Rural Scholar Joy

Was accepted into our rural scholars program this past week.  It will allow me to do several rotations back-to-back in a single location in a rural environment.  I’ll enjoy the continuity of working with the same folks for almost 4 months and be around the kind of down-to-earth, get ‘er done folks I appreciate so much. Am quite excited about the prospect and hope I find a great match and a location that helps me think through rural issues that I haven’t considered, yet. I hope to open clinics and provide access in a rural area in a way that hasn’t been done before. I hope I can transfer the knowledge I gather here to other locations that could use the help. My goal is to create very effective means of providing care while moving resources into those communities as the communities themselves choose to value and support that care. I hope to help folks take responsibility for their health and show them how they might do that individually and collectively.

I know each community will be different, but I think it will be a terrific adventure. Have been actively planning how to do this and developing contacts over the last couple of years. The goal is to have a model created by the end of school and then begin to discuss implementation when I am assigned to a residency program. Will have to wait until then to actually make it happen. Now is the time to work out the big bugs and learn from the mistakes of others.

Friendship

Have found a new buddy that has been a welcome addition in my life. He is a bit older than me, and he and I have a very similar outlook on why things are the way they are. We have a pretty good list of happy hour menus that we are compiling, so we can go out and chew the fat and not pay much over $10 each – even though the entrees at these places are over $30… Not having peers has been a palpable hole in my existence the last few years. It’s nice to have someone to listen to who works hard for a living and wants to make the world a better place in his own way. It’s nice to be able to share my ideas in a safe environment with little fear of attack from an opinionated adversary. Rather, I am only receiving a differing opinion from him, and we agree to contribute a willingness to allow one another to be just as we are.  

No... not nice. Necessary.

Bunyai the Hyundai

I’ve needed a new head gasket in my car for the last 5 years or so. It leaks.  The engine lugs and smells like oil when it is about a quart low. It runs remarkably better when it has oil in it. Haven’t changed it out because I don’t have the time to figure out how to do it myself or the money to take it to the shop. The engine leaks about a quart every couple of thousand miles. Bad for the environment, but then so is driving... Fortunately, I drive very little. Maybe that adds to my non-replacement inertia. I think if I can get thru the next year or so, I’ll have it done, so I can be ready to take trips for residency interviews and then travel to my residency when I finally learn where that will be. Why will I have money then? I won’t. However, I will pay less interest on what I spend later, and I should have more flexibility in my schedule to find a reliable shop (not easy) and get it in to them - and wait for the work to be done. Best I can tell, it still functions well in its current state.

Bunyai (2001 Hyundai Accent) has been a great little car. Have spent very little money on it and has gotten me around quite well for the last 8 years and 80K miles.  Hopefully, we’ll go another 80K together.

VA Day

The Veterans Day walk at the VA Hospital was a wonderful success.

It was a special year in that both the OHSU President and the Dean of the School of Medicine published letters commemorating the day and thanking veterans.  As I understand it, Rob West and Kathleen McFall in the Dean’s Office encouraged that to happen. I hope Rob and Kathleen, and Drs. Robertson and Richardson will accept my sincere thanks for that. I truly think veterans deserve to be remembered. Collectively and individually, they certainly made that happen.

We had nine students, a veteran friend of mine, and two gracious physicians give of their time.  They were Drs. Mark Deffebach and Jennifer LeTourneau, Julie Doberne, Annika Giesbrecht, Geoff Maly, Andrew Peckham, Mackenzie Farley, Nick Eglitis, Natalie Wu, and Albert Alaniz. Rob West also took photos. Thank you all for your kindness and willingness to give these folks a few hours out of your busy schedules. While we can’t discuss details due to privacy concerns, here are some allowable excerpts from the encounters:

"I held one veteran’s hand as he cried and described American aviator POWs being stoned to death in the streets before they could be liberated."

"I hugged a lady whose veteran partner will die in a couple of months from his lymphoma."

"One veteran told us about the way the Korean winter caused a deep ache in his newly-healed bullet-hole when he would lie on the ground at 35 below."

"One lady said that in her 50 years of being a veteran, no one had ever told her thank you."

Many asked us to stay longer. Some cried as they thanked us when we left.  It is such an honor to share a few moments with people with such huge hearts and to understand how it gives them great joy and a sense of pride and sometimes needed relief to be able to tell their stories.  I confess that sometimes I don’t do that as well as I would like, but I believe we truly made a difference for them yesterday. I know they made a difference in me.

Overall, we had tremendous support and genuinely positive feedback from the OHSU and VA communities. Thank you all for coming. Thank you all for adding good moments to the lives of these veterans as you honored their sacrifices. You guys are awesome. Will look for you next year.

Busy Week

Feels better to be feeling better.  This last illness was a doozy. Took the last of the antibiotic yesterday but am still blowing my nose and dragging stuff out of the lungs as though the vestiges of a viral infection are finally being conquered, too.  Good riddance.

Finished the make-up final and a PCM exam just fine.  Didn’t do as well as desired, but it will just have to be okay.  :0)  Can’t be at the top of your game every time.  Grades are  a great rough marker, I think.  Motivation and capacity are fairly well reflected in them.  Hopefully, we use them in a more personal way in order to guide ourselves down our own path rather than fearing how others may guide us down a path that they control.  Although there is an established framework here, we still have a great deal of room to choose and grow as we become something new.

Will do lots of reading this weekend and try to get caught up.  Lots of good stuff to learn.  Will squeeze in a run or two if I can...  :0)

Distraction

Have been sick the last week and a half.  One of the bad ones where you really can't get much done and there are a few days where you really don't function well at all.  Kept running into things, and words were turned around.  Hopefully, I didn't hurt anyone's feelings by saying something inappropriately.  Some days I wonder if this old immune system is cut out for this kind of work.... - My days have been marked by the pills I am taking.  Decided I had better write down the times I was taking them because I would be convinced I had taken one, and the paper said I had not.  I would count the pills in the bottle, and the paper was consistently correct.  Am starting to feel normal again today. 

Good thing, too, because I have to take a make-up final tomorrow.  Was unable to take it on Friday.  Was able to study some yesterday and will do my best today to go over the material.  Will be all of the material since school started.  Close to 1500 pages worth of syllabus.  How will I go over it in one day?  Who knows.  Why am I writing here instead of studying?  Distraction.  Avoidance.  It's something real I can share.  Lots of reasons, I suppose.  Will do what I can.

Have been lacking motivation lately.  Maybe just the illness.  Seems to have been going on for awhile, though.  Seems to be related to a sense of isolation here.  Am just very different from my classmates and never feel connected to the process here.  Never feel truly accepted.  Only nominally.  I know it's not their fault.  How can you connect with something you can't have possibly experienced?  Being the oldest out of 500 people isn't an easy thing to be.  Being the only anything is hard, I would guess.  I have always wanted to do something for orphans.  Maybe this will help me understand better how they feel.  Maybe.  Even the silver lining isn't very shiny today.  I have other things to write, but will not.  Back to the syllabus.

Why Run?

Seem to have gotten most of the details for the run and the VA walk finished up.  Have been terrifically supported by the folks over at the Dean’s office and the Foundation.  Hats off to Kathleen, Rob, Crystal, Sarah and Russ (and anyone else I’ve forgotten…).   The website is done, and you can find it at http://www.wix.com/psreynolds/fifty-year-run .  Was fun building it and hopefully it will generate solid interest and cause folks to put some money into a worthwhile effort (plus it’s double Green Stamps day with the matching donations by Dr Breall!) Okay, some of you may not know what Green Stamps are… Yes, I’m old… :0) Read about them here.  Some days you could get twice as many for your purchases.  We shopped those days when I was a kid…

Hopefully, this whole running around idea seems like a good one to most of you.  If it doesn’t, maybe I can explain better why I’m doing it.  I suppose first of all because I can.  I’m fortunate enough to still be able to do this sort of thing and am becoming more acutely aware that the physical is the first to go.  As I’ve said in previous posts, ‘use it or lose it’ certainly applies and maybe I’ll even get a little more mileage out of the machinery if I just keep it oiled.  Secondly, and most importantly, I think it’s a fairly obvious thing that we don’t take anything material with us at the end of this life.  If we are willing to assign ourselves personal purposes in life, I think it will have nothing at all to do with our ability to amass personal piles of stuff.  Rather, it will be the ways that we were able to give ourselves away and the extent to which we could do that which will have added meaning to our existence and be a large part of the reason for our appearance here between our births and our deaths.  I suppose it’s hard to know how we might do that best, but maybe if we can take stock of our talents and gifts and hone them with all we can muster, it will be all it needs to be.  Sharing our finest parts so that they do the most good makes us all richer in the end. 

I was lucky enough to have parents with a similar worldview.  (That was supposed to make you grin…)  They were people who saw good deeds precipitated by good hearts and looked for ways to encourage more of the same.   They took us kids around to various volunteer activities, so we could see what our hands and intent might accomplish.  Mom said once, “We may not have much money, but we can always give our time.”  And, although they preferred to demonstrate love rather than talk about it, I’ve come to realize that the way we love and the amount we love is the best reflection of what we are.  I confess that I wish I could do it better.   But, I think if we can let that love and caring sneak out of ourselves whenever we can and however we are willing, we will impact our families, friends, neighbors, communities, countries and world in a powerful way.  Hopefully, I’m right.  And, in the process, we’ll get a little exercise.

Hope to see you all out for the run.  Please add to the scholarship fund if you are able.  Thanks.

Latest stuff

Busy just happens.  Finished the third test this year.  Did better than I thought I would.  It's odd to go into these tests feeling so unsure of how well I know the material.  We just cover such a great deal of information.  So, here's a heads up to future students:  Assimilating vast portions of the knowledge base is an unavoidable part of the rite of passage.  All med schools need to present the material, and we then must engage it with vigor.  And, although it seems impossible at the time, the vast majority of us seem to be able to do it.  Do try to remain focused and motivated.  Find your groove.  Gather this knowledge like a harvest in summer.  Consider it food for a good life.  It will be part of your training to learn how to learn well.  It will need to be a mastered skill you use as a doctor.

Been planning the birthday run and the VA walk again this year.  Have some help from the Dean's office this time.  Will build a web site for the run.  Hope to raise a little scholarship money for the school.   Will be fun and will try to do a good deed at the same time.   Hopefully the legs will hold out...  :0)

Almost completely settled into the new place. Just a couple more small tasks to finish up and will call it home, I think.  It really has made a difference in reducing distraction and allowing me a sense of peace.  Has been a great change.  Am very thankful for this new space to be.

Want to look over the new syllabus before bed and get a bite to eat.  Maybe can add a few thoughts when I have more time.

Settling in

Pretty much was moved in last weekend and am now feeling fairly settled in the new place.   Am remembering the major life events that cause stress in people's lives and that moves are high on the list.   So is divorce.   Am wondering if med school is on the list...  So, this is my 5th move since starting med school.  Hopefully, it will be the last until residency (not counting rural and away rotations...).  Maybe this will help me connect with the stress that folks are facing every day as I meet them in clinic, as they lay in hospital beds and hope for recovery.  I am reminded of how good it felt to relax tonight - for my feet to get warm and to drift off into a deep slumber in a quiet room where no noxious smoke drifted into my awareness.  I hope I can remember and recognize and appreciate the deleterious effects of stress in our patients' worlds.  I hope I can find ways to minimize it for them, so they can get on with more productive efforts.

I was reading today about the wild horse auction here in Oregon.  Noticed an article about a fellow with cystic fibrosis who went out and bought himself a gentled mustang after a good experience with a friend's horse.  He said taking his horse on a trail ride was the most amazing thing he had ever done.  He said it made him forget about his wife who had just died of cancer and made the long-term pain in his back disappear.  He said doctors don't know everything.  I confess that's true, but I'm learning as fast as I can, so I won't be so clueless when I get there.  Maybe I could acquire a few of those horses and use them as therapy horses.  I do like that idea.  Would be pretty amazing, actually.

Spent some time today thinking about a rural practice that I might be able to do eventually.  Looked at the WY maps again.  Really think I'm falling in love with the state and that it truly belongs at the top of my list.  I have created a weighted spreadsheet with about 20 criteria, so I might compare apples to apples for the various residency programs I am interested in.  Have it narrowed down to 8 or 9.  Definitely a solid list.  It gives me a frame of reference and a sense of direction.  Was well worth the time putting it together last summer.  Now, it's just nice to pull it up for a reminder and to tweak it from time to time.

All is good.  Kind of digging the kidney.  Amazing organ, it is.  Will have another look at it tonight.

Hello, Blog.

Moved some stuff to the new place today. Measured some rooms and furniture to see if everything would fit. Had to sell a couple of things since the new place is pretty small. Took the bed all apart just to get that painful task out of the way. Decided to turn it the short way to have access to one side of drawers. Got a flu shot yesterday, so have been feeling a bit achy and tired, but overall a good day. I did take a nap... Will hit the books tonight and go to bed when I get sleepy.

Tomorrow will see if I can get the storage moved over to the new storage areas in the roof spaces. Pulled a muscle in my back today, though, so may not get too far. Exam on Friday, so will need to stay focused on that as priority.

Bought a dozen donuts yesterday. Felt somewhat guilty after all the nutrition lectures in our cardiovascular classes. But, not that guilty… Been going to the gym more and getting in some runs. Think I will do a run through downtown and see if I can’t raise a little money for the school to celebrate my 50th. Am thinking 7 miles will be plenty doable and a distance that might be short enough to allow others to come along and celebrate with me. Will work on that after I’m settled into the new place.

Am finding the material much more interesting this year. It’s as hard or harder than last year, but has much more of a clinical focus, and we are learning the pathology now. I confess there are still frustrations with contradictions in the material and never really being sure what will be relevant to our practices, but the journey is definitely becoming more engaging. Spending time soul-searching and focusing on a specialty this summer was a productive effort. It has given me a clearer vision and energy for the race. Am curious to see what lies around the bend. Good adventure, I think.

New Year, School Year

Finished the first test. Passed with plenty of room (as though there is much...). Southwest Clinic and the Geriatric and Palliative Care Interest Group seem to be pretty much organized and plugging along now. Am going to try to get focused more over the next couple of weeks and prepare well for the next test. The courses we are now taking are much more relevant to what we will be doing when we get into the clinic. Really enjoying that aspect of this year.

Going to move again. Too many smokers and disrespectful folks in this complex. This, of course, is in spite of the fact that my lease says this is a non-smoking property. Go figure. Found a fantastic house nearby that is owned by an amazing lady and managed by her good-hearted son. Definitely a blessing in disguise as these houses don't come available much here on the hill. Am crossing my fingers it will be a place I can stay until school is out.

The rain and cool weather have begun in earnest. Summer started halfway through August and lasted til mid-September. When people ask if I will be staying around here, I just laugh.

It sounds crazy but I'm really looking forward to learning more about the kidneys and fluid and electrolyte balance. It's really very interesting and critical in patient care. Really want to master this stuff. I know it will make a difference for many people down the line.

Let's see... a confession... I tried to go to a get-together downtown last night. Went to the address and could hear folks up on the rooftop, but couldn’t figure out how to get in. Kind of bizarre, but was unable to figure it out. Went home and got some work done. Could have been worse. :0)

Another essay

Here's a link to an essay I wrote after spending a week with a rural doctor this summer. Might find it interesting...

https://docs.google.com/document/d/1damSgtyHnYd8sh3B2Tcq58QI5hjx2BfLTX2PqTkft-4/edit?hl=en_US

Recent essay

Here's an essay I wrote in response to a prompt at this link: http://virtualmentor.ama-assn.org/site/conleyscenario.html

Essay located here:
https://docs.google.com/document/d/1l6fEC_Q0cuLHaFfM1okdSakPgyyZhux61bYn1kCPKLc/edit?hl=en_US

Thought some folks might find it worth commenting about.

On Happiness

Here's a condensed version of some ideas I have acquired over the years. It's a two-rule version of how to be happy in life. Maybe it will ring true with some of you.

1. Let Things Go

This is the opposite of being stressed. We let things go as we focus on things outside of ourselves rather than on our problems. We must regularly set those hard things aside via a favorite outlet - a sport, volunteer work, or a relaxing hobby. We need to take deep breaths often and laugh more, lighten up, and not take ourselves so seriously. We need to humbly accept our imperfections and realize it will all be okay.

2. Share Your Love

We need to both share and love. We need relationship with one another. We need love in our lives. We need to give it and receive it. It adds meaning and purpose to who we are as love happens in the midst of everything we do and all that we are.

If you can do both, happiness will surely follow.

An ending

Thought I would get the week started with a bit of catch up. Am beginning to get back on track after a setback. I mention a personal issue here simply because it occurs frequently in the lives of medical students and want folks to be aware of its possible impact on them. After much discussion and heartfelt sharing over the last year or two, my wife and I have decided that we will go ahead and be divorced this summer. We had been advised by our counselor last summer that we were probably not well-suited for one another and that we should seriously consider it. I had taken a year off from school hoping that we might repair and solidify the relationship (among other things), but we have not succeeded. We are in a great deal of pain over it, but are convinced it is for the better. Ours is less a product of med school than other influences, but the stress and strain of my schooling has certainly been a factor in our decision. Talking with other married students, I have heard many stories describing the challenges of maintaining a good relationship while enduring the pressures of the program. My best suggestion is simply to try to maintain perspective, rely on good support groups, find them if you have none, and love one another as best you can. If you have children, all the more, but I don’t need to tell you that. If you are both strong and willing to sacrifice for the long term goals of both marriage and doctorhood, I think you will be able to come up with creative methods of staying together. I wish you well if you are in that situation.

The Day After

... the last day of school. Aaaahhhhh....

Okay, so it's been two months. Two very intense months. Lots going on that I hope to write about over the summer. For now, just want to be normal again. Washed the car yesterday. Too tired to vacuum it. May have had something to do with the celebration get-together after the test... Maybe will do that today. Tons to catch up on. The list is long and am cooking my teriyaki chicken at Garrett's BBQ today. Been a loooong time since I've made it. Nice to feel like I'm human... and to have a fairly normal list of things to do. Best make a dent in it.

Good morning, good morning

Aaaahhhh.... another night lasting til 2. It's a bizarre experience to regularly look up at the clock on consecutive days and realize how late it has become. It is easy to lose track of time when so immersed in the material we are asked and expected to learn. Long gone are the days of pleasure reading and absorbing what was gently laid before us. This is a focused effort, indeed.

Nothing to fear or shrink from, however. We must all strive to become lumps of coal here. We are each the product of the vital, living matter that came before us. We are that matter compressed down into the last remnants of its energy-gathering capacity. And although we are smudgy and smelly, we are truly capable of being ignited. Not hesitating, we must allow ourselves to be ignited and ignite our own selves to provide light and warmth to anyone in our vicinity until we become ash and are blown away in the wind.

We are an odd mix. We have our 'gunners' and 'bleeding hearts', our 'ever-so-hopefuls' and diligent, 'keep-to-themselves' folks. I seem to be some of each. Most are fearful - of failure, mostly. I confess am definitely part of that secret club. Most are well-bred and are known to stay within the lines drawn by those who prefer a structured society. Of course, this is harder for me as an old guy who has long since realized that corrals are erected by the owners of horses. And, I will never become fully strong unless I run unhindered on prairies where I seek out seasonal grass. As always, my hope is that we will accept one another fully and with some grace. I hope we will believe in the best parts of each of us and goad one another to higher heights - for our sakes and for those who will come after.

To be certain this will happen less often than it should. We are a competitive bunch and overwhelmed by the challenges in front of our noses. How much it will dim the light we began with will be a testament to the way we were created. If it be a refining, for glory. If it be a wasting, for shame. The day begins.

Another month gone... I think it started with an "M"...

March was good. Blurry, but good.

Took some tests. Did some studying. Thought about the future. Got rained on almost every day. Had a Spring Break. Felt a bit more settled and got into a better groove.

Started an Emergency Medicine preceptorship. I float between Peds and Adult medicine. I go wherever the doctor goes... :0) He's actually a great doc. Even personality, wealth of knowledge, excellent teacher, takes the time to teach when he can, very dedicated, etc. Am learning and getting to see some interesting things.

Am seeing the kinds of people who come through the ED. Some of them come through more than others. Some people think they belong there. Some people think they don't. Watched a surgeon put in a chest tube. Kind of cool. Learned how to tie suture left-handed from watching him. I knew I would learn things here... - Got to take a history for a girl having an apparent asthma challenge. Was nice to see her get better. - Sometimes it's hard to tell who is sick and who isn't. We just can't seem to find anything wrong with them. Seems crazy that someone would sue you when you are doing your best.

I like watching people as they are experiencing their lives - even if the ED is a challenging place to have experiences. I like helping them through those moments. As I see more people having those experiences, I have a new source of "experiential wisdom" that I can use to guide them through the maze.

The ED is a bizarre combination of folks from all walks of life finding themselves in the commonly human predicament of imperfection and vulnerability meeting mankind's technology and systems in the hands and minds of its proponents of goodwill. We do an interesting thing there. But, stepping back, it's mostly a business. Pressure exists to get things done, and the source of it seems to be hierarchical rather than "heart-archical". It feels more like a production line than a workday at church. There are just too many people waiting outside, and we never know how many more will be coming. The fact that the folks there care as much as they do is particularly amazing. They are a special breed.

If I had a great memory....

... this post would be several pages because it's been so long since I've written anything. However, I only remember succinct details of medical terminology these days, so I will do a recap.

This past month has been eventful, test-wise. Four major exams and two small ones. Have also begun work on a ppt for our research project (SEFOM: Students Exploring Frontiers Of Medicine) and will present that next Tuesday. Have done a couple of labs including one where we were able to catheterize an anesthetized pig. Fairly exciting for folks who have only watched from the bleachers or worked on specimens saturated with various preservatives. Another included one of the computerized mannequins and was actually quite helpful. - Tests went well and am going to make a concerted effort to stay on track and even add a bit of balance (i.e. fun and exercise) to things. Hopefully, will be able to do that...

Weather has been rainy and dreary. Continue to think I will be looking for a drier, sunnier place for residency. Summers are wonderful here, but they last only a few months. Have a few places in mind.

The new apartment is much, much quieter. Am able to study fairly well and enjoying the extra space and the view. The new mattress took forever to "recover" (memory foam) but seems to be softening. This means my memory is improving... Have ordered a topper and a mattress pad to see if I can get it "just right"... Goldilocks, eat your heart out.

Am slowly getting to know my classmates. In fact, went over to a classmate's house for a pre-prom gathering last night. Skipped the prom. Feel like I'm just too old for the noise and excessive legal drugs (alcohol) of a prom party. Was pretty much done with that almost 30 years ago. But, always enjoy the company and new perspectives at a quieter gathering. Was long asleep before the first person fell down.

Off to my ppt. There you have it. I confess.

The Eyelids Part Once Again. Oh, Joy!

Good morning. Slept pretty well last night relative to most nights. Didn't seem to get much noise from the person upstairs. Have put in a deposit for another unit in the next building down the hill. Will move on the 19th. Just too noisy here, especially due to stomping and tromping from above. - Picked up the parts for the bed frame last night. Big, heavy, odd shaped boxes - pretty awkward. Had to stop a couple of times with the biggest box. The mattress will be in next week. That place is bigger with a better view. Top floor and the end unit. Am really crossing my fingers it will be quieter. I talked to the neighbor who is a librarian. He said it's pretty quiet. 'Sounds' good so far.

Read the latest Atul Gawande article last night. One of the resident surgeons gave it to me. Atul says the answer to the healthcare dilemma will arise from persons and organizations who are willing to cut healthcare costs where they are worst. 'Hot spots' as he describes them. He likes the idea of holding the hands of and babysitting folks who are provided care yet refuse to care for themselves. As you can see, I don't entirely agree with him. He says using low-level providers to provide regular or even daily follow-up to insure patients comply with lifestyle recommendations and treatment regimens is the key to keeping them from accessing more expensive care as they become less healthy. His best example of a hospital affiliate that does this is run by a gentleman whose "philosophy about primary care is that the only person who has changed anyone's life is their mother. The reason is that she cares about them, and she says the same simple thing over and over." Indeed he emphasizes that one patient only listened to the clinic's assigned "life coach" (and not to her own husband) because the life coach "talks like my mother".

While I love the idea of caring for people, I do it because I choose to. I am personally convinced that we are here to make choices and learn from our mistakes. I believe we have a purpose here that requires our ability to choose freely. I also know it is much harder to change ingrained habits in adults, and I am not convinced that we all should be required to care for all of us. Then we don't get to choose. And, people who listen because the speaker talks like their mother are choosing to behave like children. Paternalistic care was yesterday's paradigm. Atul and I do agree, I think, that the problem is rooted in human selfishness and sloth. But, he and I have different ideas about how to approach the problem. While we both agree that the solution is love, I also agree with the Beatles: money can't buy me love. Love is a selfless act. And, no matter what you pay your Mom, she ain't doin' it for the money.

I think it's laughable that folks keep trying to "prove" healthcare is too expensive. Of course, it is. It's been right in front of our faces for years. People want. People take. And, some people take what they "shouldn't". That includes hospitals, doctors, nurses, patients, government employees, insurance company executives and mailroom workers. Our society is built on improving margin. Yay, capitalism! It's one of the things that spur us to further effort and innovation. But, we all have the propensity to carry it too far. Some of us just can't keep it in check. Anytime you see a giant, monolithic structure - be it a building, a legal entity, or an organization (even a person) - you are witnessing mankind out of control. They result from false self-belief and a desire to control on the part of their leaders and laziness and self-indulgence on the part of their followers. The bigger they are, the worse they are.

It could easily be argued that we necessitate them by our very nature and that we must allow others to protect us from ourselves. The circularity is apparent here, I hope. The answer must lie outside of ourselves - and then within ourselves. If you can tell me where love comes from, I will tell you what the answer is. Maybe you know what I know.

Well, death does knock relentlessly.

Why deny it? Even better. Let's talk about it.

My buddy's Mom died a few days before Christmas. She was 70. I cut out the obituary and brought it back from my trip to TX.

He seemed to take it pretty well. Didn't really want a shoulder to cry on. Just wanted to try to recover his strength from the ordeal and get his bearings again. He talked about it some. But mostly just seemed concerned with the details of the funeral and making all of the surviving folks happy with the terms of the final settlements. The question of money seemed to come up among them all more consistently than any other topic. You'd think at a time like that it would be most apparent that you don't take it with you, but wasn't the case. Once again, this life took precedence over the next. God must have a hell of a lot of patience.

Folks get upset over strange things when people die. Little things to most of us. The wording of an obit. Where people sit at the memorial service. They seem to re-write history especially for the occasion. Makes me wonder how skewed my own perspectives might be. I hope I put emphasis on the here and now, being present, being aware, and loving and giving as I go forward. Looking back doesn't seem to provide much use if we change the past to suit our sensitivities.

My grandmother used to send me $5 for my birthday and would tell me to go out and buy a Coke. I think she had it right. Money is for giving and life is for living.

Dr. Grady

Dr. Tanya Grady-Weliky was the Associate Dean for Medical Education here at OHSU. She died last week. Had been ill for some time. Left behind a husband and a beautiful little daughter. My heart just aches for them.

I know they will eventually work through the change, but the sadness never really goes away. It will always sit beside you if you open the door and invite it in. It fades but remains for this life.

She was a devoted and heartfelt person. She loved her life and gave all she had every day. I imagine there were times I expected more of her and had no idea she had dipped far deeper into her reserves than I had that day. I resolve to slip into the shoes of others however I might and know their struggles, wear their integrity, cry their tears.

My prayer is that those close to her will find peace and joy in her memory and be guided by her spirit of kindness and love. She was terrific.

Just Write Something...

That's what I keep telling myself.

I've been writing to folks all over the country and neglecting the blog. Seems like I come up with a great topic at least once a week, dutifully record it into the voice recorder on my phone, and then promptly do nothing with it. I justify with the "isn't a priority task right now" justification.

So much has happened in the last couple of months. Took a drive to TX searching for a little adventure and dropped off a computer at my parents, so I could Skype with my Dad who can't hear much at all. Stopped off in Jackson, WY on the way back just to see the place and whether I could get stuck in the snow. Not even close. In fact, took a back road over a pass from Star Valley via Idaho 34 to Soda Springs just cuz it looked impassable. My little Bunyai (car) killed that road. Rocked it at over 60 in places. Nothing but snow-covered roads the whole way. Just gorgeous scenery.

Jackson looks like a great place to spend at least part of the year. Might be a spot to set up headquarters for something. People were nice, and it wasn't all that expensive. Sure there were plenty of goofball, high-end stores around and property and homes going for 5 times what they were worth, but there were plenty of places that were reasonable. Stayed in a nice chain motel for $35 a night. Okay... Cheaper than Portland for the very same thing. Definitely on my radar now.

Been going to the clinical class for the last 2 months (PCM). There was some overlap from the time I left and when this class ends, so it made sense for me to start at its beginning. Good thing, too. It changed. For the better, I might add. I understand the epidemiology much better, and my clinical skills are much more refined. Working at the sliding scale clinic (SW Community Clinic) has made a tremendous difference for me - and hopefully for the patients I have been so privileged to work with. Advice to prospectives: go to clinic and take on all the responsibility you can get. Read charts, think through your differential, look up diseases, become familiar with treatments. Huge.

Guess I'm ready to go back. I do like learning. Just hope it will be relevant to real life.