Ode to McDonalds and Cigarettes

You can say you saw it here. This family medicine doctor – supposed bastion of all that is healthy and wholesome – recently found himself encouraging a patient to keep up the McDonald’s and smoking. Instantly after proclaiming my support of these two great sins of the developed world, I heard my program director’s voice in the back of my head saying not unkindly, “Nice job, doctor, good work…we’ll most likely kill you in the morning.” Although never tempted by cigarettes, I frequently fight the urge to hit a McD’s and constantly rail against both as all that is disjointed and wrong with our society (celery is another problem, IMO, but that’s another discussion entirely).

I saw a patient this weekend who unabashedly describes smoking about a half-pack of cigarettes a day, and has been doing it for “goin’ on 50 years now, and I ain’t quittin’ no matter what you tell me.” The patient is 78 years old with advancing COPD. When she inhales, the wispy flimsy breath she drags down into her rapidly deteriorating lungs rattles around aimlessly like a blind baboon in Grand Central Station. She then forces the air back out; little of the oxygen actually used. She is on 14 medications to treat everything from her diabetes to the high amounts of fat in her blood.

“Smoking makes me feel…” She closes her eyes, her face taking on a distant, faraway look as if she just lost herself in recollections of her torrid love affair in Paris on a college philosophy tour, “like I’m surrounded by friends when I’m actually all alone.” How can I beat that?

This patient lived a full life, been smoking for a good majority of it. Now she is stuck in that impartial vice-like vortex of half-life and half-death that American medicine has so expensively provided us. Historically, people just died when they got as sick as her. Today, people linger, in a sort of daily, living suffering. The institutions they inhabit have innocuous-sounding descriptions like “assisted-living communities”, but everyone knows what they really are. Places where the clock of mortality hangs largest on every wall, where the clanging metal hammer pounding on anvil cannot go ignored, but can’t be rushed. It pounds in measured, inexorable rhythms, indifferent to anguish it causes. Hundreds of thousands of Americans waste away in these communal halls, most abandoned by their families, waiting for that final insult and staring droolingly at the wall in the meantime. But when this insult finally does arrive – a heart attack, hemorrhagic stroke, maybe a pulmonary embolism – it shows up with a slouch, hands in pockets, irresolute, nuanced and often as slow as a sadist. These days, the Reaper arrives in a robe of gray, eschewing the dramatic and abrupt pitch black somewhere around the time we invented beta-blockers.

So, go ahead, lady. Smoke to your heart’s content (or infarct). The damage is done, really. If you did stop today, the additional few weeks or maybe even year would be so miserable for someone who loves smoking this much it wouldn’t do much for you. Mortal time isn’t everything. There’s such a thing as life quality, too.

“The other thing I love,” She continued, “is Saturdays.”

Her face, looking like gravity used physical hands to pull her face to the ground for the past 200 years, suddenly filled with a smile. Her losing battle with age suddenly clamoring to a standstill. “My wonderful daughter comes every Saturday and brings me a McDonald’s egg McMuffin sandwich and coffee. I just love that. I look forward to it all week. Say, what day is it? Maybe she’s coming today. Do you know?”

“Well, it’s Saturday night at 11. Maybe she came earlier before your care facility staff thought you needed to come to the hospital.”

“Yes. This could be. You see dear, I can’t really tell the difference between days and weeks and months and years anymore. They’re all sorta the same to me anymore. I just know my Jerry comes on Saturday and we have breakfast together. And you know…that McDonald’s does a lot of good for other people, too. They hire young kids, old folks…give people a start in life, or help them do something worthwhile. The buy all kinds of ingredients from local grocers and farmers. Why, when they moved in here 30 years ago, my son was one of the first they hired. He has his own business today. Employs 30 people.”

“Wow. I’ve never thought of them that way.”

“And them McMuffins…ain’t so bad for you, either. They fill you up, keep you fed through almost a whole day. It’s good food.”

By any primary health care measure, someone who smokes daily and eats fast food at least once a week, is not healthy. But exceptions to every rule emerge in unlikely places. This woman did not come to the hospital to make me re-evaluate my unbending belief in the immutable evils of fast-food and smoking. But her defense of their place in her own life was unassailable. This woman won’t live to be 90 years old. The end may come in the next few days, in fact. But this is true for all of us. This very moment, our lives could be required of us. Should this happen, could you depart with the same gentle serenity?

If deprived of her simple vices, could she?

I found myself answering no to both questions. So this family doctor ended up departing the room, encouraging an overweight patient with COPD and hyperlipidemia to “keep up the smoking and enjoy your McDonald’s.”

I’ll start typing my resume. I hear there’s good jobs in the restaurant business.

New Job

factory.jpgDear Shareholders,

Please read below a brief supplemental report on the status of Family Factory 4HAU:

This report is coming from the V.P. of Resource Acquisition as our C.E.O. has taken leave for personal reasons. I am confident she will return to her regular duties in short order, if only because she even now likely is struggling to relax with the knowledge that this particular V.P. is not the ideal candidate for oversight of factory operations.

As you know, our factory produces – often with stunning efficiency – screams, giggles, dirty dishes, dirty clothes and a earth-dismaying number of dirty diapers on a daily basis. I’ve found that this factory also puts out a rather bewildering array of tin cans and plastic bottles, the sheer number of which I continually find myself at a loss to explain.

The reason for all this industrial waste, of course, is to ultimately produce 4 Human Adult Units. We expect our first fully-functional unit in approximately another 10 years. These productions will come equipped with manners, restraint and sound reasoning systems. We hope to see generally-explicable belief programs on-line as well. Add-ons at this factory include some measure of humility, ideally some chastity and at least a few documented instances of general intelligence.

Of note, currently there is a “hold” on these expectations for Model #4, which appears to have some software quirks that still need evaluation and likely some serious editing. The unit – the newest of the fleet at a mere 2 years – appears to have hard-wire fixations on specific objects such as balls of any size or bounceability, crackers and “dwinks”. Additionally disconcerting, this unit’s predilection for disassembly – bordering on bald destruction – continues to vex even our senior programming team. Thus, our predictions for this unit remain in flux. It should be noted that our site has limited experience with this particular model – the M. The three other more predictable and manageable units are F models and seem particularly compliant in the areas of safety and quietness. We suspect that these units may require higher maintenance costs over the long-run, however.

gummi.jpgOf concern, this rosy outlook is in peril of late. In the past 24 hours, we have seen significant backlogs in the areas of fueling operations, sleep-mode induction, and general factory order. Re-fueling the H.A.U.’s is a delicate process involving specific balances of amino acids, fats and constant vigilance over carbohydrates…especially of the ‘Gummy Bear’ variety. Recently, the stop-level parameters on these nutrients appear to have been subject to software-hacking: the end result being a total reordering of our daily nutrition balance. Fruits and vegetables – so ubiquitous under the watchful gaze of the C.E.O. – have been replaced by jello, GoGurt, chips and other high-calorie foods with virtually absent nutritional value. With shame, I also admit to providing our H.A.U.’s with carb and fat-laden pre-fabricated deep-fried chicken fragments that have cheap diversionary plastic objects contained in primary-colored boxes as part of their delivery system. Our four units show an almost inexplicable positive attraction to their revamped nutrient algorithm, but effects over the ensuing 3 hours are less than ideal.

happy.jpgAdditionally, concern grows about tomorrow, when educational programs will re-start after a routine 48-hour hiatus. Given the highly-complex interplay of time, preparation and travel such undertaking requires, I am dubious about the results when we go live in the morning. I would anticipate some major delays in implementing this process and have set a rather low standard for success by comparison to that of the C.E.O., which will be to simply transition units #1 and #2 into some version of education mode without all other factory operations grinding to a catastrophic halt. In general, if we manage to avoid ‘catastrophic halts’ of any kind, this interim management team is poised to term their work “a success”.

It should be noted that factory supplies currently can be found strung across floors and all work spaces. Again referring to the inexplicable volume of industrial waste, I am at a loss to explain how our environmentally-friendly recycling programs have suddenly shut down. Everything from outright trash to recyclable materials to even re-usable zip-lock bags are repeatedly being found by management in the general trash receptacles. All efforts to parse factory waste into recycle/reuse and “real trash” appear to have ceased. Furthermore, all 4 units appear to be re-setting their hard drives to function on “Lord of the Flies” mode, which has relegated this V.P. to spending most of his time trying to avoid “getting voted off”. Furthermore, given the recent hour-change for daylight savings, our factory has run into numerous, shall we say, delays in production of even basic operations such as equipping the units for daytime activities by switching them out of P.J. mode. It is with great determination that I have avoided simply plugging all units into the EM pulse machine and leaving them in mode: dormant until a more facile manager can arrive on the floor.

This brings me to my final point. There have been times when this V.P. has questioned the difficulty of the C.E.O.’s role compared to the task of resource acquisition. At times, I will admit moments of delusional grandeur when I believed myself up to the task of supplanting the current C.E.O., suggesting that she “give it a whirl” in the competitive and vicious world where I spend most of my time. Upon further consideration, I would agree with the constantly-unanimous view of The Board that current management roles are appropriately assigned. I apologize for, at any time, questioning the wisdom of our current assignments and ask only that you pass along my heartfelt wish to the C.E.O. that she enjoy her time off. However please note that her quick return is advisable, given the rapidly-deteriorating state of our Family Factory 4H.A.U.