June 8, 2017


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.

"So what brings you into the ER tonight?"

"I've had a cough"

Did I mention it's 4 am?

"How long?"

"Oh......probably at least for at least 10 years now."

"Has it changed at all?  Gotten any worse?  Coughing up anything?"

"Nope.  It's the same."

Did I mention that his vitals were stone cold normal?

"Any fevers, chills, weight loss, night sweats, etc, etc, etc"

"Nope.  Just the cough."

Did I mention that the patient is comfortable, calm, completely relaxed? 

"So what exactly made you come into the ER in the middle of the night?"

Did I mention this is the ER, stressing the EMERGENCY aspect of that term?

"Oh, I just thought I should get it checked out."

"And why didn't you go to a primary care doc?"

"Well, I don't like my doctor very much."

Did I mention that there are actually other SICK people in the ER?

"Do you smoke?"


"You, sir, likely have a smoker's cough.  Follow up with your primary care doc."

Remember this the next time someone is blathering ignorantly on about why our medical system is becoming increasingly more expensive.  Because both your and my dollars went to pay an ER triage nurse, an ER nurse, and a doc to evaluate smoker's cough at 4 am.  Never mind the infrastructure of an ER.

June 5, 2017

first, to endure

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.

My phone vibrated just as we sat down to eat.  My first weekend off in 6 weekends but by noon, I was already getting called back in to the hospital.  One of those, what I call 2-for-1 specials, came in.  In other words, a pregnant woman.  OB is one aspect of family medicine that just doesn't do it for me.  I've seen too many instances where an "uncomplicated" birth can go to a stat C-section in 5-10 minutes.  It's one of those instances where you just have to know your limitations because time means life.  For two people.

But I dragged myself back to the hospital.  Appropriately, it was raining heavily which just added to my frustrated and sleep deprived mood.  But I've learned to put that all away when with the patient.  Everything about the birth went fine.  No surprises.  No difficulties.  Perfectly routine and uninteresting which is the best kind of delivery to me.  The dad cut the cord and the parents were both joyful.  But when we asked if they had a name already picked out, the response made me stop for moment.  Josh.  I don't think I've ever delivered anyone with the same name as my brother.  No, I would remember that.  I signed the birth certificate with a sense of pride.  Probably more towards myself than anything.  I was a witness on my brother's death certificate.  And now I was the delivering doctor on this young child's birth certificate.  The words with which Hemingway signed his letters rang back through my head, "first, to endure".  I have endured.

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