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.