Death leaves an invisible silence, a wrenching disappearance of love’s voice and presence.

Your father held you in your first moments, poured his love and life into your cup, and told stories that created a fabled purpose from the dull chaos.  And then he was no more.
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Are loved ones gone forever when they die?

They live a new, unselfish life within the murky, star-forming nebula of our memories.  We conjure them in moments of anxiety, sing along with them in the music they loved, and see how they once adored us as we tuck our children into bed.  And beyond our perceptions, they exist as nothing and everything.

And if we don’t keep a keen eye on the outside world, we may miss them there as well.  On a birthday I looked down and saw this dirty little puddle.  I paused, noting that it was heart-shaped.  And as great art can move mountains within us, so too can dirty puddles speak for the dead:

I love you.

it said.

~

In the moment my father died there was a beautiful, September-like sky, crisp and blue like the month he entered the world.  He shone in the sunlit footprints of his granddaughter as she ran down the sandy beach, brimming with her young life, a torch of his own.

My father jammed the electromagnetic waves of the police trying to call my cell phone to tell me of his demise.  Four times I answered the phone to static, which has neither happened before nor since.  Stay in this brilliant moment a little while longer, son. I’m with you and your family over this warm beach blanket as I join the sky, reveling in your daughter’s giggles.  Remember nothing in the universe has produced a greater sound.

We are of the world when we are born into it, why should we not remain of it when we die?

Look for your loved ones, hear them, sense them, and hold on in inexplicable ways.

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auroraI used to think of Thanksgiving as the supremely humble, agenda-less holiday most deserving of our celebration. As an American adaptation of harvest festivals found in other cultures, it seems at once natural, secular, and modest. Yet as I called a lovely woman a few days before the holiday to inform and counsel her that she has cancer, the notion of millions of others “giving thanks” rang hollow, selfish, self-referential, and arrogant. The turkey on her table was unexpectedly as rotten as the necrotic mass in her pelvis, and her many arriving guests were suddenly interlopers in her nightmare. Perhaps there is a better way to frame the loaded notion of “giving thanks” that does not presuppose blessings, special entitlements, and personal good fortune.

The act of giving thanks necessarily involves a transaction between an actor and a receiver. Giving thanks is a reaction to something bestowed. This problem of agency is what makes Thanksgiving fundamentally flawed. An unseen God known via faith can be thanked, but to do so takes a egotistical leap over the woman with cancer. What has she received from this same God? Instead, giving thanks seems most appropriate for the transparent exchange, such as that which occurs between human actors helping one another.

So what notions would be most honorable, most worthy of our sacred celebration? The best abstract ideas I could come up with would be reverence, humility, wonder and awe.

Reverence for humanism, the natural world on Earth, a newborn child’s silky head, the brilliance of the stars, and the capacity of love.

Humility that grasps our frailty, our inherent flaws, and the acceptance that every action we commit, even those considered altruistic, is ultimately self-serving.

Awe at the enormity of the universe from galaxy to gluon, the stubborn and heroic perseverance of life, comets from the Oort belt grazing the Sun, and the beauty of snow flurries falling as we exalt in the pleasures of sharing pumpkin pie.

If we were all equally blessed, or if there were some rational justice that determines who suffers, then we should say “thanks.” Otherwise I think a good prayer before the feast should focus on the ideas of reverence, humility, and awe… and to give thanks to those who journey along with us.

Food Truck Examining Room
Given that our health care system has become a bloated carcass of once honorable intentions, I think a fundamental redesign of the examining room is in order.  For beyond the doctor and patient, the physical room which contains their ebullient repartee is the next logical target for improvement.  Here is one radical idea that may need only a few tweaks:

The foodtruckexaminingroom will roam from town to town across the United States, stopping in major cities and small towns with main streets in order to provide excellent medical consultations. The charge will be $25 per “visit”, with home made food gifts strongly encouraged. A medical “plan for your local doctor with malpractice coverage” will be generated from each visit, and will be thoroughly excellent.

The nerve center of the truck, and the heart and soul of this new concept, will be a very casual exam room inside the truck. There will be two chairs, a table, optional wine glasses, and a plush 1970′s style shag rug. A Norman Rockwell will be on the wall, a subtle and ironic nod to the midcentury demise of the “real” family doctor. Perhaps a bring-one-take-one-used-book-shelf will invite the free flow of subversive leftist literature.

A wine rack will be on the wall, highlighting the virtues of moderation and zinfandel.

Please rest assured there will be music gently streaming in the background, ranging from such therapeutic artists as Chopin, James Brown, and The Alabama Shakes. A nice, toothless, fluffy (and occasionally smelly dog) named Babaganoush will smile and purr gracefully at each patient, inviting intimacy and reducing anxiety from the start. For an additional 50 cents, “Baba” will roll around on your back, simulating a low cost sort of medical massage.

The truck will strive to park under shady trees in warm weather, and to maintain an alternate, open-air exam “area” with folding chairs. This area will have little to no privacy and so will be an optional, flagrant violation of HIPPA standards. A discretionary campfire, with a “Saturday Sausage Sizzle” (TM – trademark, all rights reserved) will mesh seamlessly with America’s entrenched tail-gating and RV culture.

On the top of the foodtruckexaminingroom will be perhaps the most important engineering feats – a mobile greenhouse growing organic kale, herbs, tomatoes, and mint for mojitos and tea. It will be fertilized periodically with excrement from the 500 pound, fully operational chicken coop. Free range chickens will be let out during the day to wander around eating local bugs, and will produce about a dozen organic eggs per day, which will be given to the first 12 patients of each session.

A beehive will be maintained on the roof as well, with honeybees diligently avoiding Bayer’s neonicotinoid pesticides, and Monsanto’s GMO crops, to bring us delicious honey, always on tap directly from the hive.

The rear of the truck will be retrofitted with a freezer for chocolate ice cream, the exclusive and happily restrictive diet that will be recommended for all willing nonagenarians.

The exercise zone will be fairly minimalistic, purposefully demonstrating that one really needs to just move around. The tai chi manual must be returned before sunset.

I am currently seeking investors and start up venture capital for this concept. I believe it to be scalable, yet inherently resistant to the mind-numbing, evil tendencies of big corporate paradigms and six sigma cannibalism. This concept will be “intuitive” and “quite natural” for patients willing to step inside the food truck and get some healing. Please allow me to clarify any questions you may have, and I would happily entertain suggestions for improvement.

book_cover_smallAuthor Danea Horn has written a book entitled Chronic Resilience in which she describes “10 sanity-saving strategies for women coping with the stress of illness.” I read a copy of the book and highly recommend it.

The stresses of being ill and suffering from chronic illness are manifold. Just today I listened to a woman in the examining room whose fear, anxiety, and sense of isolation with her medical problems were as distressing as the many unpleasant feelings of pain, dizziness, and dread. I did my best to listen to her, validate her concerns, and offer her constructive medical solutions – but I found myself also mentioning Ms. Horn’s book. Even in the first few pages of her disarming introduction, in which she describes her own congenital problems, you can sense her warmth and sincerity, and the toughness that she might lend to a besieged fellow patient and life traveler.

The ten guidelines within specifically address the many challenges of chronic disease, and give tangible means of coping with and overcoming the many adversities. Her approach is instrumental in moving past the initial feelings of ‘why me?” and on to an empowering sense of control recaptured. Ms. Horn effortlessly draws from her readings of other empowering authors, notions of spirituality, and the existential reckonings of her own lifetime to synthesize a holistic and wholly effective worldview of illness.

Instead of relying on broad strokes of clichéd and unspecific advice, Danea includes actual exercises in her approach. Similar in my opinion to the highly respected concept of cognitive behavioral therapy, these practical assignments function like homework to drive home and reinforce the positive methods that can promote resilience.

Ms. Horn shares her own experiences in a witty, candid way that fosters trust, establishes credibility, and engages the reader. But she is not content in any way to simply make this a book about her own life, but rather includes intimate portraits of nine other women whose struggles have been met with courage and grace. There is really nothing more powerful to convince and inspire the human mind than the sharing of human story. Through the lens of these women’s tales, we see ourselves as capable of facing our own trials, strengthening our own resolve, and ultimately transcending the cruel frailties of our shared human condition.

As we are all imperfect creatures, there is a lot to be gained from reading this book whether you have a major chronic illness or not. I found the book to be uplifting, inspiring, and compelling. I found ideas to improve my own approach to daily life, and ways to cultivate a healthy sense of wellbeing, even in times of sickness and despair. As a family doctor I found myself thinking of several patients that this book would be perfect for, and I intend upon recommending it to them.

Thanks for a noble guidebook through good mental health in the face of chronic disease, Ms. Horn. May your life’s work continue to make the world a better, more resilient place.

I’m not sure I can live up to the promise of this post, but as I crouched naked on my hand and knees this weekend, crippled in the 6th hour of profuse diarrhea and vomiting, a few thoughts came to me.

First, how woefully miserable it is to feel sick. Not just sniffly-nose-nasal-congestion-sick, but rather the kind of sick that if it went much longer you might question your will to keep suffering.

I felt a tight, painful clench in my trunk that would not ease; a foul urgency to sit on the toilet as liquid poured out; that familiar burst of saliva and welling nausea as I scrambled to clean one end before the guttural retching ensued on the other; the hot splashing of acid on the palate, and the awkward stare of the spinach from the toilet bowl that just moments ago was floating in my intestines; the exhaustion; the light-headed flop back into the stale bed; the pounding of my heart, craving more fluids with which to pump, but my stomach blockaded by a pervasive and perverse sense of nausea and pain.

God bless the sick.

As I slowly recovered, there were many thoughts. First, there is no greater pleasure than not being aware of your own bodily existence. Tragically we are unaware of these moments, since they are imperceptible by nature. But to lie still in a bed, or to read a book in a hammock, not beset by the gurgling and bloating of bowel, the burning of stomach acid, the congestion and difficulty of breathing through mucous, the constant nudging pain of a bad back, the pulsing of a migraine… to be free of the alarms of internal machinery is heaven. Perhaps there is a fasting monk on a mountaintop who knows what I mean.

And for as much grandiosity as I’ve already written, I know that my brief “suffering” was small, as is my very existence. Have you seen the photo that the Cassini spacecraft snapped last week of the pale, blue dot that is our Earth? Cassini Saturn Earth Isn’t it absolutely magnificent? How have the people of the world not stopped everything, laying down their baskets and bayonets and briefcases, to begin the Age of Aquarius?

Because unfortunately, when we are in our life, we are in it. We are billions, programmed to compete, stuck on this little blue dot, howling at each other. Because the struggle is actually much easier than the big picture. How luxurious it is to be grounded in misery, our bowels and bile and wars and petty atrocities tethering us to the moment. Having seen ourselves on this pale blue dot, should we choose to keep being boorishly human, or to seek an enlightened state of relative harmony, peace, and understanding among our similarly diarrhea-plagued brothers and sisters?

As a kid I imagined that once aliens reached our planet, all the different tribes of mankind would unite at last, albeit in self-defense, but finally aware of our common bonds. Yet looking back from Saturn should really be that kind of spark, too. But it fails to trigger our survival instincts, appealing instead to lofty notions of beauty, imagination, and awe. And then we go right back to diarrhea and taxes. Is there comfort in blood, muck, and cruelty? Are we shackled by double helices to be forever self-absorbed and self-serving? And when I wish to see beauty and transcendence in the Cassini spacecraft photo, am I instead glimpsing Life’s unmoored scream into the bitter cold vacuum of radiation and godstuff?

It’s hard to bring this post to any kind of sensible conclusion, but If I were to narrow it down to just two sentences it would be these. If you are currently feeling well, be aware of it, and be humbled by the Universe. And learn more about oral rehydration therapy.

Diagram of the Human Body Using Etymologies

July 11, 2013

The origin of a word is fascinating, and the etymology of a word’s evolution tells a story.  You can almost picture syllables and letters marching like armies through distant lands – Old England, Low Germany, Ancient Greece… or rising up from a dark, primordial world of shapeless magic to take form and structure. I’ve changed […]

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Hail the Sunshine Act (?)

June 8, 2013

Do you want to know if your doctor has been eating pizza for lunch that was purchased by Pfizer as she listened to a drug rep describe a new medication? Do you want to know if your endocrinologist has been paid $1,500 to give a brief talk about a new injectable diabetes medication to his […]

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Senile Miosis

May 4, 2013

The pupils of the eye become smaller as we age, shrinking to a mere third of their robust, youthful size. You knew this, even if you were not aware of the vanishing look in your grandmother’s window, the reptilian ooze of warm blood over the cliff. Open wide. Please. Open wider, so that we might […]

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Does Having Allergies Reduce the Risk of Brain Cancer?

April 7, 2013

As anyone with seasonal allergies to tree pollen knows, allergy season has begun. Aside from the sneezing, itchy eyes, nasal congestion, and general sense of being ill, is there anything good about this springtime immune system dysfunction? I came across some evidence that might slightly relieve that annual sense of “suffering” – having allergies of […]

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Is Your Family Medical History… Heroic?

March 28, 2013

There was an article in the New York Times recently about the importance of cultivating a family narrative to instill a sense of identity, control, and resilience in children. The more children know about their family story, the better equipped they are to handle stresses that would shake their foundation. Is it possible that, in […]

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Top 7 Health Reasons to Boycott the Superbowl

January 24, 2013

You’ve probably watched the Super Bowl as I have many times, faithfully, elevating the occasion to some kind of macabre family tradition. It is a spectacle of athletic agility, drama, and struggle; the pinnacle of American sporting contests. Despite the heavy onslaught of commercialism, faux halftime culture, and evident violence on the field, we suspend […]

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Organic Foods – Are They More Nutritious, Safe, or Worthy of Still Life Paintings?

November 26, 2012

I’ve been feeling a bit more skeptical of the supposed benefits of “organic” foods lately. It’s hard to imagine any greater purity as I watch this fruit in a bowl on my kitchen counter top – a sad modern still life, festooned with brand name stickers. The high grocery bills I’ve been racking up combined […]

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October 18, 2012

Dr. Andrew Weil delivered the keynote address at the 2012 American Academy of Family Physicians Scientific Assembly.  I admit that I don’t know much about him or his wellness empire, but apparently Time Magazine has anointed him one of the top 25 visionaries in the world.  Here is the gist of his keynote address, as […]

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Diapers and Condoms

August 11, 2012

While picking up some diapers at the pharmacy I noticed the adjacent, ironic placement of condoms in the same aisle. I suppose as a medical professional who does his fair share of counseling about safe sex I should appreciate the not-so-subtle juxtaposition of products rimmed for pleasure and fitted for maximum absorption. Yet I couldn’t […]

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June 29, 2012

I walked past this advertisement posted at a bus stop the other day and had to pause. It announces a new medication for the treatment of HIV-related belly fat, or lipodystrophy. It is remarkable for many reasons, but perhaps most strikingly it represents the latest sign that the battle against HIV/AIDS has further matured into […]

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