Please Stand By

For reasons of personal mental health and exercise I try to post a new entry on this site every day. I write early in the morning or late in the day. Sometimes, however, all you get is the test pattern.

Today you get the test pattern. The last 24 hours have been too busy to allow me to sit down undistracted for more than 15 minutes. Unusual. Worse still, last night I finally got to bed, a bit past midnight, konked out, and then was awakened a half hour later by my beeper going off. Again. The emergency? To answer a question about whether a patient would be staying beyond the 23 hour limit for a short stay admission. I answered the question. For the third time in the previous 4 hours.

So, test pattern it is.

Riding Toward Autonomy

It’s gonna be over before I know it. I hate that, and yet I love it. Ev is growing, growing, growing…. Don’t say it. In another week he’ll be 5.

This past week I had the opportunity to ride bikes with him. We were both on our righteous BMX bikes, his blue, mine orange. It’s been an adjustment for him as he’s moved up a size to a 16 inch bike. There’s lots for him to be nervous about—it goes faster, it’s harder to jam on the brake, and it’s a bit further to the pavement should he lose control.

Saturday morning was awesome, though. In spite of any trepidation he took off on that bike with authority. We cruised a near-by parking lot, one that is not in use on Saturdays. It has lots of ins and outs and pavement and sidewalks and porticos. “I’m the leader!” he called back to me. And for the next 25 minutes I got to see Ev evolve: I saw him grow in confidence. I witnessed the blossoming of his awareness of his own competence. I could see him beginning to understand he could own and control a piece of his world. It was seeing him beginning to understand there is a whole life and a whole world out there and he could participate.

Maybe I’m reading more into that bike ride than was there. But I doubt it. Even if I am, I can be certain of this: He’s beginning to understand he can be a real person, capable of doing and belonging. And it was great. Probably the best use ever found for a 16” boys blue BMX bicycle. And for my orange one as well, for that matter.

Granola Boy

I’m a clog kinda guy. I’m not Dutch, I just like clogs. I’ve been wearing clogs for about 30 years. Maybe it’s a 70’s thing. Maybe that’s why I like granola. Slowly but surely I'm coming to grips with the fact that I am, for sure, a child of the 70’s. And the early 70's at that.

Back in the 70’s my oldest brother was living the good life in Santa Monica, back when Santa Monica was a neighborhood, not real estate.  His old house was always well stocked with an ample supply of candles, pottery mugs, and homemade granola. But while his house had great contemporary vibe for 1971, the granola did not appeal to the discriminating tastes of this 14 year old and so I never partook.

Fast-forward to the 90’s and I’m sitting at the counter of the Fountain Coffee Room. (Personally, the Fountain Coffee Room would be one of the top three reasons I’d like to live in L.A. again.) “Hmm, Housemade Granola.  I’ll give it a try.” Game over. In that moment I became a clog wearing granola lover.

Fast-forward a few more years and Tam is doing the home-made granola thing right here in Michigan. But, it takes time and sometimes that’s not easy to find the time. The supply will wax and wane. Subsequently I set out to devise my own mix. My friend Val makes a killer granola. Tam’s is killer. Mine? Well mine, let’s say, is a work in progress. When I nail it I’ll share it.

In the meantime, where’s that shirt with the bold stripes and the collar the size of a bird of paradise?

Crunchy Granola Suite

Neal Diamond Hot August Night 1972

Feelin' Lucky

I got this notification from US Airways the other day. It was a promotional event for Walt Disney World Vacations: Book airfare and Disney World Hotel and be entered for the chance to win an all expenses paid trip…  A person also has an “equal chance of winning” if they simply register to win via internet application, no trip required. Entries are limited to one per person per day, between April 9th and June 4th.

Ev loved his trip to Disneyland last fall. I have to say I look forward to taking him again this fall and hope that works out. So, I’m thinking, should I go for it? I’m already way behind in as much as it’s already the last week of April. I’d only have about 10 or so days to enter.

Me and contests and luck just don’t happen. I’m not a gambler. I used to date a woman from a gambling family. One time I went with them to Vegas and I spent all my time shopping, visiting friends, and going out and taking photographs—alone. The first time I ever gambled was in Tahoe in 1981. I won about $300 in about 90 minutes. I thought gambling was the greatest recreation ever invented. The second time I gambled, about 3 months after the first, I lost about $150 in about 20 minutes and felt violated—especially since I still had about 1800 miles to drive to get to my hospital assignment in Michigan. That was the last time I gambled, with money that is. Since then, I haven't so much as won back a buck from a charity raffle. I've come to know, "need not be present to win" also means "need not be present to lose."

I won’t be entering the US Airways Walt Disney World sweepstakes. History won't let me be the guy to sit and enter contests day after day. I’m sure there are armies of individuals who like nothing more than entering contests, going to casinos, and buying lottery tickets. Somehow, Lady Luck is one lady with whom I’ve just never been able to even so much as strike up a conversation when it comes to contests and gambling. Fortunately, she's thrown a bit my way in life.

Hotels and Hookers and Soldiers, Oh My!

I was shocked, shocked!!, I tell you, to discover a top tier fleet of our military men have been discovered to have employed the services of prostitutes-- common hookers, trollops, tramps, strumpets, whores-- yes, all of that! Thank God our esteemed senators and congressmen will not take this lying down, er, without a fight. It's obvious to our leaders someone needs a spanking, er, discipline. Talk about blowing the job! Na, I mean screwing up. Er, making a mess, ahhhh! Doing the wrong thing!!

I have a couple of colleagues who are themselves former military. They weren't on any special assignment on their course of duty. They're just the foulmouthed Vietnam Vet types. They don't understand how this could have happened either. They, and all the other GI's they knew, always, always, always paid their hookers! They never would have let this business spill out into the hallway of the hotel!!

Hmmm. I guess military macho men have been enlisting the services of the local working girls for quite some time. I guess that would be why there were posters way back when, warning military boys about the dangers of hiring the job done. It's just too damn bad we didn't have the self-righteous, holier-than-thou, right wing, pro-family, pro-life, pro-jesus, anti-everyone else leadership we enjoy at present to step in and take control of those horny bastards way back then.

In all of this I don't for a moment mean to condone the actions of the Secret Service in Columbia. But I do think prostitution is one of those activities that has been here forever and will continue forever. I think that, rather than use this event to fashion a media play about Obama's naughty, naughty Secret Service, why isn't this being used to make a play about the plight of women in that trade? Why isn't this being used as an opportunity to talk about protecting sex industry workers? What would it take to make this event into a discussion of legalized prostitution with health and safety standards for the women and men involved? Is the only value to be found in this episode is as a partisan campaign tool for a bunch of self-serving bums in Washington? Probably. Once again, members of an ethically compromised branch of the American government are using women for their own selfish purposes.

It's A Michigan Thing

I heard something on the way home from work Monday evening. It was something I haven't heard in quite some time. Leaves. The wind was blowing and I could hear the rustle of leaves.

That's Michigan, folks. Some of us get excited about these things. We get excited about welcoming leaves back to the trees after their hasty departure last November. They're not all back, but we're off to a good start. Our big oaks, our maples, our shaggy-bark hickories-- these big cohabitants of the Great Lakes State are the sentinels of the seasons. And to hear the wind blowing through their leaves now is the prelude to the warm months ahead.

These are the months of fields filled with corn and beans and wheat. These are the months of canoe trips on the hundreds of streams, rivers, and lakes. These are the months of round after round on the manicured grounds of our many golf courses. These are the months of campouts and cookouts, bon fires and bike rides, classic cars and baseball.  These are the months where the air fills with the fragrance of barbecue and new mown lawn, the sounds of children out playing right up 'til bedtime. These are the months such a long time in coming-- the very same months that seem to pass all too quickly.

The change of seasons here in Michigan is almost always introduced by wind, the wind blowing open and close the curtain on the stage of climate. This next act should be great. The curtain is starting to open and it's just a few weeks away.

Happy Earth Day

I was a little cynical about the first Earth Day celebration. In 1970 I attended that inaugural event as observed at UCLA's Pauley Pavilion. The place was jammed. There were a slough of singers, comedians, and speakers. It was a "happening" in a time of "happenings." It was a hippie-type event in line with the Vietnam war demonstrations which were taking place about once a month on that campus. All such events provided a great reason for my brother and I to skip out after dinner, forgo the homework, and hang out with a bunch of college students holding candles, singing songs, and listening to impassioned speakers.

As it turns out, the participation piece of it was quite okay. It is fun to have those memories, to have taken a front row seat in those historic and socially turbulent late 60's and early 70's. But even then, at the age of 13, I could tell the value in events such as Earth Day lie in its "cool factor." I could tell that I wasn't alone, sitting there in that jam-packed arena, feeling that this was fun and cool.

All these 42 years later people continue to celebrate Earth Day. Now it's a global event. And now, seemingly like every other social endeavor from AIDS to breast cancer to heart disease to pet adoption, Earth Day provides a commercial platform for companies and individuals who realize that social activism can be good for sales. Like I said, a little cynical about Earth Day.

The really good news is that there were a few right thinking individuals at the heart of the original Earth Day, including the founder. Wisconsin Senator Gaylord Nelson went to Washington, D.C. in the early 1960's and immediately recognized the need for an environmental agenda. His concern, his agenda, his Earth Day celebration, is responsible for several generations growing up with an awareness of the fragile tolerance of our environment. And while Earth Day celebrations nationwide may serve as platforms for marketing and sales of stuff, the fact remains, more people know about recycling now than in 1970. The awareness exists today to have a national debate on subjects such as off-shore drilling, mining, extraction of resources, climate change, and management of wildlife.

I'm still cynical about all this. Humans are still creatures in pursuit of comfort and convenience. We are biologically programmed to do what every other organism does: live to reproduce. And, like parasites that kill their host in the process, although we have generated greater knowledge and awareness of our behaviors, the destructive behavior continues on a global scale. We deny, debate, and defer action in spite of ongoing environmental degradation. Unfortunately for the human parasite, we do not have another host at the ready for when we have finished ravaging the present body we call home.

In spite of our best efforts to the contrary, beauty abounds on this generous planet. If nothing else, perhaps Earth Day is a good day to take a look around and appreciate that fact.

The Man Behind the Curtain

Funny how you grow up as you get older. At least I think that's what's happening. I realize there are quite a few people who grew up early in life, say by 30 or 40. Not me. I'm growing up.

I say this because I just climbed out of the ring after the second go round with my financial planner. Her name is Dana but I think I'll call her Dorothy. Dorothy? Yes, Dorothy. Remember that scene in the Wizard of Oz where Dorothy discovers the man behind the curtain? That's kind of what my financial planner does. You walk in thinking you are the Great and Powerful Oz and 65 minutes later you walk out that pudgy bald-headed man behind the curtain. Less pretense, more substance. The flames are out, the show is over and you're ready to leave the Emerald City, prepared to take off back to Kansas-- or Michigan, as the case may be.

The good in all that experience is that you leave with perspective. And it's not only perspective about what you will be living on until the hopefully not-so-bitter end, it's perspective on who you are, what you've been doing (for better or worse), what it is you'd like to be doing, and how you're going to get there. A planner like Dana doesn't provide ruby slippers but she can offer you a balloon.

It's akin to visiting a shrink. You don't have to be crazy to benefit from talking to someone about one's hopes, fears, and concerns. Sometimes it's just a damn good idea to let someone take a look, listen, and a run through a few scenarios. Chances are you're not crazy, you just need a little help with vision.

As it stands at present, there will be no fire sale of any sort in our driveway. So far we're hanging on to the silver and Evan will not be spending afternoons sorting through mismatched socks down at the local cleaners for 25 cents a pair. It is a little disconcerting when the software reveals you will die in 2042 but, hey, I would've found out anyway. For now it's carry on, pay attention, and keep getting smarter.

One last thing a good financial plan helps call into question: Value. You can't budget happiness. You can't buy great memories. And while joy in life is one of the most precious commodities of all, it's hard to figure on a spread sheet. The most valuable things in life really are priceless. But for a lot of the rest of it you need to grow up, get out from behind the curtain, and get a plan.

For The Forty-Niners

Of course I'm speaking of the San Francisco forty-niners, circa 1849. I would imagine there are probably quite a few people in this country who know the contemporary           San Francisco '49s. I would venture a guess, though, that a fair number of even the most stalwart fans don't know where the name comes from. I'll keep it short: the San Francisco forty-niner's were the hardy, sometimes foolhardy, souls who came to California in search of their fortune after gold was discovered in Sutter's Creek the year before. The California gold rush kicked off in earnest that next year, 1849.

So much for background. The long and the short of it is that a young man named Levi emigrated from New York to San Francisco to supply tents to the hoards of miners headed to the gold fields. Not too long after, Levi Strauss manufactured his first pair of rugged blue jeans. As the saying goes, the rest is history. We all grew up with these. When jeans had their second coming in the 1960's Levi's were to jeans what Coke is to cola: The real thing.

So here I am wandering around Macy's yesterday while Tam was battling non-existent crowds to find non-existent help selecting an item or two. I wandered over to the men's store to look at jeans and there they were: Levi's. Levi's blue jeans looking just the same as ever with their trademark arcuate stitching on the back pocket.

I'm not an idiot. I know Levi's have been on the market, and remain on the market, all these years. I wasn't seeing anything new. It's just that it's been a while since I've given 'em a look.  And then I did something I shouldn't have: I checked for place of manufacture. For $48.00 a pair (special price!) I had to know where these jeans-- these iconic American jeans of the '60s and '70s, the jeans with the arc on the back pocket as identifiable as any other corporate mark in the world, these jeans with the 2 horses on the label trying to pull a pair apart, these jeans marketed by Levi Strauss and Company,     San Francisco, California-- where were these jeans made? Turns out, this historic family owned California company with the iconic American product does what everyone else does to make a buck: Bangladesh. There, and Cambodia. It doesn't seem consistent with the actions of a socially responsible Mr. Levi Strauss who showed such good stewardship of his employees way back when, but, nowadays, it's business.

It's good to know, really. If all you need is jeans, and your only concern is supporting the global economy, shop Walmart where men's jeans start at $9.98, Levi's for under $20.00. It's probably where the forty-niners would have shopped anyway, had it been an option.

On the other hand, if you're interested in the hardy, no nonsense, made in USA product that Levi used to be, check out Pointer Brand.

Parental Engagement

I sat across the aisle from a mom and dad with a toddler the other night. This was during a four hour flight in a fairly well packed airplane. The poor child screamed-- screamed-- and fussed miserably for at least 2 full hours of that flight.

Now I am not one of those people who believe that small children should be carried in the baggage hold of a plane. And I am not one of those people who wants airline travel to be illegal before the age of 5-- or 16, or 20.  I'm just one of those people who feel that when a small child is having a hard time a parent needs to attend the child.

In the course of that entire flight that child was spanked once. (Just once. A momentary swat to a well padded diaper butt. I tend to think the mom had a sudden vision of her frustration and corporal reaction popping up on YouTube. And CNN. And Fox. And GMA. And the Today Show. And Dr. Phil…..) He had crackers and french fries and milk and god-knows-what in a sippy cup. He was read one short Curious George book and played for an hour or so on an iPad. He watched cartoons for a couple more. The whole time he was pushed off on one distraction after another. Each change in activity was preceded and accompanied by screaming. There was no attempt at engagement. There was no cooing and cuddling. There was no going for walks up and down the aisle-- an activity in which he showed obvious interest.

Certainly I don't know all the facts. Maybe they were on the last leg of a 17 hour journey home from South Africa. Maybe the little guy was just sick. But it strikes me that what I saw happens more commonly then not: Kids are kept busy with games and activities but are not engaged by a parent. There is no sense of the parent being involved beyond purchasing and transportation. And, believe me, I get it. It is often hard to come home at the end of the day and sit on the floor with Ev to play catch, or Uno, or to look at a book. With so many devices available today it is incredibly easy to say "watch this" or "play that."

With the wealth and means we have available it is easy to find something for a kid to do. But regardless of any device or activity, a parent must remain connected. Variety and convenience can make distraction easy. Caring and nurture will always be old-fashioned: hands on, fully engaged, and done at the expense of your own personal time.

Carry On

Dr. Leila Denmark

I read about a doctor who just passed away at 114years of age. Like that isn't enough, she had retired from practice at 103. I love it!

It seems I am at that age when I am starting to hear more and more people talk about their retirement. A majority seem to simply be at the point where they don't want to work any more. Burnt out. Unlike quite a few of my contemporaries, I don't look forward to retirement. I may be looking forward to a change in the magnitude of demands but not to quitting altogether. There's more to life after 60-- or 70, or 80-- then coffee in the morning on the patio with the news.

People are social animals. Unless someone has really messed with your wiring you're supposed to want to interact with people at least part of the day. It's normal to want to be useful. It's normal to want to feel productive. Those of us who are in a position to continue our work throughout most of a lifetime are among the lucky ones. Of course, luckier still are those for whom the when, the where, and to what degree they'll continue to work is a matter of choice. I'm not there yet but it's not a bad target.

If you just can't wait to retire so that you will have more time to dedicate to the next big thing, good for you. If you can't wait to retire because of the million things you want to get at, great! But if you can't wait to retire because your job is just that bad, my sympathy to you and look out.  If you find yourself in the latter category I would suggest you start thinking about what's coming. As much as it may sound like a luxury, doing nothing is not fun. Retirement should not be thought of as quitting. Rather, consider you're just moving on to the next thing. Don't ever be done.

If you're interested, here's a link to one patient's blog about her beloved Dr. Denmark.

Meeting Time

For the second day this week I start my day with a meeting. It strikes me as peculiar that in an industry being crushed under the weight of runaway costs we find a parallel magnitude of "meetingitis." Healthcare has become beholden to a management structure which knows little about actual patient care but contends it knows volumes about the process.  Incredibly, the voice of healthcare management continues to hold audience with government and insurers in spite of their standing on the bridge of a monumentally failing business. From my perspective, healthcare managers have been about as capable with managing healthcare as Bernie Madoff was with handling other people's money.

In the meantime it's time to head off to another meeting. After all, the only way we can succeed in healthcare is to meet with stakeholders and talk about it. Some more. Right? Anybody for a donut?

Set The Wayback Machine

I read in the news the other day that Tennessee is making an effort to bring back the good ol' days. A bill sponsored by Senator Bo Watson "seeks to inform and encourage a debate about the merits of current scientific thought and theory." The debates he hopes this legislation will inform and encourage include those around global warming and evolution vs. creationism. 


I don't know, you can find that to be a good idea if you want to but I think this world has gained a lot more traction, progress, and "good will toward men" from encouraging scientific growth and thought then it has from trying to hang on to faith and superstition as a means to make the world a better place. I don't mean to say that faith is bad. Not at all. People of faith have been the voices of the oppressed and the moral beacons for mankind for all of modern history. It's just when government tries to slip into the same size suit it doesn't fit. Religion and faith are never one size fits all. And when a government tries to put on the faith garment it just ends up making a whole lot of people sore and uncomfortable.


I understand evolution is a theory. I understand science is not perfect. I understand that many hypotheses once thought sound have subsequently been dismantled. But I surely wouldn't support any attempt at undermining or otherwise stepping away from the process. Legislation like that in Tennessee undermines progress and panders to a sector of society that fears the future, a future in which standards and expectations rooted solely in faith are being challenged by the force and progress of human discovery.


Faith has immense value in the lives of millions. But that's not to say your faith has value in my life. Tennessee has led the way on this one-- straight back to Dayton, Tennessee, 1925. Good job, Bo. Sherman, set the Wayback machine…...

Grand Designs

I know a man who has famously taken and published photographs of ships. Also barns, and bridges, and trains, and the great American landscape. This weekend I purchased a publication of his Great Lakes steamship photographs. He told me how these were some his most favorite of all his many images. Odd that I would be talking with him and looking at those images on April 14, 2012, just hours before the 100th anniversary of the sinking of the R.M.S. Titanic.

I've never before given the event much thought. I wasn't swept away by the movie. I have no plans to see the 3D reprise. But my son has been Titanic crazy lately. I don't know exactly how that's come about but it's been pretty steady for the past three weeks or so. And so it is that we've watched a couple of the documentary specials they've run on public television. We've read the National Geographic children's book on the subject. In all of that I know, even as much as he can recite quite a few of the facts of the matter, his grasp of the event is all but absent. The real lessons to be learned from that terrible event 100 years ago are several, none of which he yet understands.

He doesn't yet understand the importance of never taking life for granted. I hope he grows up to know that every day lived well is a precious gift, not to be treated casually.

He doesn't yet understand the importance of never taking the love given by another for granted. I hope he grows up to know that living your life being loved by another is also a precious gift, not to be treated casually.

And perhaps the most important lesson he needs to someday fully understand is this: Human pride coupled with human fallibility is always a toxic mix, often with catastrophic outcomes. Nothing is ever so grand that it cannot fail, cannot disappoint, cannot take you down. Intelligent design always recognizes, and is built to accommodate, its potential weaknesses; whether relationships or oceanliners. I hope he grows up to understand that sailing through life requires knowledge of purpose, strength of design, and a willingness to recognize one's weaknesses.

Boys' Life

Memory Machine

If you're lucky, really really lucky, you have the gift of precious memories. You have the gift of self-confidence and optimism. You have the gift of happy childhood recollections doing fun things with friends. Speaking for myself, I'm happy to report I have my share. Some are so good the friends with whom I made those memories remain friends to this day.

As a parent I know it is my responsibility to provide a safe environment, to provide boundaries and necessary discipline, to set the example that points the way from selfishness  to social responsibility. It's also a parent's responsibility to provide the opportunities for the child to enjoy life, to find joy, to help the child on his or her way to collecting the happy memories that help teach life is good.

Evan and his buddy Parker got to go down to the Henry Ford Museum Friday, thanks to their Moms. The museum is holding a Titanic exhibition and, for some reason, Ev's pre-school has become infected with the Titanic bug. But the Henry Ford is an amazing place, too much for man or beast, or child, to explore in a day. In addition to the Titanic exhibit they went to see, they also got to make a stop to see the trains and planes on display inside the 9 acres under one 40 foot ceiling (displayed along with, it seems, one of everything else in the world manufactured in the last 120 years). For all the hassle those two Mom's went through to drive down to Dearborn, to corral and track two four year-olds through that vast space, I think the photo above pretty well documents the value of their efforts. Good job, Moms. Obviously these boys are well on their way to amassing a really nice collection of that most valuable commodity: Good times as a kid.

A Resting Place

Driving around this neck of the woods you can really see the signs of new growth: Fields are being plowed, trees are starting to take on the fine green lace of new growth.  It's almost distracting as I drive through the countryside. It's almost as if I've never seen this place before. Then again, at my age, that could just be related to memory.

Almost every large field will have at least one tree like the one above. It's a big old oak that still slumbers. This tree and dozens more like it, sit barren in the middle of plowed fields. They're not dead. They're just taking a little longer to get ready. A little more time getting the creaks out. A little more time with hair and make-up.

These hundred year old trees were the shelters for the farm hands. Before large tractors with huge plows and planters, long before mechanized combines that could take down a field in the time between breakfast and lunch, men worked in fields for days. The farmer, his boys, and a few of the neighbors would head out early and stay as long as there was light. These big trees were maintained and cared for as a place to find shade on a hot summer day.

Those days are long gone but many of the area farmers still leave these old trees in place, monuments to an earlier age when the work was more dependent on the back and arms and legs of legions of men and boys. When I drive by I always have to wonder: How many baskets filled with fried chicken and biscuits have been laid out under those branches? How many quarts of water drunk in its shade? How many times have farmers' wives and daughters carried lunch and dinner out to that island? How many hard working backs have leaned against that big trunk in order to rest and cool a bit?

Easy to over look, these big trees are are relics from pre-industrialized farming. They are the living headstones of a generation past. If you ever find yourself driving through the rural farmland, take a look. You won't see them obstructing the operations of the large corporate farms. You'll only find them on the heritage farms. Mostly farms where farmers have pride in their past, a respect for the workers in whose furrows they follow.

The Michigan Advantage

I don't know how many dads give it any thought but I had always thought I wanted my daughter to go to a small college. A small college had pretty much saved my ass from extinction and, having had a taste of life in both venues, I thought small was better. I especially thought that to be true if one was thinking about medical school.

Turns out, what does dad know? My daughter has been down at the University of Michigan for almost two years. She certainly received her wake-up call as to the need to modify study habits and the need to use resources. No cozy lecture hall with just 40 or so students in a chemistry class. So far at least, no sit around the professor's living room with a group of students for coffee and a discussion of ethics or current affairs. No, it's been pretty much tough schedules with big classes and evenings at the library.

Last night I got to witness the why of it all. Michigan has a great program called the Undergraduate Research Opportunity, or UROP. Kels has been working in her group for the past two years. She has had the incredible good fortune to have been published-- twice. She has had the opportunity to meet and work with great people involved in real research with real world implications. And, last night, she presented her work as a poster board presentation.

In a hall filled with about 50 other students presenting their work, there she stood. Well dressed, neat, proud, and congenial, greeting the various judges and visitors and explaining the research in which she has been involved. It was an amazing opportunity that required her to organize, prepare, and present her work in an open forum. It was an amazing opportunity to try her hand at what graduate students and medical residents do on at least an annual basis. It was a very real demonstration of why a dad can be glad his daughter selected the University of Michigan.

Judged by a field of individuals active in research, at a large research university, it was just so very cool to see her stand up and show her ability. And, not to brag too much, apparently her ability is pretty damn good: Allow me to zoom out on the photo from above--

Yes. That would be the Blue Ribbon Presentation.

Unwelcome Guests

I'm one of probably 15 or 16 people in the lower part of Michigan who likes the snow. When we get to late fall and the cold wind starts to blow those big dark clouds in, I feel a new energy. And that first real snowfall really brings the kid out along with that adult who loves a blazing fire in the fireplace.

But all that is November and December. Leaving the hospital Tuesday morning it took me a second to figure it out. White flakes, just one here or there, messing with my visual field. And then one stuck on my eyelashes and melted. Snowflakes.

I've seen big snow storms in April before. But this year we had an early and very warm spring so we have Tulips, and trees in full blossom. Lawns have been mowed and groomed. While it never amounted to more than an on and off half-hearted flurry, seeing the snow fly for a couple of hours Tuesday held no delight. Like trying to wind down a house party and have a last few straggler guests show up just as you're starting to pick up: It's just not fun at that point.

Hopefully that was our last hurrah. I think pretty much everyone in the state is done with it and ready to reset the stage. Then again, this is Michigan. I'll keep a stack of firewood handy for a few more weeks.

Old School

My medical assistant took a week off to cruise the Caribbean. She's my peripheral brain in the clinic, telling me where to be and what's up next. While she was away I ended up at our remote clinic, about 20 miles from homebase, without my laptop computer. That would be the one with voice recognition for all my office notes. The one with all my electronic charts for the day. The laptop with all the capacity I need to see patients for the day. Fortunately for me, I have great staff and had someone available to run my computer out to me.

In the half-hour I went without my electronic medical record (EMR or EHR in all the media and political discussions) I had the opportunity to re-visit the "good ol' days."  By that I mean the really old days. In that time I did what we always used to do: jotted down a few hand written notes for each patient. Within a few patient visits I realized I was able to record everything I actually needed to know about the patient encounter in 1 or 2 shorthand lines of notes.  It wasn't enough information to satisfy an insurance payor, It wasn't enough information to satisfy a hungry lawyer, It wasn't enough information for Medicare reimbursement.  But it was all the information I needed to know what happened, what was wrong, and what needed to be done. One or two pencil-sketched, abbreviation strewn lines requiring no more paper or space than that between the patient entries on my schedule, and I was able to record the who what how and what's next of patient care.

My experience reminded me of a long deceased uncle who was a dentist in Portland, Oregon for probably close to 50 years; I'm pretty sure into his eighties. His office was a relic even back in the days before relics. He worked alone. He had a small waiting room. No TV, no aquarium, just old magazines. Through the door was his dental chair, antique pulley driven drill, his phone, and his appointment book. Period. It was like going to the barber. I don't have any recollection of any record keeping and I'd be surprised if there was any record keeping. He didn't need it. Neither did anyone else.

I can state with confidence the simple note taking I did the other day allowed me to collect all the information I needed to initiate or continue competent care for the six or so patients I saw before my laptop arrived. My method would never ever meet the requirements of modern practice what with Medicare, Medicaid, private insurance, auto insurers, workers compensation, and malpractice concerns. But the fact remains, my notes were enough for me to provide care.

And we wonder how healthcare got so expensive.

Full Contact Egg Hunt

I heard that some communities have been canceling their traditional Easter egg hunts due to aggressive behavior on the part of parents. This is hard to understand in our day and age.

How many communities are struggling for ways to increase revenue? How many communities are having to discontinue the annual spring Easter Egg event simply because they can't afford a few dozen eggs or so? Meanwhile, how many Americans are wrapped up in the thrill of full contact sports like cage fighting and mixed martial arts? How many Americans just sit around waiting for the next big violent sport to hit the scene? How many Americans are tired of their puny video war games, tired of virtual bombing, killing, and routine destruction via computer or TV screen?

Well, here's the answer for next year: Full Contact Easter Egg Hunts. Imagine the revenue to be reaped from pay per view. Parents and their children: Gloves off, no holds barred, kicking, hitting, tackling each other in an effort to be last one standing with the most eggs intact. Perhaps we could even use raw eggs so that they could also be used as weapons. Imagine the strategy required as a parent or child tries to calculate the benefit of firing one of his or her eggs at an opponent in an effort to capture more. And the money would just come pouring in. It could be the final chapter in the commercialization of Easter, an offering to our one true god, the almighty dollar.

Here's your chance to get in at the ground level. Hop to it.

Celebrating the New

This weekend both Passover and Easter holidays are observed. Interestingly, they are very much about the same thing although cast in quite different presentations. Both are about new life. The former celebrates life after captivity, the latter celebrates life after, well, life. Both are about new birth, growth, new opportunity.

From Rabbis to rabbits, from preachers to potted lilies, it's all a celebration to remind us that, after the dark of winter, life returns. Humans, just like all of life around us, are aware and alert to the change. We cannot escape the beauty that is beginning to show face and flourish, beauty that replaces the bleak landscape that, at least here in Michigan, has lay bare and dormant for months. It's time for a new start; time to remember where we've been, how we got here, and to look forward to what's ahead.

So, whatever your persuasion, Happy Springtime. I hope that with this change of season you are reminded that the most dreary of conditions hold the promise of new beginnings.

Disney Days

Spring break is when people head out to shake off those winter doldrums in places like Florida, Mexico, and Hawaii. Never in my life have I been a springbreaker in that manner. Historically, this was amusement park week in my childhood. My best friend Danny's Dad would schedule a day off and take my brother Dan, Danny, and me to the Magic Kingdom or Knott's Berry Farm for the day.

It wasn't the only time I would get to Disneyland. My parents would end up down in Anaheim every now and then when family would visit. We'd go to Disneyland or over to Knott's in Beuna Park. But that was always on a very conservative and obvious budget. That was back in the day when Disneyland was accessed with tickets. The economy book had something like 2 E tickets, the ones you needed for the really good rides; then 3 or 4 D tickets for things like the train and the steamboat. And then came the C, B, and A tickets. Needless to say, one always had drawers at home filled with left-over B and A tickets.

But Disney with Dr. Freeman was a different story. Although I've mentioned previously how he might scheme to get us in at a discount, once we passed through the stone arch under the railroad tracks, the fun began with a capital "F". With E ticket books in hand we'd be off to the Monorail, the Haunted Mansion, whatever rides we wanted, the whole time his Dad just patiently walking along and waiting, waiting, waiting while we had fun, fun, fun. And we ate what we wanted and when we wanted-- and sometimes even when we didn't want.

The problem was this: It seemed more often than not, Passover and Easter were not in sync. More often than not, Danny's Dad would want to take this extravagant outing on the Friday or Saturday of spring break. More often than not, that Friday was Good Friday. And in my household Good Friday was stay home and go to church Friday. I remember my Mom arguing that Dr. Freeman wouldn't let Danny go with us on one of their high holidays. "We've never taken him! And this is Disneyland!!" More often than not, our pleading won out over religious conservatism.

I'm grateful for my Mom's rare acquiescence to a secular agenda. Those trips to Disneyland are now carefully filed away in that cabinet labelled "The Best of Times." I hope you've indulged a bit this Spring-- in spirit, memory or activity.

The Thrill Of It All

Flipping through the channels the other night I stumbled across the Doris Day vehicle, The Thrill Of It All. It's a spoof on the advertising industry of the 50's. It's "Mad Men" with goofballs. The movie is also a view of the American Dream circa 1963. It is presented with just as much soft focus as a Doris Day close-up.

The amazing thing is that the movie was not intended to be propaganda. It's a snapshot. Far from a panorama, the image presented is a narrow view of middle-class life: beautiful home, stay at home mom, 1 boy, 1 girl, solid income, and a nation well employed and busy preparing for a future including more of the same.

Not so funny comparison to life today in these United States, The Thrill Of It All is steeped in optimism. In that I think the theatrical image is an accurate portrayal-- at least if you want a snapshot of white middle class America preparing to enter the soon-to-be turbulent 1960's. 50 years later it seems that, what's left of the middle class is concerned with survival more so than growth. Creeping pessimism has supplanted flourishing optimism. Today, rather than reaching for the moon, building and growing, there are more than a few out there who are desperately trying to take us backward. The really pathetic part of it is that there are those-- and they are vocal, visible, and well funded-- who believe the set and setting of a movie like The Thrill Of It All. In their hands such movies, these snapshots of a very narrow slice of mid-century America,  become propaganda, the embellishment of a fictional past as a model for a fantasy future.

I guess all of that is just too much thinking. The movie was written by a couple of brilliant comedy writers in Carl Reiner and Larry Gilbart. And I love, love Doris Day for all her wholesome tomgirl-next-door-who likes-to-kiss-boys good looks and humor. So maybe it's just better if you forget all that. Just watch and let the movie do what it was supposed to: Make you laugh and take you away from all of this.

Work

I'm not sure what to make of unemployment figures but I'm fairly certain they underestimate the problem. Depending on which political candidate or media outlet you subscribe to, things are either getting better or everybody is looking for work. Everybody agrees a few more people are finding work, but, basically, "good" jobs remain scarce. With a daughter in college and a son with a long way to go I think about things like employment. I also think about things like the value of an education.

It seems there are two types of education in the US today-- vocational and the traditional 4 year degree. With the former, one attends any number of schools that have sprung up and stand ready to provide expertise in everything from diesel mechanic to nursing or other medical/technical related work. I guess if one is using a traditional 4 year college degree as a stepping stone to professional school then, that too, can be viewed as a purely vocational endeavor. The highbrow perspective on a 4 year college experience is that, regardless of where you end up, you will be a more "complete" individual, capable of sound judgement and creative problem solving. Education first, employment second. Again, I guess I've been thinking about all this lately because I have a couple of kids and hope they will one day be able to find work and support themselves and contribute to society.

A couple of weeks ago Ev and I were watching the guys at the Car Wash Carousel in Phoenix. They work very hard, work long hours, do an excellent job, and there does not seem to be any visible attitude of discontent. Watching that process and both admiring and feeling grateful for the work they do, I thought, this is work. And then I had to think, would this be okay for my kid? 

Two ideals parents frequently teach to their kids are: 1.)  choose happiness over money and 2.) you can be whatever you want to be. So many people today seem to judge work based on some sort of celebrity yardstick. It's better to be a doctor than a gardener. It's better to be an investment guy than a car wash guy. It's better to be teacher than a waiter. It's better to be miserable and make a lot of money than be happy on an hourly wage. Like everything else, we've grown to respect money and not work, income and not the person, stuff and not substance.

All things considered, I would still abide by those two ideals, happiness and setting one's sights where your heart leads you. At the same time I also think a person should be inspired to use their talents wisely and to the best of their ability. That said, happiness trumps all.

Now, if we could only get a handle on happiness. In the meantime, if you're ever in Phoenix with a dirty car...

Congressional Immunity

I can assure you it happened by accident. There is no way on God's earth I'm interested in watching Republican Primary returns. I've found the whole Republican campaign process to be an unsightly boil on the ass of American Democracy. And-- just to be fair-- I have little confidence the bipartisan campaign to November will be any more civil.  That said, there I was watching the tube last night when, next thing I know Mitt Romney has his mug on the screen gloating over the his victories Tuesday night.

Seeing Romney reminded me of how prominent a role wealth plays in a democracy. Especially when it comes to the Presidency, you don't see a whole lot of regular wage earners make a run for that stage, let alone take it. And you don't see a whole lot of retired senators, congressman, presidents, and governors struggling to make ends meet on a fixed income and restrictive health insurance. What anti-big-government, financially successful, savvy business guy wouldn't want an elected seat in Washington, D.C.?

As we struggle with issues of healthcare and Social Security, I have to believe we are making a fatal mistake when we allow leadership to exclude themselves from the problem. It's not a conflict of interest so much as a lack of interest: Our elected leaders should be provided with health insurance. And they should have a choice: Medicare if they're over 65 and Medicaid if they're under. Or, they can do what the rest of us do-- buy their own.  Likewise, our elected leaders should be provided with the finest retirement program this country has been able to devise: Social Security. If they need resources beyond that then they can do what the rest of us do: Build retirement savings and investments.

As long as Medicare, Medicaid, and Social Security are considered to be the poor man's resources they will be treated as such and the benefits offered will reflect that status.  A great many of the boomers grew up expecting more and thought they were paying for more.

I think the first step in creating meaningful and lasting entitlement programs is to remove the elected leader's immunity from those programs. Step one: The elected staff needs to start eating what they're serving.

For Your Information: An ER Primer

A family member had to go to the emergency room this weekend. All better. No tragedy. Their experience made me realize how difficult it is to be a patient in that situation. The ER is just not always the warm, fuzzy, loving, caring environment a person might like when not feeling well.

Here's the short of it: Emergency rooms are not nice places. In spite of any television and billboard advertising you may see to the contrary, emergency rooms are not friendly. Emergency room docs are often not graduates of the Marcus Welby, MD School of Compassionate Care. More often than not, emergency room nurses are not your sister or brother, your mom or your dad.

What emergency room personal are, usually at least, is competent. What they are is hard working. What they do-- beyond saving lives, beyond fixing booboos, beyond taking the front row seat in a nonstop parade of trouble and tragedy--  is take a boat load of crap.

I can't quote statistics but I'll stand by these observations: On any given day 65% of the patients in an emergency room don't need to be there. On any given day, at least 12% of the patients in an emergency room are f'n crazy.

In all of that I'll tell you this: God forbid, but if you ever find yourself on a gurney in the emergency room, remember most of the doctors and nurses are there because they love emergency medicine. They love taking care of sick and injured patients. They love caring for the nasty, bloody, sorrowful stuff that shows up on their doorstep. But a lot of the time they are taking care of either the 65% or the 12%. And if they seem to be lacking in the warmth and compassion department, cut 'em a little slack. They just want you out of there. In one piece. Alive.

The Parent's Car

I got a new Buick the other day. Seriously. I don't know if that's a nod to adult responsibility or the flight of youth. It's certainly a change of pace for this 55 year old dog. I've had more than a few cars but not much to compare with this blondey. This is definitely the ride of the responsible dad: Attractive, but not sexy. Fast, but not quick. Big, but not imposing. In short: Nice, not naughty.

My Dad loved his cars. He never had the means to go after something like the "little Mercedes," the SL, that he admired in the 60's. Nor did he have the ego to go after a Cadillac. No. My Dad chose, out of necessity as well as preference, subdued vehicles, but with a slant toward the sporty, and with an engine to match. He adhered to budget and paid with cash. So, when he bought a new Chevy in '67, it was a 2-door with a V-8 and air-conditioning. He followed that up a couple of years later with a V-8 Pontiac LeMans 350 Sport.  And if you had ever ridden along with him on the old US 99 that paved 2 lanes of soil from southern California to Oregon, you would most certainly have witnessed a demonstration of those big iron American V-8s as he stepped on the gas and blew around all manner of truck and bus and any others going just too darn slow.

My new Buick is everything he would have wanted: Subdued. Well equipped, comfy, and super quiet. Everything he would have wanted except my car has only 4 cylinders. It's probably quick enough to have met my Dad's standards but it sure doesn't sound like a V-8. Not only that, the engine shuts off when you stop in traffic or at a light. If the radio is off the car is dead quiet. No rumble of exhaust, just the soft breathing of the air system.

My Mom was not a car person. She needed the car about two or three times a month to do the shopping and any errands-- Ralph's, Vons, the May Company. When my Dad put the pedal to the metal passing another car out there on the highway my Mom's hand would rise up on the dash as if to brace for impact. She wasn't smiling at the thrill of it. It wasn't fun for her.

Considering it all I may have bought the perfect car: My Dad would have been able to pass all those slackers up and down the San Joaquin Valley and my Mom would have loved the fuel economy and environmentally friendly nature of the car. The perfect car-- if I were my Dad. And Tam was my Mom. And this was 1969.

It's a three year lease. We'll see how it goes. I must say, though, it does have the best frickin' stereo of any car I've ever owned.

Name That Car

My daughter has a friend who recently got her first car. She is a great kid. Bright, hard working, headed in the right direction. She's posted a picture or two of her new ride and seems excited, which she should be. (I was in my second semester of medical school before I had a car.) Apparently she's been struggling with a name for the vehicle and the other evening posted her success in finding a name to her liking.

I've had quite a few cars since that first blue rabbit. I have never named a one. I have called more than one of them a name on occasion but never actually given one a name like Jet or Red or whatever.

This episode recalled a time back in high school when I was out with a few friends. We were driving about 60 miles to Portland, Oregon to see either Katherine Hepburn on stage or Bette Midler in her Divine Miss M days. Both great. Can't remember which. At any rate, we were traveling in my friend Jesse's 1950-something bathtub Volvo, a car that was steeped in Bohemian cool. Unfortunately, the electrical system was both elderly and temperamental and was manifesting its failings by cutting the headlights in and out.

Because of the car's age and bad habits, Jesse decided we had better take backroads which was fine until it started to get really dark. Meanwhile, one of the girls along on the ride had felt the need to talk pretty much nonstop from takeoff to landing. Not only had she felt it, she indulged it! By the time we were having to make our third or so stop for malfunctioning headlights we had pretty much had enough of the monologue. As we pulled to a stop in the middle of nowhere, in the dark, frustrated at the frequent malfunctions, our loquacious friend took a break from the nonstop chatter and chirped up, "It's so cute. Does your car have a name?" Opening the door to go wiggle the wires under the hood once more, Jesse shot back without so much as missing a beat, "Yeah. F**khead!"

If memory serves me, the ride got better after that. I guess it's all in the name.