May 21, 2017

ave atque vale

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.’

Nearly six years to the day now.  And in that six years, I have lived and experienced six lifetimes.  One thing I have learned, that experience, that life, that patients (and patience) have taught me is, I am especially in tune with the dying and suffering.  Time and time again, I gravitate towards those patients, those experiences, those opportunities to bear witness to the dying and suffering.

March 13, 2017

a good day to die

     Is there such a thing as a good death?  Or, a bad death?  Soldiers approach battle knowing full well that they may die that day.  Lakota Sioux leader Crazy Horse would exhort his soldiers with the loosely translated phrase, "let us go!  Today is a good day to die!"  But what about those dying from a chronic illness?  After bearing witness to so many dying, some had a day or two, some had months, I am convinced that there is absolutely such thing as a bad death, and if there is a bad death, there must be a good one.  I am also further convinced that dying is WORK, at least from a chronic illness.  Aside from the physical maladies, existential pain riles underneath.  Soured relationships without making amends.  What happens when I die.  What will happen to my kids.  Can you make the pain stop.  Are you sure there is nothing left to try.  What if......what if......what if......

December 14, 2016

Steinbeck's Texas

“I have said that Texas is a state of mind, but I think it is more than that. It is a mystique closely approximating a religion. And this is true to the extent that people either passionately love Texas or passionately hate it and, as in other religions, few people dare to inspect it for fear of losing their bearings in mystery or paradox. But I think there will be little quarrel with my feeling that Texas is one thing. For all its enormous range of space, climate, and physical appearance, and for all the internal squabbles, contentions, and strivings, Texas has a tight cohesiveness perhaps stronger than any other section of America. Rich, poor, Panhandle, Gulf, city, country, Texas is the obsession, the proper study, and the passionate possession of all Texans.”

John Steinbeck

December 1, 2016


Time is a rarified commodity for me. Such is the nature of the beast of training to be a physician, both in the aspect of the hours demanded but also in the aspect of trying to stave off death for the patients. Caffeine and adrenaline are well known tools to any in the trade. Even relaxing involves an element of hurry. Hurry up and get home to furiously decompress. Always balanced against fatigue. Before it is time to go back and do it all over again. So even my beloved task of writing often takes a back seat to other more pressing matters, usually sleep. But one commitment I have kept is giving blood. I always make time for it. It has become a sacred ritual of remembering. It is a communion in the truest sense of the religious term. A communion with memories, motivations, unanswered questions, struggles, sufferings. Do this in remembrance.

November 12, 2016


There are few devices that trigger a more negative Pavlovian response than a pager.  At 3 am.  When you've been asleep for 30 minutes.  Because the last page was at 2:30 am.  When you are already sleep deprived.  And running on empty.  Apparently, there is no training on what is deemed a good, or appropriate page, what can be resolved with common sense or what can wait until the morning.  The hospital isn't Walmart.  You can't just walk in and get whatever you want.  At least it shouldn't be.

Good Page with Appropriate Response
"Doctor, the patient's heart rate is in the 130s and they are having shortness of breath."
"I'm on my way."

Bad Page with Forced Appropriate Response
"Doctor, the patient is requesting mucinex."
Silence..........."Mucinex?  At 3 am? Ok"  Click.  The patient wasn't congested when I saw them at 9 pm and asked them if there was anything I could get them for the night.  Again, not Walmart.

Worst Page with Restrained Response
"Doctor, I see you put in a prescription for lowermybloodpressure.  But I am looking at the patient's blood pressure and this is normal for them. Do you still want to give it?"

What I don't say, "no, a systolic of 180 is NOT normal NOR good.  And let us not forget another nurse, perhaps someone you may know since you're both caring for the exact same patient, paged me not 45 minutes ago to tell me about the elevated blood pressure.  Perhaps she can educate you about the dangers of elevated blood pressure since she seems to know more about it than you."

What I do say, "Yes.  It's ok to give the medication."
"Are you sure?"
"Yes.  I am sure that I want the medication I ordered to be given."
"What is your name, doctor?"
"It's the one on the order."  Click.