He wasn’t like some other men who moan and protest the very idea of shopping with their wives. He wouldn’t throw small tantrums at the idea of spending money on beauty, belts, and blouses. He enjoyed strolling around the city streets, feeling the sun warm the concrete, watching the wild array of people and their interactions with the world. But as soon as he would step into a small boutique and close the door behind him, the tinkling of little bells on the door handle was like a Pavlovian cue to feel a different sort of anxiety beyond spending money. For the walls seemed to close in on both him and those sad, tragic characters looking up from their registers, smiling and greeting him with: Hello, is there anything I can help you with today?

It was a lovely Saturday in the spring, and hope was budding on every tree limb as he found himself walking from store to store with his wife. They must have been to at least thirty stores already and he had not spent a dollar. A pair of jeans hanging in the display window of a small store caught his wife’s eye, and she tugged his elbow towards the door. As they entered the small shop a thin, middle-aged man with a receding hairline emerged from the back. There was no one else in the store. Eerie pop music emanated from speakers perched near the ceiling. Everything is fifty percent off this week, he said with a desperate grin.

They walked around the store, his wife pulling on shirtsleeves and holding up jeans for imagining. “Do you like this?” she asked him, while both she and the expectant shopkeeper awaited his inevitable shoulder shrug.

“Looks good,” he answered, but somehow his wife knew the many inflections of those two words and put the jeans back on the rack. The shopkeeper quickly procured three alternative pairs of jeans to evaluate. He looked sincere in his quest to please. Did he have a family? Three kids in college? A mortgage and a sick mother? Had this dream of running his own store turned into an imprisonment? Would his front window be shuttered within a week as the vultures of bankruptcy fed on his store’s fetid collapse? Were they as shoppers vultures too, making him dance for their disinterested fancy, juggling his blue jeans on sale for fifty percent off?

Yet he knew it was a conceit to pity the entrepreneurial shop owner. Undoubtedly some were doing quite well, supporting themselves or their families, even planning expansions and expensive trips on the money they were making. Yet the hundreds of small rejections that accumulate during a day of shopping were enough to dishearten him. He wished he could buy each small store’s entire inventory, delighting the shopkeeper if just for a day. If only his wallet were a fountain of milk and honey that flowed to all those who struggled, from this store to the artists in the park, to the coffeehouse on the corner, to the rare bookstore down the street, onwards and into the mouths and souls of every struggling being in the world.

“No thank you,” he heard his wife say. “They are very nice, but not quite what I’m looking for.” The shopkeeper pursed his lips and thanked her. They left the store without buying anything, never to see the middle-aged man with the receding hairline again.

Thank you for stopping in. Have a great day.

The heartache was becoming unbearable. “How much more shopping are we doing today?” he asked his wife. She feigned not hearing him as she pushed on to the next store, this one selling shoes and as empty as the last. The familiar bells on the door handle jingled, and a fresh wave of dread ushered him into the space. There were three women staffing the store, one straightening the shoes to perfection, another typing something into a computer, and the last one simply watching the door. All three chimed in to say hello and welcome.

His wife quickly ran through the inventory and found nothing of interest. He meanwhile was standing awkwardly in the middle of the store, his arms crossed behind his back, with morbid fantasies of single motherhood and a sad awareness of scarcity and human frailty overcoming him. He was about to excuse himself to wait outside the store when his wife pointed out a pair of leather sandals. “Do you like these?” she asked. He did. Sincerely.

He touched the leather and found himself admiring the construction. Before he could start pitying all the menial labor that had brought these shoes from the skin of a cow through some southeast Asian factory to this urban showroom one of the saleswomen was bringing him several sizes to try on. He felt terrible about life’s necessary consumption. He felt embarrassed about his own arrogance, the conceit that he should pity others or himself for our common struggles. But these sandals were feeling damn good on his feet. The saleswoman was smiling upon seeing his satisfaction.

Shall I ring them up for you? she asked.

“Yes. In fact I’ll wear them out of the store if that’s okay,” he replied. There was an exchange of money, with human hands touching and pleasant smiles traded as a scrap of manna from heaven flowed through the store. The bells on the door rang lightly, sounding both distant and near as they exited.

He was exhausted, and his heart could take no more.

He and his wife headed off towards home. She bought a few books at the bookstore and a bottle of wine along the way. She thought his brooding about the heartache of shopping was a little bizarre, which it was. As he walked down the concrete streets he marveled at how the earth felt padded in soft leather. The sandals were good things.

Perhaps the shopkeeper was a kind of artist – performing, taking risks, displaying the necessary truth of our consumptive existence, and capturing something human, unspeakable, pleasurable, and timeless in the art of the exchange.

Or maybe it was just finiteness that broke his heart, and shopping laid it bare.

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Still Life

March 2, 2010




Pills with Three Raw Pecans

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A Valentine

February 14, 2010

“I’ll be back in a little while, Hon’. Will you be okay without me?” the frail old woman asked of her husband. She was standing at the front door and breathing heavily.

“I’ll be fine,” her husband replied from his wheelchair. His voice sounded as weak as his body looked – emaciated, scaly, and full of cancer. “I’m sorry I can’t come with you.”

The woman opened the front door. A gust of cold winter air scattered dried leaves into the foyer and chilled her lungs. The lone tree in their small yard looked tired and skeletal. She coughed against the wind, but pushed on. The walk down the stairs and across the driveway was exhausting. She wrested the car door open and plopped down into the bucket seat. Her breaths came fast, and she thought of calling the ambulance instead of driving herself to the doctor. But after a few minutes of rest she felt better. Her husband had wheeled himself to the front window and was watching her with concern. A nasal cannula graced his elfin face, and the woman thought how marvelous it would be to take a deep drag of his oxygen. But she felt good enough to proceed, and waved to her husband. He blew her a small kiss from his dried lips as she backed out of the driveway.
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It is 4 o’clock on a Wednesday afternoon in February, and I’m sitting in a chair with a laptop computer warming my thighs like an obedient lapdog. I’m swaddled in a cozy bathrobe. My feet are toasty warm inside slippers as I sip hot tea with honey. I’ve raised the blinds on the windows, and as I watch the wet snow swirling sideways in a chaotic display of white, I can’t help feeling giddy that work was cancelled today. I have an overall sense of unproductive euphoria as the gears and pistons of capitalism freeze over. Could blizzards be good for health?

On a normal day I would be 30-40 minutes late seeing patients by now. I would have a dull headache from concentrating all day on hundreds of problems, symptoms, and questions, and my blood pressure would be about 135/84, pulse 89.  But the white flakes of water drifting on the winds seem weightless, elemental, and self-sufficient. They certainly have no interest in me as I enjoy their infinite procession. I estimate my blood pressure is 108/72, pulse 61.
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On the way to the funeral you wonder how you’ll be received by the grieving. Although you are confident that your care for the deceased was sincere, professional, and adept, you still question if others will so assume. There is silence in the car. This is a trip you make alone.

You manage a bitter smile as you recall stories the patient shared in unguarded moments, behind the door of a small examining room. How he beamed with content at the thought of his grandchildren; how her eyes glowed as she remembered the view from the Eiffel Tower; how the tears and sobs and memories of a lost child wracked his otherwise impenetrable façade. Sometimes you knew his spirit as well as you knew his medical illnesses, and often he hoped you would tend more to the former.
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Mouse Sperm Cooperatively Swimming Together, and Other Thoughts

January 21, 2010

Today NPR ran a story about fierce competition and cooperation among mouse sperm cells trying to fertilize an ovum. Apparently spermatozoa from the same male will often clump together, wiggling their flagella in a collective swim that accelerates the group faster towards an egg. In the race to be the first sperm [...]

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Yale is Teaching Me Astrophysics for Free

January 17, 2010

I’ve decided to take a course at Yale University called Astronomy 161 – Frontiers and Controversies in Astrophysics. Yale has agreed to allow me, a family doctor who enjoys astronomy without rigorous mathematics, to take this course for free. Although I will earn no official credit from Yale, I will be able to [...]

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Running with a baby through freezing rain on the Eve of a New Year

January 10, 2010

His father and I were once young together, runners of long distances, across fields and suburban drives and teenage battlefields.
Tonight he’s carrying his baby boy, and walking with his wife and me back to their hotel, which looks far away down the concrete city sidewalk.
Revelers in hats and soaked heavy coats celebrate with laughter and [...]

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Exfoliating Soap is Full of Plastic. Seriously.

January 4, 2010

I feel ignorant.
I’ve been buying, using, and recommending Dove Exfoliating Soap as an affordable and low maintenance facial cleanser. Doctor-recommended. In general my skin has liked the stuff. But a friend recently made me aware of the fact that most of these mass-produced exfoliating soaps contain “microbeads” of plastic. These tiny globules of polyethylene act [...]

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The Barbarity of our Medical Malpractice System

December 31, 2009

I’ve lived long enough not to expect justice in this world,
Yet I haven’t given up in its pursuit.
Being sued as a doctor,
for imperfections,
for the inevitable bad outcomes that befall us all,
diminishes and consumes your very spirit:
A doctor’s account, from The New York Times.

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Top Medical Stories of 2009

December 31, 2009

What did we learn in 2009?
The editors of Journal Watch, a publication of The New England Journal of Medicine, have compiled a top ten list for the most important clinical pearls of 2009. These stories and findings are consequential and should effect the daily practice of physicians. Although patients may sometimes be frustrated to learn [...]

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Medical Advance of the Decade?

December 14, 2009

What has been the top medical advancement of the 2000’s?
As the first decade of the 21st century comes to an end, it is interesting to look back and reflect on the most significant medical advances we’ve seen. I’ve presented 12 medical advances that I consider to have been the most important over the past decade, [...]

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Hypochondriacal Heroism

December 12, 2009

It’s morning, and in the shower he reaches a trembling hand up towards his face and strokes his jugular lymph node chain, searching for any indications that the small lumps palpable within might have gotten larger. He feels the same familiar bumps, rolls them like jelly beans inside a package, and wonders if at least [...]

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The Top Ten Preventive Services, Ranked by Bang for the Buck

December 6, 2009

With all the controversy about the utility of mammography, optimal Pap smear intervals, and risks of prostate cancer screening, you have to ask yourself – what are the most beneficial and cost effective preventive services we should be focusing on?
Here are the top 10 preventive services. These items were chosen by the National Commission [...]

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Astronomical Medicine

December 3, 2009

Beautiful, humbling, unfathomable vistas to contemplate during fretful times:
A digital, zoomable panorama of over 3,000 images stitched together, capturing the highest resolution view of our galactic night sky ever created:
http://galaxy.phy.cmich.edu/~axel/mwpan2/
A crescent phase Earth, as seen by the departing Rosetta spacecraft as it makes its 5 year journey to rendezvous with a comet:
http://antwrp.gsfc.nasa.gov/apod/ap091123.html
No worries.

(Thanks [...]

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