quality of the service they purportedly sell: health care.

But I acknowledge that we don't know for certain what's going to happen in the long term. And I hear you are scared. And I hear you don't want to change. And I hear you don't trust politicians. But I have found in life that the best way to cope with a scary problem is knowledge and an honest accounting of the situation. This bill, not perfect, and not comprehensive enough, takes a giant step forward. We'll keep working on this thing, together I hope.

And, as a country, if we let fear and division stand in the way of what's right -- at Gettysburg, in the Depression, at Normandy, in Selma -- where would we be?

Sincerely, and compassionately, and in good health,

Your Family Doctor



Note: I am referring to "freeloaders" "welfare moms" and "low lifes" facetiously above. My direct experience working with uninsured people for more than a decade is that almost uniformly they want to pay their way. They want the security of durable medical coverage and understand the value of it, they just lack the means to buy into the system that is currently available. This bill honors working people all over the country who've been screwed for far too long.


Monday, March 8, 2010

Rock and Roll Derby April 3


First show April 3. I don't think anyone in the band got into this with the intention to do anything other than play or have fun in the basement and maybe record, no plans for playing live ever. Hopefully no one expects much, but we always do have fun playing and it will be good to see all our friends come out. We have about 10 original songs at this point and 5 potential covers but will pare that down somewhat. This band is strictly influenced by the indie pop we grew up with: Pavement, Weezer, Pixies, etc. with a healthy butt rock seasoning.

Sunday, February 28, 2010

Shane Macgowan and Friends 'I Put A Spell On You' in aid of Concern Worldwide's work in Haiti

So much great stuff in this video. Comparing to the retarded We Are The World remake, it's like what (Ain't Gonna Play) Sun City was to, well, We Are the World. Nick Cave scarier than ever, Shane Macgowan actually emoting and not stumbling or slurring. And Johnny Depp's passable guitar solo (I love it, compared to Vince Vaughn standing around like a fat dumb shit in the World video).

And of course, the choice of song is awesome, playing right into Pat Robertson's horrific condemnation of the people of Haiti as voodoo-practicing Satan worshipers.

Check out this one of Screamin' Jay Hawkins' early versions:




Sunday, January 17, 2010

Dear Pat Robertson

Letter to the editor in the Minneapolis Star Tribune, January 14, 2010

Dear Pat Robertson,

I know that you know that all press is good press, so I appreciate the shout-out. And you make God look like a big mean bully who kicks people when they are down, so I'm all over that action. But when you say that Haiti has made a pact with me, it is totally humiliating. I may be evil incarnate, but I'm no welcher. The way you put it, making a deal with me leaves folks desperate and impoverished. Sure, in the afterlife, but when I strike bargains with people, they first get something here on earth -- glamour, beauty, talent, wealth, fame, glory, a golden fiddle. Those Haitians have nothing, and I mean nothing. And that was before the earthquake. Haven't you seen "Crossroads"? Or "Damn Yankees"? If I had a thing going with Haiti, there'd be lots of banks, skyscrapers, SUVs, exclusive night clubs, Botox -- that kind of thing. An 80 percent poverty rate is so not my style. Nothing against it -- I'm just saying: Not how I roll. You're doing great work, Pat, and I don't want to clip your wings -- just, come on, you're making me look bad. And not the good kind of bad. Keep blaming God. That's working. But leave me out of it, please. Or we may need to renegotiate your own contract.

Best, Satan

(LILY COYLE, MINNEAPOLIS)


A much more charitable, christian, response to this sad, old, fearful politician preacher man can be found by Don Miller on Relevant Magazine's website:

Regardless, it was sadly irresponsible for him to make such a devastatingly shocking statement in the context of great hurt. Can you imagine giving the eulogy at a funeral and starting out by saying “before I tell you about God’s grace, let me make it clear that little Johnny deserved to die because he stole candy from a store.” There is something wrong with a person who would do this. These people are often, themselves, controlling. They are wired to build empires, and in order to build empires you have to get people to do what you say, and if you have God standing behind you threatening hurt and pain, you can motivate people.


And for speaking the voice of the truly outraged bleeding-heart liberal, I'll take Jon Stewart any day:

Transcript:

Pat Robertson, sitting in front of a CBN Disaster Relief Fund Banner

You know, Kristie, something happened a long time ago in Haiti, and the people might not like to talk about it. They got together and swore a pact to the devil. They said 'we will serve you if you get us free from the French.'
True story. And by whatever sense they have been cursed by one thing after another.
Stewart [Stunned silence]

Shut yer pie hole old man. Out of all the things that you could draw on from your religion to bring comfort to a devastated people and region...
[Brings out a large bible]
Look how big your book is! Look at ... [leafs through bible]
'The Lord is close to the broken hearted
he rescues those who are crushed in spirit.'
'Fear thou not for I am with thee. Be not dismayed for I am thy god, I will strenghten thee.'

But you decided to go with "tough titties devil folk"!

Have you read this book?!?! [gestures with bible]

'From the depths of the earth you will again bring me up though the mountains be shaken and the hills be removed. "Yet my unfailing love for you will not be shaken nor my covenant of peace be removed" says the Lord who has compassion on you.'

I mean that almost sounds like it's about %&$#ing earthquakes!

You've got all this, but you went with an urban legend about a deal with the devil.

[imitating Robertson]
"Wheeeel none of this would have happened if those people hadn't drank all those pop rocks and coke."

These are terrible events! Can't we put aside ideology for a second?


Monday, January 11, 2010

Here's to you, Tony



Neither of us ever discuss it, with each other, or with others. It seems so improbable to me that there's really nothing to say about it.

20 years ago I met this Australian foreign exchange student at Berkeley. We had an instant connection, an affinity that seemed like we were destined to play a major role in each others lives. We even shared a birthday. We spent the winter after we'd met driving across the US together.

Over the years, despite being in the pre-internet era, we stayed in touch, writing letters, sending care packages, the occasional phone call. He even came back to the states for a visit.

Flash forward 10 years. I move thousands of miles for school and residency and eventually end up in Seattle. Tony, living in Paris, meets a wonderful American woman, they fall in love and decided to get married and move to her home town: that's right, Seattle. Our wives become best of friends and now, 20 years later, we both have sons that were born three months apart.

As I tap this blog entry out on my iPhone, he and Jen are out together at a party for a much needed break and I am babysitting in their home, their infant son peacefully asleep on my chest.

Life is truly wonderful and magic.