Tuesday, September 29, 2015


He squeezed into the elevator just as the door was closing.  There was a lightness about him, an excitement.  His jacket was newly pressed and uncomfortably free of nicks or stains.   He stood at attention with perfect posture.  There was no sign that working at this early hour on a Sunday morning, nor even being awake, was something out of the ordinary.  Extraordinary.

He glanced over at my tattered lab jacket without trying to seem obvious.  I'd like to think that it was the gray color (as opposed to his white) that gave me away as an attending physician.  More likely it was the telltale signs of aging that I have been doing my best not to notice.  I slumped against the back wall and waited for the doors to open.  My eyes flickered and closed for a moment, but opened quickly.

I was drawn to him.  The energy emanated from his body, and pinned me into the deepest corners of the elevator.  I couldn't decide whether to envy or pity him.  A young intern, he was at the mere beginning of his medical journey.   He couldn't yet fathom the degree of wonderment and heartbreak he would experience over the next few years.  The joy and the guilt.  The triumph and the disappointment.

There is a whole world ahead of him.  A world I have become strangely accustomed to.  Racing into the hospital on a Sunday morning is no longer novel or extraordinary.  It is part of my weekly routine.  I get up early and round at the hospital and nursing homes in order to be back home before the kids awake.  There is no excitement.

No wonder.

Instead there is a gentle quietness.  A certainly that comes from years of sparring with health and disease.  An acceptance of both the hardships and joy involved in spending one's time contending with the human condition.

As the door opened, I awoke from my reverie, and sprung towards the hallway and the ICU.  I patted him firmly on the shoulder as I passed by.

I caught one last glimpse of him as I turned the corner.

He was still standing in the elevator doorway,

his face a strange mix of confusion and pride.  

Tuesday, September 22, 2015


It was a short trip from the hospital to the nursing home.  I luxuriated in the mid-morning sun.  Wisps of fresh air snuck through the cracks of my barely opened windows.  Although I had just gotten credentials at this particular facility, the path I drove was all to familiar.  I turned my head as I passed the elementary school that I had attended as a child.

As I stared at the playground, a long buried memory percolated to the forefront of my consciousness. I must have been around 8 years old, a little after my father died.  I am playing by myself on the jungle gym, and glance longingly at the street in front of me. I am overtaken by a great sense of loneliness.   I want to run down the street.  I want to go home. 

"Home", at that time, was the building I lived in. 

Many years later, my mom remarried and we moved from Evanston (the city I was born in) to the neighboring town of Winnetka.  A mere 13 years old, feeling myself the center of the universe, I resisted the move wholeheartedly.  For years I mourned the departure from my beloved city.  Only a few miles apart, the emotional distance seemed immense. 

I pined for my old neighborhood.  I dreamed of riding my bike down the old streets to my favorite places.  I was so in love, that years later, I returned to build a family.   

"Home", at that time, was the town I was born in. 

As I got older, I found solace not in places or things, but in people.  My interest turned to the amorphous task of building relationships.  Acquaintances, friends, lovers.  People and personalities became a currency by which to measure happiness.  I bathed in the luscious glow of humanity.  I gave and I took.  

"Home" became the people I surrounded myself with.

Recently, I have begun to believe that "home" is something much more personal, more internal.  Maybe it is a construct based on those people, places, and things that make us feel most connected, most safe.  

And driving by my childhood elementary school this sunny afternoon, on my way to the nursing facility, which will be followed by a jog with my wife, and then a walk to pick up the kids...

I feel as if, for possibly just this fleeting moment,

I have finally come home. 

Saturday, September 19, 2015


He had been educated at the finest universities.  He had graduated cum laude, or whatever the term is they use nowadays to signify distinction.  His pedigree was squeaky-clean.

But as he haltingly entered the dark building at the end of an otherwise unexceptional suburban street, he felt more like a criminal than a scholar.  His office was drab.  Each room a glow with the artificial light provided by an incandescent bulb.  He often wondered whether the lack of windows was to keep the light from piercing the imperturbable darkness or to trap the terror in.

He knew his place.  He was the last stop on a frightful train line that ended in horror.  There was no solace.  His clients never dreamed of needing his services, and yet they came.  Without fail, they averted their eyes to hide the excruciating pain and loss.  He met them in life's basement.  In a lonesome quagmire, he helped them wade through the morass.

In his younger years. his work clung to his back even outside the office.  He awoke from nightmares of the vilest kind.  Remnants of the day stuck to his clothing.  He tried to scrub and scrub but they refused to fade away.  A sort of blackness pervaded his waking hours.

It was in this acrid garden that a certain soullessness grew and flourished.  He found that he could approach his clients with a coldness that became rather comforting.  Empathy wouldn't pull them through the manure laden pit that they found themselves trapped in.  His voice, certain and clinical, could.

As the years passed, his body bent and his haired thinned.  Years of tumult left scars that were far passed the point of healing.  From time to time he found himself wandering through the office on the weekends, or in the evening when no one in particular was scheduled to visit.

He sometimes felt lost amongst his family and friends.  He occasionally had bouts of agoraphobia at home with all the light and windows.

He left the office cautiously everyday and found the outside world to be a place that was no longer black nor white but filled with incomprehensible shades of gray.

And that terrified him.

Most of all.

Monday, August 31, 2015

If We Fight For It

It occurred to me towards the end of our conversation that there was a large gaping hole.  We had talked about physician burnout, career choices, and his current plans.  He had drawn a map of his future.   It originally shot like a straight arrow towards clinical medicine, but now veered precipitously.  I took a moment to first clear my thoughts, and then my throat.

Medicine, I explained, is still as noble a profession as ever.  Every day I dip my toes tentatively into the current that swirls around me.  Often I am pulled violently into the depths.  My body bumps and sways in the mass of humanity.  Our rhythms join at times and depart at others.  Amongst the tumult my mind strains to unlock riddles, my hands reach forward pawing the Rubix Cube of disjointed anatomy laid bare on my table.

I am imperfect, and it is hard.  Maddening.  I sometimes curse my own feeble abilities.  Yet this profession offers the opportunity to be with our fellow humans.   Regardless of outcome.  It offers the ability to reach an imperfect hand towards a suffering soul.  Over and over again.  On weekends, on holidays, in the middle of the night.  When it's inconvenient.  When it really matters.

You become the beacon of light to someone's darkness.  The epitome of meaning, wrapped in a profession, crafted over years of practice.

There is nothing that I would rather due for a lifetime.  No profession more worthy.  No pastime more challenging.  No calling more sacred.

We suffer today not from a failure of training nor a mighty profession gone astray, but from the greedy, lecherous, and diabolical distortion foisted upon us,

We suffer from a government so mired in special interests that often the most simplified and logical tasks become overly burdensome.  Administrators with little knowledge of actual medical practice add layers of bureaucratic minutia on the backs of hapless workers.  Computer systems are generated with the wrongheaded idea of Big Data collection as they further warp severely strained processes.

We suffer from big business, hospitals, and insurers bent on squeezing every last cent from a system where they produce nothing.  They repackage the knowledge and ability of their clinicians, and slap a brand new inflated price tag.

And we suffer from ourselves. Our medical societies who pat our back with one hand while picking our pockets with the other.  Our physicians who have lost their way, and traded in this holy art for a chance to feast on the leftovers from the carcass of their debilitated brethren.  

The doctors who value bloat, cruelty, over-testing, and over-diagnosis to add to their wealth and not the health of their patients.

Medicine can still be noble and worthy.

If society allows it.

If we fight for it.

Friday, August 21, 2015

Being Your Doctor Is...You Pick

Being your doctor is exhilarating.

Everyday I wake up to a schedule brimmed with purpose.  The door of my office is a portal into the richness of the human experience.  I become a thread in the tapestry of other's lives.  I bear witness to the joy and pain, laughter and heartache,  and mundane daily routine.

I spend my days bouncing between art and science.  Paid to be the wily detective, my brain stumbles on detail.  Some cases are typical, quickly resolved with an adjustment here or there.  Others are more enduring, months are spent contemplating the possibilities until answers present themselves.  The sick become healthy.  The terminal are comforted and allowed a soft place to land.

A familiarity grows out of the wisdom of experience.  An acceptance of the limits of human knowledge.  Self acceptance soon follows.  The connection between me and my fellow man is the bedrock of my professional existence. I help people solve problems.

I make a good living.  My title still carries a certain amount of respect.  Job security is a good bet.  And my days are anything but boring.

Being your doctor is excruciating.

Everyday I stare into the abyss of humanity.  I become a party to every patient's agony and despair.   I have witnessed pain and loss that endure.  My mind is scarred from an invisible emotional battle much like the physical ailments of an infantryman.

I am haunted by countless decisions that profoundly affect other's lives.  The devil hides behind every dichotomy.  Poking out it's steely head, waiting to attack the supple underbelly.  I remember each battle lost, each face.  Until the next horrific calamity erases the last.  Over and over again.

I rarely sleep uninterrupted.  My phone rings while I'm taking a jog, in the shower, or on the toilet.  Occasionally a nursing home thinks my mobile is a fax number, and my phone rings over and over again in the middle of the night, waking my family.

I am constantly told that I am wrong by technicians, administrators, insurers, and the government.  I often have to fill out the same paperwork over and over again.  I sign thousands of papers a month for what appears to be no reason.

I often feel crushed by both the enormous responsibility and stupidity that the American healthcare system has placed on its doctors.

Being your doctor is...

Friday, August 14, 2015

Have We Lost Our Heart?

There was once a little boy who loved to draw.  He would wake up every morning, pull out his box of colored pencils, and let his hands explore the promise of a pristine sheet of blank paper.  For him, the canvas was anything but empty,  images and ideas exploded out of his mind and magically appeared on the pages in front of him.

His parents and teachers recognized his talent early in childhood.  Accordingly, he was afforded the luxury of the finest education.  His ability grew with each class and workshop.  He graduated college among the most gifted, and found work in one of the finest drawing shops in the country.

Here, surrounded by his friends and peers, he found his daily work to be anything but taxing.  Every morning he would role up his sleeves, open the very same box of colored pencils, and draw from the early morning to the late evening.  The time would pass by unnoticed as his mind wandered, and his hands dutifully followed suit.

Others would watch in astonishment as his creations took form.  They came from far and wide to witness the miracle.  Every drawing was lovingly produced for its exact purpose.  He was an expert.  A master whose skill was honed from countless years of repetition, innovation, and experience.

It was in this state that he toiled for many years, happily fulfilling his purpose, until the day the mandates started to roll in.  His shop was bought by another, management changed.  The first directive was annoying, but easy enough to comply with.

Straight lines were no longer acceptable.  Zigzags, however, were allowed.  So he substituted where he could.  He found that if he worked slowly and laboriously, he could make such small lines that from afar his zigzags looked straight.  A pain to say the least, but a fair approximation in the end.

Next came the war on green.  His boss appeared at his desk one day and fingered through his box of pencils, removing anything with a greenish hue.  Again, a work around was fashioned.  Blues and yellows were carefully mixed to create the right effect.  Some shades were easy, others could take hours to get just right.

As usual, the boy who had now become a man, refrained from raising his voice in defiance.

The directives flew out of the C-suite at a maddening pace.  Some were perfectly reasonable, others were odd and senseless.  All required an accelerating amount of time and concentration to be compliant, and yet still create a product that he could be proud of.

He no longer enjoyed his work.  He often left the office past midnight, and refrained from whistling on his walk home.  He even stopped drawing for fun.  He didn't have the energy or interest in reading up on new techniques.

And the sad truth was that his drawings were technically flawless.  They followed each directive expertly, but one couldn't help but notice that they had lost their purpose.

They had lost their heart.

His bosses shook their heads approvingly.

His customers turned their backs and mumbled,

and never returned to his office again.

Monday, August 3, 2015

On The Internet

Of course there are patient archetypes.  We all use them.  I mean, there is the old lady that is super sensitive to even the smallest dose of just about every medicine.  The psychiatric patient whose allergy list runs a mile long.  The drug seeking guy that swears his pills were stolen from his suitcase yet again.

My favorite is the widowed war hero.  His unrequited love for his deceased spouse pervades most visits.  He writes poetry and can carry a note to operatic proportions.  He is kind and humble.  He lives lost in a world of dreams and sweet memories.  He is both jovial and melancholy at the same time.

I have known many of these.  Taken care of them.  Watched them die.  They do so with a grace and determination which is nothing less than dignified.  They take their last breaths with a certainty and peace that I can't help but admire.  Maybe they know that they are one last gasp away from their lover's arms.

And I often contemplate whether they are right.

Perhaps we physicians also have our archetypes.  The arrogant and the too busy to be bothered.  The hand-holder.  The incompetent and the God-complex.  The automaton.

Then there's me.  I have seen myself in almost every archetype, good and bad.   And as with our patients,  these are poor constructs.  Because even though our most glaring attributes fit well into cubby holes, the reality is that human beings are so much more sloppy.

I am.

Maybe a bit introspective.


The kind of guy who writes about being a doctor to no one in particular.

On the Internet.