October 4, 2016

prescribed burn

Pack up all those phantoms
Shoulder that invisible load

Haunting that wilderness road
Like a ghost rider

Show me beauty but there is no peace
For the ghost rider

Shadows on the road behind
Shadows on the road ahead
Nothing can stop you now

It is my first weekend off in roughly four months.  By this point in my journey, I am thoroughly lost.  There is no cell phone service.  There is no map.  So I settle in and listen to the woods.  Off in the distance I hear a woodpecker.  The loneliness of the ratta-tat-tat echoes softly through the forest.  While I'm sitting there, I am filled with nothing but frustration at getting lost on a dirt logging road.  And drops of rain begin to fall.  I am not in my jeep and my car is far from equipped to handle this road if rain begins to fall.  And I notice the strangeness of this area.  Where is the underbrush?  At closer inspection, the trees have that characteristic black mark on the bottom, or at least the trees that have survived, of what follows a controlled burn.  I am in the middle of nowhere, on a dirt road, lost, threatened with rain and I realize I need a prescribed burn.  To clear out all the tinder that results in uncontrolled wildfires resulting in the destruction of the entire forest.  The metaphor of putting out catastrophic fires the last years of my life is not lost on me.  I take a few deep breaths of the pine scented air, climb back into my car, and methodically find my way back to civilization.

September 21, 2016


On why medical scribes are money well spent, especially in the age of electronic medical records, which unlike my iPhone, makes things take infinitely longer. 

September 8, 2016

quackery, nonsense and utter bullshit

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.

He hands me a stack of papers and says, "I was told to give these records to you."

Hey, a patient that brings their previous medical records! Awesome! I am about to thank them but my eyes quickly glance over the first page. It is a genetic test. Talking about theoretical drug-drug interactions. Ordered by his chiropractor. A confused look frumples my brow quickly replacing the smile.

"Could you please give me a bit information on these tests and why they were ordered?"

"My chiropractor ordered them for me. And he told me to ask you about the results."

"So he ordered them and charged you, but did NOT go over any of the results with you? Is that correct? I want to make sure I understand this properly."

"Yup. He said that you would know what to do with them."

I certainly did. I wanted to put them through the shredder but now they are a legal document and I am bound ethically to them. I glance over them for 5 seconds which is 5 seconds longer than the "data" deserves. I spent nearly 15 years in research and know firsthand the utility of this stuff.

I reassure the patient, "none of this is surprising or concerning. And it is not going to change how I manage your heart disease and diabetes."

And instead of shredding them, I dutifully scan them into our system to be added to growing pile of medical records that no one will ever be able to make sense of.

August 23, 2016

that which lacks words

If we make it through the night
If we make it out alive
Lord have mercy and pray for the dead
And you say that you can save me
Don't hope to ever find me
And I fear I'm too far gone
Pray for the dead

There is a hell
Believe me, I've seen it. 

I've never written of him. At least publicly. The words remain beyond my grasp. Or, is it that words represent a poor description. A mere charicature. But he left me songs to which to listen. After all, music begins where words fail. A thinly veiled attempt to bridge that chasm of pain. To communicate that which lacks words. 

August 19, 2016


"Hey, doctor. Have you eaten lunch yet?" a nurse whispered to me.

I stop typing orders and look at the time on the computer clock. It's 11:37. "Hell, I haven't even had breakfast yet."

"We have a bunch of leftovers in the break room. We had a breakfast pot luck. Want some?"

This is what happens when you treat nurses as human beings.

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.