Headed Back to Athens

 

The Acropolis in Athens, Greece.
Athens, looking pretty. A rarity, IMHO.

For the second time in less than a year, I’m on my way back to Athens. This will be a short trip with virtually no team. My colleague organizing things in Athens has stated that she “feels sorry” for me, as the number of people signed up for the clinic appears to be quite large.

From what I can tell, the situation in Greece has only gotten worse since I was last there. Many borders and routes into Europe have closed, and migrants are being turned away at far greater numbers than they were last year. But by “turned away,” I’m not describing from Greece itself. Nope. Thousands continue to arrive on the shores of Greece every day. I’m talking about further into Europe. So, the migrant population continues to swell in Greece, especially Athens. Although authorities have begun shipping back some migrants (numbering in the hundreds) in the past few days, this is a small small number.

I say I’m bringing ‘no team’ this time, but in reality this isn’t accurate. Aside from what sounds like a great number of willing helpers in Athens, I also will bring my 14 and 16 year old daughters with me this time. I don’t know what sort of role they will be able to play in the work we do this time. It could be simply watching the children of the patients while they’re waiting the doc.

migrantsHopefully, they can learn a bit about medical care in a refugee and/or underserved situation. As their lives are largely consumed with cheerleading, skinny jeans, teen-lit, French horn, Cello, soccer and boyfriends (ex…EX boyfriends), this might be quite an eye-opening experience for them. I hope so.

My biggest concern is that we will successfully collect accurate data on the patients we see. Last time we did a fair job, under the circumstances, but in my spare time I’m STILL working through the XL spreadsheet and trying to come up with data summaries that will be of some use to the wider medical world.

This time, I hope to have time to ask better questions, and to formalize how we input the data. It is well known among those who do medical research that 80% of the study is done before the study begins. Developing a means to collect data, to college USEFUL data, and to do it in a way that is searchable and accessible at a later date is difficult. It is especially difficult when at that later date, you are dealing with hundreds, maybe thousands of data points.

I’ve had enough training in this element of the medical world to feel a gnawing sense of anxiety as I approach the issue. My medical school heavily emphasizes epidemiology and biostatistics, and I was part-way through an Master’s in Public Health degree until I ran out of money. So I have a sense for how easy it is to do this stuff badly. But I wish I had a collaborator or better skills to know I could do it well.

Still, I’ve had some help from a colleague at work who maintains a quizzical affection for XL (I can’t judge, I was once in a steady relationship with Photoshop), and he has helped me clean up our data from October. And I have a much better sense for what I need to do this time around.

14_athens_imgIt should be mentioned that most relief agencies don’t actually do any of this, even the good agencies who actually help people (lots of them are there for the photo-op and little else, it seems). I received some generous help from a professor at the London School for Hygiene and Tropical Medicine prior to my last trip, and he noted only a small number of agencies who provide care AND do good, statistical research on the populations they serve.

So, it makes sense that I’m somewhat on my own here. It’s not easy to focus on research and practical care at the same time, as one is more empathy-driven, the other much more analytical and “cold.”

Example: if someone comes in coughing up blood, you can either turn and enter “hemoptysis” into your spreadsheet (and then get the heck out of there because…ew), or you can throw on some gloves, hopefully a mask, get them on a bed and start working them up for any of the many many possible reasons for that symptom (most of those reasons being prit-TEE bad).

So, we will see how this goes. We leave tomorrow (Sunday) afternoon.

 

Ambushed!

International work, medical or otherwise, is dangerous. Maybe only a little more dangerous than normal American life, maybe quite a lot. A long-term Christian missionary doing really, really good work was gunned down in Haiti just today.

noyau-goat-3
About as remote as it gets.

I myself have done relief work in Haiti. One of the places I worked is located in the hills of a village-esque area called Noyau. This place is about as remote from civilized life as I can recall being in my life.

After an hour of 4WD driving on extremely-rough dirt switchbacks up a mountainside, we pulled on packs and hiked for another hour+ to reach the area of our clinic. If something went wrong out there, the time required to receive aid would exceed 4 hours easily. Assuming emergency crews had access to a 4WD vehicle, which is doubtful.

I recall thinking, as well over 100 Hatians stared at us zipping ourselves into our expensive tents and sleeping bags at the end of a clinic day, how honorable they were as a people. They had hiked for many hours to find our clinic, and often the only thing we had to offer them upon their arrival was a few TUMS tablets. Frequently their medical problems were either too complex for us to help with, or, more commonly, we simply didn’t have the medicine or procedural ability they needed.

But they could have robbed us. Selling our nice North Face and Sierra Designs gear would have fetched an impressive price in Port au Prince. Furthermore, they could have kidnapped us and held us for ransom. Now we’re talking real money. Until they talked to my wife, who would probably say something like, “Take ‘im. Never does the dishes anyway.”

We were totally vulnerable in that village. But the reason, I believe, nothing bad happened was simply because most Hatians are good people. Honorable people. Honorable, even, by my wealthy American standards, where respect for property and life is alive and well. They let me keep my nice tent, even though they couldn’t be sure of their next meal.

Similarly, while working in the Galatsia camp on our 3rd day in Athens, I ended up in an extremely vulnerable position. Again, we came out unscathed largely because most people are, quite simply, good.

Prior to entering the camp, I asked one of my team members with military training to effectively serve as our “security.” He took his role seriously: identifying sight-lines, exits, areas of risk, areas of relative safety. He developed rudimentary emergency plans, identified key leaders in the facility and communicated escape plans to our team.

But for some reason, when I was asked to leave our clinic to go see a patient reportedly too sick to walk to us, I didn’t think to ask our security guy to come with us. In “medical mode,” it’s difficult to think in “safety mode” too. Our task is to meet needs, not protect ourselves, and the thinking between the two is often very different.

wpid-wp-1444825879926.jpeg
See all the people? That lady in blue is an aide worker. Behind me was a large room, a courtyard, and a line of police. I thought we were going here.

I also believed we would be going to one of the large rooms with lots of people, located near the entrances, near the police, organizers, aides and managers.

That’s not where we went.

Led by the sick woman’s husband, we walked down corridor after corridor. Branching off from each of the primary hallways were other halls, down which I saw a half-dozen young Middle Eastern men, crouched against the wall, all looking at me. The halls were strewn with trash, cell phones hanging by cords from every available outlet. I heard yelling, some laughing, but mostly saw numerous drawn, emotionless, bored faces. There was no joy.

I went with our clinic organizer (a Persian woman who organized the whole medical clinic, speaks numerous languages, and knows what she’s doing) and, as luck would have it, the pastor of the local Calvary Chapel we’re working with who saw us wandering away and followed. So at least I wasn’t alone.

hostages
This happened in the Philippines just last month. However improbable, we could have rounded the corner and found guns and flags, not a patient.

But after the 3rd corridor, and up a large flight of stairs, then outside the building and then back into it and around a corner, I knew that if someone wanted to do us harm, they would have succeeded. We’d followed this guy like ducklings.

But he didn’t harm us. All the man wanted was to know if his wife would be OK, and if it might be possible to get her on her feet by that evening, in hiking condition. He intended to continue his journey into Europe as soon as he could.

I diagnosed viral gastroenteritis and told him she may be ready to roll by that evening, but giving it another day or two would be better. He clearly intended to leave that night, despite what I’d said.

Later, of course, we laughed about this. Our team leader, Sahar, laughed at me for being so worried.

But the truth is that there is no way to do this work without incurring some amount of risk. Usually the risk is small, thanks largely to the fact that although there is terror and violence in the world, most humans on this planet are good, fairly honest people. Most are just trying to make a better life for themselves and their children.

As are we all.

Lenk

switzerland

I recently returned from a church Men’s Retreat in the resort town of Lenk, Switzerland. This was MY kind of ‘retreat.’ The majority of our two days was spent on the ski slopes, not talking about God and theology and right and wrong.

 

I’ve been a Christian since I was 8, so the pastoral lectures and Bible verses never feel especially new to me.

I routinely enjoy the music, and in our case a great band led those times in the evenings, but I was happy to attend a retreat that was mostly just a cheap ski vacation. I met some cool guys, got a little better on a snowboard, and stood in absolute awe at some of the most beautiful scenery I have ever known.

 

I don’t worship God very well through study, or through listening to lectures from pastors. Lectures, ever, haven’t worked well with my brain. Ask any teacher of mine all the way back to 1st grade and you’ll probably get some version of the same mildly exasperated half-smile, and a reply along the lines of, “he really, really TRIED to give a crap.”

 

Adelboden-Lenk

But when I’m in the shadow of the Swiss Alps, with 1,000 year old glaciers clinging to jagged sawtooth ridges in a 300-degree ring all around me, I pay attention. Somehow, breathing in crystal-pure air, with rolling forests and organic dairy farms dotting the countryside in every direction far below me, I have no problem thinking about God and wondering how I couldn’t possibly be closer to His almighty Spirit for that moment.

So, it was a spiritual time for me, but with very little preaching or Bible-studying. Perfect.

 

I was also struck by the unity and beauty of the towns we passed through on our way to Lenk. Switzerland has been highly resistant to change over the years, from what little I’ve read of the country. It is fairly hard to immigrate there, and once you ARE there, good luck building consensus around any particular idea or religious creed that departs from the time-honored ways of the Swiss. Du willst ein Minaret? Das wird nie passieren!

Deutsch: Chalet in Pöschenried, Gemeinde Lenk,...
These, dotting the countryside as far as you can see. Plus snow when it’s winter.

 

 

In Switzerland, you know you are in Switzerland. Especially in the countryside. The buildings are stirringly beautiful, most made of a light-colored wood sometimes set on dazzling white painted rock or concrete bases. The barns looks related to the houses. Everything is clean, ordered, pristine.

This unity isn’t by accident. But it takes enormous force of will to maintain a cultural identity in an increasingly pluralistic and mobile society. To do so inevitably becomes political, with increasingly volatile arguments on either side.

My homeland, America, has never really had a unity of culture and history to this degree. We’re a nation of very few subjugated natives, and very very many immigrants. To walk through my country – or any large American city – is to walk around the world.

Both have their merits (except for our treatment of the natives). But there’s something so deeply peaceful about meandering through a place that knows itself so well. A place that is OLD, and has not forgotten the value of of old things. King Solomon was rewarded by God with power and money because when God offered to give Solomon anything he wanted, the young man asked for wisdom. Any place that honors age, honors wisdom, and God seems to have blessed the Swiss accordingly.

I’m not saying Switzerland is paradise or utopia. There are problems. But they’re getting lots of things right. Here, walking is revered over driving. Food is valued for quality and purity rather than quick access or cost.The country has some of the best health care access in the world, with 3.6 doctors and 10.7 nurses per 1000 people. Life expectancy is around 73 years old. Obesity is less than 8% (it’s almost 50% in the U.S.), and it is estimated that 100% of the population has access to clean drinking water and sanitation facilities.

As a Caucasian from the American suburbs, with no knowledge of my heritage further back than my grandparents, this place holds an impossible appeal for me. I don’t know my family history, whether a story of thieves or kings. My nation’s history doesn’t even span 300 years.

As our retreat drew to a close, I knew I could never truly be a part of a place like Lenk, Switzerland. I could only marvel and yearn, watching that priceless world slip past my car window, as we hurried home.

 

‘Concierge’ Medicine – A De Facto Manifesto

My blogging output has been at an all-time low since moving to Europe.  Who knows why…this place is such a bore.  I continue to hack away at my book, which never seems to get close to done – the literary equivalent of Sisyphus’ ever-rolling stone.

The other day a reporter contacted me to hear my thoughts on so-called “concierge” medicine.  It was a timely query, since I’m considering a loose offer to join a concierge practice back in the States.  In my email reply to him, I found myself writing my own little manifesto on the subject.  A treatise, if you will.  A declaration.  A primer? A resolution, a promulgation…

William Osler (1849 - 1919), Professor of Clin...
I have a idea...how 'bout I actually know who you are, AND care about your medical issues?

 

I’m a big believer in concierge medical practice, although I use the term “concierge” only as a nod to already-established norms.  Really ‘concierge’ medicine is a throw-back to true primary care medicine before it was ruled by other industries.  So the idea isn’t new.  It’s old – old as William Osler and Johns Hopkins and William Carlos Williams.
This industrial “take-over” I mention isn’t entirely due to craven insurance businessmen.  It’s also due to the allure of “Wal-Mart” pricing that so captivates Americans.  I suppose you’ve heard the adage that as a consumer, you can only have 2 out of 3 options in the market: Fast, Good and Cheap.  If you want something fast (hamburger), you can get it cheap (McDonald’s) but it won’t be good.  Or, you can have it fast and “good” (quality, taste, etc), but it won’t be cheap (maybe, Red Robin?).
This principle is true in medicine too.  Americans, over the past 20 years, have been trending toward Fast and Cheap medicine, just like they want clothes, household goods, food, etc. quickly and cheaply.  Hence, the rise of WalMart, which provides easily acquired things of questionable quality.
Concierge medicine isn’t “cheap,” by WalMart standards.  It requires real cash investment.  But it IS better.  And, while there is little problem with wearing nondescript, zero-style golf shirts to work every day, primary care is different.  We’re talking about your life, here.  Not only are you likely to live longer and healthier with good primary care, but it really is cheaper over time because it is so effective in offsetting gigantic medical calamities later.
I dispute the notion that no one can afford concierge medicine, by the way.  Most people in the richest nation on earth perceive they can’t afford it, but really can.  I blame this perception on the invention of the 10-dollar co-pay.  This idea was such poison in American medicine.  It made medical care seem like the equivalent of a few iTunes, or sunglasses from a roadside gas station – just another in the ocean of cheap, disposable and generally worthless products. Yet so many Americans shell out enormous amounts of money on alcohol, cigarettes and fast food.  They don’t think twice about coming up with over a thousand dollars to fix the clutch on their car, or to trick it out with lights and racing wheels.  But when it comes to good, relationship-based primary care, they resent anything more than “10 bucks.”
I’m currently in a line of work that provides “free” care to everyone (the military), so at the moment I have no vested interest in the above comments.  But I continue to feel strongly that it is not immoral to require a reasonable, even significant, amount of money for true primary care, especially when obtaining that care may require cutting out things that are terrible for your health.  I see major problems with a medical system that tries to provide unlimited access, especially when coupled with zero perceived cost for that access and care.
More health care is not better health care; worse, it can be dangerous.  On a daily basis, people needlessly lose breasts, prostates (read: sex life), resistance to microbes, and countless other quality of life measures in the process of hunting down phantom maladies or responding to false-positive tests.  High-quality primary care offers good, analytically based work ups of genuine symptoms that justify that work up.  NOT investigating something further can often be the best medical care available.
I mention ‘analytically based’ decisions because most mid-levels (a cost-cutting invention in American medicine) are trained to provide algorithmic decision-making:  that is, if X symptom, then Y action with little analysis involved.  recipe medicine.
Often algorithmic medical decision-making is just fine, but it easily leads to over-testing and over-treatment.  When it comes to possibly dying from cancer, for example, most of us want someone who knows us, knows how we communicate, and what is important to us (e.g. dignity vs. “full court press”). Further, we want that same person to be well-trained in weighing the risks vs. the benefits of treatment vs. non-treatment, based on the latest available medical knowledge.
Doctors seeing 20 patients a day can’t provide this adequately.  Mid-levels are not trained to provide this type of risk-benefit analysis, and don’t have the hours of training experience even if they wanted to.
Disclaimer:  I’m speaking in generalities here; there are fantastic PA’s and NP’s out there, many of whom are compassionate and professional; better than many physicians.  Most I’ve met are smarter than me.  But in general, the care from a mid-level is fundamentally of less quality because the training of a doctor is an average of 3 times more than any mid-level (roughly 3,000 hrs vs. 12,000).  This differential limits mid-levels to algorithmic, rather than analytical, decision-making.  When it comes to your health care, the mantra should be “reason, not recipes.”
These days, you can’t get this care from HMO’s (Group Health in Seattle is getting very close), you can’t get it from mid-levels.  The only place I know where you can get this level of care, is in a ‘concierge’ practice, where the benefits of the increased cost are immeasurable.

DIE-Tunes

I believe I have just witness the beginning of the death of iTunes.  As much as I’ve tried and tried to like iTunes, I can’t express how happy I am to see a true and valid competitor emerge to thwart them.  And, I think this will DESTROY them.

Amazon, you rule.

iTunes Icon
Something Tells Me I've Just Violated A Copyright By Posting This Logo.

Now you can buy Mp3’s from Amazon.com and – here’s the sell – store your tunes to the cloud, not on your own hardware. I’ve been begging (in my head) for this for YEARS.  The cost and hassle of trying to constantly figure out where to store my songs and shows that I’ve downloaded from iTunes has been one endless headache.  This has as much to do with the fact that I’M MAKING A GENUINE EFFORT NOT TO STEAL THEN (in all honesty, this is my big mistake).  Being legit, I’m constantly plagued with copyright protections on iTunes products that makes storing and moving MY copies of digital media almost impossible.

The obvious solution (one that still supports the artists and their decadent renunciation of most human moral codes) is to simply quit making me store the songs in the first place.  Just stream them from some central server that I never even deal with.  Amazon Cloud Player (actually real, actually available, actually currently playing 1 of 100 of the top trance tunes of 2011 that I just bought as a collection for…9 bucks) does just that.  Finally.

One example:  I had a tiny netbook, with virtually zero hard drive space.  So I tried to store all my tunes (and shows) on an external hard drive.  Then I switched computers, and wanted to move that data.  Tough.  Sounds easy, but it ain’t.  To Apple, it looks like I’m stealing them, or selling them in some virtual dark alley, furtively looking over my shoulder and waiting to hear Hugo Weaving bellow, “Mr. ANDERSON!”  If I’d just legitimately STOLEN the damn songs in the first place, I could play them wherever I wanted, moving them like so many Word files.

Zeus with a laurel crown. Gold stater from Lam...
SW101: God Of Ruined Mp3 Players.

 

Another example:  If ruining ipods (usually by jogging in the rain) was a God-like attribute, I’d be warming up a U-haul for my move to Mt. Olympus.  I just sorta never believe water is actually bad for anything.  It’s a swimmer thing.  Anyway, my iTunes can only be played on 5 players unless I “de-authorize” a player.  This sounds find, but how do I de-authorize a player that has suddenly transformed into really unique thin mint?  I can’t even turn it on long enough to de-authorize the glorified aluminum can.  Same for my original computer that held the results of my first foray into iTunes psychosis.  It suffered a massive “heart” attack at some point.  That’s 1 authorized player I’ll never get back.

Six hard disk drives with cases opened showing...
Hard Drives, Hard Drives Everywhere...

 

Now it doesn’t matter.  My tunes are floating out there, in the beloved cloud.  Free from the confines of my cheap, inefficient hard drives that never seem to have enough space.  With Cloudplayer, the tunes stream, so presumably, copying them illegally is much harder.  So, I would hope that Amazon will be HELPFUL when I try to use one device or another, or when I mistakenly put my Mac Mini in the microwave, expecting a nice melty pizza in 2 minutes and 30 seconds.

Plus, it’s Seattle busts Cupertino.  Kurt Cobain vs. The Grateful Dead.  The Sound vs. The Bay.

Die.  Die Tunes.  You had your chance, Appletini.

RATIONal!

Yes, throwing a few words out there again.  Can’t help m’self.  Been a bit.

Living in Europe insulates the average human from goofy, over-the-top language meant to get people to do and think in ways that OTHER people want them to.  So, I haven’t been very caught up in, or all that impressed by, all the politics and steamy language coming out of my home country these past months.

Demilitarized Zone, North Korea
We have fast government. No arguing. You like. Like pizza.

Now the election is finally over, we find that Republicans have “swept” themselves into a level of “power” that assures exactly zero will happen unless they work with all the Democrats and Independents that never lost their jobs.  Some people think all the upcoming wrangling is a bad thing; I think it’s great.  A super-active government rarely doesn’t do anything well.  There IS a type of government that “gets things done” almost immediately, with little debate.  It’s called a dictatorship.  If you’re smitten with that idea, move to North Korea and try THAT speedy idea on and see how you like it.

Anyway, I received a link to a very persuasive and scary speech given by an orthopedic surgeon named Dr. David Janda, wherein he outlined the horrors and sneaky tricks piled into the Obama health care bill.  His speech was in support of Rob Steele, a cardiologist-turned-politician likely because he was mad as hell at the terrible direction of the country (*yawn*, aren’t we all?).  Presumably, said cardiologist is now back in the clinic, since he thoroughly

Republican Party Handbill, ca. 1880
Image by Cornell University Library via Flickr

lost the election of the 15th Congressional District of Michigan to John Dingell something like 83k votes to 118k votes.  Apparently, the Dingells have run that district for generations.  If you’re looking for nutty, inflammatory, manipulative language, look no further than at a political battle between a challenger losing in the polls as s/he tries to unseat a longstanding incumbent.

The gist of Dr. Janda’s speech is how Obama intends to RATION health care.  This actually sparked my interest.  I don’t really care about health care system politics; I’d rather just see patients, frankly.  But I have to just say to my fledgling SW101 crowd, I SUPPORT RATIONING.  Of every public resource.  Food. Gas. Sex (um, although I’d readily opt out of the “public” option).

New Orleans, Louisiana, 1943. Line at Rationin...
The whole idea of capitalism is so you don't have to share. Sharing sucks.

So many people take the idea of rationing to be unequivocally bad…as if it’s totally wrong and even beyond debate.  That’s the tack of Dr. Janda.  It’s something we all KNOW is wrong.  Like sticking needles in the eyes of baby squirrels or stomping on halloween pumpkins.

Incidentally, Janda is a specialist, supporting another specialist.  Primary care docs like me aren’t especially pleased with how specialists have garnered power and money for themselves in the AMS (Am. Med. System).  In particular, I’m speaking of orthopedic surgeons and cardiologists.  Specialists make fabulous money by ordering tests and procedures, none of which have ever been regulated or rationed in any way.  Echo’s and caths pay for the boat, private school and vacations to S. Pacific islands nobody can name.  Don’t tell me the only force driving clinical decisions is scientific evidence and standards of clinical care…money is money.  But even so, I’m for rationing.

President Barack Obama speaks to a joint sessi...
Hey friends! Here's a really mediocre idea!!

Let me say that I’m not happy about Obamacare. It was said well @ a recent conference, “who’s going to do a better job coming up with a fair, affordable national health care plan, 189 laywers in a room for half a year, or 10 family doctors in a room for a week? Obama went with the lawyers, he should have gone with the docs.”

That said, I FULLY AND COMPLETELY agree with rationing because it’s a necessity. In training, I followed a patient in the ICU who was costing close to 1 million dollars a day of PUBLIC MONEY for the last 4 months of her life. Somebody, somewhere needed to compassionately deny further intensive care to this woman, instead providing dignified hospice end-of-life management. Her case justified ONLY taxpayer-funded hospice care but nobody had the cajones to tell her that.

Every precious resource, if pooled for the common good, needs to be rationed. It’s where we get the term ‘rational’ and there’s a reason for it. Closer to home, my sister apparently has a University doctor telling her that she needs a thousand dollar procedure (colonoscopy). The procedure is not done by this doc’s specialty, and my sister hasn’t even had a rudimentary work-up to justify the cost of the scope.  She has not had a professional analyze of the risks vs. the benefits of doing it, either.  Yet she’s already being told that she needs this procedure.

Remember…EVERY test and procedure has significant risk associated with it. Wouldn’t it be nice to know that the doc my sis sees for a scope is a specialist? And, since that specialist pays for the Benz and sailboat from scope income, wouldn’t it be nice to know that he moved in a stepwise fashion through the GI workup process, a process that is peer-reviewed and widely accepted as essential before a scope is ordered?  This is the ‘rationing’ process that Obamacare advocates.  It puts serious limits on specialists in the provision of their care when it comes to big-ticket stuff like scopes, imaging and surgery.

But remember, we’re talking about rules in effect ONLY if you intend to get your neighbor to pay for your health care. YOU are welcome to pay for your own scope any time you wish. YOU can fund your own health insurance – one that doesn’t make docs do ANYTHING before they dig into your body – if you want.  I watched it work this way in Israel, and it was a pretty good deal.

However, the fact is most Americans believe they are SO important that they have the right to be treated like kings…paid for by peasants. But ethically, Americans have no right to whatever care they want whenever they want it, if they also expect someone else to pay for it.

Hugh Owen Thomas (1834-1891), British orthoped...
Trust me, I'm a DOCTOR! We ALL are.

The AMS does too many procedures and tests. The result of both is astronomical costs and HARM TO PATIENTS (through false-positive test results and procedure errors). So, not only is care rationing ethical and less costly, it is absolutely safer for patients. Healthcare is NOT safe. There is a risk-benefit ratio that must be considered any time a patient comes in contact with the health care system. Waiting for non-urgent care (knee replacements) and rationing of tests and procedures is ethical, cheaper and flat-out safer.

Incidentally, I argued this point in a debate in med school…waay before Obamacare. I have seen nothing since that time to sway my opinion. In fact, training and practice have only solidified that opinion with real-world facts.

Obama didn’t make our health care system right, but he did make it better. The Tea Party idea of repealing the new law is lunacy. If they REALLY want a free-market system, they need to dispense with EMTALA laws which dictate that ER docs (and now other specialties too) are required to see any and every patient.  THIS IS UNIVERSAL HEALTH CARE!!  It’s just the most inefficient, ineffective and expensive system in the world. We do have a social healthcare system. We just need to make it rational…starting with sensible rationing of limited resources.

Reader Q, Probable Farewell

Q – I just discovered your blog and have had fun reading it, however, it seems that you have stopped blogging?

A – It’s true. I burned out a little. Well, that’s a simplification. Moving here (to Germany), emerging from survival mode from medical training and settling into a normal life opened up all kinds of new emotions in me that I didn’t anticipate. The most important of these was a distinct realization that I wanted to deepen and widen my relationship with my wife.

So instead of pounding out these blog posts, I’ve been cooking dinner once a week (“Daddy Dinners”) and spending the majority of my nights watching some show or other with my wife by my side as I run my fingers slowly through her hair.

I’m gradually putting together a new blog – “Lover, Daddy, Doctor” – that picks up where SW101 leaves off. But it reflects my new focus in life.  I’d anticipate some humor, occasionally more intensity, less medicine.  I’d even expect the occasional Bible verse to accompany an irrepressible proclivity to pepper my writing with a well-placed swear word (Hey, I’ve come a long way…plus I’ve long bet that God nods to honesty before Christian decorum).

To survive in medical training, you HAVE to make survival and success your number one priority. I would have sworn this wasn’t true for me, but it was. Failure anywhere along the training path is a conscription to a lifetime of insurmountable debt, even poverty. Now that I’ve survived, my genuine priorities have emerged. I love to write, so it’s natural that I would blog about this new direction in my life. But I’m not sure. This is personal. More personal than just the experiences of being a doctor trainee. Maybe the story of one guy’s quest to be a better man is better left to be pondered quietly in the heart.

So, I’m mulling my next “move”. Maybe I’ll just pick up where I left off and start up SW101 again (thanks, everyone of you who wrote in to ask where all the good times went). Maybe I’ll finally finish my book.

Ultimately, I just can’t tell you where I’m going because I myself don’t know.  I DO know that I’ve successfully grilled tuna fillets, invented a mango/pear/mint salad that everyone loved, and I can broil Portabello mushrooms all by myself.  I learned the difference between Goat Cheese and Feta Cheese.  I know where the measuring cups are in the kitchen.  I can tell you every character in Lost (and the top 4 theories about what the freaking show even means).

But what I REALLY know is that my wife looks at me with eyes I haven’t seen for 13 years.  And this stirs my soul in ways that make most of the rest of my life comfortably superfluous.  This blog got caught up in that eternal vortex…

When I know anything more than this, you will too.

SW101

“All that I am, all that I ever was, is there in your perfect eyes…they’re all I can see.”  -Chasing Cars, by Snow Patrol

Movie Review – Avatar

I enjoyed myself fully last night as I entered the world of ‘Avatar’, James Cameron’s new sci-fi epic that already handily broke a 1 billion-dollar landmark record of some kind.  I’d watch the show again tonight if I could.  I’d probably watch it every night for a week like my high school buddies did for “Bill and Ted’s Excellent Adventure” once upon a time.

You don’t have to care – or understand – the point of the movie to completely enjoy the stunning visual spectacle presented in wide-screen, 3D wonder.  In fact, I’d advise constraining yourself specifically to the visual effects and skip putting any real thought to the message of the movie.  In essence, just sing along with the song, but don’t think about what the words actually mean.

The story follows an ex-Marine named Jake as he becomes part of a mission to subjugate – or at least translocate – the natives on a strange new planet (a moon actually, but does it matter?).  On the n0t-so-subtly-named Pandora, the “aliens” congregate around an enormous tree set in the middle of a seemingly endless forest.  They stand about 11 feet tall, with blue skin and luminous yellow eyes and they all seem to carry bow and arrows and daggers.  These blue and tall but otherwise disappointingly human-shaped beings generally seem happiest when attending their frequent tribe-wide drum fests – with a terminally simplistic 2/4 beat rhythm that sounds like it might have been pounded out on cool Senegalese drums the Anglo orchestra bought in bulk.

These earthy aliens have a sacred, mystical, spiritual connection to the forest where they live; generally behaving like any nature-loving tribe the Europeans successfully decimated a little over a century ago in North America.  In a complete creative hiatus, at one point nature is even called a “mother”.  Why not a father, or brother, or just skip the nuclear family reference to nature entirely?  The descriptor ‘Mother Earth’ is so unoriginal, it ranks up there with Bless You and Dot Com.

Although 2 hours and something like 40 minutes, you can easily sum up the movie in one phrase: “Dances With Wolves”…but with pterodactyls you can ride.

Basically – Marine makes contact with natives through project financed by aggressive and ethics-challenged Big Business company.  Marine plans on helping his financiers destroy said natives.  Instead, he inadvertently falls in love with natives in general, and one curvaceous native in particular.  He then becomes the enemy of his former bosses, ultimately leading the meek, dumb, dark-skinned simpletons to victory over superior white man.

I haven’t decided if this REALLY tired theme of the White Male swooping down into a primitive race, seeing their genuine good, and then becoming their Great Savior is completely racist.  Some are saying it absolutely is.  I don’t really think that was the intent.  I just think it was lazy writing by a white male who deep-down believes that white men are still the best hope for the world.  That they still run it, ultimately.  But it is possible that white men really don’t have much to offer the world anymore – that we’ve had our time and made our mark.  Maybe it’s time for some non-white, non-men to run the countries, write the laws, own the companies and save fictional worlds.  Maybe the white boy has done about all he can.

Big Business takes a major hit in this movie.  It gets portrayed as the denizen of all Evil in life.  That said, it’s Big Business that has paid for every iota of scientific discovery that has occurred on Pandora.  The science taking place on this moon (and taking place on our earth) is an elevated form of existence, no question, but in both worlds it mostly exists because of Big Business, either directly or through taxes.  Scientists – and artists – need to accept the fact that to live in that enlightened world of thought and wonder and possibility depends on their benefactor’s mundane ability to sell widgets.  Big Business is rarely genuinely evil.  True, figuring out when to inject some profit-endangering humanistic principles into a business plan does takes some skill and is occasionally gotten wrong. But for the most part, if business didn’t make the poet, at least it feeds him.

The actual “avatar” is a living being made to look like the aliens, but controlled by the mind of a human.  The human links to the avatar neurologically, so it can only be controlled by one specific human.  Thus, the human lies in a coffin-like body-pod that connects him/her to their specific avatar.  Upon falling into a coma in the pod, the avatar wakes up and the mind of the comatose human controls it.

Soohh...who gets to clean this thing?

The doc in me couldn’t help but get hung up on this part of the movie.  First, all humans need to sleep.  But since the avatar wakes up as soon as the human “sleeps”, and since controlling the avatar is a conscious process, the human never actually does sleep.  For some evolutionary reason I can’t fathom, REM sleep is the foundation of all life.  This inconvenient fact defies even the mighty pen of James Cameron.  By the end of the movie, after staying awake vicariously with the characters, I felt like I’d been on call in the hospital for days on end (felt like I was back in residency again).

Also, the human lays in this coffin thing for hours and hours.  At the least, he’s gotta pee himself on a regular basis, to say nothing of the inevitable bowel movement here and there.  Plus, the main character’s avatar hooks up with the sexy female alien.  Depicted as the first consummating night of an eternal love bond – thus likely a multicoital affair – envisioning the scene (and smell) inside the pod after this particular night left me a bit squeamish.

As mentioned, the power of this movie is in the visuals.  It is a “looker” many times over.  But the general message is tired, probably slightly racist, and denigrates the U.S. Military (or at least leads the audience to exult in the widespread slaughter of American soldiers/mercenaries).  That said, perhaps our culture really should take the main theme of the story to heart.  After all, we DID decimate the Native American culture, and based on my experiences on the Crow Reservation in Montana, I’d say we continue to.  We’re also strikingly obtuse in our dealings with tribal cultures in the Middle East today.  Listening to people from a different culture – rather than melting them with daisycutters and circling drones – has some merit.

But I do wish the movie had added a little post-modernism into the mix and eschewed the evil-good idea altogether.  It didn’t have to pit the American Axis of Evil (big business + U.S. Army) against a pristine tribal culture practically perfect in every way.  Historic Native American tribes were often duplicitous, aggressive, thieving and hateful (many still are today).  They rarely trusted each other from tribe to tribe and may have been just as irresponsible had one tribe attained the raw power that the U.S. Government currently has.  The Arab tribes we’re tangling with recently have a litany of faults and cobwebby dark corners too.  But they are also a just, priceless, sacred, honorable people.  This dichotomy exists in virtually every race in our world.  Americans seem to hate this complexity in our fiction – it’s easier to hate one thing and love another and then watch them duke it out.

Yeah, YEAH! Die lame-oh Americans! Wait, didn't an American make this movie?

Thus, the conflict in the movie could have been between two parties filled with faults and frailties but ultimately imbued with genuine honor, honesty and a respect for the rights of others.  Standing between them is something they both deeply need and want (trees, mineral ore…whatever).  In life, conflicts almost always boil down to two parties who both have blood on their hands, but both are essentially good, honorable…and in the right.  e.g., Palestine wants the land, Israel wants the land, both have been evil at times, both have been angelically good at times, and each have some form of legitimate claim to the exact space of real estate.  Stick that conundrum in your avatar’s virtual peace pipe and take a deep drag, nature-brother.

Depicting this nuanced world may have weakened the sense of righteous rage as the Army went Operation Flatten Everything.  It may have lessened the gloating release when the Ultimate Bad Guy finally met his ignominious end.  But it would have made a better movie.  It would have made the written story as complex as those fantastic visuals, and created a worthy counterpart to such a sparkling, wondrous vision.

20

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Giant Party at the Brandenburg Gate

20 year ago tomorrow, the Berlin Wall was breached.  The first East Berliner to make it across – legally – was a woman named Angelika Wachs (news to me…old hat to everyone over here).

thefirst
Algelika Wachs

My favorite band of all time – U2 – performed a live show in Berlin this past Thursday to start the festivities, which will continue through this week.  We live 3 hours from Berlin, and may as well still be in Olympia, unfortunately.  The celebration isn’t history…but it will get close and I’d love to be there.

The U2 show was free.  All you had to do was get a ticket via the internet.  And you had to do it within a 3 hour time-span because that’s how long the 10,000 available tickets were available.  Being a free concert, you might find the need for tickets a bit ironic.

Even more ironic:  if you didn’t have a ticket, you couldn’t see the show.  Why?  Because MTV (the show’s producers) had erected – you guessed it – a WALL to obscure the performance.

crowd

3

At Least Insurance Is Unhappy

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The day that medical insurance execs and medical malpractice lawyers are screaming that their sky is falling, is the day that the U.S. has gotten serious about health care reform.

It sounds like half that equation is at least whining, so maybe some modicum of real reform is coming.