A death in the office

Physicians are trained from the very outset of medical training to deal with death. Its a huge part of the medical world, obviously. The natural cycle of life moving on to death. It is rarely a welcome, if not grudgingly accepted, part of a physicians life.
Especially in the hospital. From severe injuries and overdoses and heart attacks in the emergency room to the more expected loss of seriously ill patients in the intensive care units and hospital wards, death is not an uncommon occurrence in a hospital, varying of course on size, location of the hospital. Its expected that one will encounter death in a hospital setting.
I did a trauma medicine rotation at Ben Taub hospital in inner city Houston , Texas where we had at least one gunshot or other violent death per shift. Of course at a smaller hospital you might have one death a week.
However, when you have an office based practice you just don't expect to see much of death in your workplace, however it can happen.
I was the county coroner in my rural county of 15,000 folks for 7 years, so I was no stranger to deaths elsewhere in the county. Motor vehicle accidents, farm accidents deaths at home all happened at least several times a month. So even after training I was no stranger to death. But I only had one death in my office. It was my first year in practice here ,about 1o years ago.
Mr. James (not his real name of course) was a police officer in our small town. A real salt of the earth, rural raised kind of fellow, he was the type of man who never went to a doctor. I had never seen him as a patient but knew his extended family, including his children well.
It was during a very busy cold and flu over run kind of day that his wife called and spoke to our nurse and explained that he was having chest pains.
I did not take the call as I was seeing patients but it was relayed to my senior partner and the patient was told in no uncertain terms that he should seek immediate care at the ER of his choice.
A less desirable option was given when his wife explained " Oh he will never go to the hospital", was to be seen at our office immediately, as in right now, get in the car come here kind of right now. His wife said she would talk to him and try to get him to come.
Very frustrating to me in retrospect as I lost my own Father the SAME WAY, as he was having chest pains for 3 days and for reasons known only to him, be it denial, fear or some other hope that it was just indigestion, simply refused to go to the hospital.
So before we left the office late that night we tried to call his home, got no answer and hoped that he had decided to go to the ER.
All these interactions were dutifully recorded in his chart.
Of course the daily grind of a busy little rural office went on with or without this patient as it tends to do. A call the next day by my nurses revealed that he had gotten better and decided not to do anything at all. An option for which they were admonished.
Now two things locked in my meeting with fate.
One was the fact that the senior partner was now taking Thursdays off, more to allow me a chance to fully integrate into the medical practice by being the only man around for a day than to give him a well deserved step back from his 30 year medical endeavors.
The other circumstance was that I had INSISTED upon a cardiac monitor with built in defibrillator when I came to the practice. I just felt it was tempting fate not to have such a tool in this rural isolated setting. And the entire staff had dutifully trained on the use of this awesome little intensive care unit in one little portable package.
Early that afternoon we got the call that Officer James chest pain had not only returned but had worsened and that he was on his way to the office. So we set up our little trauma room with our monitor and ACLS drugs (those are all the meds used to try and treat a heart in distress like you see being used during a code in all the movies) and I told the nurses to hook him up to a monitor and get a 12 lead immediately on his arrival.
This was done efficiently and quickly and within minutes after his arrival i was handed an EKG with his name on it.
One quick glance at it revealed that he was in the throes of a full blown heart attack with "tomb stone" T waves in the inferior leads.
"Youch!" I said not even realizing or caring that I said that out loud. "he's having a full blown MI right here in front of us." Call the E squad start an IV line, put him on 4 liters of oxygen by mask!" We had a pathetic little bottle of oxygen that held probably 30 minutes of oxygen.
I strode into the room to see a man looking older than his years, he was pale, sweaty and he looked scared. The kind of fear a man gets when he knows that something very bad is happening.
I told him that his heart was not getting enough oxygen and that he needed to get to the emergency room, well like 2 days ago.
I asked him about where, when, how bad...he answered my questions briefly and in measured short breaths.
Our eyes met, and he said simply " do what you need to do doc.." he said in a grimace as he dealt with what was obviously classic crushing chest pain.
Those were his last words.
I turned to tell the nurse to give him 2 mgs of morphine. On paper we did not have any controlled substances in the office, but we actually always had on vial of morphine on hand. My ever resourceful senior partner had literally years ago found himself "one vial ahead" as he explained it, so when we used this one we wrote a script for whomever we used it for and replaced the always present single vial of morphine. A little trick that would never work in any other medical facility except our little backwater clinic.
I had no sooner said those words when out of the corner of my eyes I saw the patient go limp, I glanced at the monitor and instantly recognized classic V-fib. Not a good rhythm. Not compatible with cardiac blood flow or well ... life.
One of the RN's in my office looked at me with fear and pain in her eyes and said (literally, I am not making this up.) "He's my uncle , Doctor, don't let him die!"
I didn't find out until later, but this intelligent, beautiful ,and talented young lady had a cross of her own that she had born, rightfully or not, for years.
She had been driving her cousin to the mall years before, not long after she had gotten her driver's license and a tragic accident had occurred in which the cousin had lost her life. A cousin who was the daughter of the man now before us. Only in a small town, I remember thinking later.
I can only imagine how his heart must have broken when he heard that news, but right now this man's heart had had enough of this low oxygen game, and was in the middle of giving up.
We all launched into our positions, observed collapse so one precordial thump, Shock, check rhythm, shock, check rhythm, shock, epinephrine, shock, lidocaine ...monitor?? asystole... well this went on it seemed for hours but it was only 22 minutes. Check monitor between compressions and med administrations nothing..nothing...nothing. Time to call this code....Time? That's the time of death.
The nearest hospital is 22 miles away, and I supposed that even if the E-squad had gotten a crew together his chances were better with me than with an untrained ambulance crew. Which is all our county had. It had been probably 45 minutes since we had put out the tones but in this small town daytime crews were hard to come by. People had to work.
I told the family that had assembled in my waiting room that he was gone. Yes a heart attack. Yes, he should have gone to the hospital days ago. I know, I know he just wouldn't go. What could you do? Put a gun to his head? Yes we tried everything this little clinic had to offer. He needed clot busting drugs 2 days ago.
The overwhelming stress of the situation hung heavily on my office staff. They had performed well , especially given the circumstances, and I told them so and gave them hugs all around.
I never told anyone, but I cried that night. For my lost patient yes, but also for myself, as I had lost my dad the same way nearly 15 years before. The irony and similarities were just too much to bear. I had always sworn that I would never lose one that way...

Tainted love..America and beef

America has a love affair with beef.

It didn't used to be that way, as beef was just too expensive to eat more than once a week for most families until the development of huge feedlots, and the use of corn and pharmaceuticals to greatly speed up the trip of a head of cattle from birth to slaughter.

A steer gets from 80 pounds to 1100 pounds in 14 months using tremendous quantities of beef derived byproducts of slaughter for protein and fat supplementation a lot of corn and an arsenal of new drugs.

In the old days on a ranch this process took 2-3 years.

So how can this be bad? Bringing cheap food to the tables of America?

Well its just not the same food. Feeding cattle corn instead of grass changes the composition of the beef. Instead of a product that has ratios of good fats to bad fats that are highly favorable this process has made a product that contains an undesirable ratio that is pretty much one to one, when it used to be 20-1 in favor of the good fats.

Its the amount of omega 3 fatty acids in beef that makes it so much less desirable in ones diet. And nowadays its ALL beef you really can not go to a store and buy grass fed beef..

We've come to think of the term "corn fed" as a banner of goodness instead of the health risk that it has really turned out to be.

The American diet has become deficient in the good fats, omega 3 fatty acids versus omega 6, that the rates of heart disease, obesity, diabetes, and even diseases of inflammation like arthritis, cancer and autoimmune diseases such as Lupus, MS are commonplace having skyrocketed over the last 50 years.

Additionally when you feed cattle corn and the by products of cattle slaughter houses and cramp them into feed lots standing in their own feces, not surprisingly, YOU MAKE THEM SICK!

So to protect the investment from high death rates they are given hormones and antibiotics.

And this system is accepted as the standard. No questions asked from the American public.

From the outrageous rates of heart disease and diabetes to the E. coli outbreaks and mad cow disease we happily munch on McDonalds burgers. (Grass fed cows raised on pastureland have very low rates of E. coli colonization for a variety of reasons)

SO this may make you want to ask Why did we get away from feeding our cows grass, which is essentially free, to giving them corn, which one has to buy and makes for some very unhealthy eating?

Well it was collusion between farmers and big government.

Farmers began to "Finish off" cattle or fatten them up for the slaughter when they ran out of good grass in the fall and winter. Corn is a very dense source of calories and fattens the cattle up faster than grass. This also tended to eliminate seasonal differences in beef in regions that had longer winters, or draughts that hurt the grass yields in the previous summer.

Over time, especially as government subsidized corn became cheaper and cheaper and the farmer found he could buy it much cheaper than he could ever grow it himself, it no longer made sense to raise cattle on pastureland and cattle began to be raised in huge feed lots.

To help dispose of the rising mountain of corn that the government was subsidizing, these lots were encouraged by the government through tax breaks, promoting a system of grading beef based on marbling that favored corn fed over grass fed beef, and exempting these lots from clean air and water laws. (15,000 head of cattle produce a LOT of manure which instead of being an asset which was used to fertilize pastureland was now a toxic cesspool!)

In time the cattle themselves changed, bread for fast growth and large size whose energy needs could hardly be met on less calorie rich grass.

Am I suggesting that this was done on purpose to harm the American public? Not at all. It was simple economics.

But now we have a health care system that is busting at the seams and costs more than any other nations. If you think about it, you can pay more for the grass fed beef, fix your diet to correct your intake of omega 3 fatty acids, or you can continue to feed our families what we are now.

In other words you can pay now or you can pay later. Both as individuals and as a society.

We have to put some thought into what we are putting into our bodies. And it's not easy, as chicken and pork are fed corn too. It's believed though not proven that grass fed beef is better for you nutritionally than corn fed chicken.

It's not as simple as being personally a few pounds overweight or feeling good about ourselves, it effects our entire society.,

http://www.mercola.com/2001/may/19/grass_fed.htm

Under rated dietary supplement, amazing Vitamin D

I liked this cartoon, Out of AMA News, I think many of us tend to look for the magic pill instead of common sense nutrition and fitness. Maybe that's why the supplement industry is so huge, as they tend to promise the easy fix. In that sense the supplement and homeopathic industry is NO BETTER than the pharmaceutical industry. The lies and deception of the supplement industry easily rival those of the drug companies, but that's another story. As a physician I try to sell the hard work common sense health fixes, but I meet a lot of resistance!!

So you can see why I have a bit of an inherent pessimism when it comes to claims made about vitamins and other supplements. Having said that, I have spent a great deal of time in the past year studying and researching nutrition, supplementation and herbal medicine. I have learned a lot and it has changed, to a certain extent, how I look at the practice of medicine.

I am a big believer in selecting foods to meet nutritional needs rather than supplementation when possible.

There are several notable exceptions, the first is Omega 3 essential fatty acids, such as found in fish oil. It is extremely difficult to get what one needs in the diet, as all livestock are now fed corn instead of the grass that makes them so much healthier. (venison anyone?) I don't like seafood so I take supplements. I use vegetable sources because I don 't like the fishy taste and this eliminates that "fishy repeat".

The next supplement is red wine extract that contains resveratrol. This is one of the components in red wine that has some truly amazing effects in the human body. I will discuss that molecule some other day.

But maybe the most underrated forgotten vitamin is vitamin D.

It appears to be very important in decreasing cancer rates, easing the effects of aging. In addition to its effect on bone.

These seem to be some pretty incredible statements, but research is convincing enough that the USDA is considering raising the Recommended Daily Allowance (RDA) from 400 IU to 800 IU and studies show that 1200 IU/day may be the target dose to decrease cancer. (take a look at this article on that topic http://www.forbes.com/health/feeds/hscout/2007/06/08/hscout605382.html

It has long been noted that cancer rates increase in direct proportion to latitude and decreasing sunlight geographically.

Other evidence shows those levels decrease muscle loss, falls and memory loss in the elderly.

Doctors have done a good job emphasizing calcium intake but the body cannot absorb calcium without appropriate vitamin D intake.

Its not recommended to take more that 2000 IU /day and vitamin D3 is the more active form.

10-15 minutes of sunshine on the face and arms a day along with a balanced diet is all that is needed to meet the bodies needs. I however do take a supplement with D3 and calcium in it and maybe I 'll mention that once a day that I have chosen another day.

Vitamin D may not be one of the glamour supplements but this workhorse vitamin should not be overlooked. Choose foods high in calcium and vitamin D, consider a daily supplement if you are not meeting your goals with diet.

Cancer...What is it?

I find in my dealings with my patients that they really have no clue what cancer really is.
Cancer is a loss of control of the growth cycle of a cell at the genetic level. Its a mutation in DNA. It a cell that has lost the ability to grow and mature and reproduce at a normal rate and does so at an uncontrolled rate. It's a loss of normal cell cycle control.
Every type of cancer is really a totally different disease with the common factor that the original cell type, whether its skin, lung, brain or bone, has lost the normal ability to regulate cell growth.
So when some one states " why can't we find a cure for cancer?" They are really grouping together many different diseases as a given type of cancer in general would have a different cure.
In addition cancer is a genetic disease and medical science really has discovered no way at present to change the DNA of a person back to the way it was before. Similar to other genetic diseases like muscular dystrophy or cystic fibrosis the root of the problem is a mistake in the DNA and fixing that in every cell in the body is a very daunting task.
So how does cancer cause problems for the body? In general you repalce healthy tissue and organs with cancer cells. In general cancer cells do not carry out the normal functions of the cell that they mutated from. Cancer cells can spread to different placed throught out the body and damage other organs. This process of spreading is called metastasis.
Cancer is named and categorized by what cell or tissue it mutated from and not by where it spreads to. If breast cancer spreads to the spine lung and brain its still breast cancer and not bone or brain cancer. This is important because the cells still act like breast cancer cells and not like brain or bone cancer cells.
I often have patients tell me that their family member died of lung and brain cancer. Most likely they had lung cancer that metastasized to the brain and not two separate cancers.
There are some cancers that are near totally curable. Seminoma, a cancer of the testicles that Lance Armstrong suffered from, it is exquisitely sensitive to radiation and almost no one dies from it. Additionally lumps in the testicles are often found early before the cancer spreads. Whereas pancreatic cancer is difficult to diagnose because of its location deep in the pancreas inside the abdomen often leads to a diagnose when the cancer is at an advanced stage and because its growth really is not affected by radiation and chemotherapy.
Something to think about, if you want to read more about cancer and how it spreads and how its named and treated visit http://www.cancer.gov/ and look around on their site.

78 Silver Anniversary Corvette

This is a picture of my car, A 1978 Silver Anniversary L-82, four speed Corvette that I bought in 1998, I bought it from the original owner with 5000 miles on it. It was subtly customized at that time with a fully chromed engine compartment, which is really an amazing site, removal of the smog control, removal of the catalytic converters, blow proof bell housing, changed brakes over to silicon fluid and a whole host of other upgrades.

I have added a new Weber 4 bbl carb with electric choke, I put new chrome valve covers on it recently, (yes I kept the original L-82 valve covers!!) shocks, clutch, drop out bearing ,turned the flywheel, replaced the shocks, new Eagle GT2 s all around, vintage style upgraded stereo and speakers with a new power antenna. I have put on a smoked one piece roof panel that really accents the car. I found that on E-bay.

I don't drive it often and it now has about 13,500 miles on the clock. It has never been driven in the snow or the rain.

This picture is older, I think I took it in 2002. It was taken in my side yard one fall day. At that time the tires I was running were the Goodyear Eagles that were on it when I bought the car. It came originally with Goodyear Eagle radials which are not made any longer. When I changed them recently it was due to dry rot and not due to tread wear issues. The manufacturers date on the tire said they were made in November 1983. That amazed me.

This car was a special edition to commemorate the 25th year of the Corvette, I have the original sticker, and this paint scheme, the two tone silver, was a 400 dollar option. Chevy sold over 17,000 corvettes with this paint option that year, but only about 1500 of them are the L-82 (high compression 350 engine) with the four speed transmission. All 1978 corvettes had the special commemorative badges.I am considering selling this special car, as I might just get a C-4. anyone interested drop me a line.

The 50th anniversary corvette came out in 2003. I was all excited about this and actually made plans to drive my car to the corvette factory for the unveiling ceremony for the 50th anniversary Corvette. I had dreams of a beautiful gold Corvette being unveiled for the 50th anniversary and maybe some real high performance engine options. But GM had other ideas and made the 50th anniversary Corvette nothing special, just some badges and a funky red paint. (Go figure, I read the gold paint was nixed due to quality concerns). Luckily they announced that in advance, so I didn't haul all the way to Bowling Green, Kentucky to be disappointed, I could stay home and be disappointed.

More amazing science as art

Seen here is a photo micrograph of a fungus that I found in National Geographic. It reminds me of the fractal art done by my brother-in-law . Fractals are graphic computer representations of complex mathematical formulas .

To see some examples of fractal art please visit his blog http://www.josekpaul.blogspot.com/ Look under categories on the right hand side and simply click on FRACTALS. They are truly amazing works of art.

He describes fractals as " shapes too irregular to be described by euclidean geometry, that follow certain rules such as self-similarity (ie, a smaller part of the shape will look like the whole). A lot of shapes in nature are fractal in nature (coastlines, patterns in broccoli, shape of a tree, etc.)"

I have two examples of fractal art hanging in my game room (next to the beer signs and Corvette memorabilia!!)

My brother in law is truly a talented artist and his site has examples of his sketches, watercolors and other examples of his work. I wish I was talented!!

WE are the most common cause of poor health

It never ceases to amaze or confound me how much we as human beings, seem to be unable to assume responsibility for our own health. Heart disease, cancer, infection are in a very large part controlled by how we treat our bodies.
We all gripe and complain about the high cost of medical care, medicines, hospital stays take swipes at the very quality of medical care in the United States, but I maintain that a large part of the poor quality of medical care in the United States in the highly processed, fat laden, carb laden culture that we all participate in here in our country.
We all hear about obesity, cholesterol, blood pressure, lack of exercise, and nutrition but we (and that includes me too) don't do enough to take control of our personal health. A large proportion of the patients that I talk with have no clue how to eat well. And I understand because as a single parent I often struggle to put together meals that have some form of nutrition.
I tell people, especially diabetics, that you cannot eat fast food at all. You cannot eat processed foods at all. White bread, white pasta, soda, TV dinners , microwave foods and yes even the very beef that we all love so much. Even small changes like whole grain breads and pastas makes a difference.
The less processed the better it will be for you. So get used to serving whole grain bread products and eating bread in moderation. Use whole wheat pastas. Change how you think about food. My daughter and I had turkey tacos last night.
Do away with soda as a drink in your home. It has no purpose in the human diet, Milk, real juices (in moderation) or water. Sports drinks are a myth propagated by the cola companies that have no purpose except in elite athletes in certain situations.
And then there is beef. Americans have been sold a huge line of crap when it comes to beef.
Interestingly enough beef didn't used to be all that bad for us. Then around 50 years ago the beef industry started feeding cattle corn.
Cattle are not meant to be fed corn, they are meant to eat grass. When you feed cattle corn you set off a series of actions that destroy the nutritional value of beef and destroy the environment.
First the nutritional aspect, and this is a very important point. When you feed cattle corn you change the natural omega 3 to omega 6 ratio in the beef from 20-1 to pretty much 1 to one. What does that mean? You make the meat that was full of good fats that the body needs and can't live without (omega -3 fatty acids) and tip it over to the bad fats that clog arteries, and set up a pro inflammatory environment in the body that promotes hardening of the arteries, cancer, diabetes and in general shortens the lifespan of humans.
If you haven't heard about omega 3 fatty acids you will. I could write a book on how they are good for you but suffice it to say here and now we need to increase the foods in our diets that have high omega 3 fatty acid ratios like our grandparents down on the farm. They are the good fats and are plentiful in fish and grass fed animals. That is why fish oil is proven to be so damn good for us.
Of course we used to get plenty of it in our diets. but not since corn became king.
You now see labels on food that address how much omega 3 fats are in the product, its becoming the "new cholesterol".
My patients tell me all the time that their grandparents ate beef, bacon and other red meats. OF COURSE THEY DID BUT THEY WERE FED GRASS NOT CORN!! Grass fed beef is probably better for you than corn fed chicken!
We grow more corn in the US than any country in the world. Corn is KING. Its cheap as heck to grow because farmers have switched huge tracts of land to corn and dump fertilizers on it and then get a subsidy to grow it from the US government. Technology has driven the ability to produce corn so efficiently that the price has fallen because of all the corn on the market. We then prop up the price of this corn with those government subsidies making farmers reliant on the government for survival.
We then stuff it down our cows, chickens and pigs throats, fattening them up quickly and lowering the price of production of all food, but with the long term price of destroying the health in the of all those that eat it. It's so cheap now we put it in our bread, in our juice drinks, in our sodas as High Fructose Corn Syrup.
It makes the cows so sick that we have to pump them full of antibiotics and hormones just so they will live long enough to make it to the slaughter house. Corn fed beef is a carrier of the deadly E. coli bacterium whereas grass fed beef rarely carries the deadly bacteria because they are so much healthier.
And if you think about what the growing of corn has done the the environment, we basically have taken the feeding of the cows natural food, grass, which takes sunlight and converts it to protein by nourishing a cow, and replaced that with cows fed by corn grown with petroleum based fertilizers. So instead feeding our cows sunlight we essentially now feed our cows petroleum!
Grass fed beef is more expensive, but we can pay now or we can pay it in our food budget or we can pay it in our health insurance premiums like we do now. And if the demand goes up the price will eventually come down. The same goes for corn fed chickens and the eggs they lay and all other livestock.
An excellent and very well balanced explanation of what cheap corn has done to human nutrition is well researched and documented in an unbiased way in a book called THE Omnivore's DILEMMA by Micheal Pollan. Its not an anti-meat, left wing environment tree hugging book as some might say. It's truly a fair and balanced look at how we produce food in the US and why its so damn unhealthy. It also takes a fair and balanced look at how we produce beef and other livestock in the US. But this look is all wrapped up in the fair question of "What should we eat?"
I suggest anyone who has any interest in what they put in their bodies read this book. You can get it at your local library. Here is a description of this fascinating book http://www.michaelpollan.com/omnivore.php.
I obviously cant cover this topic all right here, but i can get people thinking about eating better, and eating grass fed instead of corn fed livestock. Educate yourself on what it means.

The beauty of the human body

This amazing image is from the September issue of National Geographic. Its is actually a 3 dimensional CT scan color enhanced image of the sinuses of the human skull, through the frontal bone imaging the intricate sinuses in the human skull.

Evolutionarily it is presumed that sinuses (which are simply hollow spaces that develop in the skull bones) evolved to lighten the weight of the skull, particularly in upright walking mammals that don't have large posterior neck ligaments opposing the pull of gravity and supporting the weight of the skull, like horses or cows for instance. Humans are not born with sinus cavities but they are fully developed by about 6-9 years of age.

I often ordered CT scans of the sinus area if I suspected chronic sinus disease in a patient, which is not uncommon in the Ohio Valley with the high rates of allergy and the pollution from coal burning power plants that line the banks of the Ohio river. I ordered just a 4-6 cut quick sinus CT to decrease costs. X-rays of the sinuses are not accurate enough to be used to diagnose sinusitis.

Interestingly, acute bacterial sinusitis is believed to be grossly OVER diagnosed and treated inappropriately with antibiotics, but chronic sinusitis is believed to be UNDER diagnosed and treated with courses of antibiotics that are often too short to eliminate infection in the sinus cavities, which have relatively poor antibiotic penetration due to much less blood flow compared to other areas of the body.

Symptoms of chronic sinusitis can be some what subtle. Chronic fatigue, pain, pressure or fullness in the facial area or frank headaches, chronic postnasal drainage resulting in chronic cough, nausea or loss of appetite. Rarely fever. They are more common in those that have allergies, and after acute sinus infections that are most likely caused by viruses. When the sinuses are clogged with mucus and other materials or don't empty properly due to inflammation of the lining they are more likely to become infected by bacteria.

Treatment consists of long course antibiotics in CT scan confirmed chronic sinusitis, 21-30 days is not unusual to fully treat this condition. Short term topical decongestants are helpful. Also nasal inhaled topical steroids to calm the inflammation of the nasal area which harbors the openings to the sinuses and to treat underlying allergies if that condition exists. Lavaging or washiing out the sinuses daily with a special type of salt water you can make yourself can be done and is VERY effective way to treat recurrent sinus infections, allergies. Google "sinus lavage" for details. Most people just won't poor fluid upo thier nose no matter how great and low cost and effective it is. That's too bad.

Why I went to medical school

Its not unusual for friends and acquaintances to ask me what motivated me to become a physician. It's a question that always makes me take a deep breath. "Do I really want to go into this?" I ask myself.
It 's not an easy question because it brings up a lot of emotions that I really haven't dealt with in a long time. It's almost as if so much has happened that it is hard to tap into all the emotions that drove me to 9 years of schooling. Its such a long process and there are so many different hurdles that sometimes I forget how lucky I was to really get through it all.
I could just give a rehearsed one line answer that while somewhat informative, doesn't really invite a lot more questions.
"My father died of a heart attack, basically right in front of us at home.. and it motivated me to go to med school" I often say straight faced.
"Oh.." is the answer I most often get. "how about those Buckeyes? think they will beat Michigan this year?"
I was 16 almost 17, it was a hot summer morning near the end of my junior year in high school. Late may of 1982. I was in the shower and I heard an ungodly "BANG!" It just wasn't normal. My brother was off in the army, my sister was in her freshman year at Ohio State. So the house should have been quiet. My parents were asleep after working afternoons at their factory jobs. As if to confirm my fears I heard my mom yell "Jeff !"
I jumped out of the shower and grabbed a towel. I remember looking into my parents bedroom and seeing my father lying on the floor.
Really the next thing I remember is my father in a robe, and my mother driving like a bat out of hell to the hospital. We lived in a rural area and had no ambulance service that I can recall, and I 'm sure response times were very slow.
He lived to the hospital, and it was actually relayed to us that although he had sustained a heart attack that he would be fine. I actually went to to school for a while that day. When I went back to the hospital later that afternoon mom told me my brother Kevin was being sent home emergently on leave, and that I was to go to the bus station in downtown Youngstown to go get him. I was actually quite excited, I hadn't seen my brother for months, and to drive to go get him was kind of a big deal.
When we got back to the hospital it was after dark. We were greeted with an ominous site. The headlights of the car played across the emergency room entrance and as they did, my brother and I made out a familiar figure in the dark... my mother.
We both knew instantly even at some 50 feet away from her that our father was dead. My brother rushed to her as I parked the car a few feet away. I heard her say "He's gone" through her tears.
I truly don't remember much after that for the next 2-3 days.
I do remember going to the morgue to see my father one last time. My father was quite adamant that he did not want a funeral of any sort. He would be privately cremated and his ashes spread in his garden. the walk to the morgue seemed to take hours instead of minutes. My mother, my dads brother, Kevin and I taking what seemed an amazingly round about way to the basement, accompanied by a policeman that by the look at his face would have preferred dental work without the benefit of lidocaine. Can't blame him there.
Suddenly my father appears on a gurney with a sheet covering all but his head, I try to run to him but something is holding me back, literally. Its the policeman. The scene was just too much for my mother, uncle and brother and as I turned around they were gone. The policeman decided that I should go to. I always hated him for that.
The next thing I remember is I 'm waking up in the family van and its morning. We had driven to Columbus to get my sister, who through a strange decision on my families part, is not told that my father has passed away. It is decided that she should hear it from us.
She lived in the tower dorms that year, Lincoln tower I believe, a place I had visited several times her freshman year at OSU because I was trying to be cool and hang out with college chicks (that never worked unless you count my sister, by the way). This is a huge 20 story dorm with hundreds of college students living there. It was quite early in the morning, finals week at OSU.
I'll never forget as my sister came off the elevator and ran to hug us, her smiling face. In her reality her dad wasn't dead, she was still happy, hopeful.
Until she saw the look on our faces.
So... I was going to be the best doctor in the world, a cardiologist that never lost a patient to a heart attack. That never had to tell a family that their father was ... gone.
I wasn't that good a student. Luckily I was half intelligent. I had no clue what the journey that lay ahead of me would bring or what it was all about. I'm not sure I even comprehended the concept of 8 years of education in which I was about to partake.
But it kept me motivated throughout undergrad to work hard, and strive for the goal of admission to med school and even on through med school.
I wish I could tap into some of that naivete, the raw desire and unlimited motivation now.

WOW the Doc finally blogs!!

Well, I've thought a lot about putting my view of the world for those who cares to see but now I'll put those thoughts into action. I've been a physician for 15 years. Started out as a military Doc in Korea and Hawaii, then settled into a family practice in rural Ohio. I had my own practice for 10 years but recently sold it and am now pondering my next move. I've been all around the world and seen about everything at least once. Even though 'm still a young man at 41, I do have some time to sit and ponder the world more than most.

I have read a good bit about North Korea in the news lately.
I spent 13 months in Korea near the DMZ, '93-94. I was there when Kim Il Sung died and his crazy son took the reins. We were on alert seemingly non-stop after that because no one was sure he wouldn't just up and attack the South when he took over. He was deemed that unstable. Interestingand somewhat unnerving times because we were really considered a mere speed bump on the road to Seoul.
All military Officers in our division were required to read a history of the Korean war and I read several. It was heartbreaking to study the suffering of our troops that were urgently deployed from Hawaii and Japan in August of 1950. They were ill equipped and ill-trained for deployment and had basically been hanging out in Japan and Hawaii partying when the balloon went up.
If you want to read a tale of woe and sacrifice read about Task Force Smith that left from Hawaii as the rapid reaction force to Kim Il Sung's invasion.
I was walking around on base in Hawaii after my Korean tour one early morning and acidentally came upon a small plaque honoring Task Force Smith and was deeply moved, since I had also stood in Korea where they had landed and was acutely aware of the hardships they endured. The rolling hills of Southeast Ohio look amazingly similar to those of the Korean countryside that I often swept over while hanging out the door of a UH-60. (pilots hate when the Doc does things like that). They bring back may memories of the year in Korea and often trigger a memory of the stories in the history books of the war that raged in Korea nearly 50 years before I stepped foot there.
One interesting story I often tell of those unnerving days right after Kim Il Sung's death was that immediately after Kim Jung Il took the reins from his dad, I was in a Brigade level staff meeting and the brigade S-4 (Intel officer) briefed us on a curious finding. All military personnel in North Korea had been ordered to shave their heads. All 1.7 million or so. Interesting, but why are you telling me this we asked? Well either they are preparing for attack and the shaved heads fit much better under a gas mask, or there has been an outbreak of lice with no money in the austere budget to pay for the treatments.
I found myself in the curious position of hoping that an entire army had lice .
Well he didn't attack, as most of you are well aware but he sure did shake up the world scene. From the acquisition of nuclear weapons to the near starvation of his people, and tales of his outrageous appetite for western excesses to cross border attacks into South Korea (nothing new there really).
Here it is over a decade later and it appears that relations with South Korea and the West are truly warming. The reactors have been shut down and there are scheduled summits with the south. Now if we could get the 50 tons of fissionable uranium into safe hands.
It sure would be nice to get our forces off that peninsula and into the rotation elsewhere. There is an entire division of the US Army up near the DMZ (bout 17 000) and total US forces on the peninsula of 35,000.
I was told that every base and every building on every American military base is obligated to be simply handed over to the Koreans when we eventually leave. Billions of dollars of barracks, offices, runways, hospitals... I bet there are Korean developers just drooling over the chance to get thier hands on that real estate at a bargain price.
I think the South Koreans can take care of themselves now. We have met our commitment to protect the free Korean people and then some don't you think?
As for my sacrifice for the cause, my only daughter was born when I was stationed there, and while I was granted leave for the birth, I shipped back 3 days later and didn't see her again until she was 6 months old.
Interesting stuff , maybe next time I'll stick to medicine topics?