Ave, Atque, Vale

Carried through many nations and over many seas,

I arrive, brother, for these wretched funeral rites

so that I might present you with the last tribute of death

and speak in vain to silent ash,

since Fortune has carried you, yourself, away from me.

Alas, poor brother, unfairly taken away from me,

now in the meantime, nevertheless, these things which in the ancient custom of our ancestors

are handed over as a sad tribute to the rites,

receive, dripping with brotherly weeping.

And forever, brother,

Hail and farewell.

Time heals all wounds.  We've all heard it.  I've had so many people tell it to me myself.  And I wonder, do they believe it to be true?  Is it something they tell themselves to feel better?  After all, it IS simply easier to forget those left behind and move on.  But then I would not be true to myself.  Which is one of the most important things The Bard could've written.  To thine own self be true.  But then, Polonius was a fool.  So where lies the truth in these platitudes?  In experience.  I have holes and wounds that have scarred over.  But the scar still remains.  The absence of that limb still remains.  Have I learned to live without it? Of course. But it still is missing. As so many things are missing...

hemingway's whiskey

I know it's tough out there, 
a good muse is hard to find.
Living one word to the next,
living one line at a time.
Now there more to life then whiskey,
there's more to words than rhyme,
Sometime nothing works,
sometimes nothing shines.
Hemingway's whiskey


Sail away, sail away,
as the day grows dim.Live hard, die hard,
this ones for him.

Hemingway's whiskey
warm and smooth and mean,
Even when it burns,
it will always finish clean.
He did not like it watered down, 
he took it straight up an neat.
If it's bad enough for him,
you know it's bad enough for me.
- guy clark

The world breaks everyone and afterward many are strong at the broken places.  But those that will not break, it kills.  It kills the very good and the very gentle and the very brave impartially.
- ernest hemingway

The sounds of the talking heads vaguely reach my ears from the TV.  Yet another study came out touting the benefits of alcohol on longevity.  Countering that was a physician saying that he wished patients could instead use yoga or meditation to relax after work instead of lifting the bottle.  Having pronounced my fair share of patients dead from the liver failure that resulted from hitting the bottle for too hard, for too long, I could see his point.  But the pious, self righteousness of his tone couldn't help but accompany his words.  If only the patient would do what I tell them to do.....What would he tell Papa?  Would he pretend to know what is best for that brilliant wordsmith, that tortured soul, that broken man, that icon of icons?

My yoga mat is rolled out in front of and I stare at it, as if by gazing at it long enough, the pain will subside enough for me to even do yoga in the first place.  Which I do to reduce the pain.  But the pain is keeping me from doing it.  A catch-22, if ever there was one.  Next to my mat is a glass of my type of whiskey, a bourbon flavored with that nectar I have cherished since even as a young child - honey.  If it's bad enough for Papa, it's bad enough for me.

down the road

Advice to a future me (and future doctors)

When in doubt,
     Talk to the Patient,
           Listen to the Patient,
...
...
...
...
...
...
Clarity. Will. Return.

begins with a broken heart

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.

"If we live long enough in this world, we will have our hearts broken.  And do they heal?  Well, maybe not fully, ever.  But in the cracked and broken pieces, that's where the light shines through.  We walk in the world forever after with more depth, more sensitivity, more compassion.  Our love affair with the world begins with a broken heart."
- Marilyn Sewell

He faced an aggressive cancer.  He was facing death.  He certainly faced physical pain as evidenced by the multiple bone metastases.  My experience tells me that bone mets are some of the most painful conditions imaginable.  Experience also tells me that the existential anxiety is equally painful, though.  And he was young.  But not ONE doctor had sat down and asked he how he was doing. And I mean, how are you DOING.  No one had sat down and gotten their hands dirty.  Which is to say, gotten their emotions dirty.  Expose themselves emotionally.  Be open and listen.  Hear the full extent of his pain.  Things he could not tell his spouse.  Things he could not tell his parents.  Things he could not tell his children.  Things he could not tell his best friends.  Things he could not even tell himself.  But things he could tell his doctor.  If only, they would be willing to listen.  So, I listened.  I spent nearly two hours with him.  And I by the time he left.........

A wise man, mentor, and friend once advised me, you're going to have to figure out where to draw the line.  It does no good to open up to every patient if you lose yourself in the end.  You cannot save everyone.  I am still figuring out where to draw that line.

miles to go

The woods are lovely, dark and deep,

But I have promises to keep,

And miles to go before I sleep,

And miles to go before I sleep.

Not exactly an even wear.  On a riding heel, no less, so that's not a trivial amount of mileage.  Not ridden atop a mighty steed, but ridden hard and long nonetheless.  And whipped many a time with a riding crop.  It's my left foot.  I don't even need to check which foot it is.  It is the foot that drags when my back starts hurting.  And I don't mean hurting.  I mean REALLY hurting.  A pulsing numbness, yet combined yet with searing pain exists in a mutually exclusive duality going down my left leg.  Numbness.  And pain.  There's no explaining how those two exist side by side unless you've felt it.  And my wife looks for a new pair of boots to last this final sprint towards the finish line.  An identical replacement, really.  For they have served me well.  After all, I have earned the name of Vaquero Doc.  Why trade it in now?

the honest man

Ever since I was a kid, I have attracted stray animals.  Dogs, cats.  Even turtles.  It seems I attract the same types of patients.  Among my colleagues, I have become notorious for being A Black Cloud.  You see, we are a highly superstitious lot.  Even more than athletes.  As one off service resident told me, it was a pleasure working with you but I NEVER want to work with you again.  One of my close friends dreads working with me again towards the end of our residency because they know what is in store.  As I work nights in the hospital and admit new patients from the ER, I hear comments from my day team colleagues who then have to deal with the aftermath of my admits.  Such comments as:

Really?  You had to pick THIS one?
Seriously?  Do you go looking for these?
WTF???
I hate you so much right now.

Even multiple attendings in clinic have asked me, don't you have any normal patients?  You know, like simple diabetes or high blood pressure.  Regular stuff.

It makes me laugh inside.  Sometimes, one laughs to keep from crying.  What else can one do?  But I continue to accumulate my menagerie of strays.  As time has passed, though, I do not simply inherently attract disasters, though I do seem to do that.  Patients share their disasters with me.  For whatever reason.  They tell me things.  They tell me things they have never told anyone else.  Honesty, has tattooed itself all over my face and patients feel comfortable telling me things that they have not told anyone.  I have accepted that role and embraced it.

i am the brute squad

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.

Some people never go crazy. What truly horrible lives they must lead.

- Charles Bukowski

"Am I going to have a call a Code Green?" the charge nurse asked, referring to a psychiatric emergency.

"Don't call a Code Green.  Call me.  I am the Code Green."  She smirked and agreed to put the patient on the floor against her better judgment as I gave her both my hospital phone number and cell phone.  My bravado, my swagger, and my humor helped sway her.

My junior resident asked me, "should I be talking to the charge nurse?"  Huh?  I was confused by the question.  But then it became clear with one statement.  "Well, I've just never seen one of my uppers talking to the charge nurse."  Seriously?  I then explain how 90% of being a good doc is simply giving a shit and getting stuff done, which means talking to all the people that get shit done. It's a lot of work but in the end, it matters.  Remember your humanity, I tell them.

This patient had been sitting in the ER for six days.  SIX days.  I was looking for admissions and the ER attending didn't sugar coat it.  I had paid my dues in the ER and earned their respect so was treated as one of their own.  The patient had broken their elbow, had surgery with pins placed which were extruding from the skin.  One pin was missing, though.  Oh, raising my eyebrow.  The patient had removed one pin by their self.  And then proceeded to attack what they thought were demons present.  So now the patient sat in the ER pending transfer to a psychiatric hospital but no one would take the patient with one extra weapon in the elbow just waiting to be unscrewed.  My junior resident looked at me as if to say, you're joking.  No wait, you're crazy.  Indeed.  I smiled back and tell the ER that we will take the patient.  Fast forward a few days of heavy duty psychiatric medications, including an episode of me, in fact, functioning as a Code Green.  Today, orthopedics removed the remaining weapon, aka pin, and the patient is pending transfer to a psychiatric hospital, without a built in weapon.  My Texas bourbon tastes extra good today.