July 21, 2016


The twisted and rusted iron well represent the Muscle, Sinew and Will. A Will which struggles against the load which threatens to crush him.  Down on the right knee.  The left leg unbalanced and straining but with the foot dug in to regain a position of strength.  Metal rust bleeds down onto the concrete base.  And what gives blood it's red hue if not rusted iron?  How many times have I passed this sculpture?  First, as a candidate for medical school.  Now, as a physician......the metaphor of Atlas has deepened with experience in ways I suspect I will never truly comprehend. 

July 19, 2016

listening for nothing

I place my stethoscope onto the chest and reflexively bend my head down.  It could be mistaken for supplication.  Maybe it is.  It also pulls the ear buds on the stethoscope snuggly into the ear canal.  Sometimes there are electronic noises from beeping IV pumps to vital sign alarms.  Sometimes there are crying family members.  But what I am listening for is silence.  No heart beat.  So I mentally block out all the noise, as much to give a moment of silence to the recently departed as anything.  A heaviness is present in that silence.  Soon it will be broken by speaking with the grieving family members or speaking with the nurses to fill out the paperwork.  But in that moment, there is nothing but heavy silence.

July 13, 2016

end of the rope

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.

     Every month I am a different doctor.  One month I am a family doctor managing patients in the hospital.  One month I am an ER doctor.  Next month I am a surgeon.  And you have to embrace that because they each approach problems very differently, and deservedly so.  But underneath it all, I am still me.  On this particular day, I was a surgeon, more specifically, a colorectal surgeon.  That may sound like a big stretch but not as much as it could be. I am one of those rare family docs who is also learning colonoscopies.  And if one is going to learn colonoscopies, learning about colon cancer comes with that.  It is my way of saving someone from having to experience bone metastases as without colonoscopies, we usually find colon cancer once it hits the bones.  And if you have read my blog from a few years back, you can imagine what bone mets feel like.  It ain't pretty.  And so on a day where the clinic day is colorectal patients, one can imagine a fair share of them are there for colorectal cancer appointments either as follow ups after surgery or to be assessed as surgical candidates.
     This particular patient had been referred by their medical oncologist to assess whether they were a candidate for surgery after they had completed chemotherapy.  A common scenario.  In fact, I had dealt with it two times already that morning, neither of which had any hope of surgery improving those patients' quantity or quality of life.  But the third one of the day.....they had completely mistaken notions of the results of the most recent CT surveillance scan.  Their cancer was not in remission.  In fact, it was back with a vengeance.  And I simply could not do it.  I could not bring myself to tell a third patient that day that their results meant that surgery held no hope for them.  Maybe it was it was because I was exhausted.  Maybe I was tired of playing the surgeon.  Maybe consoling two before lunchtime had left me devoid of any further ability to empathize.  Maybe I had reached the end of my emotional rope because of my own baggage with cancer.  Regardless, I let the attending tell them. 
     I felt horrible afterwards.  I apologized to the attending.  I felt as if I had let the patient down.  That if a family doctor can't console someone then what the hell is that doc worth?  The attending looked at me and reminded me it wasn't my job.  It certainly wasn't expected that an off-service resident should be able to interpret a CT scan and interpret whether surgery was off the table or not.  But for me, it was not about being able to make the medical decision.  It was about being able to be there emotionally for the patient.  I left that day feeling worse than if I had made an actual medical error.

July 11, 2016


Pack up all those phantoms
Shoulder that invisible load
Like a ghost rider
Just an escape artist
Racing against the night
A wandering hermit
Racing toward the light
- ghost rider by n peart

June 22, 2016

my mixed heritage

On one of the few opportunities where I was driving during daylight hours, I noticed this billboard. Someone in the Dutch company of Heineken marketing gets the Texas mentality.

May 22, 2016

god has a horrible sense of humor

I am signing an order that needs the date and time so I ask the nurse. "May 22nd". Of course. Why else would my very first patient in the ER be one suffering from the horrific pain that bone metastases inflict? At the end of my shift, I was able to get them admitted to the hospital. And got a thumbs up from the patient. I will not elaborate upon what Herculean (and self alienating) measures were required to get to that point where a thumbs up is the best possible outcome one could wish for as a doctor. Instead, I look down at my left wrist, my familiar and well worn Mala beads rolled comfortably around my wrist. I roll one unnoticeably in between my thumb and forefinger, close my eyes, and become grounded to these ancient words which arose from my memory five years ago on a Sunday morning at 3:30 am. 

Through many countries and over many seas
I have come, Brother, to these melancholy rites,
To show this final honour to the dead,
And speak (to what purpose?) to your silent ashes,
Since now fate takes you, even you, from me.
Oh, Brother, ripped away from me so cruelly,
Now at least take these last offerings, blessed
By the tradition of our parents, gifts to the dead.
Accept, by custom, what a brother’s tears drown,
And, for eternity, Brother, ave atque vale
‘Hail and Farewell.’