Practice makes perfect? Or: That’s why they call it the practice of medicine. 0080

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Doctors amazed me. In fact, the entire medical establishment amazes me. think about it. Nurses care for you. They take care of you. nurses treat you. One says, “I am a nurse.” Or, one may say, ”He or she is a nurse.” But you never hear anybody say, “She practices nursing.” on the other hand, you often hear of a cardiology practice or in internal medicine practice, or “She practices internal medicine.”

Frankly, I don’t want someone who’s going to practice on me! I want someone who knows what they’re going to do. I want somebody who practiced on somebody else. Or, at least I want somebody was being supervised by somebody who doesn’t practice any more! Practice on the other guy. Treat me.

While I am at it, I have another bone to pick. If I need a plumber, I look up plumbers, and I select the best price with the best experience for the job I need done. I pay for it. The same goes for the people who cut my grass, clean my carpets, replace my Windows, and sell me car insurance. My employer doesn't pay my car insurance. (I wish they did.)

Now, I am typically not placing my life in any of those peoples hands. Sometimes, I may opt for the cheapest price. Sometimes, I may opt for the best price with the right level of experience. However, when it comes to medical care, in this country, we usually leave it up to someone else. This typically, we have the customer. We aren't a liar. Our employer is.

How many of us have employer paid health insurance? How many of us have HMO or PPO plans? How many of us have someone else tell us what Dr. we can see or what medical procedure or test we can have done? It’s a life-and-death decision which is handled by organizations that are looking for the cheapest price and are paid by somebody else, somebody else who isn't sick, injured or dying! The person footing the bill doesn't have a stake in the treatment. They wanted cheap, not good, not excellent. They are happy with people at practice.

We wonder why health care and health insurance is so expensive. Well, it's simple marketing. If I have one guy competing to sell me a peanut, and he's the only guy with a peanut, and all my neighbors want to buy that same one, the peanut is going to go to the highest bidder. But if there is thousands people selling peanuts, thousands of peanuts, and millions of buyers -- there is more competition. Peanuts get cheaper. We need millions of individuals to be competing for cheap healthcare and cheap insurance, not just thousands of companies. There are approximately 300,000,000 people in the United States. 300 million shoppers can definitely get a better price than 300,000, or the Fortune 1000, or the Fortune 100. There is very little economic incentive to cut medical costs in this country.

By the way, is everybody entitled to a $500,000 or million Dollar medical procedure? Is everyone entitled to the best possible care, the best care they're willing to pay for, or the best care they can afford ? Good question! Nobody is willing to pay me $1 million a year right now -- however, some insurance company might end up having a $1 million in medical expenses! That's just weird.

We maybe the doctors patient, but we are certainly not the doctors customer. That bothers me!. I don’t let my employer pick my grass cutter or my plumber -- and they’re not even going to kill me if they screw up! do I really trust corporate America with my life? Something is  definitely wrong with this picture.

You are what you carry (0061)

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Back when the west was very young, There lived a man named Masterson.
He wore a cane and derby hat, They called him Bat - Bat Masterson.
A man of steel the stories say But women's eyes all glanced his way
A gambler's game he always won.  His name was Bat - Bat Masterson The trail that he blazed is still there. No one has come since, to replace his name. And those with too ready a trigger, Forgot to figger on his lightning cane.
Now in the legend of the West, One name stands out of all the rest. The man who had the fastest gun, His name was Bat - Bat Masterson.

-- Theme song from Bat Masterson TV show

First, a serious note. Then we'll have time for a little humor.

Physically, my recovery was pretty remarkable. I got out of the wheelchair. I forced myself to. I got my right arm out of the sling. I could walk on cement, concrete and hard surfaces. I started walking with a cane, one of those canes that has four legs on it. Gradually, I started walking on grass and uneven surfaces.

But, as my physical improvement progressed, the disruption of my sleep schedule continued. On top
of that, the almost year long euphoria evaporated. I was beset by a crushing, suicidal depression. I literally wanted to end it all. Fortunately, I have a higher than average IQ. I could see, could realize what was happening to me. I’m convinced that it was by sheer willpower alone that I didn’t just slit my wrists. Every time those thoughts entered my head I thought about my kids. I thought about my mother. I thought how upset they would be. And frankly, even though I am a physical and financial mess, I still managed to help my kids and my mother. I think that’s the only thing that kept me going.

Now it's time for a funny, illustrative story of strokes in human behavior.

Okay, I admit it. I'm getting old. But you people under 50 should really watch this TV show. I mean, the guy was cool. He lived in a wild West, always dressed up, didn't even limp, but carried this amazingly cool black cane with a silver handle, kind of a ball shaped affair. Very debonair.

I went from being paralyzed in the hospital, to negotiating my way in a wheelchair when I went home to finally walking with a serious lip. For a long time, my right arm was in a sling and totally useless. But now things are getting better.

I switched to a regular cane. I got better and better at it. Now, in familiar surroundings, I walk without a cane. I noticed something. If you limp, and have a weak arm, and don’t walk with a cane -- people look at you funny and young children (at least the bratty ones) snicker. However, a man with a cane... that is sophistication. A man with a cane is someone to be reckoned with. A man with a cane gets doors opened for him.a man with a cane is called Sir!


Of course, that depends on what kind of cane you carry, I discovered. I have a fancy, jet black, L-shaped affair that I got to go with my tuxedo for my son’s wedding. It is very debonair! Walking with a that cane garners instant respect. I had one of those aluminum jobs with the foam rubber on the handle. It was better than limping nakedly, but only marginally. I think people take pity on somebody with one of those aluminum and foam rubber jobs. However, my jet black number, that gets respect. isn’t it amazing how appearances affect behavior?

I eventually got my arm out of the sling. I was in the sling because the weight of my arm hanging down was actually separating my shoulder joint! Again, with therapy, I gradually got back the use of my arm. It’s not like it was. I have no fine motor skills. I can pick things up. I can hold a hammer. I can do things that don’t require fine motor control. So, I guess, typing is out of the question Thank God I was left-handed!

Maybe I'll just mosey on down, and get myself a derby hat!

The Exploding Pill: A bit of humor.

I presume that someday this story to find its way into Brain Storm, but, it actually happened much earlier, and is only tangentially related. But it is funny!

I have had a condition known as gout, for years. I was first diagnosed when I was about 17 years old by a doctor who was also a family friend. Prior to that, I have complained of pain in my knee for about two years and had the diagnosed with all kinds of strange ailments. None of them actually turned out to be true. . However, my mother sent me off to her friend. Knowing my history, he smiled the minute I walked in. You have gout! That's what he told me. He didn't even ask me any questions or look at my knee. My mom had filled him in on the symptoms. Of course, he had to do some blood tests to verify. He was right.

That was back in the 1970s. The treatment of choice for gout, at the time, was a pill called Colchicine. I took it every day. However, I was warned, take it with food. Well, I was late for work. I popped the Colchicine, hopped in the car and started to drive to work. Suddenly, I had indigestion. It wasn't bad, just a little uncomfortable. Then I burped! Blue smoke came billowing out of my mouth accompanied by a horrible aftertaste! I had no idea what was, but the discomfort when away, and I didn't think about it for a while.

A couple of weeks later, I was relating the story to a co-worker. I hadn't figured it out, but driving to work I mysteriously belched blue smoke! I cited the smoke and the foul taste. And she immediately started laughing. I agree, it was funny. But not that funny.

Then she told me that she had a similar experience. She asked me if I had gout. I said yes, of course. Then she asked me if I was taking Colchicine. Yes, I answered unexpectedly. She advised me that she also had gout, that she had been prescribed Colchicin, that they told her to take it on a full stomach -- and she didn't. The consequence was that pill blew up in her stomach causing her to belch blue smoke, have a lousy taste in her mouth, and, since she was obviously smarter than me, call a doctor! He told her what happened, said she was lucky, and told her not to take the damn pill on an empty stomach. anymore.

Now they use a drug called allopurinol. Although Colchicine has very rare uses -- it is also called the horse pill because then as now, it is used on thoroughbreds who get sore ankles! It's still a veterinarian's dream.

A Blast from the Past

Suffice it to say that we are things continue to happen, one after my stroke. This is a tale of one of those situations.

I had a female friend who hailed from a foreign country, for now it doesn’t matter which one. Let’s call her Susie, for now anyhow. I met Susie under strange circumstances years ago. We communicated, long-distance, by phone and computer for a long time. One day I was particularly harried at the office, and Suzy called on the phone. “Today’s a really crappy day,” I said to her on the phone. We often shared the good and the bad in our weird telephonic relationship. “I feel like shooting myself in the head right now,” I said in my particularly American, over the top way. We chatted a couple more minutes and I went on about my business.

Flash forward – many hours later. The phone rings. It’s Suzie. “I will be there in a few hours,” she informed me, and hung up. I wasn’t going to be! I called my son who happen to live with me and warned him that some stranger from a foreign land would be descending upon the house looking for me. As always, my son expected the unexpected. He let her in. I arrived later. I found them out by the pool sipping a beer.

We had a fabulous, romantic, sexy friendship for a while. I don’t quite know what happened. She was making a trip back home and we did a little he said/she said, and it was over. But it was a very memorable couple of months.

Flash forward – a year and a half after my stroke. Facebook is an amazing thing. I get a message from somebody named Susie Jones. Either no one is Susie Jones. I do, fondling, remember Susie though. It’s her! Out of nowhere. Somewhere in the dim past of my memory every member Suzy got married. Well, Suzy was informing me that she was now divorced. She was just using Facebook to catch up with old friends and acquaintances. She saw my picture, and wrote. And we wrote, and talked, and wrote, and talked, you get the picture. As soon as Susie gets her passport – she’ll be here.

Probably a couple weeks after a move into the new house. I can’t wait to see her. Although, I have to wouldn’t, I tried desperately to dissuade her. I had her stroke… unemployed… paralyzed on the right side… old man now (as always, the women in my life were substantially younger than me)… not working… broke… you get the picture.

Now you have to remember, Susie was an athlete. A world-class skater until she busted ankle. A dancer, a sportsman. A model. You get the picture.

Susie’s response, “You will never believe this. I went back to school, became a nurse, and am currently working in a rehab center helping stroke victims. We can do rehab. We can go horseback riding together. Lots of stroke victims do that as rehabilitation…” Okay, how do I turn down an offer like that? I mean, seriously.

I’ll keep you posted.

Reconnecting

A few people wondered why he seemed so he was for it in the hospital. I spend more than a month they are recovering from a stroke. One thing that amazed many people, including my family, including me… was my unusually good mood. Here I was – no income, in the hospital, paralyzed on the right side and unable to walk or use my right arm or hand. You would think that would be a very depressing thing. But I wasn’t impressed at all. My kids and my mother attributed it to some really good rugs they must have been giving me. It wasn’t until I got back home that I realized that I was now taking the same drugs that I was taking in the hospital. There were no magic mushrooms to perk up my mood. Just stuff to keep the blood pressure down, fight off blood clots and keep the gavel under control. That’s it.

What accounted for my usual attitude in the hospital? If you couldn’t walk or use your right arm, if you were scooting around a wheelchair, if you had been fiercely independent and were now dependent upon the people around you – that would seem like a prescription for depression.

After talking with my stroke doctor is, Dr. Hayes, I figured it out. I had lived a high-pressure lifestyle. The highs were enormously high. The lows were cavernously low. Very little time was spent in the middle ground. Although I love my kids and my kids love me, my relationships managed to alienate them. My romantic relationships were volatile. I was an all or nothing person.

The euphoria that I experienced after my stroke wasn’t due to drugs and wasn’t experiential. It was because, for the first time in my life, a really treasured those simple things in life that we forget about when we are busy – family and friends. Disabled as I was, the workforce would have to wait. My kids, my mother, a few of my close friends were the most important things in my life. Their presence, their happiness and their companionship was what made me happy.

It’s a good thing too… while I was sick I lost my house and most of my personal possessions! I had a couple of van loads of stuff. But I had family and friends. As time went on – I realized who my real friends were. My partner at them had been my friend for more than 20 years and he stood by me. My friend and business associate Arnie, ditto. As my recovery progress, I found a few more of those old friends. Bill, Tara, Andrew and Sheila, Jonathan, Mimi, Charlotta, Adam2 and Zannell, Frank, Manny, and more than I can even remember (hmmm… there are a lot of women in there, aren’t there?) have stayed in touch and supported me throughout my ongoing recovery.

That’s worth more than cash.

Sleepless in Seattle -- or somewhere

Pace ... set ... watched TV... read ... pay some more ... lay in bed with eyes closed ... lay in bed with eyes open ... pace ... I think I will go crazy if this doesn't quit soon. Insomnia. The inability to sleep. It's driving me nuts.

The average person needs eight hours of sleep a night. There are basically three sleep stages. The eight hours is divided into a) about 2 1/2 hours of various sleep stages to get to sleep, b) 2 1/2 hours of various sleep stages to wake up, and c) three hours of deep, restful, dreamless sleep known technically as somnambulism, otherwise known as deep sleep (getting there and waking up are called REM, initials for rapid eye movement, characteristic of that form of sleep).

Some people, either naturally or through training, can get to deep sleep very quickly. Those people need the ability to sleep three hours, and spend whatever time it takes to fall asleep and wake up. falling asleep and waking up times seem to have no effect on the body.

When I was younger, As a result of training, I used to sleep only about four hours a day. It gradually became more as I grew older. but basically, anybody can train themselves to fall asleep and wake up quickly. I used to be able to sleep on planes trains and automobiles. Basically, if I was moving and not driving, I slept. It was a very useful skill.

For the first several months after my stroke, sleeping was not the problem. I'd sack out of 8 or 9 PM and wake up by 5 or 6 AM. It was actually a very nice schedule. I also noticed, I might trip to Connecticut, but I hadn't lost my skill of falling asleep on the airplane. Life was good. It was after I got to Connecticut that I started having problems. At first, I attributed to a new environment, doing something exciting, lots of reasons. There's only one problem. It's a year later, and I still can't sleep.

Maybe I should just hire somebody to drive me around the block and park near the driveway once I fall asleep!

Fear of Flying.

When I was flat on my back in the hospital, my dear friend and business partner Adam came to Florida to visit me several times. After I came to my mothers house to live, Adam suggested that I make a trip up to Connecticut to visit him and my son Christopher, who lived in the nearby town. What was once as natural as breathing became one of the scariest events in my life.

I hadn't yet recovered enough to drive. I rarely ventured outside the house. In fact, I had just learned to walk with a cane and forgo the wheelchair. the world outside was terrifying. I couldn't read street signs. I couldn't remember words. I had no peripheral vision on the right hand side. Everything looks strange, smelled strange, tasted strange. My senses deceived me. It was as though I had dropped into an alien, foreboding, parallel universe.

I mustered up the courage. I had always been an adventurer. This was just another danger. Para-sailing, bungee jumping, all those risky things than I did in my former life paled in comparison to stepping on an airplane. But I did it. I guess, even with the stroke, once an adrenaline junkie, always an adrenaline junkie. All that changed was the drug.

I had a wonderful, two-week trip. It broke me out of my shell. It forced me to begin tour the world. What seemed an insurmountable obstacle, at first blush, turned out to be a mere annoyance. A little harder to do than before.

As humans we need to push ourselves. We need to do that which is slightly fearful, to overcome small challenges, so that we grow and can overcome larger challenges. I suppose I knew that before I had my stroke. But I never consciously thought about it. Now I do. And I'm grateful for the lesson.

Siddhartha Gautama -- the Buddha.

I was lying on my bed in the emergency room, waiting for the verdict of the pain in my back (see previous article on kidney stones). I have studied the life of Buddha before my stroke, but hadn't had much time to consider it since. Now I think the reason for my kidney stones was really a way to get me to watch this television show.

Buddha started off life as a prince. He was tampered by his father, never being allowed to know or understand hardship. he was to be the next king. He was married at a young age and had one child. Early in his adult life he ventured out into the world, unattended by his father's guardians. He saw pain, suffering, hunger, illness -- things he had never seen before.

The Buddha left his life of luxury and ventured into the world in search of truth. He lived as a student, learning under knowledgeable figures of the age. He tried to attain lightning than by self mortification. Ultimately, he realized that we construct our own pain, and we manage our own joy.

The story is much longer, and I will not tell it all here; however suffice it to say that I read learned lessons I had forgotten. The greatest of those lessons is that I am here, alive, and there must be some purpose to my life. Whether it is to it merely experience a raindrop falling on my brow; help the number one daughter during her time of need; watch number two daughter graduate from college; or, just observe my son, his wife and their child grow up learning. There is joy to be found, happiness to be found in the simplest of things.

Unhappiness is rooted in reflecting on what we have lost or what we do not have. Happiness is rooted in rejoicing over the love of others, considering what might be yet, and will we might yet achieve.

Buddhists will tell you that the history of Buddha need not be accurate. The stories and parables from his life may be true or not. That is not the point. The point is the message. The point is the learning. Strive every day to make one other person smile, to make one other person's burden easier, to reflect on the miracle of the seedling growing into a flower.

Easter Sunday 2010

This is the second Easter since my stroke. I don't remember much about the last one. But today, I'm in Florida, living at my mothers house, and I'm alone. My mother is still in rehab from her back surgery. When I'm not sick, I go over and visit, almost everyday.

I've decided that it stinks being alone! All my life I've either live with my parents, lived in a college dorm or live with the wife. This being alone stuff is new to me. I don't quite know how to take it. Since I lost everything in my stroke, I live with my mother in a retirement community. Everyone that lives in the section of the retirement community is about my mother's age. The are all 30 years older than I am. Is this what I have to look forward to in my old age? it makes you pause and think, reflect on your life, your accomplishments and your failures. The real question is -- do I have one more mission in me? Do I have one more success? Or, is this all there is. Good question don't you think.

I prefer to think that I have one more success in me. 55 is too young to roll over and play dead.