Smokin'

My future operating room

As the healthcare environment twists and turns along a mysterious course of regulation, struggling to achieve better outcomes, more satisfied patients, and lower costs-- more and more docs are starting to stand up and look for the exits. The administrative piece is becoming too onerous and sucking the life out of the profession.

I moved an inch or two closer to launching my new career over the past holiday. I still love what I do but always keep an eye to the future. As a surgeon I'm PDG but someday I may find the demands of the job are just too much. When that day comes I hope I can fall back on one of a couple other areas of expertise: One of my favorites is cooking.

This weekend I took another step toward gastronomic greatness. My wife loves barbecue ribs. I've done ribs a time or two and have read all kinds of recipes and heard all manner of suggestion as to cooking them up just right. The fact is-- say what you will-- the only way to do ribs is "low and slow," as the saying goes. Low heat over the course of several hours. Not boiled. Not in an oven. Not grilled over charcoal briquettes. Cooked in the low heat and bathed in the heavy smoke of a wood fire.

I was a regular pit boss out in the backyard Monday, splitting up pieces of wood, keeping a steady stream of smoke pouring from the little chimney. It took about 4 hours to do one rack of baby backs. I think it took 'til Wednesday to get the smoke residue out of my nose. But I think I'm just about there. Those ribs were absolute killer.

Just a couple more turns of the healthcare screw and I might just have to open my own rib joint. Wait a minute-- does the government regulates those as well?

A/C Off

Memorial Day has come and gone. It's time for white belts to match white shoes, white purses and white pants. Hot weather and high humidity. And broken central air.

Anyone that knows me knows I'm an A/C kinda guy. From the time my Dad brought home that first Chevy Impala blowing ice cold air I was a believer. The first year I lived in Michigan I learned the importance of having the same appliance in the home: Finding your book of stamps glued together and every book on the shelf starting to warp was enough to make me shut my windows for good. The humidity is too much for this boy and his trove of books, magazines, photographs and art on paper.

Over the weekend, as the humidity climbed and the temperature in the house hit 80, I was just grateful the unit went down on the tail end of a holiday weekend. The repair guy was here and gone in an $80 minute Tuesday morning and both temperature and humidity were well in hand by nightfall.

I love a cool breeze. I love a warm day. Hot, cold, arid or humid; I love weather and all the sights, smells, and sensations it brings to the senses. Just not in my house.

Water vs. Wind

Leaf  blowers are big here in Michigan. I guess by now they're big everywhere. But it wasn't always so.

Growing up on the west side of Los Angeles one would see a gardener at work on any given day of the week but Sunday. In those days, they were mostly Japanese gardeners. My Dad would marvel at how meticulous they could be mowing and trimming a property. Moving from Oregon, he was especially impressed with how they would wash the entire place off when done: Sidewalks, pathways, patios, driveways. Everything got a bath before they packed up and pulled away. My Dad, being the passionate gardener he was, soon parked his broom and came home with a high pressure hose nozzle to send all manner of grass, dirt and debris cascading down the driveway and sidewalk and on its way toward Warner Avenue. Ah the good ol' days of unrestricted water use and no thought as to what went down the city's sewers.

Here in Michigan-- where we have no shortage of water-- I've seen noisy leaf blowers used to clean off lawns, sidewalks, and driveways. I've seen them used to clean out garages and I've seen them used to blow snow off walkways.  I don't have a leaf blower. So, when it came time to clean out the garages the other day, Tam, being a native Michigander,  thought I should fire up the compressor and blow 'em out using compressed air. Next best thing, right? No way!

To the contrary I did the only thing any guy raised in LA in the 60's would do:  I got out my hose with its high pressure nozzle. I haven't washed off a driveway, sidewalk, or patio in over 40 years. That said…. Damn that hose did a nice job! Quite therapeutic really, watching all that dirt, those leaves, twigs, and chips of wood go flying out the doors. Water vs. wind? It's water, hands down. And Tam was blown away.

Memorial Day

I came across a post Saturday with a link to this recent editorial in the Wall Street Journal. For most all my life I have been conflicted by the persistence in human history of war and government sanctioned killing. On the one hand I love where I live and the comforts and relative safety of living in the U.S.. On the other I think war is an abomination.

It's Memorial Day weekend and we have to be so very grateful and acknowledge our indebtedness to the thousands upon thousands of people who have died in creating and preserving the life we enjoy. Cemeteries are filled with the remains of men and women who have gone to war -- many involuntarily conscripted to battle. Lives ended in their youth. Families shattered with the loss of a parent or child. Men and women forever disfigured-- mentally and physically. The sorry fact is that many of these people have died in battles fought in response to the tyranny imposed by just a single individual and a handful of supporters imposing their will on a nation. Toxic leadership.

I have a friend who has trouble sleeping nights. He is a surgeon who has treated thousands of patients. Now, in his 60's, he has a son in Afghanistan. He has a son who, all his life, has wanted to be a soldier. He has a son who believes it is his duty and calling to go to war. He has a son whose dad can't sleep well anymore, who worries, who is scared. It is amazing to think we have never gotten to the point where there are just too many sleepless nights, too many broken bodies, to many broken hearts to carry on this way.

I'm grateful for every tyrant that's ever been forcibly removed from the face of the earth. And I'm grateful for every soul that has felt it was their duty to preserve our safety and well-being. But, as is true with so many cancers and infections, prevention is key. It is our great downfall as a species that we cannot see the value in working to eliminate the intolerance, inequality, and resentfulness-- the stubborn, shortsighted selfishness-- that leads to war. Thank a vet. But enough already.

Done To Perfection

My daughter turns 20 today. No more a teenager. 21's a bigger deal but I'm always happy when my daughter has another birthday.

I'm among the most fortunate of all parents. My daughter has grown up virtually trouble free. She's been conscientious, industrious, fairly well self-motivated, and never spent a night in jail-- at least not that she's shared with me.

I can tell you this: I certainly know enough not to take it for granted. I'm happy to report that after 20 years I don't know what it's like to have a daughter who doesn't come home. I don't know what it's like to cope with a pregnancy in high school, or before. I don't know what it's like to watch as my child drifts away with the wrong crowd in the wrong direction. Father's like me are among the happiest guys on earth!

Sitting out by our little makeshift campfire this evening I paid homage to Kels. I toasted a marshmallow just the way she likes it. Where she finds the patience to sit and carefully nurse that highly flammable confection to a toasty brown I'll never know. I'm a flamer and always have been. Give me a marshmallow, a stick, and a campfire and that baby is a flaming char-ball in seconds flat: Peel the top layer and she's ready to submerse again. Not Kels. She'll concentrate and remain vigilant that her little treasure slowly tan. No smoke. No  flame. Done to perfection. Just like her first twenty years.

Happy birthday, kiddo!

Toona Tartare

I stopped eating meat a couple of years ago. I haven't lost an once of extra weight but I feel better. And I can look my food in the eye. There are a few foods I do miss though, and it's not cast in concrete that I would never eat them again: A bone-in Kansas City strip at Chicago's Tavern on Rush. A Hickory Cheese burger at the Apple Pan in West L.A.. Tuna tartare almost anywhere.

A few weeks ago I had a salad with watermelon chunks in it while out in Scottsdale. It had an unusual dressing and an idea came to me: Watermelon might make the perfect faux tuna! The color is just as bright and red as the freshest piece of yellow fin. Okay, okay. I know. But look at it from my perspective-- I've gotten to a point where I just really don't like to think about the life forms I'm eating. So I had to do something!

So here it is. I think. (I didn't really write the recipe down as I was doing it so I hope this will be close to what's in the photo):

about 1 cup of watermelon cut up into very small squares, 1/4 inch or less
about 1 cup of cantaloupe cut the same
1 thin slice sweet onion minced
about 1/2 firm avocado cut up in smallish pieces
small amount minced cucumber
small amount minced celery
small amount minced jalapeno
small amount minced green pepper
minced cilantro
coarse ground pepper
toasted sesame seeds (I forgot these)
toss with a few tablespoons of unflavored oil (e.g. canola) with a dash or two of sesame oil mixed in
(I can't remember but a spritz or two of lime juice might be in order. Sorry. That's how I cook.)

If you have a can for stacking your mixture into a tower that might really help the presentation.

The heat of the jalapeno and the smokiness of the sesame oil are really great. I've only made this once and am not so sure the cantaloupe has any rightful claim to the dish but, for now, it stays.

Bon appetite!

The Political Voice

This past week I read a story on the campaign funding activities of J. Joseph Ricketts and his political agenda. I realize he is just one of many wealthy individuals who actively play the Monopoly game with our country, its politics, government, and our future. I realize, too, such individuals are representative of and support both the Democratic and Republican parties, liberal and conservative agendas. I don’t know how it will ever change in as much as our democracy, though built on a foundation of great principle, appears to stand as a monument to ascendant affluence and personal wealth at this point in our history.

As the campaigns move forward we will be bombarded with all manner of advertising touting political, religious, moral, and economic agendas. We can expect advertisements that will be rude to the point of malice while others will offer promises to the point of pandering. I cannot imagine anyone in this nation who will not be physically sick of the process by the time November rolls around—save those who are paid to generate such intellectually offensive litter—and the self-serving individuals who finance them.

It’s a healthy desire to want to make the most of oneself. It’s a healthy endeavor to strive to take advantage of every opportunity. It’s healthy enterprise to actively seek ways to create, to build, to grow. But wanting more for the sake of more is not healthy. And wanting more at the expense of oppressing others is definitely not healthy.

The beauty of this country is that we each have personal freedom: Freedom to worship or not. Freedom to travel or stay safely in our homes. Freedom to speak our mind or remain silent. Those principles, among a host of other core values, are what make us great. Each of them intended for the benefit of all. We have asked, and continue to ask, our young men and women to lay down their lives to defend those many liberties.

As the campaigns move forward and the media assaults begin I hope we can each keep in mind those core principles and ask ourselves: Do we honor our democracy when millions of children and adults go to bed hungry or poorly fed each day? Do we honor our democracy when we spend millions of dollars fighting over the subject of gender, sexual orientation, marriage, and religion? Do we honor this great land when our elders cannot afford retirement? Is the America where healthcare remains unavailable to millions the one we praise? Are we showing proper care and keeping of this precious nation when we allow wealth to grow among the few while the number living in poverty grows to levels not seen in almost one hundred years? Do we honor this democracy when our once great public school system faces financial challenges to its very existence? Is forging a future for this nation wherein the wealthiest can continue along an unobstructed path to greater riches, while poverty grows and the middle class withers and contracts, is that the future we want our children to defend with arms?

For generations we have been able to state, without reservation, this is the greatest country on earth. We’ve held that belief because this is a land of opportunity; opportunity provided without prejudice, opportunity provided without qualification, opportunity available to all who would avail themselves of our great physical and social resources. This is a land of abundant opportunity and one funded by the individuals and businesses that prosper within this great nation.

This year I will be listening for the voices that speak to restoring and preserving those many opportunities and resources. As such, how I would love to hear the candidates address restoring America to greatness: the elimination of hunger, the restoration of public education, the creation of broad and affordable healthcare, ensuring a sound and meaningful system of old age pension. That is the great nation I thought I was born into over 50 years ago. It’s not socialism or communism. It’s historic Americanism.

Times have changed. But the principles remain and wait to be returned to prominence. I want to know we can feed and educate our children and care for our aging. I want to see a nation that cares about the many not the few; recognizing that true wealth and security comes with looking after the wellbeing of all. And if there’s a billionaire somewhere who wants to promote that agenda…more power to ‘em.

Doris Meet Ginger, Ginger, Doris

Well, I have shamelessly schlepped my way through another season of Dancing With The Stars. I didn't watch every episode but I definitely watched enough to recognize the cast and contestants, to realize there are far too many commercials to make watching enjoyable, and that I probably won't bother next year.

That said, I was surprised by the success of the woman in the middle above. Her name is Katherine Jenkins and she is a Welsh born classically trained singer from across the pond. I'm not the guy who's really plugged in to this sort of thing but I don't think she has the kind of popular presence in the U.S. one typically associates with contestants on the show. She was a poor fit: Too humble. Too reserved. Too well spoken. Too good a dancer. Way too good a singer. That said, she lasted right up until the very end of the popularity/talent contest that is DWTS. I think it was, in part,because she was so, well, wholesome and refreshing.

At one point during the final show I had to say to Tam, "She's like Doris Day." I can only imagine there's a producer out there somewhere waiting to pair her with the next Fred Astaire-- and an english sheep dog. Yeah. Maybe a show about eating some kind of plant or flowers.

Death Of A Roommate

What a contrast in Tuesday’s local paper: On page one, a photo, headline, and the story of the sentencing of a young man for the death of another, a death which he states was entirely accidental. On page 8, three paragraphs and no photo, on the sentencing of a young man for his role in the death of another, a death in which he states he had no direct intent to cause the other young man’s death.

Without any discussion of the deeds themselves, recognizing the vast difference between aiming a gun at someone and invading one’s privacy, I have to wonder: What if their places had been changed? What if the young, wealthy, well schooled, Dharun Ravi had been charged, convicted, and faced sentencing for shooting his roommate with a gun during “horseplay”—A gun that he contested he had thought was not loaded. And, what if the young Aaron Feliu, a product of the mal-functioning foster care system (eventually adopted into a home where the minister-father was subsequently convicted of child molestation and pornography) without means, and of limited education, what if he had faced sentencing for using a spy camera to invade another young man’s privacy resulting in a suicide?

Frankly I don’t know “what if.” But I am willing to bet dollars to donuts that had their roles been switched the sentences would have as well.  Both cases had to do with irresponsible acts resulting in tragic outcomes. Both cases involved 20 year-old men. Both involved the death of a roommate. Both involved individuals who stated they had no intention of doing any harm whatsoever. Both cases involve the death of an 18 year-old young man. Feliu's case resulted in 3 to 15 years in prison. Ravi's resulted in 30 days in jail and probation. 

I have confidence in the U.S. judicial system. The work is often difficult, the decisions equally difficult, and the outcomes usually fair. The contrast of these two cases, however, point to a social bias that seems too old, too much of a stereotype, and too obvious to persist. But persist it does. I don’t know if it’s any more or less fair than life itself. But it’s existence is certainly hard to overlook in the remarkably similar circumstances surrounding these two cases and their remarkably different outcomes.

Field Trip

As a member of my hospital's board I found myself on a field trip last night. I think the last field trip I can remember prior to that was a trip to the Griffith Park Observatory, probably in 1969. Last night's trip utilized a much smaller bus, a much smaller group, and a lot less noise.

At 5 o'clock we all dutifully boarded the bus for a one hour trip to another hospital. Armed with iPads and smart phones we were relieved to see the sign indicating the bus was wifi equipped. Pulling away from our hospital we quickly came to realize, however, that the wifi on the bus was not working. The level of distress quickly became audible. And, I have to admit, I was among those who were annoyed as hell at not having internet access for the course of the one hour bus ride. (Note to self: Always keep phone fully charged in case hotspot use is required.)

I'm happy to report it didn't take long for me to realize how silly it was to be getting upset over being denied internet/e-mail access for the course of just over an hour. It's amazing just what one can see and experience if there is not an electronic device demanding your attention. It was a beautiful afternoon and the golf courses, farmland, and watersheds we passed by offered some really beautiful views I would have never otherwise seen. And on the trip home, the lingering twilight was absolutely gorgeous, the various barns, silos and other structures reflecting the soft fading light.

I was aware of it at the time and am even more struck by the fact this morning: Our impatience, impatience bordering on panic, when denied access to our portable electronics is a frightening development in this era. Not only do I worry about the attachment and dependence we have for the devices, I worry about what we're missing by staying so "well connected."

Summer Camp

Growing up, I was not a camper. I think it was a combination of expense, disinterest, and "other agendas" that kept my parents from sending my brother and I off to camp. Not that we minded. I found the idea of leaving home for a day-- or a week or two-- I found the thought totally threatening. Why go off and spend time eating crappy food, sleeping in crappy beds and using crappy bathrooms when I could just hang out at home with Dan? We could swim and ride bikes and do our paper routes. Who needs camp?

So here I am Sunday, driving out in the middle of nowhere so Tam and I can check out a possible summertime day camp for Evan. He's just turned 5 but friends say the Y camp is fantastic. So, off we go with Evan to check it out.

Over the river and through the woods and down the long dirt road. There's the driveway, complete with stone columns and log archway, "Camp Shiawassee" the sign reads. If it were an overnight camp I'd be inclined to name it "Camp Stephen King." The dining area was a rustic covered slab of picnic tables. The bathrooms? In that building "over there." So far it was pretty much living up to my uninformed expectation. (Although I do remember taking Kels to a Girl Scout camp years ago that was equally rustic. And she had to spend the night!)

Then we met Shane and Mitchell.These guys were obviously professional campers. In an instant they realized it was about Ev, not Mom and Dad. Off we went. Ev was impressed although visibly reluctant when shown the 50 foot climbing wall. But as we journeyed on from activity area to activity area these guys got him more and more engaged. A balancing cable, balance beams, tire swings to navigate. Slowly but surely they got him involved and engaged his confidence. I would have to say that, by the time he took his second trip across the 250 foot zip line, they had pretty much succeeded. (Although Mom did have to do a demonstration run. Had to.)

By the time we left I knew what I had missed. Although he's only 5, Ev is going to camp this summer and he can't wait. What he'll be bringing home will be confidence, strength, self-reliance, team ability, and a widened sense of self and capacity in the world. That, and hopefully a whole lot of really great memories. Something I would know nothing about.

Missed Opportunities

Everything but the tractor

Saturday morning while I was driving back from a surgery in our neighboring town I saw a great photo opportunity. Clear skies. Early morning sunshine. A farmer in his blue jeans, blue tee-shirt, and a blue ball cap, riding on his trusty tractor-- John Deere green with the yellow wheels and trim, pulling a John Deere green and yellow corn planter. Not the big giant stuff one usually sees on many of the farms in this area. This was the old time stuff. A tractor the farmer rides on, not in. It was the perfect portrait of a farmer and his tractor at work on a beautiful sunny day.

I have started to carry a camera in the car and I have a cell phone camera as well. The sad thing is, in spite of having all the right equipment, there is no photograph to share. That's because, in the time it took me to see the tractor, to process the scene, and to consider the traffic behind me, I felt it was too late. On a two lane road between two small towns with little else on the agenda, I felt it was too late to pull over, turn around, and get the shot. So I didn't.

Barring a mechanical or medical emergency that farmer and his tractor will not be back planting in that field for at least another year. Not having a photograph of the perfect farmer on the perfect John Deere pulling the perfect implement is no tragedy. But the lesson here is about opportunities, about moments. If you are like me there are any number of moments that we encounter each day, week, month, and year. Taking a moment to call a friend. An evening to share a meal. Turning around to say hello. Leaving early to spend some extra time at home. Too often we are content in thinking "it doesn't matter" or "I'll do it later" or "I don't need to." And when we're lucky, we're correct. We can do it later, or it doesn't matter, or it doesn't need to be done.

But often enough it happens that we won't be so lucky and an opportunity will slip away forever.  Maybe not so bad if it's just a tractor in a field. But, then again, maybe it is. Much like with tractors working a field, when it comes to the care and keeping of friends and family, a certain diligence and sense of urgency may just be in order.

Orgasmic Expecations

One of my colleagues told me of a recent encounter. After hearing it I could only think, the bar has been set. That, and I'll never look at an octogenarian the same again.

If you're like me, in spite of mountains of evidence and personal experience to the contrary, you find it hard to believe your parents ever had sex. They kissed, sure, that was great. But that's as far as it went. There's no way on earth adults the age of our parents ever did that.

Then comes my partner's patient the other day: A woman in her mid-eighties who is concerned she may have a pinched nerve. She's been having pain and some numbness and-- that's right-- her orgasms feel different. Mid-eighties!

Okay. I'm impressed. My visual capacity might be suffering in a manner to test its limits but, God bless her and, I assume, her capable husband. And let me just say, as 10,000 people a day in the U.S. reach retirement age, the bar has been set! It's nice to know that life ahead is lookin' good!

The Kid Problem

There is an awful lot of talk and attention being paid to the obesity epidemic.  An extension of that problem was the subject of a recent NPR blog that included this passage: "According to one estimate, about 2,000 children and teens suffer strokes every year as a result of hypertension. But the good news, says Washington, is that medication is generally not needed for this age group. Simple life style changes can do the trick. Cutting down on high fat foods and high sugar drinks, along with active family outings, can make a big difference, he says. And, because of higher metabolism, kids have an easier time shedding pounds than adults."

I have a skinny little kid with a skinny little mom and his parents are conscientious about what goes into mouths around here. Likewise, we're very conscientious about being active. I seriously doubt he will ever be obese. But he is more an exception than the rule around these parts. I see a lot of overweight kids. I also see a lot of poor kids.

In town, and nationally, there are all kinds of programs to get kids to eat better and exercise more. It doesn't work. At least not here. And here's the reason why: Kids are only as good as their parents when it comes to mealtime and exercise. That, and a diet that includes lots of fruits, vegetables, and other fresh ingredients is expensive. Unfortunately, diets that are high in fats, salt, and sugar are relatively cheap. In short: As incomes shrink, waistlines grow.

You can lecture and advertise all you want. You can make clever tag lines and set the bar high. But if you're not willing or able to buy the goods, you're not going to get the results. Talk is cheap. Getting fat is even cheaper. Of all the pitfalls and potholes thrown at a child, one of the worst is poverty. Poverty is depressing and, for many, erodes the initiative to do the right thing. In the place of an active lifestyle and good food choices you find inactivity and overeating.

Maybe it's an unfair generalization. I realize it takes more than poverty to make a person gain weight. Maybe it's a disservice to suggest that anyone other than the individual is responsible for his or her own health. Maybe. But when it comes to being poor, lacking cooking skills, and being hungry, our grocer's shelves and freezers are well stocked with quick, easy, and filling selections. Many of them covered by food stamps. Most of them at discount prices. Most all of them fattening. And the really sad thing is this: The food and agriculture industry makes a whole lotta money selling that cheap crappy food.

For my two cents I think the solution, for now, lies in the public schools becoming a model for lifestyle. I think our public schools need to provide that home where smart choices become second nature, just like I hope they are in my son's home. Problem is, the schools don't have any money either.

Omega 3's And All of That

I was at a show in town here over the weekend. It was a Jersey Boys like tribute to Frankie Valley. Not exactly my cup of tea but, over all, an evening's entertainment.

The venue was nightclub like with narrow tables of 10 and a steady coming and going of cocktail servers throughout the show. The crowd was nightclub noisy but enjoyed the show.

As I sat there and listened to this music of the 60's and 70's I had to think about the absence of smoke. I'm fairly certain that, even at the end of their long careers, the Four Seasons never played a gig where cigarette smoke wasn't a part of the environment.

24 hours later I'm watching a TV show at home when an ad comes on for some food or supplement that contains all the necessary vitamins, minerals, anti-oxidents, and omega-3's to promote health and long life. I'm watching this ad casted with smiling adults, hair touched with just a few virile wisps of gray, mouths brimming with bleached-white teeth, white folks looking trim, fit, wealthy and healthy, and I had a peculiar thought: When did living a long life become the objective? Does our current 79+ year life expectancy offer us more and better compared to the 69 years a person had back circa 1960? Are we accomplishing more? Are we more industrious? Are we more kind? Do we care more about others? Are we any funnier that we used to be? Or are we just living longer?

I have to wonder if that previous generation, those sorry bastards who schlepped along with a measly 68 or 9 year lifespan, I have to wonder if they weren't a little more concerned with how they lived more than how long they lived. Here's the really absurd question: Was the smoking a part of that? Certainly smoking was a part of the shorter life span but what I mean is something different.  I'm wondering, was the smoking an activity that was a partner to their nervous industry, the perpetual energy of an industrious generation? Were those seemingly ubiquitous cigarettes part of the equipment-- as useful at work as they were at play?

Walking home the other day a car passed by. It was a beat up little Chevy making sounds like there was a terminal problem under the hood. Behind the wheel was an overweight young woman in a hoody, cell phone held to her ear with one hand, cigarette held to her mouth with the other. It struck me, that woman has become the image of the smoker in contemporary society.  Just the opposite of the demographic that's out there sucking up those omega-3's.

It's been a long time since smoking was cool. Too many really miserable deaths have pretty much put an end to cigarettes-- at least in reasonably educated circles. Certainly not universally, but significantly. But still, when I see our current almost infatuation with health and longevity I have to wonder: Why? What are we living for? Are we simply afraid to die? And, like the alcoholic who gives up his booze but doesn't do his work and doesn't understand his alcoholism, have we lost something of our industry in our effort to promote health and longevity?

For the record, I am extremely happy that smoking has disappeared from the world around me. I'm thrilled to death that smoking has been relegated to noisy old cars. Even so, smoking was an integral part of the frenetic society of the 20th century. They may not have lived as long but, damn, they got a lot done and knew how to have a good time. And I do miss that.

A Simple Loaf of White

I made a loaf of bread this weekend. One loaf of white bread. First time ever. And the result was not half bad. Not that it was especially difficult or time consuming. If you don't believe me check out the recipe. Problem is, when you make something like a loaf of homemade bread you start doing things you shouldn't. Like having a late night peanut butter & honey on homemade white. And, although I love PB & honey on homemade white, I haven't had it in years and probably shouldn't start having it at 9:30 PM now.

In grade school and junior high, peanut butter and honey on homemade white was my manna. The difference was, back then, homemade bread was not cool in the opinion of this 14 year old. Funny how things change. Back then it was the same thing every day: Unwrap the waxed paper and find that sandwich, bread soaked with honey oozing through every pore in my Mom's homemade white. While now it's a happy memory back then it was, "Why can't I have Wonder Bread like everybody else?"

Obviously the recipe I used is nothing like that of my Mom's. The bread I turned out is dense and without the big air-holes my Mom's suffered. Either my Mom was in too big a hurry when it came to kneading the dough or it's just a much larger task when turning out 5 or 6 loaves at a time. At any rate, try making a loaf of white. And don't skimp on the kneading. Kneading bread is a great way to relieve a little stress.

Just watch out when those late night carbs come calling.

Mother's Day

If you're happy to be alive, then today is your opportunity to thank someone for the fact. If you carry warm memories of a favorite comfort food, then today's the day to say thanks to the cook. If you were fortunate enough to have someone keep you clean, make certain you were warm, look to see your shoes were on the proper feet, to make certain your hair was combed and your part was straight, then today is your opportunity to thank someone for being so concerned.

If she's passed on you can be grateful you did have someone who cared. Take a moment and say thanks to the universe, the Lord, to the gods of good fortune, that such a person was in your life to care for you when wanted and when needed-- to look after you even when you didn't feel it was needed!

If she doesn't exist in memory then you'll have to take it from me: Being a mother is far more than a biological circumstance. It is a responsibility one takes on for life. Sometimes by choice, sometimes by accident, sometimes by circumstance, sometimes by proxy. In any event, it is a role that is never retired, a role that never allows time off, a role that is never done well on a part time basis. And the pay is, well, let's just say personal and variable. We can all be grateful, no matter our personal circumstance, for the mothers who have done it so well for so many. The love and humanity that exists in our lives is largely the product of good mothering.

I don't know what it's like to be a mother. But I do know what it is to have one. To all of you who have taken on the role and who wear it so well, Happy Mother's Day!

De-Mythifying Canadian Health Care

Well, here I am only 3 months into my AARP membership, and I'm already reading their newsletter. The article I'm linking here was an eyeopener for me.

Let me just get this out there right now: I'm an advocate of single-payer health care. Seriously. So, when I saw the article, 5 Myths About Canada's Health Care System, I had to take a look. I'm embarrassed to admit, however, I was surprised by what I read. I was certain I would find AARP doling out the usual b.s. about unavailability, rationing, and dissatisfaction. Living in a border state I frequently hear a colleague or acquaintance comment on someone they know who came to Michigan for joint replacement or some other surgery. Some of these discussions are so derogatory one would think Canadian doctors implant used parts or something.

I had the opportunity to sit next to a university professor from Canada last year. He had dual citizenship and hails from Illinois, having moved to Canada in his 30's and living there for the past 20-some years. "How do you like the Canadian healthcare system?" He couldn't say enough about the luxury of not having to be concerned with doctor visits, medication costs, and hospital services. That professor gave Canadian care a solid "A."

Of course, there is a substantial population of individuals in the U.S. who also have no such concerns. Two populations as a matter of fact: Those who have excellent health insurance and access to everything they even think they need, and those who have no money and no insurance and know better then even thinking about obtaining medications or care.

It's amazing how effectively misinformation can be manipulated to generate the fear and misunderstanding necessary to convince people to support the wrong thing. The facts of the matter seem well presented in this article. The unstated fact of the matter is that, as long as the interests of a market driven economy are driving healthcare delivery, you will never have truly patient-centered care. Instead, you will have what currently exists: Healthcare modulated by the constant tug-of-war between patient needs and private profits. And that, as the saying goes, is no contest.

From Zero to Nothing in 2.3 Months

I can only imagine what it must have been like for those sorry souls who moved their life savings into the hands of Bernie Madoff. It happens to others as well. People hear about a guy, a broker, a deal, a sure thing. Next thing they know they have nothing. A long anticipated and previously well-planned retirement nest egg gone without a trace.

I can relate, but in reverse. Since Tam and I have started working with Dana I seem to be steadily losing everything and gaining a lot. In the course of just a bit over two months I've gotten rid of a great big fat diesel truck that, while I loved to drive it, was both an energy pig and a nightmare in winter. I'm also teetering on the brink of dumping a second home in Arizona. I've totally abandoned the idea of getting wrapped up in a third property. I feel like the guy who is taking baby steps to giving up smoking. First you get filtered cigaettes. Then you give up the first-thing-in-the-morning smoke. Then the drive-time cigarette…..

Like giving up smoking, this is something that is really good for long term health. At least that's what I keep telling myself. It's just that it's so very hard to mend some of those single guy ways. Irresponsibility has always had a certain appeal for a guy like me. And, while I'm fortunate to have the income and lifestyle I enjoy, a bit of perspective, circumspection, and longer-term planning can't be all bad.

Now, if only there were a transdermal patch one could wear for the retail impulse.

Healthcare 101: How to Make It Work

After 27 years as a physician I think I have finally got the U.S. system of healthcare figured out: I saw a patient the other day just a week after surgery. Unfortunately, she was having pain after her surgery and the medication prescribed was not working to relieve her discomfort.  Problem was, the one was not working, and she was allergic to another entire class of pain medications.  So I did what I could and prescribed another, third type of pain medication. It is an old-timer, effective, and available as a generic. No problem, I thought. Good solution. Wrong.

An hour later we received the message from the pharmacy: my patient’s prescription would require pre-authorization from the large national chain prescription provider in charge of managing her Medicare medication plan. Okay. We were operating out of our remote satellite clinic and didn't have the same staffing as our primary office but, again, no problem. She needs it-- we’ll do it.

Thirty minutes later, while other patients had quietly waited, we had finally completed our odyssey through an almost never-ending phone-tree, spoken to a representative with all the sympathy of a cold piece of stone, and had finally obtained our pre-authorization. Well, not exactly. After all that what we received was an assurance that she would put a rush on our request for a pre-authorization. With any luck, my patient would have her answer in 24 hours. Thank goodness we asked for a rush appeal in light of the fact my patient is in pain.

This is a recent and endlessly frustrating episode. But it is not an isolated one. This routine is repeated every single day in our practice as we attempt to secure approval for prescriptions, diagnostic tests, or to schedule surgeries. I can’t help but believe that, for any dollars saved, an equivalent amount is wasted staffing these pre-authorization centers and our offices with personnel to chase down the approvals.

And so it is that, after 27 years, I finally realize how we can navigate this insurance controlled, money driven, convoluted system of  U.S. healthcare-- no hassles, no expense, no frustration:
                                          Don’t get sick or injured and you’ll be just fine. 

Birthdays

May is birthday month. Not mine. Not my wife's. But it is my son's and daughter's and a whole lot of other people I know. Forgive me and avoid this space for the next few weeks if you fear the risk of running smack dab into a collection of birthday reminiscences. It may not happen a whole lot, but if it does, consider yourself warned.

May 9th is one of those dates I always remember. Even if I don't see Greg for the better part of a year, I always remember the day. I'm fortunate that way. I made a lot of close friendships in childhood and a fair number of them remain to this day. Come to think of it, quite a few people I know who are my age still have contact with childhood friends. I am going to guess that is owing to the ready availability of electronic communications. Starting with the telephone and continuing up to the present era of social media, we have grown up instantly and effortlessly connected. I certainly don't remember such a long reach of friendship in my parents' generation. I'm not sure it was any more or less meaningful but it certainly took more effort to remain in touch with old friends in the old days.

Be that as it may, Happy Birthday Greg. I will never forget that birthday early on in our acquaintance when you took Neal and me to Yamato. In a time when the Century Plaza Hotel was a dazzling jewel giving credibility to a place called Century City, in a time when sushi meant absolutely nothing to probably 98% of all Americans, your parents took us to an incredible, and incredibly rare, Japanese restaurant where we were introduced to ice sculpture, sushi, sashimi, and teppan-yaki style food prepared right before our eyes. And all the while your Dad fueled our imaginations with stories of Geishas and Japanese bath houses. It was all so sophisticated. And why not? It was Los Angeles. And 1967. And we were 10 years old.

The Unlucky

I saw a young man the other day, 16 years old. He messed up his knee and needs to get it fixed. When I asked him if he was in school he told me no. He was there with his parents, neither of whom seemed too sharp, and neither of whom seemed too concerned. In my practice I see people like them all the time, seemingly defeated by a lifetime without means or opportunity.

Owing to a recent behavior incident he's not in school right now. He's been temporarily suspended. Temporarily for 180 days! (Long story, but it seems credibly circumstantial)

Talk about bad luck following no luck at all. You spend 10 minutes with this kid and his parents and you walk away wondering and worrying, just where will this kid end up? What will it take to divert this kid from the fast track leading to a lifetime of welfare or the corrections system? Does anyone in the world actually believe that turning such a kid loose for 180 days will fix anything? Is that the best that can be done?

"Leaders" in education talk about best practices and metrics to measure success and outcomes, improved methods of teaching and evaluating students and teachers. A kid like this just doesn't seem to fit in any of their designs. He's not dumb. He's a big, good-looking kid who speaks pretty well and obviously has a brain. Unfortunately for him, I'm not sure the system is smart enough to see it.

Meddle Managers

Can someone tell me what it is with middle managers? I can't imagine this virus is unique to hospitals and healthcare, so what's with all the on-line baccalaureates who run around businesses these days looking for things to do where nothing needs to be done? What's up with the don't-just-stand-there-do-something let-me-f-with-that attitude?  It strikes me as more akin to puppies chewing on shoes than coordinating work environments and facilitating production.

Nowadays it seems if you want to get a job with a salary and benefits it requires a bachelor's degree and a "management" position. Any bachelor's degree. And, once obtained and once hired, you're ready to raise a little hell. For some reason, apparently this is thought to be the requisite behavior for individuals in such positions. Meddle in other people's sh*t, whether you know what you're doing or not. And when the whole spool starts to unwind under your watch, well, then it's time to start taking names and kicking some booty. "Reconsider" is not be be found in their vocabulary or responses.

I'm fortunate in that I've been able to live my working life out of reach of the meddling middle manager. That said, I work with a fair number of individuals who do and it drives me crazy to see what they have to go through.  But, like I said, it appears to be a virus. One for which, as yet, we have no vaccine. For now, take two aspirin and call me in the morning seems to be the best approach to coping. And, there's always some hope for those who suffer: Middle mangers do get canned with some regularity.

Back to the Future.

My son's 5th birthday party turned out to be quite the affair. He had classmates, cousins, aunts, uncles, and grand parents. And it was definitely a kid party with hot dogs, mac 'n cheese, a pinata, presents, and train rides. 3 hours of organized mayhem and a good time was had by all.

So, after cleaning the place up and packing up the car, I hop in to drive home. The radio was on to some mixed variety station and as I pull out the song is Humble Pie, "30 Days in the Hole." Talk about your basic "who'da thunk" moment. I hear a song like that from 1972 and all I can think is, wow, I hope Ev is better grounded at 15 than I was. At 5 you finally feel like you're getting a foot in the door to personhood. At fifteen you're pretty well convinced you're ready for independence. It takes a musical flashback to bring it all into perspective.

In short, there is no possible way to understand at 15, anymore than there is at 5, what life will hold at 55. I guess the only people with any possible inkling, any possible insight, are mom and dad. And good luck selling that idea to your kid! Meanwhile, rock on old old-timer!

Loose Change

I'm bragging a bit but I made that card. Ev had a birthday recently and the old coin cards popped into my head.  I don't know if they still make these or not. It was a last minute thing so I just made a quick one of my own.

It's funny how, of all the birthdays, parties, cards, cakes, ice cream, and gifts, the item I remember most from being a kid and having a birthday are these coin cards. Did you ever get these? Do you remember ever squeezing an envelope between your fingers and thumb, trying to feel if there was a coin card inside? Would it be pennies, nickels or dimes? Would it be a dime for every year? 5 cents for a Hershey bar made a 60 cent card a real treasure.

Change is a commodity that is rapidly disappearing. On that rare occasion that I use cash it seems the change I receive back gets relegated to riding around in the cup-holder of my car or sitting on a kitchen counter. It's a phenomenon that must be more widespread then just my life, though. Look at your keyboard: My big Royal desktop typewriter from the 1940's has a cent symbol among it's many characters. This little modern Mac has none.

In as much as we don't let Ev get within a quarter mile of a candy machine, he has little use for loose change. He does, however, have a growing collection of well-stuffed piggy banks and even got a new one this year for his birthday. He's become quite efficient and helpful when it comes to keeping cup-holders and counters cleared of loose pennies, nickels, dimes, and quarters. I don't know that he has any concept of ever using any of that change he's collecting but he's definitely got quite a bit of dough stashed away.

Hmm. Saving money. What a smartypants.

Not Me, Not There, Not Now!

Bad news for every 14 year old on the planet: I did 14 41 years ago and I've been going to school work with a pimple on the tip of my nose all week. This is prom week here in my home town. I'm not going this year but it serves to remind me all the more of the trials and tribulations of pimples. That's right, zits. Those nasty little bacterial eruptions with an uncanny ability to show up and pitch a tent right there on your front lawn at the worst possible time.

In adolescence I was one of those fortunate ones who didn't have the struggle with acne. With whatever issues I was strapped as a teen, bad skin was not one of them. Nonetheless, there was always that rogue blemish that would ride into town every now and again and start a campfire right there on my forehead, between my eyebrows, or on my nose.

One hopes, expects, and believes this problem will evaporate with time but I'm here to tell you otherwise. Worse still, not only does that angry rogue outlaw still ride onto my facial plain every once in a great while, the effect is still the same: I go to work feeling like a hapless teen. You sit down with a patient and immediately check to see where their eyes are focused as we talk. "Are you listening to me or just looking at my pimple?!"

Not that I'm insecure or insufferably vane, but a zit at my age can still be perceived as a physical manifestation of immaturity, a sign of an underlying refusal to grow up, of one's persistent denial of responsibility, evidence of chronic uncontrolled adolescence and bad diet. And with my bio, it can sometimes be difficult to credibly refute the evidence! I definitely don't need this kind of help.

Thunder and Lightning

I woke up this morning to the sound of thunder. For me, thunder has to be one of those lifetime events that never goes unnoticed by me. By now I enjoy it more often than not.

As a kid, thunderstorms gave rise to my first concerns that my Mom didn't really care if I lived or died. I remember, as a small child too young to go to school, running to my Mom when we had that rare thunderstorm in Portland, Oregon. I would be in a panic and crying, scared out of my wits. Her response was always to pooh-pooh the thing and tell me how, when she was a little girl in Mankato, Minnesota they had massive thunderstorms-- like that information was a comfort to a 5 year old. So, I'd close my eyes and cover my ears and just hope to hell I didn't get fried. (Turns out that was a harbinger of future coping mechanisms I'd employ.)

After living in Michigan all these years I've grown accustomed to thunderstorms. In fact, I've come to enjoy their awesome power and display. My favorite time and place to enjoy a thunderstorm is at home, in bed, at night, with my wife. Cuddle up! It's storming!! Least favorite place is in the OR where you can neither hear nor see the show.

By and large, I've come to really enjoy a good thunderstorm for what it is, an absolute statement of the power of nature. It's one of those rare events when you simply are forced to realize just how insignificant you are with your own power; just how overwhelming the power of a few electrons can be by comparison.

Sometimes it's good to have that kind of reminder. It's good to have your limited capacity demonstrated for you once in a while-- as well as to have the opportunity to realize just how fortunate once is to enjoy safety and shelter. Kels and Ev don't seem to have any fear of the storms. I guess that comes from growing up in this climate. But, if either of them ever came running to me in a thunderstorm, I'd just hold 'em close.

2012 Buick LaCrosse: Size Matters

The other weekend Tam and I decided to take Ev out to the driving range. He loves hitting golf balls with his little set of mini clubs and about every 3rd or fourth shot is really good. He's almost 5 and I'm seeing potential for a retirement supplement when I see him swinging that miniature iron. So off we went.

Because I was on call we took 2 cars. Tam and Ev took off ahead of me and I was going to meet them at the range. I almost didn't make it. Of all the cars I've ever owned I've never had one that more clearly says "middle-aged golfer dude" than my new Buick. It's a four door Buick sedan, for godssakes. It's snazzy enough but vanilla at the core. It's not for tennis. It's not for soccer. It's a golfer dude car.  Until you open the trunk. (I should have seen it coming: The weekend before when we went to the airport and I struggled to get one big suitcase, a mini bag and a back-pack stowed in that same small space.)

It took a few tries but I was finally able to get my set of clubs in the trunk. The result was awkward and looked about as functional as a fat guy in a Speedo. That's why I took the picture. I finally got the clubs wedged in there on diagonal but I wouldn't want to do it more than once a month.

Now I'm not terribly upset about this because I'm not a golfer. I had a go at it a few years ago and gave it up in the name of public safety. When I hit a golf ball the opportunity for personal injury is real, very real. Nonetheless, I believe it's reasonably safe to go to the driving range with my son and I'd like to be able to take his clubs and mine. What upsets me is seeing the Buick Division of General Motors, a Michigan company that sponsors the annual Buick Open-- a major PGA tournament -- manufacture their contemporary version of the proverbial big fat Buick and have it ill-equipped to carry a set of clubs in the trunk. God forbid you should want to drive by and pick up your buddy for a round. You can fold down the back seats and let your clubs protrude into the passenger compartment (if the seats are not obstructed by a center-mounted child seat) but, please, where's the cool in that?

On pretty much everything else the car is not half bad. As the saying goes, it's a nice ride. But, when it comes to the damn trunk, well, you'd better just carry your own bag.

May Day

Welcome to May. May Day. A festival day of flowers and spring. The arrival of May Day brings a couple thoughts to mind. First, in as much as the year 2012 is absolutely sailing along at warp speed I am reminded how my mother and father used to warn me that time passes more quickly as one gets older. Seeing this is May 1st, I can only agree. How we got here so fast I cannot possibly fathom. If time is passing this fast at 55 I think I can pretty much discard my calendar entirely by age 60. A watch will suffice.

May Day used to be something of a celebration as a kid. May Baskets and such were still at least talked about at home. I think I may have seen some version of a May pole that kids would wind around. I'm thinking that celebration is pretty much extinct and, frankly, I guess not much of a loss. What's one pagan holiday more or less? Besides, May Day was never associated with either of the two things that really make a holiday relevant to a kid: food and presents-- unless you want to count May Baskets, and no kid ever would.

That said, welcome May Day. We can be grateful we are observing May Day as opposed to Mayday, Mayday, Mayday, the international distress call which, by the way, has nothing whatsoever to do with the first day of May. Rather it is derived from the French, venez m'aider.

Hopefully, you are far removed from having to put forth a distress call today. I hope, rather, you are able to take a few minutes, have a mug of joe or spot of tea, and perhaps enjoy a songbird and a blossom or two today. Any day you're safe and warm is a good day to celebrate. No matter how fast the years are passing.