Meandering Musing

Thoughts on Medicine, Life, Technology

2019 was not my best year. Or was it?

flight landscape nature sky


The 46 Project failed.  Long live the 46 Project.

Ok, maybe that’s a bit dramatic.  Or maybe it’s not dramatic enough.  The 46 Project was a constantly moving contradiction – the likes of which I hope I do not see again.

Of course, I’m writing this, so I lived to see 47, but 46 was absolutely nothing like I had imagined it would have been.  It offered lessons and despair and good and evil and hope and failure.  It offered choices to do right or to just be comfortable.  It offered nausea and tears.  Waves of nausea and tears.  It was a professional and personal roller coaster that would not relent, and it left me reeling nearly every moment of the ride.  From a professional standpoint, all I knew is I wanted off the ride – even if I was still 1000 feet in the air and had no way back down.  From a personal standpoint, if I’d forced myself to stay on that ride professionally, I’m confident I would have ended up finishing the personal ride alone.  No one in their right mind would have wanted to stay on it with me.  I was a miserable S.O.B.  That, in fact, might be one of the greatest understatements of 2019.

So, I unlatched my seat belt a few months ago as I reached a crest and was moving slow, jumped down to the track, and spent the last two months of the 46 Project slowly climbing back down toward sanity and God’s purpose.  One rickety, wooden rung at a time, with friends and family holding fluffy blankets below to catch me if I fall.  And that is the one true beauty I found in the 46 Project – the people in my life that matter most wanted me to do the right thing for myself.  That is a gift beyond measure, as many people on this earth I fear feel trapped by the ones they need the most.   They aren’t blessed with the support I had, and without it, doing the right thing for one’s self seems all the more daunting.  Particularly when the first step is unemployment!  When I was most lost and weakest is when love from friends and family buoyed me to get to the next day.  And the next.  And the next.  Until I could find the courage to jump off that damn roller coaster.

And this may be a surprise to those who look at my Facebook or who received a Christmas card.  If you judged me by those highly curated pictures of travel, adventure and relaxation, you’d think I had the best year ever!  And in those fleeting moments – I was happy.  But travel and vacation are escape in many ways.  While it is certainly good to have focused time with family and to be free of the stress of work, it was all too often a temporary band-aid.  For much of 46, the times I was on vacation were the only times I really felt connected to my wife and kids.  Which left about 48 weeks of distraction, angst, worry, and fear.  And anger.  I can’t forget how angry I was.  So much wasted time and opportunity.  My greatest regret of the 46 Project.

In all honesty, it was the hardest year I’ve lived in my adult life.  The year Lori was diagnosed with cancer is certainly a close second, but I won’t even presume to think that year was nearly as hard on me as it was her.  That year, she fought for her physical health with an unrelenting energy that carries on to this day.  That was her year to re-center and focus, and sometimes all I felt I could do was watch her in amazement.  That year was her turning point.  Physically and emotionally, she was a changed woman on the other side of that year.  Cancer made her better.

My battle has no doubt taken a negative physical toll, but much of that has been due to exhaustion peppered with laziness.  I felt so drained fighting an existential battle of self, values and purpose against some fairly nefarious external forces that I had nothing left to give myself at the end of each day.  The details aren’t so important, but let it suffice to say that I could no longer sit idly by while my peers and the patients we were there to serve were being neglected if I were to respect my calling in life.

So now I’m hoping my refusal to do the easy (and wrong) things in life is my turning point.  Ambition of someday being an executive in a massive organization that threatened my value, morals, purpose and well-being was not what God had in mind for me – of that I am certain.  So I jumped off the fast track roller coaster of “job security” and “success” and now I’m crawling – but crawling in the right direction.  Three jobs in a span of 9 months.   That is some serious stress and whiplash.

But I’ve landed where I’m supposed to be, in a place that I cannot even call a job.  It is a calling.  It is my calling, and while my associates have specific needs and expectations of what they need accomplished, it is aligned with my own personal and professional values.  That is what had been so desperately missing.  And if I can keep winding my way forward, the dream is to someday help others find similar working relationships.  Physicians sacrifice so much to get where they are and are deserving of more than just being replaceable cogs in a cold, uncaring, dispassionate machine.

And honestly, I really don’t know why I even write this stuff down.  I’ve lived it, so I already know it.  Self-deprecation?  Sure.  I’m pretty good at that.  Pride?  Proud of what?  Finally having the courage to do the right thing for my family, myself, and patients?  No, I think more than anything, it is a means of more formal processing to solidify what I’ve hopefully learned.  And I can imagine someone out there might identify and maybe find a little hope and inspiration that all is never lost.  Not from anything particular I’ve said or done, but rather in opening your heart to what God wants you to do.  On my own, I was a failure.  An abject, absolute failure.  All I did was open my heart to God and affirm that the roller coaster was not my intended ride.  All I did was open my heart to God.

There is no 47 Project.  There is no time limit on what I need to do.  No labels, no resolutions.  Just better.  Everyday trying to do better.  And most importantly, to stop wishing for tomorrow to come.  Tomorrow may not be greener, or easier, or happier.  It is just a fantasy we use to help us gut through today when today is rough.  Well, fantasies are dangerous things.  It is hope wasted on an idea, when the effort should be on today – and being better in the present.  Hope belongs in the present.

Yes – Hope belongs in the present.  We belong in the present.  God is waiting for us there.

What’s in a Name Plate?


The weirdest thing happened to me at work today.  A lovely woman appeared at my door with a name plate.  I figured she was there by mistake.  This had to be mistake.  I had not possessed a job with a name plate in over a decade. I’d only been in this office less than a month and it may be little more than temporary housing for me in the vagabond world of modern medicine.  There was no way this company would have bothered to do this.  But nope – it was no mistake.  The shiny letters of title and name were mine.  And it looked weird to me.  Surreal.  I mean this was truly very strange to me.

Most people in “normal” office jobs would probably think absolutely nothing of this.  You get a job, they give you a name plate and plunk you down in your cubicle or office and that is just usual office protocol.  It gives you a small piece of real estate to do what you have to do.  While you may not own your office equipment, cubicle walls or office door, the space you now have is your space in which to operate.  And that name plate helps assign that space to you.  A place of purpose and task, yes.  But it is your place of purpose and task.  And it helps people find you, and talk to you, and work with you.  It’s not just a name plate, but rather it is a tool of the enterprise.

And so I stood outside my office door in stunned silence, seeing my own name on a name plate for the first time in 16 years.  In fact, I can remember the last time I had a name plate back in 2003.  Our pediatric resident clinic would slide our name plates into the mounts on the patient care rooms we were assigned for the day.  I vividly remember my last time in that clinic and being told I could take my name plates with me.  Sure, they were cheap plastic, but they had served me well for several years in my training.  So, of course the pack rat that I am took them home.  They represented a history for me – a place of purpose and task.  They represented an ownership of what I’d done, and as I moved on, new residents would take over that purpose and task.  Cheap plastic name plates that I took for granted as what I thought would be the first of many.  And I’m pretty certain I simply pitched them out at some point shortly thereafter, thinking a grander-appearing name plate would be somewhere in my hard-earned future.  Oh, you naïve young version of me…

You see, I’ve worn a few different hats with different entities in the ensuing years, but not one department chair, or hospital exec, or clinic director, or executive “this”, or vice-president “that” ever thought to put my name on a wall, or a door, or a cubicle – until today.  And it isn’t even a typical employer who thought I’d be worth the few bucks this thing cost to make, but rather a client who just wants my input and assistance for a while.  A partner of potentially only temporary work and housing placed more value on my name and education – giving me a designated place of purpose and task – than the traditional medical employers for whom I’ve previously served the past 16 years.

Oh sure, once upon a time my name was written on a mail file hung next to the door, but that was pretty much it.  A place for mail.  They clearly think, “Doctor- who works for this cog of the healthcare machine, educating the young and impressionable students and residents, or caring for the sickest of the sick in our hospital environment – we deem your name and title worthy of a piece of paper, sticky noted on a mail file, outside a tiny office you now share with 4 other people.”

And to those who read this and knee-jerk believe this is about ego or pride, I’d say for a few doctors out there, you would be right.  Some docs are definitely hung up on their title and seeing their own name in ads and billboards.  But for me, it isn’t about having my own office, or desk, or wall art or any such whimsical thing. For the vast majority of us, it is about the place of purpose and task.  It isn’t the actual name plate that is the important thing, but what it represents.  Its presence – or absence – conveys a lot about the philosophical and  enterprise-focused value placed on us as physicians.  It is about being involved in the planning of how we take care of the patients for whom we so dearly care, rather than just being expected to blindly do what we are told.

The name plate represents a seat at the bigger table of purpose and task, and being a voice that is not ignored out of habit.  It represents an opportunity for dialogue to contribute ideas and energy born from experience.  And as I’ve seen all too often, doing the right (and sometimes even more cost-effective) thing makes more work for the non-clinical folks in the short-term.  And a lot of leaders just don’t like that.  I get it – we are all stretched thin, but loads are lighter when we lift them together. We need to move past the pervasive and oft-repeated business approach that it is easier to balance budgets through cost-cutting measures of reducing employees, or benefits, or services – rather than digging deep in the weeds with the entire team (not just the managers, but the actual scut level workers who get their latex-gloved hands dirty on a daily basis) to find efficiencies, potentials and plans that cannot remotely be viewed from 50,000 feet.

The name plate is not about me – but more about the value placed on our relationship. And it opens up a simple and seemingly innocent question.  But also one that is intentionally loaded to give us deeper insight into the very essence and culture of the places we live and work.

“Am I worth a name plate to you?”

Damn You, Lin-Manuel Miranda!

man carrying woman standing on beachside

Truly.  Damn you.  You wrote a musical I tried to ignore because I never believed anything could be as good as all that hype.  I believed nothing would ever knock Les Miz off its musical pedestal.  I wouldn’t even listen to this thing until three days before our tickets to see the tour production.

And now I cannot listen to anything else!  Damn you.

Les Miz knocked to my number two.

You inspired a notion to fight for freedom – damn the cost to self.

You cause tears to well in my eyes  with quiet blubbering at the thought of something happening to my children.  Every.  Single.  Time.

I smile ear-to-ear as Hamilton yells, “Sit down, John – you fat mother——!”  because my life is full of fat mother——- to whom I would love to do the same.

And then there is Hurricane.  The storm of this life.  Violins, harp and a bell.  Delicate choices for a wrecking ball of a song.  Musical perfection.  Your lyrics have nothing to do with our current circumstances as physicians, but could just as easily be about the chaos permeating the lives of so many of my brothers and sisters in medicine.  Every day feeling like the day we could drown.  Every day, waiting for it.  Whatever it may be.

I already fell to the urge to write my way out, but you have helped turn it into an imperative that I begin catching up on 25 years of words unwritten.   You fill my head with the absurd notion I can do something just by writing.  Damn you for inspiration.  No longer waiting for it.  Can’t just wait for it.  No choice but to try and write our way out.

Name the Disease – Find a Cure

round white fruit


It’s time to come clean.

I have suffered from ASLS – acute self-loathing syndrome.  And to be clear, it is pronounced just like you’d think. I’m lucky, as some people have the more serious ASHLS – acute self-hate/loathing syndrome.  Finally, there is the metastatic form – MASHLS – where the afflicted cause everyone around them to feel ill.  I’ve had a few bouts with MASHLS myself over the years, and it is horrible.  You can’t stand where you are and what you do, you feel unable to bring about any positive change in your work/career, and you want no one and everyone to know about it.

The cause of MASHLS is all too often the not ironically named pesky virus massivus a$$holus.  You know, the tireless, relentless, exponentially exploding army of Burberry and Prada clad healthcare administrators that has never touched a patient in their entire life but have somehow intertwined themselves into the very DNA of the doctor-patient relationship.

And absolutely no joke, the episodes of MASHLS truly are dangerous, because the support people and support systems too often want to quarantine the afflicted so as to not get caught up by the contagion of despair.  They simply don’t know what to do with people who feel so trapped and lost at the same time.  It leaves the victim further victimized.  It can be the start – or the end – of spiraling out of control.

I’ve been lucky enough to find an effective cure for MASHLS by getting out of those increasingly hopeless situations, but it nonetheless can return, and all too often does.   I’ve simply been blessed more than others to have the ability to make changes when needed.  Fear of change runs deep through human nature, and that fear of change keeps too many chained to abuse.  It’s like an event horizon for so many – once reached – they will never be able to escape.

Of course, none of this is real DSM-V disease.  It is a ridiculously lame attempt to make this topic more approachable for those that can’t relate by experience.  It would also be better described as chronic self-loathing syndrome, but CSLS just isn’t funny.   An acronym that sounds like a naughty word makes me chuckle, after all, I am a kid doctor.  And we desperately need moments of levity as we take the journey down this rabbit hole together.

Sadly, a change of scenery all too often does not eliminate the problems we face, and ASLS/CSLS creeps in again.  Some docs are blessed with an immunity to this disease, but that comes at the price of often turning a blind eye and deaf ear to those who cannot fend off the attack of externally created self-loathing in order to preserve themselves.  I get it, and begrudge them nothing.

We should be one another’s professional support systems, but that sounds like – and would be – a lot of extra work for people who are already exhausted from their own careers.  Just because one appears impervious to ASLS/CSLS doesn’t mean they have the energy to help others.  It’s hard enough for those folks to keep their own stuff together.  So the sufferers keep on suffering.  We have no wide-spread, formal systems to deal with this crisis.  Just downtrodden docs fending for themselves.

My sarcastic, sardonic wit has been my most valuable survival advantage so far.  Humor has been one of my only effective shields against despair.  When I stop laughing at the ridiculous predicaments in which I sometimes find myself, it is time to move on.  For other docs, coping can be booze, or drugs, or affairs, leaving the healthcare sector altogether, or suicide.  The last being the total absence of self-love. Desperation and darkness. The event horizon for the soul.

With my childhood friend’s suicide, I’m running out of ways to find any of these heavy matters humorous, tolerable or humane.  We’ve been largely abandoned by our own professional organizations except for a little lip service about physician wellness, and there is no mechanism to bite back or formalize repercussions against those who abuse us.  We need help.  No cavalry is coming.

Quite honestly, DSM-V doesn’t remotely come close to meeting our needs.  Between anxiety, depression, fear of litigation, tolerance of abuse, dehumanization of the most human of professions, we needed a new classification anyway.  So ASLS/ASHLS/MASHLS/CSLS is born.  And while I won’t get a much-deserved Nobel prize for this brilliance, I’ll sure as hell going to try and help my fellow docs get better.

Sure, we are a high strung bunch of folks, with a lot of OCD and anxiety tendencies.  Those are common threads through so many in our profession.  They are useful traits that help us succeed in many situations and are desirable for long-term success when kept in check.  And depression – more common than any of us would openly admit.  But if you show me an oncologist who has never been a little depressed by their work, then you are showing me someone I would never let treat me or my family.  I would fear they have a total lack of empathy.

Mild depression is probably a baseline in 30% of our profession.  I don’t think we can get a survey to really answer that, because we won’t answer it honestly.  Pride, fear of showing weakness and fear of punishment let the elephant sit in the room completely unnoticed.  And most importantly, it isn’t typically our own psychiatric tendencies that lead to ASLS/CSLS spectrum disease,  but rather external assaults on our psychiatric well-being.

Fact – a little over a year ago, I asked my former regional CEO if there were any dedicated, developed, shared programs in our massive, multi-state benevolent non-profit healthcare system focused on physician well-being.  No.  None.  Sorry.  Just keep smiling.  My MASHLS immediately flared.

After my last writing that touched on suicide, one of my dearest and oldest (sorry LKF!) childhood friends asked if greed was the driving force in this quagmire of medical psychiatric assault.  It is certainly contributory, but the root cause for many that suffer ASLS/CSLS is their dehumanization.  Dedicated, experienced, kind, compassionate physicians feel reduced to being cogs in a machine we can’t even begin to fully comprehend. It is intentionally built to be complicated beyond our understanding. A fantastic opinion piece in the NY Times ( recently discussed how health systems fully take advantage of physician and support staff altruism.  They think of it as free labor.

News flash to the MBA crowd – it is not free!  It costs a little piece of your employees’ dignity and soul every time it happens.  It is time they do not get to themselves, their families and their own life priorities.  It is time they do not have to reenergize for the next day’s work, which makes them less happy and less efficient.  And if there is anything I’ve learned by being a hospital physician – death comes.  It’s inevitable.  And no one looks back at the end of their life and thinks, “If I could only get one more shift…..”  But to the MBA crowd, if it’s not costing actual money, it doesn’t matter.  Helping the bottom line by hurting dedicated employees wrecks trust and loyalty.  And those can rarely be regained once lost.  As I said earlier, they are dehumanizing the most human of professions.

Fact – sometime about 6-7 years ago, my highly trained, dedicated, brilliant physician colleagues and I all had to attend a mandatory evening session to learn what kind of bird we are.  Yes, you read that correctly.  I said what kind of fucking bird I am.  Shocker to you, dear reader, I was an eagle.  Good luck doves, they will eat you for you breakfast.  Dehumanizing?  Damn straight it is.  Literally pigeon-holing us into bird stereotypes.

Fact – same evening session, same non-clinical health system employee encourages us to always smile.  In the hallway, in the elevator, in your patient’s room.  Probably even in the bathroom, but my memory is fuzzy on that one.  So, dear bird person, I’m supposed to smile as I tell my second patient of the day they have cancer.  My ICU colleague is supposed to smile as they break ribs doing chest compressions on the terminally ill 30-year-old mother of two whose body is riddled with cancer.   The critically valuable housekeepers who I should know by name, but do not, are supposed to smile as they clean the blood and feces off the walls, floor and ceiling in the trauma bay.  That just doesn’t sound right, but whatever.  What do I know?  I’m just a doctor.

Just smile.  Ok.  Roger that. Check.  Except… don’t have the foggiest idea what the hell  you are talking about.  But I smile and walk out, after having lost 90 minutes with my family and file it away in the overflowing folder of “time I can never get back,” because of the ever growing burden of things we are mandated to do that have nothing to do with making us better doctors.  Just another little bit of soul and dignity lost to the wind.

Which brings me around to where I go from here.  My most recent bout of ASLS has become manageable by speaking up in defense of myself and others.  By saying something.  By doing something.  By trying to right wrongs that were bigger than just me.  I’d known for several years I wanted to help more than one patient at a time.  I needed to do something different – and looking at my profession as a diseased patient has given me ideas and a new sense of purpose.  I do not think the patient is terminal, but critical care interventions seem to be appropriate.

It also appears I’ve struck a nerve with some peers, friends, and total strangers.  I’m happy for that fact, and love the love that has come my way. Words of kindness and support have been appreciated, but like so many times in life, thoughts and prayers are all too often vacuous expressions.  Don’t get me wrong – words of encouragement are wonderful –  and I can use all the encouragement I can get.  But more importantly, I am looking for ideas.

All the ideas.  Brilliant ideas and stupid ideas and proven ideas and failed ideas that might work if tried in the right hands.  I’m looking for contacts with people that can move this agenda forward and do more than just little ol’ me.  Friends, please help.  It is sometimes the friend of a friend of a friend who can move the mountain and work through the road blocks.  For now, my contact is  All correspondence will be handled in absolute confidence.  Trust me, I’m a doctor.

However, any threats of harm to others will be reported to authorities, so please don’t do that.  I’m also not a psychiatrist or a crisis center. But a crisis center dedicated to healthcare professionals seems like something that should already exist, doesn’t it? Idea #1.

Finally, there are a growing number of physicians who are taking on this previously taboo subject.  Dr. Pamela Wible has presented lectures, TED talks and has written books on the matter. One book is entirely letters of med students, residents and physicians who have taken their own lives.  You think this essay is a little dark and melodramatic?  Read that book and get back to me.

The only way to make this subject less dark is to finally shine a light on it.  Don’t like that I try to poke a little fun at the mountain of problems facing us?  Imagine what happens when we collectively lose our ability to laugh.  To find joy.  To feel anything at all.  Oh, and then imagine that with $200,0000 of student loan debt hanging over your head with a newborn’s mouth to feed and get back to me.  The physicians of today are NOTHING like the paternalistic mold of the 1950s who were 94% men typically with stay-at-home wives.  No, now we are the wives, and single parents, and medical marriages (both spouses as doctors), and everything is changed – except public perception has not.

We argue with Dr. Google and celebrity “experts” every day.  We have mortgages on our homes, loans on cars, and we effectively mortgage ourselves with crushing amounts of medical school debt.  The problem is we can sell a house or a car to pay off a note, but we can’t sell ourselves to pay off that loan.  What used to be a carefully calculated investment on ourselves with a high probability of long term success has now turned into a high stakes game of craps.  The House is winning.  And the laws of diminishing returns are in full effect.  More on this frightening topic later.

And Despair – my old nemesis.  I still see you there waiting the shadows.  You wait for one of us to stumble in school, or at work, or at home, and then you try to devour us from within.  I warned you last time I wrote, but maybe I wasn’t very clear.  It is not just me that is coming after you, it’s an army of doctors who have had enough.  We are just now getting our stuff together, but we will reach the critical mass it will take.  So, Despair-  my final warning – step in to the light and run back to hell.



For Peg.



****This reflects my opinions only and not that of employers past or present****

no title. just read it. please.

black and white black and white depressed depression


Despair has been trying to find me again.   That fickle fucking bitch is breathing down my neck once more.  I know her all too well – she has nipped at my heels most of my career, and has kept me running for the past 20 years.  Running from friendships, running from family, running from loss, running from debt, running from jobs, running from guilt – running as hard as I can, just to run another day.

Now I consider many of you who will read this my friends, and the words I’m about to put forth might just blow your mind.  My apologies in advance.  For as much as I sometimes blather on in friendly and benign conversation, it is too often a mask to hide the sweat and tears streaming down my face from running nonstop.   These next few paragraphs are going to unload some things you may not want to know.  Fair warning.

For you see, I can’t run another day.  Today is the day I stop running.  I’ve truly had it with the role of being prey.  It’s time to turn around, square my shoulders, and tell despair she’s in for a fight.  It will be her or me – and it sure as hell isn’t going to be me.  She will growl and snarl and bite and claw.  And all I can do is laugh in her face.  For me, the pen is my sword and it is now Game On.

So why take the fight against despair public?  Because I am not the only one running.  Depending on which survey you read, upwards of 60 to 70% of physicians may be running their own race with despair.  And the dirty little secret is we largely have our own profession to blame, as select winners from the past few generations of physicians have become the very teeth of modern-day despair.  Those old docs gave up the race and made deals to buy themselves a little more time before they would let the wheels of modern American medicine start grinding us to bone.  Medical heroes turned villains, willfully.

And it is hard, if not damn near impossible, to get anyone outside of medicine to understand the assault on physicians.  Too many folks still think we all get paid vacations to play golf in the Caribbean, and that our Porsches and BMWs are outward trappings of immeasurable, luxurious success.  It’s hard to find a sympathetic ear when those are the preconceived notions we have to overcome.  I do not golf, have never had a free vacation, drive a Ford, and can’t get a free pen these days.  Hell, I couldn’t even get my last hospital to buy a bag of decent coffee beans for my team.  Hospital coffee is a cruelty in and of itself.  Seriously.  And as for the fancy cars, and boats and houses – all too often it is just docs trying to cover their own sense of loss, emptiness and void with material stuff.  I would hardly consider that a measure of true success.

Over the past two years, I’ve worked with more physicians than I can count who have been victimized by our own profession.  Our boards create more and more expensive hoops to jump through and fill the coffers for a select few – leaving us no choice but to comply if we want the illustrious “board certified” title behind our name.  Payors pay less while electronic medical records decrease efficiency and cause overhead to skyrocket, forcing tired and overworked doctors to see more and more patients just to not lose more money.  And the public is then complicit in the attacks.  Nameless Google reviews rail against doctors who then can’t answer the complaints for fear of legal repercussions.  The wild west of the internet is all too often the bane of our professional existence.

Reflecting on my own journey, I realize I have no choice but to fight to restore dignity to our profession.  I’m bound and destined for this fight, and each day I ignore the bell and settle for just hiding from despair, I’m at odds with my purpose.  I’ve written before about the loss of my Mom when I was a child and the impact it had on my life.  It was immeasurably painful, but the experience strengthened me and forged a resolve that matches anything this pitiful monster of despair can throw at me. 

I’ve been given the undesirable, yet invaluable, gift of “despair context” that so many of my peers do not have.  They feel the crush of growing and unrelenting despair, and its overwhelming nature puts them in harm’s way.  And for far too many – medicine kills them.  The profession of love, mercy, compassion and healing destroys them, and inflicts collateral damage on their friends, family, and colleagues beyond any measure.

Taking care of patients was just the start of my calling.  Helping my peers is now an equal part of that calling.  I will freely admit I cry on occasion, but not only for myself.  I shed tears for my brothers and sisters who don’t know how strong and resolute they truly are.  Too many are trapped by debt and circumstances in jobs that intentionally keep them down.  It’s almost as if there is a business class that teaches it is easier to control and manipulate a demoralized work force – except a depressed work force performs worse in every metric you can imagine.  Placing value and dignity on physicians could reap unimaginable rewards if CEOs had even just a little imagination.

And finally, there is Peg.  We were childhood friends and went to church together as kids. Her family was a pillar in my hometown.  She was a beautiful woman, inside and out – and she took her own life earlier this summer.   In fact, I’m weeping as I type these hollow, empty words.  Equal parts sorrow and equal parts rage.  Medicine – promises of cure and a disease at the same time.  So much conflict in one little word.

Peg called me before going to med school, as I’d already been there and done that.  I desperately wish I could remember what we had talked about when she called me those many years ago.  But the years have washed that conversation from my memory, and sadly we never spoke again.  Now she is gone.  It is inexcusable, immoral and senseless that healers are dying by suicide at higher rates than any other profession in this country.  Roughly one doctor dies each day at their own hand, and countless others will live shorter lives because of the self-neglect this career continues to breed.

You can search this subject on the internet and find stale, cold, and dispassionate talking points.  We treat the disease in our own profession as if we are watching a surgery in the old school surgical theaters.  The academicians ponder and study and talk and talk and talk, while the corporations consider risk analysis and liability exposures.  State medical boards still consider psychiatric stressors as character flaws. The human cost in all of this is an inconvenient variable that cannot be openly discussed.  As for me, I will rage and write. Emotion is precisely what is missing from the conversation, when it should be center stage.

The absence of consistent, safe, structured, and non-career threatening mental health care in our profession hearkens back to days before antibiotics.  It’s what the generations before settled for, and we now reap what they have sown.  Peg cannot die in vain.  The thousands of other medical students, residents and physicians cannot simply die in vain.   Medicine must stop eating its own.



It means you care.

So today I stop running.  And despair, you might want to get a move on.  For it is now my turn to come after you.




**These comments are strictly my own and in no way reflect the opinion of employers past or present.  Yes, they make me say this, but it seems pretty obvious**


Questions and Noise

night television tv video

So, when I started The 46 Project I thought I’d have no problem writing something profound every three or four days.  Well, that was pretty naive.  Having a few days off between careers gave me a false sense of how simple all of this might be and just how easy it might be to help others as I helped myself.

Wrong, wrong, wrong.  Wrong.

Writing is cheap therapy, but has been a victim of the clock.   A few folks have checked in with me from time to time and wonder what the heck I’d initially been rambling about and how I’m doing.  The honest answer – I wasn’t happy.  I wasn’t healthy.  I was most definitely on a road to physical and emotional ruin — and something had to give.  I could keep trudging forward as a foot soldier in a broken system that didn’t really value my patient care outcomes or personal well-being — and die young myself,  or I could do something else.  Anything else!

Over the past couple of years, I’ve consumed far too much online content from others in an effort to organize my own thoughts, plans, goals and aspirations.  The result has been mostly noise.  Static.  The opposite of clarity.  A bunch of upbeat twenty- and thirty-somethings who’ve barely started their adult lives claiming to know the secrets of happiness and success.  And I can say with the benefit of age and experience, a lot of it is bad advice wrapped in a virtual world insulated from the people it hurts.

There is a flood of bloggers and YouTubers espousing to have the answers without really defining the questions.  And certainly without defining my questions and problems.  Compare that to the doctor gig – where bad advice can hurt your patient and even cause death.  Even good advice all too often has significant risk, and we are on the hook for whatever happens.  Such responsibility breeds maturity, but at a very real cost.  Insulation and disconnect just breeds more noise.

I started this post after watching a highly renowned marketing guru adamantly state that every single person should blog and post something every single day.  I sat down, inspired.  And then I thought–if everybody–posts something–every day–then no post is special.  It’s like a statement made recently by a colleague that if everything is emergent/stat, then absolutely nothing is emergent/stat.  It all just becomes homogenized noise.

So, what are my questions and problems?  Many are personal and will remain that way, but the most relevant problem today is the one that finally beat me down and out of practicing hospital medicine.  I saw one patient at a time.  Then the next.  Then the next.  Day after day after day after day.  Each patient already diseased and stuck in the hospital due to their disease(s).  I was working at a far end of the spectrum, where failure, misery and death was far more commonplace than any real degree of happiness, hope or joy.  I lived and worked at the part of the bell curve where no one wants to be.  I, myself, was drifting to that end of the bell curve, and I knew exactly how my own story would end without drastic change.

Going to work everyday and seeing patients suffering from diseases of affluence and overindulgence while others suffered from diseases of economic, emotional, and spiritual poverty was draining in a way from which I will never fully recover.  And that is a good thing.  The toll on my own soul was real and still weighs heavily on my heart.  But instead of focusing on the burden of yesterday, I am focusing on how it will motivate me today and tomorrow.

American healthcare can’t win the battle with one doctor, seeing one patient at a time.  We need to be creative and industrious.  We need to embrace new ideas and move past models that are little changed from the ’50s and ’60s.  So, I opted out of what is a failing system for a chance at success.  And in so doing, I’m doubling down on being a physician and helping myself while I explore new ways to reach out and help others….before they need my colleagues in the hospital.  Physicians are teachers, as well as life-long learners, and today I finally hear the school bell cutting through the noise.  Class is in session.

Out with the Old.

We all love new things.  New home.  New car smell.  New kid.  New puppy.  I’ve had all these new things.  We tie happy memories to the new thing day, and over time, those new things inevitably get older.  For the important people in life (and I’ll thrown in pets, with the caveat that animals are not our children), hopefully our love intensifies and matures over time.  It feels like I love my wife and kids now more than ever; however, in reality, our love of family goes beyond any quantifiable measure.  It simply is.  The day we bring home a child we think there is no way I will ever love my child more than I do now.  Yet in time, that babbling bundle of joy becomes a real and individual person, and as they do, our love for them intensifies.  I don’t love them more, but rather more completely and maturely.

But the love of things – that’s a different matter.  Hopefully, it isn’t really love at all, but for so many, we confuse things and people far too often. I’ll be the first to admit I’ve thought that way at times.  The day I picked up my new (used) Ford Explorer, I remember thinking, “I love this car!”   There is nothing better than twin turbos at your disposal when you need them. In Tulsa, some on-ramps feel like only 30 feet, so serious acceleration comes in handy! But a cracked windshield, a few door dings and 50,000 miles later, it is definitely like, not love. We grow old of cars, their mounting miles and imperfections, and finally sell or trade them away for new models. Good thing family is not a motor vehicle!

I’m not particularly a “car guy”, but I know plenty of men and women who are. A new (not used) car every 2-3 years with all the time and effort that then goes into buying and selling these things. That’s time that could be spent with family. In fact, the money for those loan payments has to come from somewhere — hours added at work that could have been spent with family instead. And in the age of constant ads on your TV, in your email, on Facebook and YouTube, no one is entirely immune to the distractions and “stupid tax” passions in life. The marketers may very well know your next major purchase before you do!

So many of us, including myself, suffer from an affliction I will dub newthingitis (rhymes with meningitis!) We grow tired of the “old” well before it is worn out, broken or unrepairable. We have an itch, and the only thing to scratch it is something new. The cell phone companies love that itch. They feed that itch with slick ads and marketing, and what they really want is for you to feel good if you get their new device and bad if you don’t. How awful! In the photographer world in which I dabble, they call it GAS (gear acquisition syndrome.) That disease is the false belief that the newest and greatest equipment will allow you to take better pictures. Marketers want you to believe that your work is not going to be as good without their new and obscenely expensive camera. While some occasions do require specific and more modern gear, 90% of my hobby could be done reasonably well on gear I bought in 2006. If I were actually a better photographer, that number would probably be 95%.

The list of things simply goes on and on and on. Newthingitis is an epidemic. It is, in many ways an assault on happiness, family and self-worth. And I certainly followed along in blissful and blinded ignorance for many years. One of the focuses of The 46 Project is to explore ways to rid my mind and soul of these distractions. One tool I’ve been exploring the past 6 months is the concept of minimalism. That’s just a fancy word for living simpler, with less focus on things, and greater attention to self and the important people in our lives. It is nothing new, but it is one of the cultural movements I see taking shape that appears to have real staying power. If you want to dip your toe in the pool, watch the documentary Minimalism on Netflix. I’ll touch on the work of these guys in some upcoming writings, as I like much of what they have to say.

My post frequency will be a little slower now that I’m out of retirement and have a day job once more, but I’ll strive to put something up around once a week. I truly need to spend more time reading and actively learning. Vegging on television and the internet need to become a thing of the past. Life is too short. Grab it!

A Happy Post

I asked my wife, Lori, if she had read any of my blogs. Some, she replied. “It seems to me you might need medication.” I get it. A lot of death and sadness and job crap and not quite enough rainbows and lollipops. Fair enough. On the other hand, for me, writing about my experience is the best therapy – it’s free, and has limited side effects. The main side effect is Lori thinks I’m crazy (though that is nothing new). She is the more stoic one in our relationship, and I’m the emotive one. Opposites attract and I’m ok being dorky Phil Dunphy to her sophisticated Claire.

She should also be careful what she wishes for, as I then sat down to write this happy post. And what makes me happier than anything else in the world? She does. Ha!

I have no idea how I would have ended up if we had not crossed paths in residency so many years ago. As I write this, I actually tried to imagine who I would be today.  I had to shut that mental experiment down real quick. Nothing good there. Brian without Lori is like peanut butter without jelly. It’s ok, but only a fraction of how good it should be. In fact, I will heretofore refer to her as my better 75%. I would never have ended up as solid as I am today if she were not beside me. And some days she’s behind me, pushing me to be better. Other days, she’s in front of me, dragging me toward the best version of myself she sees. Without her, I’d only be 25% as good.

To be entirely honest, I can’t imagine where I’d be without her. It turns out she likes projects too, and fixing my broken heart and soul must have seemed like a fun challenge (sarcasm intended). There are two things I love about her more than anything – her family comes first and foremost in her life, and she never quits on anything (or anybody). I simply do not know a better person – and the fact she showed (forced??) me how to take myself less seriously and did not enable me to stay in dark and sulky places is the greatest gift I have ever received.

The 46 Project is all leading into something I will be building with her. A project bigger than both of us, but doable because of our strengths combined. It may take a year or two (or three…) to really develop, but it will be every bit worth the wait. I am eager to see it evolve, but for now it’s mostly ideas on a crazy looking spreadsheet drawn by me and her fastidious notes. She’s the brains, I’m the brawn (and the blubbering tears). She is, and forever will be, My Happy Post!

The Last Word

grayscale photography of human skull

My planned four day retirement only lasted 48 hours.  I logged back in to our electronic medical record to complete some unfinished work.  What remained in my queue was a discharge summary for a patient I had seen a few weeks before.  Not sure why I hadn’t done it sooner, but I’m inwardly glad I had waited.  It felt poetic.  My last day in the hospital had come and gone, and so had my patient’s.  He had died, as I’ve seen happen in the hospital more times than I can possibly remember.  The words I was about to write would be the last physician note in his chart.  We call it a death summary, and in it we explain how the patient got from here to There.

Some deaths are good, some deaths are horrible.  This death was beautiful.  My patient’s body was riddled with cancer and they knew he was going to die soon.  I saw him in the morning after his overnight admission and he was having severe pain from all the fluid in his belly.  The opiates helped some, but he was still suffering.  I ordered a procedure to drain off the fluid and several liters were removed.  I went back to see him after this and he clearly felt much better.  He had a smile and a laugh.

And the room was filled with people.  I don’t know if the fire marshal has a rule on the number of people we can cram into a hospital room, but I think he had passed the max.  He looked so much better, I said my goodbye for the day and left.

The next morning, I walked in and fully expected to see more of the same.  He had looked so good!  This was not to be the case, the blinds remained closed and the air in the room was filled with the heaviness of death.  His family was grateful for our care and shared how wonderful his day had been.  He had exhausted his body with visiting and after all of this, they knew he was ready.  The raggedy respirations were starting to take hold and I thought his mind and soul may have already moved on.  He did not live to see tomorrow, and that was a blessing.

I’ve seen countless patients die.  It is one of the incalculable job hazards we face as hospital physicians.  In my first week as an internal medicine resident, I had a patient die in the ICU every other day.  Just a few weeks ago on the hospitalist oncology service, I again had a patient die every other day.  The point is, I’ve seen death a lot.  And it always strikes me that patients’ bodies seem to shrink just a little into death.  That the person they were has already moved on, and just an empty vessel remains at the end.  And so it was for him.  Dark and quiet at the end of the hall – away from the commotion that always streams from the nurse’s station.  Peaceful.

His last day on earth.  My last words in his chart.  Amen.

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