“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






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Portrait of Dysfunction


There's an age-old debate: Is medicine an art or is it a science? It is, of course, both. The science without the art is research; the art without the science, faith healing. I can state one thing for certain, and that is whoever takes the practice of medicine halfway seriously will be forever changed by it. The Hippocratic Oath, one of the most moving and inspiring pieces of writing ever, makes this clear. I am not the person I would have been had I not become a physician. Left to my own devices, I believe I would have turned out to be the isolated mad scientist type. The blessing of my profession is that it forces me to confront, observe and understand humanity on a daily basis. I have learned from this and (I hope) have become a better person, though I undoubtedly have a long way to go.

To be a good doctor, you have to do two things: Listen and observe. It is amazing how much you can learn from body language and from watching family dynamics. I was reminded of this basic fact this week in the split second of observation that came when I walked into an exam room to see an elderly patient.

Every primary care doctor deals with gerontology (medical care of the elderly) though most of us are not necessarily specialists in this area. In case you were wondering, gerontology is now its own specialty and requires board certification. This fuels my belief that medicine is being fractured into smaller and more senseless specialties every day, but we can go into that some other time. (Just to give you an amusing side story here... many years ago my father, a family practitioner, took the gerontology boards when this first became a recognized specialty, hoping to get grandfathered in. He did not pass. With smoke emanating from his ears, he declared this was because "the only answer they want is 'Don't give them medication'! That's bullshit!" Shortly afterwards my grandmother's doctor, a boarded gerontologist, lost his license for drug abuse. My father's response: "Can you find out what drugs he was taking? Because maybe if I take them I can pass.")

Though I am not a gerontologist I certainly see my share of the elderly. One of the saddest things I see with aging patients is the conflict which so often develops between elderly patients and their concerned children/nieces and nephews/neighbors. Frightened aging people, feeling their autonomy slipping away, will defend it with everything they have. This holds true even for the most minor details of their lives. It's as though they are going through the Terrible Twos all over again, and for a similar reason. It's all about control.

To come to the point: this week I saw a longtime patient of mine with her daughter. The patient's health has been worsening for a long time and she is not the most compliant patient. The daughter often gets frustrated with her. As I opened the door to the exam room, what I saw was the patient clutching her cane and staring straight ahead while the daughter, arms wrapped tightly around her chest, stared angrily out the window.

Sometimes that's all you need to see.

Labels: Medicine

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Oh, Dammit.

Farewell, Nero Wolfe:

Maury Chaykin Passes Away on 61st Birthday

Pfui (as Wolfe would say). He was a terrific character actor. If you watch "Eureka," on SciFi, you may remember him as the sheriff of the town in the pilot episode.

Labels: Pop Culture

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150 Angry Potential Jurors [Prequel to Twelve Angry Men]

So last week I had jury duty. Again.

I don't know what it is about Los Angeles, but they are perpetually jury hungry here. After getting hit up four times in fifteen years I have learned a lot of dodges. I always postpone jury duty as much as I can (up to six months without requiring a note from your doctor) which stretches things out a bit more; I also recommend picking a week with a national holiday in it if possible. This year I picked the third week of July because currently California has a court furlough day the third Wednesday of every month. This is because we are broke. I could go on at great length about the pack of clowns who run this state, but I will spare you that. (Except to comment that the libraries are now closed two days out of the week to save money, which infuriates me. I love to go to the library.)

As you may know, to find out if you are going to have to go to court on a given day you have to call in the night before. This flat out ruined my schedule; I had to close it for the week every day but Monday and despite my best efforts wound up seeing only five to seven people per day on the other days.

I evaded the clutches of the court for a few days, but my luck ran out when they nailed me on Thursday. I did get lucky, though; I was not called for any jury and was let out early. It was a very unproductive day. I read the newspaper and some outdated magazines (I forgot my CME journals I had meant to bring) and wandered around reading exciting stuff posted on the walls. Even the bus schedule for Culver City was an object of fascination, to say nothing of the posters of various celebrities who had done their civic duty by obeying the call of the Los Angeles Superior Court. (Sadly, neither Harrison Ford nor Edward James Olmos, both of whom apparently have done jury duty in the past, was attending that day.)

After sitting all morning, going to lunch and returning in the afternoon, an announcement was made at 2:45 that one of the cases scheduled for that day had settled without going to trial. Therefore some (not all!) of the jurors would be let go. The iron-fisted ladies running the jury program began calling names at random, and you could almost hear the prayers ascending around the room. Just as I had given up hope I heard my name called and I felt like I'd won the lottery. You never saw such a giddy bunch of people as my fellow escapees and I packed ourselves into the elevator and got the hell out of there.

I realize this isn't a very exciting story, but it's the only one I've got. After my dearth of posts I figured I might as well tell you what I've been up to.

Labels: Los Angeles, The Doctor's Life

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I'm Going to Break Down Into Gooey Stuff For a Minute


It's been awhile since I posted... since the end of vacation, in fact. Things are happening, as they tend to do, but I have just not felt like blogging. Here at The Firm we have had the Drama and the Bad Stuff. This month has been rough; I diagnosed one patient with acute leukemia and lost another to ALS (Lou Gehrig's disease). The ALS patient was only 34 years old. Last week I had another with newly diagnosed gastric cancer. Suffice to say I phoned my mom and broke down sobbing. I had to call her twice this week to reassure her that I was not ready to head off to Bellevue.

But I saw a movie this week that punched my spirits back up. You may or may not feel like seeing it, but I personally would recommend it if you are feeling sad and down.

The movie in question: Despicable Me. Yes, it's an animated feature. (Or to put it another way, a cartoon.) It ain't Pixar, but it's really good. Apparently this is Universal's first entry into the animation market, under the banner of Illumination Films. The main voice actors are Julie Andrews and Steve Carell. You've probably heard at least something about this film by now, but just to recap: Steve Carell plays Gru, a supervillain with a Russian accent, a subterranean lab in his suburban home and an army of minions. He's been at this gig for awhile and is slipping into middle age. A newer, younger, hungrier supervillain named Vector has just stolen the Great Pyramid and Gru has to fight this fellow for funding to steal the moon.

Did I mention he has been fixated on the moon, and on gaining his mother's approval, since early boyhood? This fact is neatly established in the movie by way of flashbacks to the original moon landing, which will resonate with those of us who are of a certain age. At any rate, in order to steal the shrink ray which he needs to get the moon, he has to adopt three adorable orphaned girls - the reason why will become apparent when you see the film. Suffice to say that he plans to temporarily adopt and then dump them, but quickly changes his mind and winds up becoming their adopted father.

This sounds corny, but there is more to the film than you would think from this recap. The minions are adorable, I have heard them described as "animated Twinkies." Although they look almost exactly alike, Gru clearly recognizes them as individuals and addresses them by name. Their shining moment comes during the credits and is reason enough for seeing the film in 3D - although I think 3D adds quite a bit to the whole movie. The orphan girls are played by quite good child actors and have plenty of spunk and personality. There are neat little hat tips to adult viewers throughout the film (references to The Godfather and Airplane!, not to mention a reference to a certain defunct banking firm).

But what about the acting? Well, Steve Carell does a fantastic job with Gru. He revels in the character's evilness, but also makes him sympathetic. And his relationship with the girls evolves believably, to the point where he's gnawing his nails about the conflict between stealing the moon and going to their dance recital. (What dad can't relate?) His best friend and right-hand man Dr. Nefario is played by Russell Brand, who played the rock star in Get Him To the Greek. Brand is excellent.

The little touches are also fun. To hide the pyramid, Vector puts it in his backyard and paints it sky blue with a few clouds on it. No one questions it. Agnes, the youngest orphan, has a fixation with unicorns - this joke is revisited several times in the film and is both funny and cute. And when Gru reads the girls a bedtime story... well, if you don't melt you have a colder heart than I. All I can say is, Go see this movie. I don't think you'll regret it.

Labels: Pop Culture, The Doctor's Life

posted by Dr. Alice at #