Heard in the OR

Under the Drapes

2012-02-02T16:18:00.000-08:00

Why do you do it?

Do what? Get up in the middle of the night? Rush in to the hospital to patch mangled bodies, sew holes closed, stick my finger in a dike spewing blood and, hopefully, repair what’s broken and allow some unfortunate soul to live and love another day? A good question. I could have been a pediatrician, almost became one as a matter of fact, or a plastic surgeon, but I failed the ego test. No, I had to be a general surgeon… for glory? No… for personal satisfaction? Maybe… for intellectual stimulation, perhaps… for the money, definitely not. Then…Why?

Why did I go to school for all those years? Elementary school, junior high school, senior high school, four years of college, four years of medical school, five years of residency, working a hundred hours a week. All for what? To be able to wrestle with an intoxicated man at 3 am, trying to evaluate the stab wound to his buttock or fathom why a beautiful woman would decide, in a moment of severe, devastating depression, that she didn’t like her breasts and try to cut them off? Or why a distraught father failed to check behind his car as he pulled out of his driveway, just to pick up a container of milk, and inadvertently ran over his two year old daughter?

Why do bowels perforate, aneurysms burst, appendices rupture, arteries clog, gallstones form; why does anything bad have to happen? Why do the nicest people you could ever meet develop inoperable and incurable stomach cancer; why does anyone have to get cancer? Can’t we do something to prevent it?

You ask why I do it. Can anyone answer even one of these questions or a million other, similar ones?

But, every illness, all the injuries, all the misguided thoughts and actions, every trivial, little act that we wish we could take back, every moment that should never have happened, all these things that bring us to a doctor seeking a remedy, are they reason enough? The battle against disease rages onward, fought by doctors, nurses, technicians and therapists at all hours of the day and night; most of the time the battle is won, but the war always goes on, never ending. And if it never ends, if there can be no victory, what’s the point?

Is it enough to replace the look of overwhelming fear and distress, a look I routinely see on patient’s ( and their family’s) faces, with a smile? Is the look of relief on the faces of worried family members when they are told that everything went well, that the lump was benign, that the injuries are not severe, that their son will be back on the basketball court in just a few weeks, is this enough reward?

I’ve asked myself these questions over and over again. Sometimes I have the answer; sometimes I just shake my head in bewilderment, but all the time I answer the call, do my best, and hope that those I try to help, the sick and injured, return to a normal life.

So I come to the hospital at 3 am and probe and palpate and listen and probe some more. And then, I cut and dissect and clamp and tie and cauterize and sew and resect and reanastamose and bypass and sew some more. All of this so that, in the end, a person, broken by the struggles of life in this fallen world, can have a few more moments as a complete individual.

Why do I do it? Because of what’s waiting for me under those drapes. A patient, with a name and a family, who has entrusted me with their very being. But…do I deserve such trust?

This is the first chapter of "Under the Drapes: More Mystique of Surgery", a follow up to "Behind the Mask: The Mystique of Surgery and the Surgeons Who perform Them".

Thief

2012-01-06T14:06:00.000-08:00

I have the misfortune of living in the same household as a diminutive, diabolical thief. She joined our family about four years ago, an innocent young thing, fresh off the plane from Hungary. She moved in and made herself at home right away. Of course, we cared for her, gave her food, a place to sleep, kept her sheltered from the wicked Houston heat and she flourished. It wasn’t until later that her true colors emerged.

The bandit I’m talking about is not a cat burglar or armed robber; she’s a cute, moderately (well more than moderately) overweight Norwich Terrier named Zoe. And, she doesn’t strive to steal just anything. She is only on the prowl for food, particularly dog treats. Her victims are, primarily) our three other dogs, Bonnie, Coconut and Leo (AKA Dumbo).

From the moment our little Zoe arrived she had a strong hankering for food. Despite our best efforts she grew; primarily sideways, to the robust weight of 19 pounds. The supposed ideal weight for a Norwich Terrier, the smallest of the true terriers, is 12 pounds. We have done our best to limit her eating, but, apart from her robust appetite, she also has a particular attitude towards exercise. Her motto is “No Pain, No Pain”. Her favorite activity, after eating, is curling up on the couch and snoozing. But, back to her light fingers, well jaws in this case.

Our dogs are all fed at the same time each morning, Zoe receiving about half a cup of food. In the evening, the dogs all expect a few treats. However, unlike little Zoe, who devours her few biscuits in a matter of seconds, the other dogs will often carry their stash of goodies around, sometimes “burying” them in one of the dog beds which are strategically positioned around the house. This is when Zoe goes into action. First she makes the rounds of each bed, searching for stray treats. None being found she will next try to sneak up on one of the other dogs, most often Bonnie, our Basset Hound, who is the largest dog, and gets the largest pile. Of course, Bonnie is well aware of Zoe’s tricks, but sometimes Zoe manages to sneak up and snatch a biscuit.

To accomplish her task Zoe will crouch down low and creep towards our unsuspecting Basset. Sometimes one of Bonnie’s treats is a few inches away from the rest. Often, while Bonnie is gathering her stash into her mouth, Zoe manages to slip in, grab a wayward morsel and spirit it away. The worst she has to suffer is a short sharp “Rowf” from Bonnie. And, that short bark will often cause Bonnie to drop her carefully gathered hoard and allow Zoe to grab even another treat.

Sometimes this surreptitious behavior is adequate. But sometimes Zoe is forced to be a bit more imaginative and resort to a diversion. This is where Zoe’s genius shines. A bit of background: at our house, whenever a stranger, particularly a strange dog, walks by, our dogs race out to the driveway and bark at them through the gate. Rather, three of our dogs. Zoe rarely joins the fray. However, she has learned to use such acts to her advantage. Should one of the other dogs have a particular treat that Zoe fancies, and attempts to sneak up and steal it have been unsuccessful, Zoe will head towards the back door and start to bark, thus signaling to the other three that a stranger is afoot. Defending the house trumps treats in canine minds, I guess, because those three dogs will race out to the driveway to investigate, barking and howling, leaving Zoe free to choose, at her leisure, from the treats that have been left behind. Brilliant, truly brilliant.

I’m not sure if sneakiness and dishonesty is an inbred characteristic of all Norwich Terriers, or if it is peculiar to Zoe. I do know that if we find any food missing in our house our first suspect is our short, stocky thief.

Treat the Patient

2012-01-01T15:51:00.001-08:00

It happened again. A phone call from an Emergency Center at two am requesting that a patient be admitted to my service. The ER physician explained that the patient had a small bowel obstruction, a problem commonly managed by general surgeons. I pressed the ER doctor for more history.

The patient was thirty on years old, had been sick for about twelve hours with abdominal pain, nausea, vomiting and diarrhea. The obligatory abdominal and pelvic CT Scan had been performed and the reading was “small bowel obstruction”. I asked for more details, which was almost like pulling teeth. The patient had not had previous surgery, there were no apparent hernias on exam, but the CT report was unequivocal: “dilated proximal small bowel with collapsed ileum and normal appearing colon”, the classic radiologic appearance of a small bowel obstruction.

I explained to the calling physician that, almost certainly, this patient did not have a small bowel obstruction; most likely it was acute gastroenteritis and it would likely resolve spontaneously within twenty four hours. The ER doc persisted, however, stating that the patient had an elevated white blood cell count at 21,000, there were ketones in his urine and the BUN was elevated at 28. I did agree with his diagnosis of dehydration and that the patient would benefit from admission, so that IV fluids could be administered. I saw the patient in the morning. His pain was gone, his nausea and vomiting had resolved, he still had some diarrhea, the WBC had decreased to 12,000 and the BUN was normal. I started him on a liquid diet, which he tolerated without problem and he was discharged that day without any significant sequelae. In retrospect, the patient could just as easily have been managed in the ER with an infusion of IV fluids and discharged home with medication to address his symptoms; admission being reserved only if he did not improve with such measures.

The scenario above is played out on an almost daily basis around the country. A patient is admitted to the hospital because an X-Ray or lab test suggests a certain diagnosis, even if a patient’s clinical presentation suggests something completely different. The patient above gave a pretty good history for acute gastroenteritis. It is unusual for patients without hernias or previous surgery to develop small bowel obstruction, certainly not impossible, but definitely out of the ordinary. But, the hallmark of diagnosing intestinal obstruction is the X-Ray findings. The CT Scan clearly demonstrated the classic appearance of small bowel obstruction. Sometimes, I wonder.

The clinical presentation of acute gastroenteritis is, typically, sudden onset of abdominal pain, often crampy, nausea, vomiting, malaise, fever and diarrhea. But, what happens to the bowel in such a situation. Does it become hyperactive, trying to expel some offending agent, does it stop altogether and dilate, as our body’s defenses are mobilized to attack the noxious invader causing the illness? Does the bowel contract, dilate, or does it do both; perhaps the stomach dilates, while the small bowel contracts or vice versa. I don’t know.

Common teaching about acute gastroenteritis is that it is an exclusionary diagnosis based on clinical presentation and the absence any other discernible underlying cause of the associated symptoms. General consensus is that viral infection is the etiology and it is a self limited disease, usually resolving in 2-3 days. There have not been any good studies, at least to my knowledge, that document the CT scan findings of a patient suffering from acute gastroenteritis.

These days it seems to be common practice, by some physicians at least, to treat patients solely on the X-Ray and lab findings, often ignoring the fact that there is a patient attached to those images and numbers. These doctors are guilty of ignoring clinical judgment, treating the X-Ray and not treating patients. In my mind, it is one of the cardinal sins of modern medicine.

Diagnosis and therapeutic management of a patient requires that every aspect of the patient be included in the evaluation; history, physical exam, laboratory data and imaging. Each factor is weighed against a variety of possibilities and a diagnosis is made. As I’ve written previously, (See Talking to Patients, July 10, 2010), the majority of patients will tell you what is wrong within the context of a 5-10 minute interview. All the testing that follows confirms or rules out the various conditions that appear within the differential diagnosis. The knowledge necessary to ask the proper, probing question is taught in medical school and the skill is refined during residency and post residency practice. In our modern, harried, defensive, get ‘em in and get ‘em out quick, medical world, taking the few minutes necessary to properly interview the patient may not be seen as cost effective as ordering a CT Scan.

And, if the patient winds up being treated for the wrong condition, well, the CT Scan said they had it and that’s documentation enough to provide proper coverage of one’s derriere.

The only problem with this approach is that the patient suffers. Far too often, patients are sent home because the White Blood Cell count or CT Scan is normal, or admitted to the hospital because one or another exam is abnormal. The history and physical exam may suggest a serious condition, but the imaging and lab were unremarkable. Would it be better to forego such testing and base everything on clinical impression? Certainly not. As I’ve stated previously, it is best to approach patient care utilizing all the tools available. CT scans provide a great deal of information; detailed images that help clarify a murky clinical situation and allow physicians to say it’s OK to defer surgery or, conversely, to say that surgery is absolutely necessary.

For example, a 20 year old male is minding his own business, sitting on his porch reading his Bible when “two dudes” come out of nowhere and shoot this poor unfortunate soul in the right flank. He walks into the ER complaining of pain at the site of the wounds. There are entry and exit wounds, one just medial to the right anterior axillary line and the other posterior and a bit more lateral. The physical exam is equivocal and the chest X-Ray is normal. What should be done? In this case the CT Scan provides a wealth of information. Very often the latest model scanners will provide images that demonstrate the path of the bullet and provide information regarding damage to organs in that path.

I cared for a patient with this exact scenario recently. The path of the bullet was obvious, there was an injury to the right lateral aspect of the liver and the bullet appeared to have nicked the right kidney. The only thing I couldn’t be sure about was the hepatic flexure of the colon, a devastating injury if left untreated. I decided it would be best to operate on this patient. At surgery, the findings correlated perfectly with the scan. The bullet had travelled through the liver, just missed the colon and nicked the upper pole of the right kidney. The injuries required no special repair, just leaving a drain in the area of injury, and the patient recovered uneventfully.

What about a much different, but very common presentation. A few weeks ago I was asked to admit a ten year old boy who presented with complaints of right lower quadrant abdominal pain, present for twelve hours. CT scan was done and reported as acute appendicitis. Specifically, the appendix was described as having enhancement of its wall, a sign of inflammation, and was minimally dilated to 7 mm with inflammatory changes surrounding it. The boy was admitted to the hospital and seen by me about four hours later. When I evaluated him he reported that the pain had disappeared. His exam was perfectly normal; by normal I mean I could push on his abdomen through to his back and all he did was smile at me. What to do? In this case, nothing. I observed the patient in the hospital for about 8 hours more and then sent him home with instructions to his mother to call if any symptoms recur. Most likely, he had a self limiting stomach bug that had caused the CT Scan changes.

I suppose there are some surgeons who would have operated on that patient and, perhaps the appendix even would have been abnormal when examined by the pathologist. I have to believe, however, that it is always best to remember that radiologic images are only shadows, lab results are mere numbers and there is a live patient that comes with both.

Medical Terms

2011-12-11T12:55:00.000-08:00

Antiseptic: the woman married to Uncle Septic

X-Ray: pornographic picture

Cine X-Ray: pornographic movie

CAT Scan: Imaging a patient by running a feline over their body

PET Scan: Similar to CAT Scan, except a variety of animals may be used

Perirectal: in and around a lizard or snake

Clamp: a pain in your side that develops while exercising

Ultrasound: a noise that can only be heard by dogs

Operation: A children’s game that asks the contestant to remove the “wishbone”, “spare ribs”, etc.

ICU: looking at someone

Surgeon: a large fresh water fish

Tumor: one less than three more

Carcinoma: Short for leaving one’s automobile in Omaha

Cervical: a British nobleman named “Vic” for short

Thyroid: a hemorrhoid on the upper leg

Appendix: a program for I-Phone

Kidney: part of a child’s leg

Rectum: stopping short of killin’ em

Resect: have intercourse again

Anal: to dissolve a marriage

Duct: feathered, web footed water fowl

Spinal Cord: a collection of musical notes

Lung: reaching for an object

Lymphatic: physically dependent on tree branches

Hypoglossal: not very shiny

Vagus: not very definite

Peritoneal: Two Irish brothers

Gastric: a joke performed with flatus

Parathyroid: two hemorrhoids on an upper leg

Bile Duct: to purchase a feathered web footed water fowl

Bunion: an onion roll

Metacarpal: to encounter a scavenging fish while swimming

Humerus: funny

Feel free to add to the list

Celebrity, Inc.

2011-11-02T16:26:00.000-07:00

I sat in the waiting room clutching my portfolio waiting for my name to be called. This is it, my big chance, I thought. All those years of hard work were about to pay off.

“Ethel McDuff”, cried the receptionist, her voice betraying just a hint of contempt. A tall, thin young woman, with a face like a turkey stood up and approached her desk.

“I’m Miss McDuff”, the woman exclaimed, a bit breathlessly.

“What is it you want to be famous for?” the receptionist queried, looking a bit bored.

“Supermodel”, Miss Mcduff answered. “Here’s my portfolio. Also, here’s my sex tape and police reports detailing the terrible abuse I suffered as a child. The sex tape appeared all over the Internet. Her are links to blogs expressing my outrage that something that should have remained private was so shamelessly spread over the web without my permission.”

“Uh huh”, the receptionist responded.

“And, you can see from these police reports what shameful abuse I suffered at the hands of my high school Physics teacher. Why, there’s no question I’m scarred for life. And, my parents divorced when I was seventeen. Surely, coming from a broken home, suffering such abuse and then the final humiliation of having my private moments smeared across the Internet qualify me for celebrity status.”

“Go right into Room 22, Miss Mcduff. Mr. Qwan, our modeling coach is waiting for you.”

I watched her walk out and down the hall; shoulders slouched, head bobbing up and down, her backside sticking out a bit too far. All she could model would be a Thanksgiving day turkey, went through my head. I pictured her covered in feathers, making turkey noises.

“Allen Brown” The sound of my name brought me back to reality.

I grabbed my recordings and sheets of music and approached the desk.

“What do you do?” The receptionist asked, still looking bored.

“I write music, all types of music and I play the violin. I have discs with all thirty of the symphonies I’ve written, each performed by a major symphony orchestra. The last, Symphony Number 30 was performed by the Philadelphia Orchestra last year. And here is the Met’s presentation of my opera, “The Minotaur Revisited”. It played to sold out houses for its entire run. Oh, and I have over fifty concertos and I’ve scored three Broadway musicals and Eight movies.”

“How old are you, Mr. Black?”

“Twenty two, and the name is Brown.”

“Any scandal in your life? Were you abused as a child, come from a broken home, suffer a life threatening illness as a teenager from which you miraculously recovered? Have you ever sailed around the world solo in only a dinghy or climbed Mt. Everest without an oxygen tank? Were you a sports star, perhaps you broke your neck playing football and were paralyzed from the neck down and learned to play your violin with only your lips?”

“I’m sorry Ma’am, I haven’t done any of those things. All I’ve done is write and play music, since I was two. See this Concerto, I wrote it when I was three. I did get straight A’s in school and I was the youngest winner of the Vienna Violin Competition.”

“Boring…nothing of any notoriety.”

“Should I make a sex tape?”

“Sex tapes only work for girls unless you make one with another guy and appear victimized, or if you’ve changed your gender. Even then, it’s a hard sell. I’m sorry Mr. Blue, I don’t see anything here that qualifies you to be a celebrity. Have a nice day.”

A bit of an exaggeration; you decide.

Haunted Houses

2011-10-09T15:37:00.000-07:00

It’s that time of the year again; the time for witches and ghosts and other creepy things that come out top frighten us at night. In recent years, Haunted Houses have become big attractions. Scarier and scarier effects, live actors and actresses made up in ghastly displays, multiple themes are all created to make us scream, cringe and soil our underwear.

I have to admit that I’ve only been to a few haunted houses over the years and these have been at commercial theme parks. The Haunted House at Disney World is a tame, whimsical ride that barely calls for a peep of fear; the one at Universal Studios is a bit more frightening, but still pretty innocuous. One thing that almost all commercial haunted houses share is the certainty that, no matter what may seem to be happening, the visitor will, physically at least, be left unharmed.

But, suppose this wasn’t the case? Suppose the evil characters were allowed to touch their hapless prey. I believe there is one haunted house in New York that requires its patrons to sign a release which specifically allows physical contact. Certainly, such contact, even if relatively benign, considerably heighten the scare factor. But, suppose it is taken a step beyond mere incidental touching. Suppose, the character was allowed to accost his “guest” and cart him or her away. Allow Vampires to grab the unsuspecting soul about the neck and pretend to drink his blood; faux mass murderers could throw their victims onto a table while a buzz saw hovering overhead descends ever so close to their uncontrollably quivering torso. Scenarios like these and others would be overnight smashes. People looking for the extreme fright would line up days in advance for such an opportunity.

What about taking it all a step farther? Introduce the real possibility of physical harm. Not for customer; perhaps one out of every thousand or so visitors would actually be attacked and have to to fight off Leatherface’s chainsaw or battle ghoulish Zombies or face the consequences. Let’s have a random client be locked in a room overrun with live rats and scorpions and snakes and then have the room gradually shrink in size until our poor visitor is buried beneath a mountain of deadly vermin and reduced to shaking bowl of jello. That would be a real scare and well worth the price of admission. I’m sure there would be endless self described macho men who would go through the house over and over, just to have the opportunity to show their stuff.

What about going even beyond? Instead of bored, out of work actors pretending to be monsters, psychopaths and villains, employ the real thing. When I was in medical school I spent at day at the state psychiatric hospital and I can attest that the patients there were beyond bizarre and I wasn’t even allowed to venture near the high security ward for the criminally insane. Let’s give those inmates a meaningful job, doing what they do best. Instead of a fake ax murderer chained to a wall brandishing a rubber ax, bring in the real thing and, just for screams, let him loose every thirty minutes or so. The pyromaniac behind bars? Give him or her some real fire to play with. Hannibal the Cannibal? Keep him locked away, but every so often give him a knife and fork, open the bars to his cell and let him provide the smug visitor with a truly worthwhile and cleansing scare.

You, dear reader, may think all this far too extreme, but in this day and age, where we read about murders and arson and violent assault on a regular basis, where such evil is all around us, on television, our computers, in our schools and workplaces, it is necessary to push the envelope if one wants to be a success in the fright business. And if someone ends up injured or worse, there are always a gaggle of lawyers ready and waiting to step in.

Now that’s really scary.

Looking Cool

2011-10-01T13:35:00.000-07:00

When I was in medical school, during my surgical clerkship, I was introduced to a large number of surgeons from a variety of different specialties. I always found the actual surgery to be fascinating, which is one reason I decided to specialize in this area. But, I also was fascinated by the surgeons. They all seemed so confident and comfortable in the operating room, like they were born to be there. In those early years, I also noticed that there were certain things that the surgeons did that looked “cool”. I distinctly remember being impressed by one surgeon’s ability to orient a needle exactly how he wanted it by manipulating it with only the needle holder. To my neophyte eyes this was the ultimate cool; recently I started thinking, again, about what it takes to look “cool” in the OR.

The cool OR façade begins with appearance; properly styled, slightly form fitting scrubs, preferably monogrammed or inscribed with the individual’s logo, are a must. Designer scrubs are most cool for women. Scrubs that are too tight or too loose are a no-no. Scrub bottoms that are pulled too high or hang too low are definitely uncool. Even slightly different colored tops and bottoms disqualify the wearer from membership in the cool surgeon fraternity. Men should sport surgical caps jauntily worn slightly to the side. Bouffant style head covering is not acceptable for male surgeons, which leaves me among the uncool. Women may wear the bouffant style, but custom designed ones are required. There are no requisite shoes to be amongst the cool, although clogs tend towards being cool.

The real test of coolness comes during the operation. The aforementioned ability to manipulate a needle without holding it is still way cool. Holding multiple instruments on one hand is also considered essential cool. This skill involves putting your ring finger through ringed handle of scissors and/or clamps and flipping them back out of the way while operating with a different instrument. One instrument on the ring ringer qualifies for mild coolness, two brings the surgeon to the intermediate level, three raises him or her to expert and four means membership in the exclusive “superstar” club. Of course, any fumbling at any time, no matter how many instruments are involved, demotes the surgeon to complete uncool status. Similarly, attempting to manipulate the needle sans hands, being unsuccessful and then having to use fingers to adjust it also is very uncool. As a resident, one particular attending repeatedly tried to teach me to hold instruments on my ring finger instead of putting them down, which was my preference. He wasn’t really trying to teach me to be cool, he ws trying to teach me to avoid wasted motion. I never really mastered this skill; I still put the instruments down when I’m not using them and exchange them as necessary. I guess I’m still making unnecessary wasted movements. I don’t think my patients have suffered because of this deficiency.

Music played in the OR also can be a major contributor to achieving the proper state of coolness. Heavy Metal Rock and Roll played at over 100 decibels is supposed to be cool, while country western is not far behind. Listening to Swiss yodeling, classical music (my preference) or no music is not cool and also relegates me to the uncool category.

Being cool in the OR has the potential for all sorts of benefits. Having one’s choice of surgical techs and nurses is one perk. Being forgiven rude or ill tempered behavior also seems to be the province of the “cool” surgeon. Charming the OR scheduler to get a favorable start time for surgery also comes much easier to the coolest surgeons.

After thinking about all this coolness I realize that nothing I do fits into the aforementioned cool category. But, there are some things that surgeons do that are really, really, really cool. Treating the surgical staff with the greatest respect, being attentive to the worries and needs of the patient before, during and after surgery and making their families fully aware of what has or may transpire throughout the course of surgery; all these are the true epitome of coolness.

Throwing instruments, belittling and berating staff, ignoring patients and their family’s questions and concerns are definitely uncool. The coolest surgeons put patient first, do what’s right whether it’s the middle of the day or 2:00 am. Doing the right operation, at the right time and staying on top of any bumps in the surgical journey is what’s truly cool. All the rest is empty window dressing.

However, being able to flip the needle around with just the needle holder still looks pretty cool.

Sign Out

2011-09-08T17:47:00.000-07:00

Weekend sign out between Dr. Venable, who will be covering for Dr. Fresh over the weekend:

Dr Fresh, a young surgeon, who finished residency one month ago and came to work for General Hospital with a salary guarantee of $300,000/yr.: “Thanks you so much for covering for me this week end, Dr. Venable, my husband made plans to take me shopping and I don’t want to disappoint him and my nanny is off on Sunday, so I need to stay home with my daughter.”

Dr. Venable, a surgeon in his sixties who came to General Hospital 30 years ago and started in private practice with only his congenial smile, two hands and $2500 in the bank: “I’m happy to do it, Louise; I have to stay around anyway, to check on Mr. B. I did an esophagectomy today and he’s a bit frail. I want to make sure he’s OK.”

Dr. Fresh: “I’m surprised you still do big operations like that. I usually call the Foregut Surgeon to do such cases.”

Dr. Venable: “Well, I’ve always done them and I can’t remember having any serious problems, so I see no reason to quit. How many patients do you have in house?”

Dr. Fresh: “Only four, so it shouldn’t be too much work for you. First is Mrs. G. She had a mastectomy and is doing fine. Took me a while to do the surgery, however.”

Dr. Venable: “Big tumor?”

Dr. Fresh: “Not really, but I had never done a mastectomy before, so it took a bit of time, feeling my way around the anatomy.”

Dr. Venable: “You could have called me for help, I’m happy to assist.”

Dr. Fresh: “You’re right, I should have called you. Anyway, next is Mr. P; he had a colectomy ten days ago. He had a bit of fever today, 102 and is a little tachycardic, but otherwise he’s OK. Dr. Bug from Infectious Disease is supposed to see him today.”

Dr. Venable: “Ten days post op, do you think he’s leaked his anastamosis? Is he very tender when you examine him, is he eating, having BM’s?”

Dr. Fresh: “He was fine yesterday. I only saw him briefly today. I noticed the fever, that’s why I called Dr. Bug. He’ll sort it out; that’s what he gets paid for. In 312 is a young guy, Mr. X. I saw him in the ER with belly pain. His work up is in progress, CT Scan, Ultrasound, MRI. Results should be available tomorrow; just do whatever’s appropriate. He doesn’t have insurance anyway.”

Dr. Venable: “Oh, yes, his PCP asked me to take a quick look at him. I stopped and chatted for a few minutes and felt his belly. He said he’s had pain for three days and is pretty tender in his right lower quadrant. Probably has appendicitis.”

Dr. Fresh: “Can you take care of him? I need to get ready for this weekend and I don’t want to disappoint my husband. I’ve been so busy; I haven’t seen him all week. My last patient is in the ICU, Mrs. Q. I admitted her last night. She was in an MVA, has a few fractured ribs and CT showed a small splenic laceration. She’s stable, however. But, if you think she needs surgery please call me. She’s the wife of Mr. Q, who’s on the Board of Trustees, but I think she’ll be fine; her last hemoglobin was 9.5, only down one gram from the previous one, but her vital signs are stable.”

Dr. Venable: “Certainly, I’ll take good care of all your folks. Say hello to your husband for me.”

He smiled at her and patted her on the back, but as she walked away he shook his head and then turned to take the elevator to the third floor to see Mr. P.

The above scenario is only slightly exaggerated. I asked several physicians and nurses if they perceived any differences between younger physicians and older ones. Although there are many exceptions, the general consensus was that younger doctors are more likely to spend less time on history and physical exam, depend more on imaging and lab studies to establish a proper diagnosis, and be more concerned with lifestyle and financial benefits. The reason for these differences, in my opinion, traces back to the limitations that were placed on residency programs in the late 1980’s and early1990’s.

It seems that, at least in surgery, the physicians coming out of residency have had less opportunity for responsibility, less experience and more limited operative caseload. It may be as one older Ob-Gyn said to me:

“The young physicians say that ‘being a doctor is what I do’; older ones are more likely to say ‘being a doctor is what I am.”

Think about the difference.

National Moon Day

2011-09-04T17:20:00.000-07:00

It is obvious to me that this great country of ours is in dire straits. Mired in an economic quagmire, the national debt spiraling out of control, gridlock in Congress and a President who doesn’t seem to realize that he can’t will a recovery by wishful thinking, it’s time for the people of this great nation to make ourselves heard and seen. It’s time for all of us to go to Washington DC and let our elected officials know just what we think. It’s time for a National Moon Day.

What is a National Moon Day? I’m glad you asked. It’s to be a day set aside, almost holy; a day when every man, woman, child, toddler, infant, dog, cat, bird, mouse and rat (excepting those already ensconced in the Capitol building) will descend upon our nation’s capital city, gather together on the National Mall, peacefully, but with steely determination; a day to show our government leaders that we are serious and mean business. Then at precisely 1:00 pm, a nice round number, this great mass of humanity will, in unison, give a collective Bronx cheer, lasting for one minute. Then, on cue, everyone present will pivot 180 degrees, face the Washington Monument and simultaneously drop their drawers and “Moon” the Capitol and our Congressmen. The mooning will last twenty seconds and then everyone will disperse.

Such an act of complete meaninglessness and stupidity will send a powerful message to our elected officials, a message that we are tired and frustrated. It’s time the people of this still great nation were heard and seen. And it doesn’t matter if a Democrat, Republican, Tea Partyer, Independent, Liberal or Conservative is shocked or offended. They’re all to blame and they’re all worthy of our wrath.

The date for this great event is October 13, 2011, coinciding with the full moon. The demonstration is limited to those actions noted above. Any speech making will be prohibited; no obscene gestures, no profanity, no “Full Monty’s”, no alcoholic beverages or illegal drugs and no smoking will be allowed.

So be a part of a movement, mark the date on your calendar and show our elected officials that we’re ready to bend over and stand up to them with this one really idiotic gesture and, come Election Day, back up your bottom with your vote.

REMEMBER OCTOBER 13, 2011 NATIONAL MOON DAY

PASS IT ON!!!

I Have Seen the Future

2011-09-02T18:57:00.000-07:00

The last four days have provided a sharp glimpse into the future that awaits those of us in the health care profession, physicians in particular. Over the last few years physicians have been burdened with mountains of paperwork, most of which contributes little to patient care, while taking away time that could be better utilized caring for our patients. (See my blog, http://heardintheor.blogspot.com,“Form Police”, January 15, 2011). However, the last four days have demonstrated that the administrative load that has encumbered us is now becoming a hindrance to proper patient care. The next few paragraphs detail actual events, each happening at the same hospital over a four day period.

Four days ago, while making my standard visit to my patient in the pre-op holding area, one of the nurses informed me that, per the Surgical Care Improvement Program (SCIP), my patient needed to receive different antibiotics than the one I had ordered. The patient was to undergo a laparoscopic biopsy of a retroperitoneal lymph node, with the possibility that she may require an open surgery, which would necessitate a much larger incision in her abdomen. Laparoscopic surgery is done with very small incisions, working through small cannulas, the operative field displayed on a high resolution monitor. The antibiotic I had ordered was Cefazolin, perfectly appropriate for the scheduled operation. The nurse informed me that, because there was the possibility the operation could be converted to open, she also had to receive Metronidazole in addition to the Cefazolin. I told her that the particular antibiotics she was insisting be administered were indicated if the patient was undergoing colo-rectal surgery, but all that was needed in this particular case was the Cefazolin. She replied that she was following the SCIP protocol and she would get in trouble if I didn’t order the Metronidazole. Not wanting to argue with the SCIP police, I ordered the additional antibiotic.

That same day I was to perform a major surgery on an elderly lady who had a large tumor in her abdomen; a tumor the size of a volleyball. The preoperative evaluation suggested that it could have been a large cyst that, perhaps, could have been removed laparoscopically. However, when I reviewed her CT Scans (X-Rays) just prior to surgery I was very doubtful that the surgery could be properly performed without a regular incision. I informed the OR crew that I would take a look with the laparoscope, but that almost certainly the surgery would be open and to be prepared. The surgical tech and circulating nurse did everything correctly, having both laparoscopic and open instruments opened and counted from the start of the operation. A quick look with the scope confirmed my suspicions and the surgery proceeded through an eight inch upper abdominal incision and the tumor, which was arising from her stomach, was removed, along with about ¾ of her stomach. As the surgery neared its completion I was informed that policy mandated that an X-Ray be done. I asked the reason why and was told that because we had converted from laparoscopic to open surgery, an X-Ray was required to confirm that no sponges or instruments had been left inside. I tried to explain that we had more or less planned to open the patient with a regular incision and all the instruments and sponges had been counted. The response was that it was corporate policy and I had no choice. The patient remained under anesthesia for an additional twenty minutes while the unremarkable X-Ray was obtained.

As this particularly surgery neared completion I informed the circulating nurse that I thought this elderly patient would need monitoring during the immediate post operative period and I requested that she go to the Intermediate Care Unit, which is a step below Intensive Care. A few minutes later I was informed that my request would require approval by the Case Manager, a nurse employed by the hospital whose primary job is to facilitate smooth transitions for patients preparing to leave the hospital. I asked what would happen if the Case Manager denied my request. No one had an answer; luckily, the patient apparently met the criteria for IMCU monitoring. Such criteria is a closely guarded secret, privy only to those that have been accepted into the Secret Fraternal Order of Case Managers (not really, although it often seems that way).

Two nights later I was on call for the Emergency Room. I received a call at about 10:30 pm from the ER physician requesting that I immediately come to the ER to attend to a Level I (most severe) trauma that had just arrived. He took the time to explain that the trauma was a BB gun shot to the shoulder area and that a Chest X-Ray had already been done which was normal except for the BB which could be seen overlying the right clavicle (collarbone). He added that there was a small amount of swelling over the area the BB had penetrated, but otherwise everything was normal. My logical response was “Why do I need to come in to see a patient who obviously can be discharged home with an ice pack, po antibiotics and pain med?” I was told by the nurse in charge that once a patient has been declared a “Level I” trauma I was mandated to see the patient within 30 minutes and only I, as the trauma surgeon on call, could make the decision to downgrade the trauma level. The trauma protocol clearly states that all penetrating wounds to the thorax be classified as “Level I”. The fact that this particular patient did not have a penetrating injury to his thorax was deemed irrelevant by the nurse who made the decision. The fact that the ER physician had evaluated the patient and determined that there was no significant injury was also deemed immaterial. I did get to meet a very pleasant family who were happy to be reassured that their son had not suffered any serious injury.

The final incident happened the following morning. A 13 y-o boy was admitted at about 5:00 am with an uncomplicated appendicitis. The OR was busy at that time, so the boy was scheduled for surgery later that morning, around 11:00 am. I saw the patient about an hour before surgery and, during my evaluation noticed that IV fluids were not being administered. I asked the nurse why and she informed me that pharmacy had not sent her the proper fluids. The fluid ordered was Lactated Ringers, one of the most commonly utilized IV solutions in the hospital. The nurse stated that they did have that particular fluid on the floor, but policy was that pediatric patients had to receive their IV fluids from 500cc bags and they only had 1000cc bags on their unit. This makes perfect sense if the pediatric patient is a baby, but this patient was an adult sized adolescent. He had been in the ER for several hours, had been on that particular unit for five hours and had eaten very little the previous day. All this made for a significantly dehydrated patient; one who was to be going to surgery a short while later. The nurse informed me that she was not allowed to go against policy. I asked her if she had considered calling me to inform me of the dilemma, but she hadn’t. She had been on the phone with pharmacy half a dozen times, but they still wouldn’t send her the proper 500cc bags of Lactated Ringer’s solution. Eventually, the boy received the fluid as ordered and he underwent an uneventful laparoscopic appendectomy.

These five scenarios have a common thread. They all illustrate that rigid adherence to written policy can be detrimental to our patients. As best as I can determine none of these five patients actually suffered or had any morbidity; but in none of these instances did the policy enhance the patient’s care or contribute to an improved outcome.

In each instance, however, there was real potential for injury. Administering unnecessary antibiotics opens the door to potential side effects, some of which can occur after only a single dose. Disruption of normal, symbiotic bacteria by the administration of antibiotics can cause transient diarrhea or severe colitis, while allergic reactions are always unpredictable. And, of course, the whole purpose of the SCIP program is to administer appropriate antibiotics in the appropriate manner. Yet, here is an example of the SCIP administrators, who are not physicians, insisting on inappropriate antibiotics. Every surgeon learns, as part of their training, the proper way to administer prophylactic antibiotics, which medication to order for which procedure and for what duration. But, surgeons also understand that there are often situations where deviation from the usual regimen is not only allowable, it may be vital and life saving.

The requirement that an X-Ray be obtained if a planned laparoscopic surgery converts to open is certainly reasonable. Very often, the conversion needs to be done expeditiously and there may not be time to count instruments and sponges properly. However, if such a conversion is planned and all the usual operating room procedures have been followed and the ending sponge, needle and instrument counts are correct, the immediate post operative X-Ray is a needless waste of time and money, besides requiring the patient to remain under anesthesia for an additional 20-30 minutes. It is usually in the patient’s best interest to perform operations with as little wasted time as possible. I believe the policy, which was written by corporate attorneys, not physicians, is correct; the administration of this policy, in this instance, was not.

The necessity of seeking the approval of Case Management for post operative monitoring is simply wrong. The surgeon best knows what occurred during the procedure and the co-morbidities the patient may have. The need for ICU or IMCU monitoring should be a decision left only to the physicians caring for that patient.

The patient with the BB to the clavicle was a case of bureaucratic overkill. Trauma is an area where adherence to certain protocols has been proven to improve survival. The first hour, the so called “Golden Hour”, is an important time of resuscitation and evaluation of the critically injured patient. However, in this situation it was obvious to everyone involved that the injury suffered was minor. Such strict adherence to protocol didn’t harm the patient and was only an inconvenience to me, as I needlessly come into the hospital late at night. However, in this particular hospital there are only three General Surgeons taking call, often we are being called all night. Unnecessarily calling one of us does put a strain on system that is already overtaxed. Such stress, theoretically, could lead to poor performance by the on call surgeon.

Finally, the last case; the failure to administer ordered IV fluids. Of all these events, this is the one with the most potential for harm. The patient with appendicitis often has had poor oral intake for the duration of their illness, usually 1-3 days and thus may be dehydrated. In addition, intra-abdominal inflammatory processes often result in significant body fluid shifts into the area of inflammation. Adequate fluid resuscitation is one of the first things a medical student learns. Withholding IV fluids because the right bag wasn’t available caused this necessary surgery to be delayed; waiting for the patient to be adequately hydrated. The appendix in this case was very inflamed, about to rupture. The nurse should have informed me or her superior of the difficulty she was having with pharmacy so that the situation could have been remedied in a timely manner.

All the protocols and policies that are developed are supposedly designed to help optimize patient care and improve outcomes. At what point is this goal lost? Starting in medical school physicians are taught that every patient is an individual; residents, no matter what their specialty, are taught to approach each patient with a fresh perspective and treat that individual’s unique problems with a therapeutic plan designed specifically for that individual.

Cookbook medicine, inflexibility and strict adherence to sometimes arbitrary rules developed by administrators and lawyers are destined to clash with the individuality that is inherent to a physician’s approach to their patients and the provision of what we doctors hope is high quality patient care. Physicians study textbooks during medical school and residency; one of the main things we learn from these books is that the majority of our patients are not textbook cases. Why should those individuals that are trying to formulate policy and protocol assume otherwise?

Why have all these rules and regulations been developed? What has happened in the medical profession that has caused government, insurance companies and hospital administrators to be compelled to draw up an ever growing mountain of rules, protocols, policies and forms that are heaped upon the shoulders of doctors and nurses, thus weighing us down and ultimately interfering with the quality patient care they are trying to deliver? I don’t have all the answers, but I believe there is a perception among non medical professionals that the health care system has let them down. The study done years ago, which was widely trumpeted by the media, that there were thousands of deaths caused by medical errors, fueled this drive towards creating a standardized approach to medicine. But, of all professions, medicine is the one that least lends itself to such an approach. The human body is a remarkable creation, able to withstand unimaginable insults and attacks. Sometimes, however, the body breaks and a doctor is called to evaluate, diagnose and treat the ailment. This is where the art of medicine comes into play. And it is an art; a combination of knowledge, judgment, experience, insight and, sometimes, a bit of intuition. To try to create a cut and dried recipe for every conceivable clinical situation will lead to mediocrity and less than acceptable outcomes.

Should doctors be allowed to run wild? Certainly not. It is the responsibility of our medical schools and residency programs to teach and train the physicians of tomorrow to be informed, conscientious, and diligent; always putting the needs of the patient first. Students who fail to measure up should be steered into areas where their particular aptitude is best suited. Students who are perceived by the teaching faculty to be lacking the proper skills to be a quality physician should be directed into other fields. Once finished and out in the real world doctors always need to keep the patient’s needs in sight. At the same time our health care administrators need to allow doctors to practice unencumbered and, if a physician persistently performs in a substandard manner, corrective measures should be instituted.

This brings us back to the problem at hand. Rigid regulation, as I have attempted to demonstrate, can become detrimental to patient care. Every aspect of health care should be directed towards optimizing patient care and improving outcomes. Clinical guidelines may be helpful, but it must be remembered that they are guidelines only. Doctors now are forced to follow an ever growing list of rules and protocols which have never been shown to improve patient outcomes, but do carry the potential to be a detriment to patient care. Nurses are threatened with a variety of sanctions if they deviate from these protocols; protocols that have never been adequately explained, the rationale for each protocol remaining a mystery to many of these nurses. Indeed, I have been to meetings where the administrators who formulated these policies have demonstrated that they are totally clueless as to the reasons each protocol was established in the first place. Provisions in the Affordable Care Act call for the creation of more protocols and policy, attempting to standardize health care delivery. Such a plan can only be successful when humans are built in the same way we build cars and computers, everyone the same and with identical, interchangeable parts. I don’t see this happening anytime in the near future; in fact I hope it never happens. (see Brave New World, Aldous Huxley).

The United States has long been cited as having the best healthcare system in the world. It is the doctors and nurses who deliver this care that built this great system. Let them do what they have been trained to do.

A Simple Solution

2011-08-06T19:20:00.000-07:00

The rising national debt is on everyone’s mind and lips these days. The recent fight over the debt ceiling, the downgrading of the United States Government’s credit ratings, and political rhetoric from both Democrats and Republicans all point to an impending crisis that looms in the months and years to come. It’s not time to point fingers or attempt to lay blame on any individual or political party. The truth is that every one of the 545 government leaders is to blame (1 President, 435 Congressmen, 9 Supreme Court Justices). They make the laws, they do the spending, they should be able to fix the problems they create. It has become painfully obvious that such a fix, left to the politicians, will never come. It’s time for the people of this great country to take matters into their own hands and remedy this potentially disastrous situation.

First, however, let’s look at a few numbers. The current National Debt stands at about $14.5 trillion dollars or about $47,000 for each man, woman and child in this country. It increases by an average of $3.95 billion each day. Insurmountable, one may say; it can never be fixed; it’s too overwhelming. But, now is not the time for despair. There’s a very simple solution. Just think about it. When you were in school, elementary, middle school or high school and you needed to raise funds for a trip or new uniforms, your group would hold a fund raiser. A bake sale or car wash; candy or cookies sold to coworkers, gift wrap or such sold to willing family members all generated adequate revenue to send Little Johnny to New York to perform with the orchestra, or Suzy to the National Junior Tennis Championship. Why can’t our elected officials apply this tried and true method to raise the capital needed to balance the budget?

But, the deficits too high, they may whine; or we don’t have the time, they say. Nonsense. It’s time our elected officials took responsibility for the fiasco they’ve created. Donating a few hours on a Saturday afternoon isn’t too much to ask of Mr. Boehner when the fate of the nation is at stake. Let’s look at the numbers. There are an estimated 247 million vehicles in this country. Mandatory federal carwashes, held monthly and asking a donation of $6 per car would generate almost $1.5 billion per month or $18 billion/year. Just scratching the surface? Perhaps, but consider this. Every minute that Al Franken is buffing a 1967 Mustang is one less minute that he is in the Senate chambers, dreaming up ways to spend our hard earned money. And, at least we would be getting something more than hot air from those individuals that are supposed to be representing us. Of course, the hot air that they generate would go a long way towards drying off some of those vehicles.

Then there are paper drives. The amount of useless paper generated in Washington DC must measure hundreds of tons. Just the healthcare reform bill alone could pay down our debt significantly. Take all that useless paper and recycle it; entire forests would be saved and billions more dollars could be earmarked for debt reduction.

What else? There’s always the ubiquitous bake sale. Let’s send Nancy Pelosi into the kitchen to bake some strawberry tarts; I hear that Chief Justice Roberts makes a mean chocolate chip cookie. Who could resist buying apple pie from President Obama? I suspect that a national bake sales, held bimonthly could generate another $10 billion annually. What about selling government memorabilia or renting out space in the White House or House of Representatives. Bill Clinton had the right idea when he allowed supporters sleep in the Lincoln bedroom. I say, make it a weekly event.

“Sleep at the White House, have breakfast with the First Lady, only $10,000/night”. I think the calendar would be full months, if not years in advance. Want to go jogging with the President? For the sum of only $5,000 you can have his ear for two or three miles. Breakfast with Harry Reid? Yours for $2000.

Too little, too late? Perhaps, but it would be a start. And, it would instill a work ethic and a sense of camaraderie in our politicians that is badly needed. I say, let’s give it a try. And, if our elected officials resist; if they say it’s beneath them and not dignified; then I say it’s time to send them home and elect men and women that are willing to roll up their sleeves and be serious about fixing the problems that our past and present politicians have created.

Food Demons

2011-07-11T15:39:00.000-07:00

My name is Father Runyon; you probably never heard of me, but in the supernatural world my name strikes terror into a legion of demons that devote their time and energy to terrorizing the unsuspecting, natural world around us. Who are these demons? What do they do? They enter our homes and take over our food, bringing their evil into our kitchens, restaurants and eventually into our bodies. That’s where I come in. The bread that refuses to rise, cookies that burn without the slightest provocation, spicy food that’s bland, bland food that’s spicy; all these and so many more are the results of this vicious cadre of food demons.

Of course my services are not nearly as famous as some other priests; those who cast out demons from possessed individuals, rare events that are overly publicized. Food possession occurs on a daily, no, hourly basis and my phone never stops ringing, my e-mail overflows and I can’t keep up with the texts. I have hundreds of thousands of followers on Twitter and my Facebook fans number in the millions; all grateful and faithful recipients of my unique talent.

By this time you must be asking yourself, “Father Runyon, how do you perform these miraculous tasks? I never knew our food could be so dangerous.”

Well, it’s time to face up to the truth. Let me give you an example: Aerosol Whipped Cream; harmless, tasty, visually appealing. But, let one of these cruel and unrelenting devils penetrate the metallic can and, literally, all Hell can break loose. Just imagine a hot fudge sundae: Ben and Jerry’s Chocolate Chip Cookie Dough ice cream, a generous dollop of Hershey’s Hot Fudge and then, to top it off, Extra Creamy Reddi Whip. You spritz it on and plan to sit down and indulge in this most decadent dessert, but the Reddi Whip refuses to stop, it just keeps coming and coming, overflowing the bowl, spilling out onto the table and then to the floor. Still it keeps coming, a relentless blob engulfing everything in its path. You and your family run screaming from the house as Reddi Ship pours from the windows and doors. Then you remember Rusty, your dachshund, trapped in his pen, undoubtedly drowned or crushed by this white, creamy tsunami. That’s when they turn to me. I get calls like this all the time. Luckily, in this case, I was able to stem the tide of dessert topping, banish the evil fiend to its rightful resting place in the depths of Hell and, happily, rescue Rusty from certain death. We found him, in his pen, passed out, but still breathing, his belly swollen to near bursting by the forced consumption of aerosolized whip cream.

This is just one example of food taken over by the nether world. Let’s talk turkey, as in Thanksgiving Day roast turkey with cornbread stuffing and giblet gravy. November 23, 2006, Great Wappinger Falls, South Dakota, the entire town sits down for a sumptuous, homemade turkey dinner and, just as Pastor Salvatore Linguini is about to slice off the first drumstick, as if on cue, every one of the 40 turkeys that Mrs. Elderberry lovingly roasted rose up and, en masse, attacked the good people of that God fearing town. The town was in a panic and, despite my best efforts, I got there a few moments too late. Poor Tiny Tim, only 19 years old and scheduled to leave for South Dakota State the following year on a football scholarship, was struck down by a knife wielding roast turkey. Let’s just say that from that point on, Great Wappinger Falls celebrated their Thanksgivings with quarter pounders with cheese; shunning turkey for good.

And then there are hot chicken wings. Invented in Buffalo, New York, at least according to legend. However, the truth is that these microcosms of Hell spring directly from the bowels of Satan. Harmless, you say; true a bit hot and spicy, but definitely tasty.

But, have you ever ordered your chicken wings mild, only to have them explode inside your mouth as molten relics from a demonic volcano, burning the unsuspected palate going in and coming out, sending the unfortunate soul into near convulsions. The diner complains, but the chef’s kitchen contains only normal “Frank’s Louisiana Hot Sauce” and, perhaps, a bottle of “Tabasco”. Leave it to Satan’s diabolical henchmen to so corrupt our favorite foods.

“How can we be safe?” you ask. “Is there any way we can be shielded from these evil forces emanating from the underworld?”

Call me, Father Runyon, at 888-555-HELL and my team of ordained priests, specially trained in all the latest exorcism techniques and incantations, will free you and your kitchen from the ravages of food demons. We’ll stop milk from going prematurely rancid, cast out the pesky oven imp, the one that causes casseroles to burn or overflow. We’ll rid your refrigerator of butter trolls and lettuce ogres and all for FREE; that’s right we won’t charge you one penny. Just a small donation to the Runyon Church Fund and expenses.

So, get rid of all your food worries, make your kitchen, dining room and pantry safe. Call Today!

The Lost Light

2011-06-26T08:19:00.000-07:00

XII.

I returned to my apartment and found an empty shell, windows cracked and broken, the grass brown and withered, littered with dead plants and the interior a wasteland of dead computers, televisions and every other appliance humanity had relied upon to ease the troubles of this world. I tried to turn on some of these electronic devices, without any success. Of course, there wasn’t any electricity, no running water, nothing. One portable computer, battery operated, briefly started up, but died as the power ran out. One thing that did work was the gas stove and I found some packaged food that was still edible.

I went out to find my neighbors and the few that had returned were in a similar situation. We pooled our resources and hoped that the leaders of the day would find a solution. Leaders, I thought, are there any leaders left in the world? They are probably in just as dire straits as everyone. At this moment I felt a tremendous sadness over what we had lost and I was more than a bit worried.

I was in my apartment shortly after my encounter with Dr. Greenwood, savoring the paltry dinner I had scraped together when I had a very unexpected visitor. Any knock on my door caused the hair on my arms and the back of my neck to stand up, but this visitor more than any. I peeked out the door and saw Meno waiting, alone. I pulled the door open a crack and was greeted with the same smile I had always loved.

“Hey, Doc. Can I come in? It’s just me.”

He was holding his side in a funny way as it became obvious why he was there. I opened the door and hustled him in; I glanced down the hallway for his entourage, but he truly was alone.

“What happened to you?” I asked, although it was obvious that he had been in some sort of altercation. I moved his hand away and a blood soaked towel fell to the floor.

“It seems that Tyrone didn’t like the way I was running things; thought I was too meek and not using all my influence as I should. We had a bit of an argument and I guess I lost.”

“No doubt about that”, I answered as I examined the wide gash in his right side. “This goes through the muscle, almost into the peritoneum. Another half inch and you’d of had a big gash in your colon and probably be dead or close to it. But, I think I can stitch you up. Let me get a few things.”

“Take your time, Doc. I’m not going anywhere. Nice apartment, at least I think it used to be nice. Could use a bit of spiffing up, but, then again, everything needs a bit of spiffing up these days. I guess that’s where me and Tyrone had our disagreement.”

“How’s that?” I rummaged through my closet and found my old emergency kit. I opened the case and found some suture and instruments. The vial of Xylocaine had only a few drops.

“I hope you don’t mind a bit of discomfort. I don’t have any local.”

“I’ll grit my teeth; maybe you got a bullet for me to bite on?”

The wound at least was a clean slash, obviously the product of an extremely sharp blade, the type so popular with the gangs of years past. It was as clean and straight as the sharpest scalpel could make, perpendicular to the skin and straight down through the muscle, stopping just above the transversalis fascia. Meno winced as I washed it out with bottled water and then I began to sew.

“So what happened between you and your buddy?” I asked. I really was curious and I also thought that the conversation might take Meno’s mind off the pain he surely was feeling.

“Well, Doc, Ow…I was thinking about Abraham Lincoln and his second Inaugural Address, ‘Charity for all, Malice towards none’ sort of thing. I mean look at the world now. All we have are memories of our old advanced society, at least technologically advanced. But, now we have to start to rebuild from scratch. I proposed that my followers set an example, actually to emulate the man we sent away; to be servant leaders and embrace our enemies, Ow.”

“Sorry, I’m being as gentle as I can. I take it Tyrone disagrees with this approach.”

“Tyrone believes it’s time for us to be on top, to take what we want or need. We’re the strong now; the people follow me, at least the people in this area. You know, Doc, I spoke at the old Arizona stadium a few days ago. It was overflowing with people and all I had was a megaphone. There must have been 80 thousand, young, old, men, women, children; all sitting silently, listening to my every word.”

“I guess you’re the new Messiah”, I observed. “I’m done with the deep layers, just the skin to close now.”

“Well, Messiah means ‘Anointed One”, which I certainly am not. If we all do what’s right we can put this world back together in months. If we fight, exploit and lord over the weaker members of society we’ll destroy ourselves once and for all.”

“Sounds like you’ve got the right idea, what’s the problem…Tyrone?”

“Tyrone and his buddies; all those that felt like society owed them something. Eddie also doesn’t seem happy, although he’s not as vocal or as prone to violence as Tyrone; usually he just goes with the flow, but he also likes being on top for once. Me, I guess I never had that feeling of being downtrodden; I was on my way to a better life when all this started. I mean, I always thought I’d be in politics, but not like this.”

“You’re way beyond politics”, I observed. “There, that’s the last stitch.” I covered the wound with a clean dressing as Meno got up.

“Thanks, Doc. Good work. I just don’t know if I have the courage, you know; the courage to stand up to an angry mob. So, what do I do? Give in and hate myself for the rest of my life or stand up for what’s right and commit suicide in the process?”

“Do what’s right”, I answered. “Years ago, one of the younger doctors came to me with what he thought was a big problem. He was a Urologist and he was caring for a patient that needed to be treated with a stent. The patient was in the hospital and didn’t have insurance; didn’t have any resources at all. This doctor was worried that if he placed the stent he wouldn’t be able to remove it at the appropriate time because of her lack of insurance. I advised him to treat the patient in the best way he could, not to compromise the care he provided because of a social problem. Physicians are called upon to care for the sick and injured, not just the well healed sick and injured. Do you see my point?”

“I understand, but it may not be that simple. Maybe, I have a sense of how Jesus felt. He prayed to god to take the cup away; to find another way, apart from the Cross, to bring salvation into the world. But God said no, ‘it’s my way or nothing’. But, I’m not Jesus; I’m not sure I’m ready to go the Cross.”

“These are the times that try men’s souls”, I answered, empty words that offered no solace. “Follow your heart and do what’s right.”

“Maybe, Doc. But it may not be that easy. Thanks for the patch job. See you around and be very careful”, he advised as I closed and locked the door. I soon learned that he was not the man I thought he was.

XIII.

A few relief efforts had barely begun when the violent gangs appeared. The paucity of resources led to hording of food, fuel supplies, clothing, even water. The age old story of haves being attacked by have nots led to this violence and destruction. They were mostly young men drawn together by their shared misery, individuals who found strength and power in the anonymity of the mob. There were also young women within the gangs drawn to or forced into a life of near servitude in order to survive. They were the strong ones at that moment and they mercilessly exploited the old and weak.

Meno was at the front of the largest gang. His was the most powerful; thousands followed him and his every utterance, every command led to more violence. Whispers through neighborhoods spread the news. There wasn’t any radio, television or internet. Those that were considered to have a useful skill, who had the potential to be an asset to the gang were made to join; the weak, disabled, mentally ill or those who just didn’t fit the proper mold were eliminated, cast off, thrown into the fire like garbage. And Meno smiled, and his friends smiled. I knew Meno would come for me one day. After all, I had some skills that were scarce, but also in great demand. All I could do was wait. I thought about his ideals, his desire to do good, those attributes that he had in the past; now buried away, pummeled into oblivion by the temptation that comes with the power to dominate and exploit. What good was he doing now? Abraham Lincoln he was not; Adolph Hitler or Joseph Stalin maybe.

“A new order has begun”, they said. “Only the strong can survive. There is no more God, no religion, only those of us who have the vision to see a future where we will be stronger than humanity ever dreamed.”

The entire scene reminded me of the old movie, Mad Max and, as I thought about it, the whole depressing scenario truly was a post-apocalyptic nightmare. Violence and death became the way of life. Civility, decorum, manners, whatever one wants to call it became vague memories of a world that was now dead and buried.

The irony has made our whole situation almost comical, but actually supremely depressing. The media always portrayed scenarios such as ours as the consequence of some human created disaster or natural disaster. The aforementioned Mad Max, a Boy and His Dog, The Omega Man and so many other books and movies seemed to share this idea. War or disease could wipe out everything and leave desperate shells of humanity in their wake. The apocalypse brought about by humanity’s failings or by Satan, perhaps, that I could accept. But, how could God, who is supposed to love us and has given so much of himself, how can he turn his back on his people. As I think about it now, I realize that it was not God that brought this upon us. It was our own fallen nature, Satan’s final triumph that is leading to our ultimate demise.

I refuse to put the leader’s name to paper; he had a choice; he could have led the people back to civilization, established order and reason. Instead he chose wanton destruction. I thought he was a friend, but I could never call anyone friend that could carry out such violence. If mine is the only record of these horrific days, let it be written that it was human nature that led to our downfall, not a single man and not God.

It was hard for me to gather the courage to leave my apartment. The streets were now a dangerous place and there was nothing there. Withered, dried up trees and bushes, replaced by the cactus that had flourished before the Light appeared. Eerie silence filled the air. The old sounds were gone; no cars or buses, no bustle of people moving from here to there. Only an occasional dog rummaging through piles of garbage, baking under the desert sun. The daytime was quiet; the heat discouraged even the heartiest soul, the marauders preferred the coolness and cover of the night. I walked along abandoned streets, staring up at a relentless blue sky. This was a different light, one that brought no comfort, only anticipation of violence and death.

I went by my brother’s apartment one day, even started to walk up to his door, but I couldn’t bear to see him again. Perhaps he was the only sane one, safe in his fortress living on Spam and beans.

I walked to Ace’s home, figuring he was living the life of luxury. The grounds were dried up, like everything else. I knocked on the door, but there was no answer. The door was open, however and I gingerly pushed it open and called his name.

“Ace, you home?” No reply. His “autocycle” was gone as were a number of other items. The kitchen was a mess of open cabinets and drawers, everything emptied. I saw a pair of feet in the backyard, behind a wooden fence.

“Ace”, I called as I ran towards the lone figure. There I found him, I recognized his shoes; he was propped upright in a lawn chair, his hands folded in his lap; a perfect picture of serenity that lacked only one item: a head for the body. This is no time for entrepreneurs, I thought as I carried the headless body into the yard and buried it in a shady spot behind the garage.

“I guess it’ll be my turn soon”, I said out loud.

I left Ace in peace and wandered through the decaying streets of what had once been a bright, vibrant city. The desert sun scorched my neck and arms, but I was oblivious to the burning; the emptiness in my soul burned far more. Some people were about, foraging for anything little thing that could ease the pain and poverty of this new life “under the sun”.

A crowd approached and I saw my brother at the forefront.

“John, John; it’s Dan”, I cried.

He stopped as I approached and those following him also stopped.

“What’s all this; where are you off to?” I asked, curious, but also a bit fearful of this unknown mob following a man who recently had been holed up with a lifetime’s supply of Spam and beans.

“We’re going to find the Tree of Life”, he said enthusiastically.

“How do you know that it’s here and where to find it?” I inquired, even more curious.

“Listen, I was wrong about the Morlocks, OK. We had a rebirth of the Garden of Eden, didn’t we? And, in the center of that Garden is the Tree of Life and there should also be a Tree of Knowledge of Good and Evil. All we have to do is find the center of the Garden and we’ll be there. We eat from the tree and, bingo, we’re good forever.”

“Where’s the center?” I was almost afraid of his answer.

“Well, if the whole earth was “the Garden”, then it would be at the center point for the planet.”

“You’re going to the earth’s core?” A touch of sarcasm accompanied my question.

“That actually was my first thought, but that doesn’t make sense, I mean Hell would be there. No, after a great deal of thought, and a vote of all the people, we decided that Centerville is the place.”

“Centerville?”

“Centerville, Texas, to be exact. Halfway between Dallas and Houston, the perfect spot.”

I shook my head and then turned to all his followers. I saw a mass of tired, bedraggled people who shared only one thing: a look of hope. I couldn’t bring myself to say anything that might shatter that hope, the only thing left of any value in this world.

I smiled and held out my hand.

“Good Luck, John”, I said as we shook hands, “And good luck to all of you. Don’t forget me when you reach Centerville.”

The followers all wished me well as they left, a few implored me to go with them, but I politely declined. I slowly walked back to my apartment. I wondered about Phyllis and Dr. C and even went by their house, but it was empty, abandoned or worse.

I passed by the spot Dingo had occupied, waiting for his Savior. Dingo was gone, only a pile of rotting apple cores remained. I wondered if he had left with Jesus or had become a victim of the mob. I suppose it didn’t matter. His was a faith that couldn’t be shaken and either way he was now in God’s house, perhaps reunited with his mother who loved the lord in such a strong way.

Finally, I reached my apartment and made my way up the stairs. There needs to be a record made, the truth about these times saved for future generations. I suspected that time was short, at least for me. They would come; he would come and it would be the end. I could never join him; death would be preferable.

Darkness was falling now. Soon they’d be out and no one would be safe. I need to put all this down while I still could.

As I record my thoughts I realize one of the great truisms of the world. “Those who don’t learn from history are destined to repeat it. I think it’s now too late. It’s only a matter of time before we destroy ourselves. Memories of the abundance we used to have fuel hatred now. But, how could you let this happen, dear God; surely an omniscient God would have looked into the hearts of his creation and seen that all that was inside was hard stone. Love and Charity and goodness had long been replaced by a myriad of games, drugs and every other hedonistic desire imaginable.

As I finished writing there was a loud, crashing noise in the corridor outside and I heard voices outside my door. I put my writing in the desk drawer, in a panel hidden beneath the middle drawer, and I picked up my nine millimeter weapon. They were coming now, he was coming now and I knew that there was no reasoning, nothing I had that could satisfy their lust for death and destruction. Humanity finally unleashed. Joseph Conrad said it best, “The Horror, the Horror.”

And, somewhere, perhaps on a lone mountaintop looking out over the world or in the crowd that followed Meno and urged him on to greater destruction, Satan smiled.

(I originally ended the story at this point, but was told by my retired partner. Dr. Ebeid, that it left the reader in despair. I added the next chapter to provide some hope, Let me know which ending you prefer.)

Afterword

The words you’ve just read were recounted to me by my mother, Miriam. Dr. Marcus was my father and before his death he told her his story. His exact words were stored in her remarkable memory and she passed those words and his writing on to me. Almost every night she would sit with me and tell me the tale and I committed every word to memory, just as she did, to be passed on to the next generation. She witnessed the final conflict and was with my father at the end. Here is what happened:

The mob burst into the room as two shots rang out; both came from Dr. Marcus handgun. Two of Meno’s gang fell to the floor before the doctor was subdued. He was carried out into the street and, just as the doctor anticipated, Meno came to him. The grand leader was dressed in a dark suit and he wore dark glasses, even though it was nighttime. In a gesture reminiscent of Judas in the Garden of Gethsemane he approached my father and kissed him on the cheek.

“I considered you a friend”, he said to my father, “a man with special talents; someone who could have joined me to help rebuild this world. But, you have rejected me and this is something that I cannot forgive.”

All this time Dr. Marcus was restrained by two of Meno’s henchman. As Meno spoke to him, my father relaxed, which cause his captor’s to relax. He gestured for Meno to come closer, that he had something to say to the “great” leader.

“You…you could have helped bring light back into the world”, he said in a weak raspy voice. “You could have followed the example set by Him. Instead, you are leading the people to death and destruction. God knows this and in the end you will be judged and you will pay for your sins.”

Meno laughed. “God has forsaken this place. We are all alone and it is I who sits in judgment now. It is I who sentence you… to death And, because you put such great faith in this God who has abandoned us, you will die in a truly biblical way. Take him.”

Meno leaned forward as if to kiss him again. At that moment my father jerked his hand free and his arm shot out with a powerful and carefully measured back hand slash. The retractable scalpel blade found its mark with a surgeon’s precision; blood spattered my father as it sprayed out of Meno’s severed carotid artery and filled the hole that had been sliced into Meno’s trachea. In less than five minutes Meno lay dead on the ground.

The mass of people stared in disbelief at Meno’s lifeless body. Out of the silence, Tyrone jumped forward.

“You will pay dearly for this crime”, he hissed between clenched teeth, but he also had a sly smile on his face.

They took my father and beat him and carried him down the street. They chained him to a fence and, in true Old Testament fashion, they stoned him, mercilessly. My father went calmly, telling his attackers that they should put their faith in God, that He hadn’t abandoned humanity and that He would return. The Bible said so and nothing could be more true. He repeated the words over and over, until there was nothing let of him, only a bloody pulp; left for dead by the raging mob.

As the mass of people moved away, one person stayed behind, my mother, Miriam. She had been looking for him ever since their brief encounter; to tell him she was carrying his child and, perhaps, to fashion some sort of life together, facing the hardships of a world gone mad together. She had followed, shrouded by the safety of the crowd, protected by the anonymity of the mob, led by a sixth sense that told her that somehow Meno and my father were destined to meet.

She freed him from the wire fence and was surprised when she felt him take a breath. He opened his eyes and gave her a faint smile and she smiled back.

She took his mangled, bloody hand and placed it on her rotund belly and whispered, “This is your child that’s growing inside of me. I’ve been looking for you for months and now you know that a part of you will live on.”

I’m sure that in those dying moments he didn’t remember her or truly understand that it was his child that was growing inside her; I suppose it didn’t really matter. It was then that he told her his story and she committed every word to memory. He told her where to find his written record and the Bible that was stained with The Savior’s blood. And, he told that even though the world was chaos and destruction and death seemed to rule the day, there was still hope. The words of Revelation had not yet been fulfilled and Jesus would return again to vanquish evil and bring the new Jerusalem to all those who believed.

That was thirty years ago. Miriam is gone, Tyrone is gone, but the Word made flesh lives on. Now, our numbers grow everyday. The ravages of war are past and humanity is rising from the ashes like the phoenix, rebuilding this earth and carrying God’s word to every corner of the world. The blood on this Bible cannot be washed away. His blood brings hope and salvation to all of us.

The Lost Light

2011-06-24T15:17:00.000-07:00

It was a short time later that the grumbling really started. Just a few malcontents voicing their displeasure. We want our games, they said, we want to be able to see and talk with our friends and family far away. We’re tired of fruit, we want meat, we’re tired of the Light. But, before long the numbers grew.

Meno was at the forefront of the movement. Everywhere he went crowds followed. His message was clear. We don’t want religion, We don’t need religion, we don’t need God, we don’t need Jesus. We were happy before; happy to be free; to struggle. In spite of the lack of phones and other communication devices, this new message spread. I was at one of Meno’s rallies and it left me afraid; afraid for humanity which I feared was coming to an end.

Meno stood on a podium, speaking through a makeshift bullhorn, his voice carried through the still air with remarkable clarity.

“We never asked for this light, did we?” he shouted to the crowd, a gathering that stretched as far as I could see.

“No”, the throng replied.

“We were happy before; even those who were poor had more than we have today”, he preached.

“We’re happier now”, responded a lone female voice.

The crowd shouted at her and she was set upon by everyone around her as Meno stood at the front, smiling, doing nothing to stop the wild vicious attack.

“We are not happier now; it’s time we reclaimed our world; it’s time to send this false Messiah home. It’s time to say to this uninvited and unwanted intruder that the world is ours; we will make it a paradise, a paradise of our choosing in our image.”

“MENO, MENO,MENO, lead us to a better world”, the crowd shouted in unison, led by Meno’s lieutenants stationed at strategic spots.

Meno held up his arms to quiet his ardent followers. Silence filled the air.

“It’s time…it’s time to find our enemy, to send him away and rebuild our world, bring back our technology, bring back our food. Send the light away”, and shouting loudly, “SEND THE LIGHT AWAY”.

The crowd started chanting, “Send the light away; send the light away”. The chanting grew louder until it was a thunderous roar:

“SEND THE LIGHT AWAY,SEND THE LIGHT AWAY.”

Meno marched off his podium towards downtown Tucson and all the people followed. At this point I ran to the beaten woman; she was lying motionless on the ground, but I saw that she was still breathing. I ran to her and cradled her head as all the people, some surely her assailants, slowly moved away.

I looked at her face and then sat back suddenly, for there was Gwen, her face bruised and swollen, blood pouring from her mouth and both ears.

“Gwen…oh Gwen, why did you do it? Why didn’t you stay with me?” I cried.

She opened her eyes, “Dr. Marcus, How good of you to care.”

“Let me get you up, let me help you…save you”, I cried.

“Leave me, doctor, I know you have seen Him. And, if you have seen Him, then you know that I am already saved. I was lost; I was dead, but now, even as I breathe my last breath, I am finally made whole, His touch made me whole. Perhaps, now, my daddy will forgive me, because, I know, I am forgiven.”

She closed her eyes and the life went out of her.

“Gwen, Gwen”, I shouted s I lifted her up. “I’m still a surgeon; I can save you.”

They were empty words; I had nothing else to offer.

“She is with my Father now”, a familiar voice said from behind me.

“Can’t you save her? Won’t you save her? If you touch her I know she will be healed”, I cried.

I laid her on the ground and turned to look at Him for the last time. He was shaking His head and then He looked upward, towards Heaven, I presumed.

“She is with my Father; she is at peace, finally. Like the lost sheep, she strayed far away, but her faith was great. There is great rejoicing in Heaven at this moment; a lost daughter has come home.”

I watched Him silently for a few moments. There was a mixture of sadness and joy in His eyes.

“The mob is looking for you”, I informed Him.

“I know; and before long they will find me. They will try to kill me, but just as before I will pass through them unharmed. It is almost time to return to my Father. When the time comes for you, remember Me. If enough people like you and Gwen and many others remember, hope will live on. Then, in time I will return.”

He walked away, leaving me by myself. I felt great loneliness and briefly despaired. I carried Gwen’s lifeless body to an empty field and laid her among the wild flowers, consecrating her to a God I was barely beginning to know.

After Gwen’s death, I wandered through the streets of Tucson aimlessly for a while. I knew that salvation was present in this life, there for the taking, but there was so much anger; anger which fouled the air. Jesus had left our area, but the unrest remained. I saw Meno walking through the streets one day, surrounded by his entourage, dozens, perhaps hundreds of followers. People with fear in their eyes hailed him nevertheless as he surveyed the land. He was carried by his people, elevated as if he were God, offering salvation. Confrontation was inevitable and I knew it would be soon. I tagged along with the crowd; morbid curiosity overcoming fear.

I didn’t have to wait long. Jesus returned and spoke to a crowd just outside the city. Word reached Meno and he went out to meet this adversary.

“I bring you a great gift”, Jesus preached, “Salvation from My Father; return to Paradise, to the perfect world that We created for you. It is here now, all around. But, there is so much more for all of you. When the time is right all the glory of Heaven will come to this place and you will know such peace and happiness; greater than the greatest thing you can imagine.”

“Lies…all lies,” Meno’s voice pierced the air. “It’s always the same thing. It will come, you will find happiness and peace sometime; sometime in the future. But what about now? Now we have nothing but fruit and light. I say to you, false diety, we had so much before you came. It’s true, this world wasn’t perfect, but at least we had dignity and freedom. We aren’t made to serve any false god, we’re made to struggle, to fight for every inch of our being.”

Jesus remained outwardly calm as he turned towards Meno, “Fool, do you know what you are saying? Do you know where your words come from? The Evil One has taken your heart. Do you know what will come?” Tears filled Jesus’ eyes as He spoke. “Do you really believe that you will make a better world for yourselves? Do you so openly reject God?”

“We not only reject god, as you call him, we condemn him and you and we sentence you to death”, Meno answered angrily, hatred filling his voice. “Seize this false god.”

The mob rushed forward, but, just as He had predicted, He passed through them unharmed. The crowd shouted as He walked away. So many stood and watched, myself included.

Shouts of “Be Gone…leave us alone…Go back to your own world” followed Him. As he walked into the distance, I suddenly realized what a stupid idiot I was. I burst away from the throng and went after Him. He was several hundred yards away, but as fast as I ran I could not catch up to Him. I watched as His image faded away. And, when I could no longer see Him, I knelt down and cried.

Soon, everywhere He went He was met by angry shouting, people raising their fists in rage. Those who were happy with the new order and who spoke out against the protests were beaten, violently subdued and, although their injuries were quickly healed, the voice of God was silenced. As the rebellion spread, Jesus disappeared. A few reported that they saw Him ascend on a cloud, but I doubt this was anything more than wishful hyperbole. After all, there weren’t any clouds. In reality, He just left.

XI.

But the clouds did return, the Light quickly faded and the sun began its daily travels across the sky; although it seemed dimmer than before.

When the light had finally receded completely, when the feelings of contentment and happiness finally disappeared, the trouble really started. The trees and vines withered and with them went the fruit, vegetables and everything else. Shells of buildings remained and, in a few areas, a few good people tried to organize the masses and start rebuilding our nearly forgotten, past civilization. Many gave up hope; after all God had abandoned them and all that remained for them was a life filled with pain, followed by death and oblivion.

I went by the hospital after He left. I thought that I’d soon need to return to my old life. The hospital was still empty; the front entrance padlocked, the windows all closed and locked. But, I had my ways and I still had my keys. Many years before I had convinced a young and naïve hospital administrator that I needed access to the hospital any time and that going through the ER entrance wasn’t always in my best interest. She gave me a key to the door that opened into the kitchen and, as luck would have it, it still worked.

I made my way between the empty appliances, through the cafeteria and up one flight to the OR’s. There were still stretchers in the hallway and the last OR schedule dangled from the bulletin board adjacent to the main desk, held by a single, tenacious thumbtack. There was my name at the top, Dr. Daniel Marcus, Right Inguinal Hernia Repair and so many other names, colleagues I hadn’t seen in years.

“It’s terrible…such a waste”, I murmured to myself.

“That it is”, a voice answered.

I turned and saw Nate Greenwood walking towards me, Dr. Greenwood, an anesthesiologist I had worked with in the past, never a close friend, but we always had a collegial sort of relationship; the sort of mutual respect that can develop after taking care of octogenarians with ruptured bowels at three am.

“I suspect we’ll be busier than ever soon”, he stated. “Now that things will be getting back to normal.”

“Normal”, I cried, “how can anything ever be normal again. Everything we used to have is long gone. Everything that should have kept us content and happy has left us. Nothing will ever be normal again.”

My voice grew louder. “Do you think there is any chance that we can all just return to our old homes, go back to shopping at the supermarket and complaining that the lettuce is wilted, or send our children to school to teach them how to make this world a better place.”

I was shouting now and Dr. Greenwood had a look of fear on his face, fear of me. I didn’t care what he thought as my tirade reached fever pitch.

“We had our chance, Dr. Greenwood, and we blew it. Traded an eternity of peace and contentment, no, an eternity of glorious, ecstatic, perfect joyful happiness; traded it for an empty world, devoid of hope, filled only with flawed humanity, suffering, and, very soon, starvation, disease and death. I hope you don’t consider that normal.”

He looked at me a bit aghast and slowly backed away.

“Have some faith in human ingenuity, Marcus. It will all work out for the best. People will naturally band together and inside of two years we’ll have this old world humming along like nothing ever happened.”

I noticed he continued to back away, but by now I had calmed down.

“I hope you’re right, Dr. Greenwood, I hope you’re right.”

I watched him walk away. I just shook my head as I pondered what we each had said. If he was right it would be better for all, at least in the short run, but, as I thought about all that had happened I was convinced that I was right.

The Lost Light

2011-06-22T16:37:00.000-07:00

VIII.

All everyone could do was stare at the light, or walk among the people staring at the light. There was an abundance of fruit and vegetables to eat, some of it seemed completely new, to me at least, and almost everyone I met seemed to be content, the light had a calming effect, almost like everyone was drugged. As I moved among scores of people, young and old, children, adult I remember thinking that maybe my brother was right; somewhere, at some point Morlocks would come out of the shadows and drag unsuspecting victims underground. But, there were no shadows, just an enormous sense of well being and a great feeling of happiness.

Of course, there was no way to know if this “happiness” was universal; at this point I could only comment on Tucson. Everywhere the people walked among the flowers, picking fruit, no cares or worries. Many shed their clothes, the feeling being that humanity had returned to Eden, their shame of nakedness vanquished. Indeed, it was paradise; wild animals, coyotes, scorpions, even snakes all walked amongst us without fear or animosity.

But, as I talked with different people I heard the same thing over and over.

“It’s good now, enjoy it while it lasts, troubles will surely return, just be ready.”

I walked up to Gwen’s old apartment, fully expecting to find it deserted; my former lover off in pursuit of nobler things. But, I tried anyway and I still had feelings for her, maybe even love. I knocked on her door, but, no surprise, no one answered.

“She’s been gone for weeks”, I heard a woman’s voice behind me. “She dressed herself up in some white robes and took off, looking for God I imagine.”

I turned around and saw a very attractive woman, long black hair, dark brown eyes, perfect figure, dressed in a white tank top and cut off jeans.

“I’m Dr. Marcus, Dan; I dated Gwen for a while, before all this happened. Do you have any idea which way she went?”

“Miriam”, she answered and she held out her hand, which I took and gave a short kiss, feigning lost chivalry.

She continued, “She went that way”, pointing north, “but I don’t know how far she’s gone. It’s been weeks now. I’m sure she’s found the new Jesus by now. She did tell me something as she was walking away. She said, ‘I’m going to find the brightest spot of light and there I’ll find some peace.’ I hope she’s OK. She was a good neighbor.”

“Well, thanks for the scoop, Miriam. I guess you’ve got lots of free time now. Are you all alone?”

“Yup, just me here. Mostly single folks live in these apartments. A lot have left; gone back to nature or something like that I suppose. I’m not complaining, although I do get lonely at times.”

She gave me a short smile and then walked up to me took my hand and gave me a long kiss. We walked hand in hand into her apartment, into her bed and then I never saw her again.

IX.

But, it went on and on. I lost track of time, without day or night, no clocks, not even sundials all anyone could do was wait, be content and wait some more. As I look back now it was this feeling of waiting that was the greatest portent that something was coming. If only we all had accepted what had happened, embraced it and accepted true contentment I wouldn’t be writing this now.

Finally, He came. I had expected His arrival for some time; everyone had been expecting Him. He brought the same message that was brought over two thousand years ago. God loves you and all He asks is for you to have faith; to trust and believe Him. Jesus appeared everywhere, moving like a whirlwind from place to place always bringing the same message of God’s love. The word of His return spread among all the people and most rejoiced.

He even came to Tucson and I heard Him speak. He stood on a hill in the middle of the city and His words echoed those he had uttered more than two thousand years ago.

“God has sent me into the world to bring His word to all the people, all His children. He has made the world pure again and offers freely the gift of His love to every man, woman and child of His creation.”

His words touched my soul and, I think, the heart and soul of everyone that had ears to hear. There was a power in his voice, but also gentleness. He dressed in a simple white robe, but he shined brighter than the light that filled the sky. I was overcome with peace and contentment as I realized that every care that I’d ever had was gone. The words he spoke were a soothing balm to the troubled feelings, the doubts that nagged me from the first moment.

As quickly as he spoke, he seemed to vanish and I heard he had moved on to the next stop, bringing the love of God to all humanity. And, He asked nothing in return. No repentance, no confession of faith; just acceptance of the wonderful gift.

Gwen was in the crowd, sitting right up front, eyes fixed on The Messiah. I saw her from the back and managed to inch my up until I was right behind her. I sat down and listened, but with only half an ear at first. I mostly gazed at the back of Gwen’s head, waiting for an opportunity to speak to her. I thought I was over her; our last encounter had an air of finality about it, but I still worried about her and I told myself I wanted to be sure she would be OK.

As I stared at her head, His words seemed to gather force and I forgot about Gwen, her hair, and everything. His word was powerful and simple. When it was over I thought about Gwen again, but she was gone. I saw her in the front of the crowd that had encircled Jesus. I saw Him gently touch her cheek and then they both disappeared into the throng.

But, there were some who doubted Him; they began to question His every word and His motives. Why now, what do you expect from us, we don’t need God, we didn’t ask for this.

He answered simply, “Why not now? Mankind has suffered so and it is time to return to the God that loves you”. Evil was cast out of many hearts by His kind and gentle words and gradually it seemed that even those who doubted Him began to believe, began to embrace Him and the Light.

But, not all. I don’t think anyone knows when the rebellion started, but like a whisper that builds into a roar, it did start. I think it was somewhere up North, the question was raised.

“Can we have some of our things back?”

Jesus’ answer was simple, “You have all the love of God, what more could anyone want?”

I was alone in my room when He came; I don’t know why He chose me, or, perhaps, He visited many people. He didn’t say and I didn’t think to ask. Up close there certainly was nothing heroic about Him. He wasn’t handsome; He didn’t seem particularly powerful; no, there was nothing special about this man. Well maybe His eyes. He had the sort of eyes that could look right through you as if you weren’t even there or they could look right into your heart and mind. Somehow, I had the impression that even before I ever said a single word He knew everything there was to know about me.

“Why now?” I asked, getting straight to the point I thought.

“Why anytime?” He answered, sounding a bit weary. “The world has fallen farther and farther and now you’ve all been returned to the Garden. You want for nothing. God is here, with you; is there anything more?”

“Is it true what has been written? I mean about you, your birth, your life, your death, your rising?”

“You have read the testimony. My Brother’s words that attest to all that they saw. You know what happened to them and to so many others because of me and still you do not believe. If you had been there with Mary, surgeon; if you had attended to my birth, would that have been sufficient? If you had seen the blind man’s eyes open or the paralyzed man pick up his mat and walk away, would you be asking me now? If you had tended to my scourged back or taken me down from the tree and placed me in the tomb would you now believe? If you had seen me throw off the funeral shroud and rise from the tomb, if I had come to you and shared a meal, if you had seen me ascend on a cloud and were witness to me sitting at the right hand of my Father would that have been sufficient? I see the doubt written on your heart, even now; even after all that has happened. Hope has returned to this world; but hope, I fear, has found the door locked and will be sent away.”

“But, how am I to know you are Him?”

“Here I am. Behold my hands, my side, my back. Use your skills, surgeon, and then tell me.”

He rose and took off his cloak and tunic and raised his arms. There was a short wound in his right chest which looked fresh, as though it had been suffered only hours before. I saw the same thing on his back and hands, wounds so deep that muscle and bone were easily discerned, mangled and torn, with nerves laid open and raw. How could a mere man stand such pain?

“I can see that you have suffered, but to what purpose?”

“You don’t need to ask such a question. Look around you. See what the world has become. You have been given everything that man has asked for, even after your father and mother were cast out. Now, you are back home, with God, in a world that is safe and free from death and disease.”

“Are we better off now?” I continued. “So many people are becoming restless; wandering around without purpose. Is that to be our future?”

“A future walking with God, can there be anything better. Can man create anything that compares with all that is here? Can any camera, digital, SLR or anything compare with the precision and beauty of an eagle’s eye? Can a computer create anything even remotely comparable to the art of Michelangelo or Da Vinci or Picasso, all God’s creatures using God’s gifts to His glory.

“You know”, I answered, “it sounds perfect, a real Shangri-La, but something just doesn’t seem right; it seems like something’s missing. I know it seems crazy, but we’ve learned to live with the struggle. I guess we’re pretty empty if we don’t have anything else.”

“But to live every day in perfect communion with your Creator, to have all the Glory of God descend upon this world for all the people; how could even one person reject such a thing?”

“I think you’ve come at the wrong time. We’re not ready.”

“Would you ever be ready? He asked as a tear formed in his eye. “Such is humanity, such is the power of Satan. There are some who are prepared, those who profess true faith in Me and My Father. Alas, there time here will be cut short, but they will see God in all his Glory before everyone. Even so, it is far too few.”

“What about you? Are you destined to suffer and die for us again?”

“You’ve been reading the Bible; surely you know the answer.”

“John 19:30, ‘It is finished’.”

“Yes, my atonement was sufficient to satisfy My Father’s wrath and free the world from its sins. I have returned now to bring the message of God’s love to this world, to seek repentance and forgive its sins. But, I’m afraid Satan’s grasp may be too strong.”

“Will there be no hope, then? Is there still time to repent? Listen to me, I sound like Ebeneezer Scrooge.”

“Scrooge did repent and found salvation on that Christmas Day, salvation through charity, in a huge turkey and in Me. What God has done cannot be undone and there is still time, even as the days grow short. The tidal wave started by your friend, Meno, will sweep across the world and, in the days to come, there will be much sorrow and people will curse God and themselves. Even then some will repent and find salvation, while for many the sin that is buried in their soul will rise and fill the world with hate and greed and violence.”

I sat silent for a while and He sat with me. I felt His grace as he touched my shoulder. As night fell and the room grew dark I drifted off to sleep and when I awoke He was gone. Nothing had changed except there were drops of blood on the cover of my Bible. They looked fresh, but they could not be wiped away. At that moment I said a prayer of thanksgiving.

The Lost Light

2011-06-20T16:08:00.000-07:00

VI.

Most of the people simply continued about their business, some still working, others raising families, thankful that life had become much easier , never questioning why. The initial fears seemed to subside as everyone came to expect something new and wonderful each day.

I do remember reading about the probes of outer space; a majority of scientists were convinced that everything happening had to be the influence of some sort of superior alien; one that was making our Earth suitable for an impending visit. The skies were probed and scanned night and day, from every corner of the globe, but nary a sign was detected, no unusual flicker of light, electromagnetic wave or any sort of energy disturbance.

It was when the light finally appeared that the true meaning of it all became apparent. It started over South America, the Amazonian rain forest to be exact. The few observers said it was like the sun started to expand. Bright light filled the sky and blocked out everything else, no clouds, no sun, no stars or moon at night, just bright, white, warm light, day and night; without a flicker, but steadily expanding.

And, it wasn’t just the fact that there was this bizarre light “down there”. The “light”, wherever it shined, permeated everywhere and everything. Inside, outside, in a closet, even in the deepest cave, it found you. Slowly, over a few weeks, it circled the globe, carrying its luminescence to every nook and cranny. There was no hiding place, no day or night, just bright, warm, and, surprisingly, comforting light.

It was a true joy to be outside. I walked along streets that were covered with soft grass. Everywhere it was softness and comfort. Hard asphalt was gone replaced by a natural thick, plush carpet of blue green grass. Trees and bushes, laden with fruit grew everywhere. Most of the people seemed happy, content with this new world order. On one of my walks I met Dingo, at least that’s what we’d always called him at the hospital.

Dingo’s real name was Dennis, but he was given the nickname Dingo sometime during his younger days and it stuck. Dingo had Down’s Syndrome, had lived with his parents for years until they both passed away a couple of years before all these changes began. Social Workers brought him to a halfway house where he had a roof over his head and someone to look out for his needs. He always was around the hospital and we gave him lots of simple chores to do, deliveries to make and storage rooms to straighten and such. He really was a tireless worker and compulsive enough about doing a good job to have been a surgeon.

He was sitting in the grass eating an apple when I saw him.

“Hey, Dingo, how’s it going?” I asked, standing over him.

A big smile lit up his face as he patted the ground, an invitation to sit with him I surmised. I picked an apple form the nearby tree and sat down opposite him, staring at his beaming face.

“Don’t you think this is great, Dr. Marcus? God is coming back to us”, he stated as if it were a generally accepted fact.

“You may be right, Dingo. That certainly would be the best explanation for everything.”

“Oh, I know it’s God. It’s just like my Momma would tell me, before she went away. She’d set down next to me and read me some of the Bible and then she’d close it and say, ‘Someday, little Dennis’, she didn’t call me Dingo, ‘someday God is going to remember our little world here. He’ll remember that He made us and this world, just like it says in the book here, and He’ll come back for us and gather us all up to his house in Heaven and there’ll be such a party in Heaven. And, little Dennis, we’ll all be the same, He’ll look at each of us and love us the same. He won’t care if we’re rich or poor, smart or dumb. All He’ll know is that He made us, that we’re His children and the He loves us all. Even though we’ve been bad, he still loves us.’

“That’s what Momma used to tell me and now’s the time. You know, Dr. Marcus, I’m going to sit right here, eat the fruit He’s left for us and wait for Him. Because He’s coming and pretty soon we’ll all be in Heaven.”

I sat and stared into his innocent, believing face and saw hope and trust. No cynicism, no anger, no suspicion. We sat together for a while and then I left him. I envied him; simple faith is something I had never known.

VII.

It was at this point that everything stopped and I mean everything. Nothing worked, every TV, computer, automobile, every mechanical, electronic machine, even wind powered or solar powered simply went dead. As a matter of fact, I looked into the back of my computer and dust wafted out; the circuitry had become a mass of fused metal and silicon, perhaps useful as scrap meal, but totally nonfunctional.

With all this free time I went to visit another old friend, Mickey Simons, a very successful businessman, the inventor of the personal motorcar. “Ace”, as he was called by everyone that had ever met him, had designed the extremely low priced, but very functional, almost disposable vehicles as a way to travel around local areas vey inexpensively. He made a fortune before he sold out to Ford Motors. He lived in a huge mansion on the outside of town; I hadn’t seen him for years, but with nothing but free time I took the walk across town, curious to see hear his opinion about the strange happenings.

I found the green metal gate open when I arrived and the premises a bit unkempt. I knocked loudly on his large, imposing front door. Ace answered after a few minutes.

“Hello, Dr. Dan; good to see you, thanks for coming by”, he exclaimed, grabbing my hand and shaking it vigorously. “Come on in, Come in.”

It seemed like he was expecting me; as if I was an invited guest, rather than a surprise visitor. The huge mansion seemed deserted, except for Ace. I wasn’t sure if he was still married. I vaguely recalled that he had a wife named Judy, but something about an affair and a nasty divorce stuck in my mind, but then again it may have been someone else.

“Anyone else here with you?” I asked, trying to be nonchalant. It seems like a big place to manage alone.

“No one but me, at the moment. My wife left last year, took the kid with her and my hired help left when all these strange things started to happen. I had a handyman who took care of the grounds and his wife kept house. But, they left to find Jesus or God or something. Times being what they are, I’m managing OK. But, come with me; let me show you something.” His voice rang with enthusiasm.

I followed him to his garage where I saw a funny, strange looking vehicle, sort of part car and part bicycle.

“Meet the future”, he exclaimed proudly. “The autocycle, self propelled, uses the earth’s gravity and rotation along with the pedals to move. Has a solar panel to provide some juice. In the days ahead this baby is going to be humanity’s salvation.”

“Does it really work?” I asked, a bit skeptical that this freakish “autocycle” was anything more than a gimmick designed to put some cash into Ace’s pocket, sort of like the scam artists that sold radiation detectors to people in California after the earthquake and Tsunami of 2011.

“Of course it works”, Ace answered, a bit of irritation in his voice. “Climb aboard; take it for a spin. It’s top speed is about 35 mph.”

I climbed in and headed out and around his long circular driveway. The pedals turned with a minimum of effort and it was very comfortable and easy to use. I eased it back into the garage and stepped out, greeted by Ace, grinning from ear to ear.

“Great, isn’t it?” he asked as he opened the door.

“Looks like you’ve got a winner, Ace. Just one question, though. Why does anyone need to go anywhere? From what I can see, it’s the same here as at the South Pole.”

Ace’s grin grew even wider. “That’s true, for now, you’re right. But, do you really think all this peace and joy and tranquility is going to last? Let me tell you; we were thrown out of the Garden last time. This time we’ll leave of our own accord, probably shaking our fist at the God who has the audacity to think that he knows best. And, when the crash finally comes, I’ll be there with my autocycle; get as much as I can and live out my life in comfort.”

I stared down at the ground, slowly shaking my head. Sadness overcame me as I realized that Ace was right. God would be rejected, again, and all that would be left would be autocycles, hatred, selfishness, envy and death.

“I hope you’re wrong”, I whispered as I turned to leave. “I hope you’re wrong.”

As I walked a way I heard him call out “When the time comes I’ll be waiting; I’ll sell you one at half price.” His voice faded away as I walked quickly home, brushing a tear away as I passed a large group of people gathered on what had been a street corner, when there were actual cars that ran. I saw Meno standing on a bench addressing the crowd. I only caught a few of his words as I passed by, but the crowd was sizable and he seemed to be keeping the throng enthralled.

“Is this what we want? A promise …?”

I wasn’t sure if he was for all these changes or against them. I made a mental note to stop next time I saw him and listen more closely.

The Lost Light

2011-06-18T11:27:00.000-07:00

IV.

But, it certainly didn’t seem like the end; even as the changes continued. Food seemed to become available at every turn. I remember one day I ate an apple, the last one that I had in my refrigerator. I remember this incident so clearly because after I finished it I really wanted a second one. I searched through every drawer and shelf in the refrigerator and throughout the kitchen and I was sure it was the last one. Well, what do you think; that night when I looked in the fridge there was a bowl full of apples. My first thought was that a friend had brought them by and left them without telling me, but after talking with others and hearing similar stories I suspected that it was something else.

So, in spite of having no work and no income I still lived a comfortable life. Food was no problem, as long as I was satisfied with fresh fruit and vegetables. I managed to keep myself busy, catching up on my reading, meeting with people that I hadn’t seen for years and just enjoying all the new things that were popping up all around. The bizarre occurrences certainly gave us plenty to talk about.

My old mentor, Dr. C, as we called him, was one of those people I visited with all the free time. He was 92 at that time and had been in failing health for several years. Chronic Obstructive Pulmonary Disease and Congestive Heart Failure had kept him in a chair or bed for the last eight years, the product of years of smoking Cuban cigars, I figured. I expected his wife to answer when I rang the bell at his home; but was only mildly surprised when Dr. C himself, looking tan and fit, answered the door.

“Great to see you, my boy”. He exclaimed effusively, grabbing my hand with a surprisingly strong grip. “It’s wonderful, don’t you think?”

“It certainly is Sir”, I responded with my usual respect. Although we had been friends for years and I had even fixed his hernia years before, I always treated the old boss with the greatest esteem and deference.

“I see these strange happenings have been very kind to you, Dr. C. You look thirty years younger”, I added.

“Certainly, certainly, that’s true. Come in, come in; have a seat and we’ll chat about it all; about old times and our current good fortune.”

I followed him to the living room; his wife Phyllis was sitting on the sofa, weak smile on her face. She looked a bit uneasy as she poured me a cup of coffee.

“Fortune seems to have smiled on you, Dr. C. You look like your twenty again”, I observed.

“Feel that way, too, my boy. All those parts that haven’t worked for years are humming along like well oiled machines, if you get my drift. I’ve been out of the house for the first time in years; looked up a few old friends and acquaintances. Phyllis still likes to stay here; some things never change.”

I suddenly realized why Phyllis looked to be upset. Dr. C. getting out of the house and “looking up old friends and acquaintances” meant that his poor wife was out in the cold, so to speak. All those years serving as his nurse seemed to have been forgotten. Her slightly bloodshot eyes told the whole story.

I turned to Phyllis and asked, “Has the boss been behaving himself?”

She looked as if she was about to burst into tears until I added, “Or is he back to smoking those vile cigars?”

She gave a heavy sigh before answering, “Oh, he’s been behaving himself that way. I guess he has learned at least one lesson, but some habits never seem to die.”

Dr. C gave her a sharp glance, but then changed the subject.

“What have you been doing with yourself, son. I suspect that these mysterious events have put you out of a job.”

“That’s for sure”, I answered, “No sick people, not even any trauma. I’m trying to get adjusted. I figure I’ll use the free time to look up some of my old friends; see how they’re getting along. But, I also figure I need to stay prepared, you know, just in case…”

He interrupted, “Just in case everything blows up. I suspect if that happens you’ll have more business than ever; or else…”

“Or else”, I interjected, “We’ll all be gone, nothing left but the rats and cockroaches.”

“Exactly, but, for me, I’m going to use this good fortune to catch up on the things I’ve been missing these last few years.”

He shot a glance at Phyllis, who suddenly stood up and ran out of the room.

“I don’t know what’s bugging her”, Dr. C stated.

“You certainly do”, I replied, my voice rising a notch. “All those years you’ve been wasting away in that chair, while she waited on you and tended to your every need. I know they say you can’t teach an old dog new tricks, but you don’t have to stay an old dog. You’ve been given a great gift; we’ve all been given a great gift, whether it lasts for two weeks or two thousand years. Second chances are rare in this world. I hope that you; that we all, use it wisely.”

Dr. C stared at his hands, but didn’t say a word. I couldn’t tell if his well known temper was going to show itself or if he was going to break down and cry. For the longest time he just sat and stared.

Finally, he looked up and said, “I think it’s time to go. Thanks for coming by to see me.”

He stood up and offered me his hand, which I took and he held it in his strong grip for almost a minute, but still remained silent.

“Good-bye, Sir. And, please be kind”, I pleaded as I the door closed behind me.

I never saw them again, but I began to wonder if these strange times were a blessing or a curse. As I walked through the streets towards my home I passed Meno and his two friends. They were with six women and, as always, Meno seemed to be in charge.

“Hey, Doc”, he called. “No more law school, times being what they are. Me and the boys here are starting on politics, if you get my meaning.”

I stopped and stared at what was a growing entourage.

“It looks like you’ll be leading us all before too long”, I answered.

He waved as he walked on and I made my way home, feeling more than a little depressed over what the world was becoming.

No more illness, an abundance of food, lush plants springing up in dry barren desert; it seemed like a return to paradise to me and, for the most part, I sat back and enjoyed it.

As the months went by more and more people found it unnecessary to work. Things seemed to stop breaking; there was no more wear and tear; as a result, clothes and appliances and such didn’t need to be replaced. Large communes sprang up all over, composed of people convinced that it truly was time to drop out and commune with a nature that had become very accommodating. Cries from religious leaders continued, some calling it the hand of God, but many others saying it was Satan tempting us.

With nothing but free time I made it my business to continue catching up on visiting old friends and family. My brother, John, lived only about twenty miles away, but I hadn’t seen him in a couple of years. He went through a nasty divorce the previous year and had shut himself off from most of his friends and family afterwards. His work as a software developer allowed him to work from home. I tried to call him as I drove to his home, but his phone went straight to voicemail. His home looked different than I remembered, but at first I wasn’t sure why. Then I noticed bars over all the windows and a tall, thorny hedge around the entire yard. I rang his bell and a disembodied voice answered.

“Who’s there?” I recognized John’s voice, although he seemed a bit distressed.

“It’s your brother, Dan”, I screamed into the air. “Open the door.”

“Put your right eye up to the scanner”, the voice commanded.

I looked around and then I saw a small cup shaped spot just below eye level. I stooped a bit and put my eye up against it and a bright red light scanned me back and forth. A few seconds later I heard a faint whirring noise and then the door seemed to relax and I was greeted by my brother, John, dressed in army fatigues and sporting what I was sure was full body armor beneath his military garb. He quickly grabbed me by the arm and ushered me inside.

“Quickly, we can’t let them in”, he said as he glanced around his yard and then slammed the door. I heard the whirring noise again, which I deduced was a magnetic lock, usually powerful enough to keep out the most determined intruder.

“You certainly look like Dan, but you can never be too sure. Morlocks can be very sneaky, you know. Still, there isn’t a Morlock that ever lived that could stand to have their eye scanned. Just a minute…”

He tore a sheet of paper, with a graph of some sort inscribed on it, from a device next to the door and perused it for a moment. It was the results of my scan, no doubt. After he had looked at it he smiled and then put out his hand.

“Dan, so good of you to come.”

“Well, with all that is hap…”

He didn’t let me finish as he started speaking rapidly.

“I’m glad you’re here, you’ll be safe here and two of us can fight them off; better than one and we can take turns being on guard…”

“On guard for what?” I asked, finally getting a word in.

“For Morlocks, of course. That’s why we can’t sleep. They can only come at night. But they will be coming, but it sure seems too soon. I didn’t think we’d have to worry about them for thousands of years. But look at what’s happening. There’s only one answer; we’re being fattened up, just like cattle. But I’ve got them beaten. They can’t get to me here and I can stay here for years if I have to. Look at everything I’ve stored up.”

He brought me into the next room where I was greeted by row upon row of cans, two different types: small cans of Spam and larger cans of Van Camp’s Baked Beans. At the same time I noticed his eyes, which were deeply blood shot with thick dark circles beneath them. His hair was disheveled and his finger nails were dirty and uncut.

“I’ve read that these two items provide all the nutrition an individual needs; all the vitamins and protein and calories. The only other necessary ingredient is water and I’ve got plenty. Beneath this house there’s a tank that is filled to the brim, over a hundred thousand gallons in an impermeable tank with lead shield, guaranteed to keep water fresh for over five hundred years. With all that and enough weaponry to stop a herd of elephants I think I’m safe.”

I looked into the wild eyes of my brother. His red hair went in every direction and there was a full beard; the product of at least six month’s growth.

“Do you think it could be anything other than Morlocks?” I asked in as non-threatening manner as I could. “I mean some people say it’s God or Satan.”

“Nope, no question, it’s the future come early. I’ve seen that movie hundreds of times. Everything done for us, food, good health, perfect weather. All right out of H.G. Wells. I wouldn’t be surprised if Rod Taylor parked his machine in my front yard. Of course I can’t wait for Weema to make her appearance. Nothing wrong with taking the good with the bad, if you get my drift.”

He threw a hand held rocket launcher over his shoulder as he popped open a can of spam.

“I always eat it straight out of the can. I figure I need to get used to it. It tastes pretty good…try some?”

I waved him off, not ready to give in to Morlocks or paranoia just yet. I walked over to the large, wooden closet set opposite his food stores. Inside was his arsenal: rocket launchers, automatic weapons, gas masks, hand guns, body armor and enough ammunition for a small army.

“How could you afford all this?” I asked. “You’ve got enough to hold off any enemy for years.”

“When all you eat is spam and beans you can save quite a lot.”

All of a sudden I felt the need to get out of there, Morlocks or no Morlocks. I didn’t think that my brother was dangerous, but something made me very nervous.

“I’ve got to go”, I lied. “I’ve got to meet someone, a woman”

“Is she blonde, is it Weema?” he asked, plaintively.

“Oh no, I haven’t seen Weema or any blondes for months. No, it’s my old girl Gwen, a nurse, brunette. She’s coming over to my apartment. But, I can see I don’t have to worry about you. You look more than prepared for anything. I’ll keep in touch.”

As I started to leave, he reached into his closet and pulled out a holster.

“Take this, you know, just in case. You never know what’s coming.”

He handed me a nine millimeter handgun, a box of cartridges and a powerful flashlight.

“If you come across any Morlocks, shine that light at them. They hate the light. They’ll be stunned and then you can shoot. Be careful.”

He gave me a hug as I waited for the door to unlock. I turned to wave back at him as I walked away and saw a look of sadness in his eyes, but only for a brief moment. He quickly slammed the door and I heard the faint whirring of the magnetic lock. I wondered if I was really the crazy one as I slowly walked back to my apartment.

The Lost Light

2011-06-15T17:14:00.000-07:00

II.

After I read Dr. Khalil’s letter, a few phone calls confirmed that surgeons everywhere were noticing the same thing. At the time we scratched our collective heads and were outwardly thankful for the good fortune. But, within a few weeks we noticed a new change, actually several changes. First, patients that had been sick for weeks or even months started to recover. Not only make some improvement in a minor parameter. No, these were dramatic changes. Severe, comatose head injury patients, long given up as hopeless, suddenly woke up; patients chronically on ventilators seemed to grow new lungs and were being weaned and discharged. Then, terminal cancer patients saw their disseminated disease melt away. Similar reports came in from all over the globe; all very heartening, but everyone I spoke with had a touch of worry in their voice. Unexplained phenomena have a way of frightening even the most learned of scientists. And, these occurrences went well beyond the unexplained. Supernatural is what some were starting to say.

I began seeing Gwen almost every night. The sudden outbreak of good health gave us much more free time. At that time, I was at a total loss to explain the phenomenon. We both agreed it was for the best, while not understanding any of it. That night, while lying in bed together, she was talking, to no one in particular, sort of thinking out loud.

“Do you think that it’s God?” she asked. “Is He somehow reaching out of Heaven and touching our sickest patients and healing them, just like Jesus did in the Bible?”

“That’s as good an explanation as any; God, Jesus, or the devil”, I answered. “I’m happy to have a light schedule, for a while. Of course if it keeps up I’ll be looking for a job digging ditches or something. But, don’t worry; whatever I do I’m sure that I’ll need an assistant.” I rolled over and kissed her and we forgot about God and the devil and everything else for awhile.

As all this was occurring I noticed that my usually busy office was nearly empty. There were a few post op patients, all recovering uneventfully, but after another week even they stopped coming. I suppose that I was happy that people weren’t getting sick, but I also started to worry that I wouldn’t be able to make a living. I remember I felt a slight pang of guilt, something I had felt before when I thought about the comfortable lifestyle that I lived, all courtesy of human suffering. But I could always rationalize that what I did served humanity. The mixed feelings I had about this sudden outbreak of good health, which should have been a cause for joy, were making me feel very guilty.

When I went over to the hospital, I realized my feelings were universal. There were plenty of doctors in their clean white coats standing around talking to the nurses, while every few minutes an administrator dressed in a suit passed by, a worried look on their face. The hospital was empty, the surgery schedule was blank and nobody had a clue.

Hey Meno, you’ve still got work to do?” I asked, slightly envious of the custodian who still had some meaningful work to do. Sadly, I didn’t know his last name, even though we talked almost daily.

“Well, Dr. M”, he replied, “Even though there aren’t many sick people, all you doctor and nurse types still make quite a mess.”

“How true, how true”, I answered. “But, just you wait. With all these strange goings on, I won’t be surprised if this old world starts cleaning itself. Then you’ll be out of a job.”

“Fine with me, Dr. M. It’ll give me the chance to do what I really want. Finish law school, practice for a while and then get into politics, really help some of the downtrodden in our town. Oh, maybe not save them the way you do, but I think the world needs people in politics that want to do what’s right.”

“Good for you, Meno. You could be a first; a truly honest politician; someone looking out for the oppressed in society, without a thought or care about his own well-being. I’ve heard similar stories before, but politics seems to have a way of smashing even the strongest ideals into a fine powder that blows away with the first wind of temptation.”

“Just you wait, Doc; I’m going to be different, I guarantee that when I’m Mayor, then Governor and, then President I’ll always look out for all the people and do what’s right for everybody.”

I thought about the dramatic changes we’d all seen in the hospital, the strange phenomenon, all of it good, but still unsettling to say the least. Meno’s eager face gave me a touch of hope. His idealistic outlook and spirit seemed to be the best part of humanity and if the world was becoming a better place his ideals would be all the more important.

“Meno, you just keep those thoughts in your head, because I think, before we’re all done, we are going to need as many people like you as we can find. For now, there aren’t any sick people so I will leave you to your work. If I don’t see you again, Good Luck. Unless something changes I don’t think I’ll be needed around here.”

“Hasta luego, Doc. And, don’t worry. When I’m in charge I’ll be sure to look out for you.”

He gave me a big smile and put out his hand. I grasped it in mine and we parted; I still felt a bit envious of him and his lofty goals, contrasting sharply with all the worries that raced around my brain. I walked way admiring the gleaming floors that shined in the wake of Meno’s mop.

I knew that Meno worked until after eleven pm and almost always met two of his friends at Zola’s Pool Hall after he finished. I was at Zola’s one day when the three of them arrived; each loudly ordering a beer, putting their money down and shooting pool, nine ball to be exact. I joined the three of them that night and learned that they had gone to high school together and got together almost every night to shoot pool, have a few beers and dream about a world where they were the ones in charge. I remember that night as if it was yesterday.

“Watch this shot, Ty”, Meno yelled above the loud music to Tyrone. All three, Meno, Tyrone and Eddie were twenty three years old, single with menial jobs. The only thing they had was each other and dreams of a better world for themselves. Only Meno had any sort of plan. Tyrone worked for the city, maintaining the parks and all the public areas. Eddie hadn’t graduated from high school and worked any odd jobs he could find. He was remarkable with his hands and could fix almost anything and he was the best pool player in town. His reputation brought him plenty of work and frequent challenges in the pool hall; both endeavors helped him maintain a fairly easy and comfortable life. In the end, in a way, they did realize their dreams.

III.

The lack of business gave me a well deserved break and I took advantage of the opportunity to catch up on reading, do a few neglected chores and play some golf, fully expecting that calls would start coming in requesting my services. But, none came. Nancy, my office nurse did call and told me she was working part time a local nursing home. Apparently the elderly and infirm still needed some assistance.

That same day I went for a stroll through the park. It was midday and I expected the usual hundred degree temps and near zero percent humidity that was the norm for June in Tucson. It was a bright, sunny day, but surprisingly comfortable, not too hot and not too dry. As I walked through the park I was struck by the bright green foliage, some trees bearing fruit, mixed in with the expected cactus. Curiouser and curiouser I thought, the scientist in me becoming aroused. I left the park and took the short walk to the university to talk to my squash partner, Allen Summersby. He was one of the world’s most accomplished biochemists. Maybe he had an answer. On the way I picked a peach from a tree that had sprouted up in the park. I remember I examined it very closely, thinking at the time that all these strange happenings were some sort of trick and perhaps were dangerous in some way. I sniffed the fruit and turned it over and over and finally took a bite. It was the best peach I’d ever tasted. I finished it off and picked three more for later.

I finally reached Summerby’s office and knocked on the door. I heard a soft “Come in” and opened the door to find him sitting behind his desk staring at his arm. He looked up at me and then held his arm up.

“You won’t believe this”, he said, pointing to a spot on his arm. “I injected this spot with toxic Strep a week ago and look.”

I studied his arm up and down and didn’t see a spot.”Where did you inject it?” He pointed to the middle of his forearm which looked pristine.

“There’s something very strange afoot and I have no idea why. As a matter of fact nobody does. I’ve talked with biochemists, geneticists, microbiologists and every other biological scientist I could think of and we’re all stumped. Of course, it all seems for the good, but I’ll tell you… we’re all a bit uneasy.”

“I know; you’d think we’d be rejoicing. I mean diseases seem to have become a thing of the past. Maybe the world’s being sterilized by some invading alien. Remember what happened to the Martians in the “War of the Worlds”, I replied.

“Great, that’s all we need; to be turned into a huge delicatessen for some space monster.”

We talked for a bit more, but he didn’t have any more answers than I had. It seems that we were all asking the same questions, but the questions only begat more questions. A few hours after this meeting the big worldwide conference was announced. A forum of political leaders, scientists, representatives of international space agencies and even religious leaders were to meet in New York at the UN the following week to discuss the recent events and formulate policy.

Meanwhile, I was, for all practical purposes, unemployed. I went for daily walks, chatted with anyone and everyone about current events and did my best to keep occupied. Like everyone else I was a bit worried.

I still saw Gwen almost every day, but she seemed to be distracted. Her normally voracious sexual appetite had waned; although we still “did it”, there was a noticeable lack of enthusiasm on her part.

“You seem far away”, I commented as I stroked her long black hair. She just stared at the ceiling.

“I feel like something huge is about to happen in this world and I really want to be a part of it. I’m sure you don’t know, I mean how could you know, that I’m a preacher’s daughter; grew up believing in Jesus and the Gospel and all that. When I went out into the world it was quite a shock; I learned a lot more in Nursing School than nursing. And, then my mother died of cancer, acute myelogenous leukemia to be exact. She got the flu one day and two weeks later she was gone. I guess it was at that time I stopped believing in God and Jesus and became a ‘fallen woman’ as my Dad would say.”

I wasn’t sure how I should respond to her words and decided it was best to remain silent. She continued.

“I guess I’m distracted, as you describe it, because everything that’s happening has to be the hand of God. Perhaps, Jesus’ return is imminent and, if that’s true, then I guess I feel like I should be preparing; preparing for judgment or salvation. I guess what I’m trying to say is that I need to be good and ask for His forgiveness.”

“I understand”, I lied, disappointed that our encounters would be coming to an end.

I gave her a big kiss, got out of bed, dressed and left her. She seemed more relieved than upset and, surprisingly, all I felt at that moment was indifference.

The big summit was, for the most part, a colossal anticlimax. Theories varying from solar flares to impending alien invasion were espoused. Religious leaders mostly said it was the work of the Devil and the world needed to repent of its evil ways. One question was raised suggesting that perhaps it was God intervening, preparing the world for his imminent return; a theory that was immediately rejected as being contrary to the available eschatological scripture. The mention of eschatology was a bit unsettling. I, and many others I’d talked with, was not ready for the end of the world.

The hospital closed for lack of patients. I ran into Meno as he was leaving his class at City College.

“Still studying law, despite everything that’s happening?” I asked.

“It keeps me busy; I’ve already paid for the classes, so I might as well finish. The way things are going, there won’t be any more school or work; just hanging around waiting for something to happen. I liked it better when it took a little struggling to accomplish something”, he answered. “You still dating that hot Momma, that nurse…Gwen?”

“Naa, she’s waiting for the second coming; repented of her wanton ways, which left me out in the cold, so to speak. I don’t know what I’ll do with myself, but I’m pretty sure something’s about to happen; something big. I just hope it’s something good.”

“Of course it has to be good, Doc. How can any phenomenon that heals the sick be bad. Sounds very Biblical to me; sounds like God or Jesus is coming. Well, I need to get going; see you around , Doc.”

“So long Meno, Good Luck”

The walk home was slow as I stopped and chatted with all the people who were out and about, like me. Most were confused, some seemed very content, many more carried an air of indifference, were enjoying the fine weather and free fruit and veggies that were everywhere. I sensed a lack of purpose among most of the people and fear of the unknown.

The Lost Light

2011-06-11T12:44:00.000-07:00

I have to get all this down before it’s too late, I thought as I sat at the table. The dictation system wouldn’t work, so I fumbled through the drawers until I found a note pad and a pen. I checked the doors to be sure they were securely bolted and the heavy shades were drawn down, shielding me from the noise of breaking windows and gunfire, the flickering light from burning buildings and mounds of rubbish managed to sift into the room through the tiny cracks beneath the curtains. I felt for my weapon, comfortably seated in its shoulder holster and, as an afterthought, I took it out and placed it on the desk next to the note pad. I thought for a moment and started to write.

It was four years ago when the first changes were noticed. There was a letter to the editor in the Annals that caught my eye, first because it was from Dr. Khalil, who had been a year ahead of me in training and because the heading reported on a phenomenon very similar to something I had started to notice.

“Unexpected Rapid Recovery” it said and the letter reported on over thirty patients that had undergone major surgery, the type that usually took 5-7 days to recover from, but these patients had recovered in only two days. Incisions appeared completely healed, normal physiology was restored in a remarkably short time. I found it striking because over the previous three months I had noticed the exact same thing. Major colon resections, big cancer operations, severe traumas, were jumping up out of bed in short order, demanding to eat, pacing the corridors and returning to normal productive lives in one or two days, not the usual seven or ten, or longer. I thought it was due to my superior surgical skills, but now I was beginning to think that there was something else afoot.

That day, the day I read that letter, caused something to gel in my head. I remember talking to Gwen, the head nurse on Post Surgical.

“Did you notice this, Dr. Marcus?” she asked.

I looked up from the chart, first staring at her ample chest and then looking into her eyes.

“Notice what?” I murmured, still thinking about her breasts instead of my patients.

“Mrs. Feinstein in 335, the colon resection you did yesterday, the one that took five hours and had abscesses all over; she’s up walking around, vital signs perfectly normal and normal BUN and creatinine. The last words caught my attention, because Mrs. Feinstein’s baseline BUN and creatinine were 40 and 2.2. A colon resection, even one that drained a bunch of pus, would never have reversed such a chronic condition.

“Repeat the lab, Miss Hadley and, if there’s no error ask Dr. Surham to take a look at her…thanks”, I remarked. My thoughts started to drift away to recollections of similar stories, but this was certainly the most blatant example. I walked away, still thinking about Gwen and her breasts, but also thinking that these events would allow me to get to know the amply endowed and very attractive Gwen Hadley on a more than professional level.

Of course the repeat lab confirmed the unexplainable improvement and I glibly concluded that her previous condition must have been due to her diverticulitis. In a way I was thankful for Mrs. Feinstein because she gave me an excuse to have dinner with Gwen.

As I was leaving I passed by Meno, who was busy mopping the floor, whistling the latest hip-hop as he rolled along. He stopped his work as I passed by and gave me a big smile, exposing his bright, white teeth.

“Hey, Doc, what’s going on?” he exclaimed loudly enough for everyone in the hall and most of the patients could hear. He held out his hand and I gave it a short slap.

“You’re certainly in a good mood”, I observed. “Even more than usual.”

“I got an “A” on that political science paper I was writing. The prof said it was the most original thing he’d read in years. One more semester and then, with any luck I’ll be off to law school and then watch out. The only floors I’ll be mopping are the courtroom’s with my opponents faces.”

“Well, you’ve certainly got the proper attitude to be a lawyer, that’s for sure. I hope you’ll be on the doctor’s side if the situation ever arises.”

“Don’t worry, Doc. You can always count on me to look out for you.”

I wished him well and went on with the day’s work.

That evening, over the finest Scallops Madeira in town and a vintage red wine, Gwen and I talked about the series of freakish events.

“You must be some kind of fantastic surgeon, besides being kind of cute”, she observed. “I mean, besides Mrs. Feinstein, there’s also that old lady, you know, the ninety year old with the stomach CA. Grover, Eileen Grover. Near total gastrectomy; eating and out of the hospital in three days.”

I smiled at her as I thought about that particular patient and about a dozen others. “I guess I am a fantastic surgeon…” Conversation turned to other more important items like where she was going to sleep that night and we forgot about medicine for a while.

Surgical Deficiency

2011-05-22T14:31:00.000-07:00

It has recently been brought to my attention that certain skills that many surgeons consider absolutely vital to success are lacking from my repertoire. Elective courses in medical school and residency equipped many surgeons with certain knowledge and abilities that I am completely lacking. My sense of fair play and the need for complete disclosure mandates that I make this report. Listed here are those courses I failed to take during my surgical training, vital lessons that may make me wholly inadequate to practice surgery.

Instrument Throwing 101 and 102

A two semester course that instructs the surgical resident in the proper technique for throwing an instrument off the operative field. The first semester covers blunt instruments, such as clamps and forceps, while the second part instructs on the proper technique for hurling sharp instruments, scalpels, needles and scissors. Proficiency in the short Mayo toss, the medium range Anesthesia throw and the long range Nurse hurl is expected by the completion. Final exam is judged on accuracy of the throw, amount of disorder created and physical and emotional damage inflicted. Measurement of stress is also graded.

Tantrums 100

A one semester course offered as part of the medical school curriculum, tantrums will provide the student an introduction to those situations where an outburst is considered appropriate and necessary; differing tantrum techniques and proper targets. An extensive video collection, demonstrating everything from the red faced huff to the hot air tempest, is required viewing. Final exam will be part oral, grading quantity and quality of the student’s angry fit and part practical, measuring the negative impact on a recipient subject: nurse, technician patient, family member or hospital administrator.

Condescension 330

This is an upper level course which has Tantrums 100 as a prerequisite. Advanced techniques of sarcasm, insulting and belittling are taught. Extra credit work in racial, gender and sexual preference slurring is available. Final exam is written, true false and multiple choice.

Physical Assault 600

A graduate level course open only to those who have successfully completed all the above courses. Appropriate technique for pushing, bruising and surreptitious sexual harassment are taught by experts in each area. The first half of the course is didactic classroom work, while the second half includes field training in the operating room, ICU and patient ward. Passing this course will be at the discretion of the instructing faculty, but any arrests, indictments or lawsuits will be grounds for summary failure.

Far too often stories of such inappropriate behavior surface. Any such behavior detracts from patient care and leads to an atmosphere of tension in the operating room and other patient care areas. Everyone who works in the healthcare arena has a shared goal of taking the best possible care of the sick and injured patients that come under our care. There is no place for inappropriate actions and behavior. I apologize for my lack of skill in these areas.

A Fantasy

2011-04-23T12:25:00.000-07:00

George, a man of 75 in good general health, felt sudden pain in his upper abdomen and went to see his family doctor, Dr. West. After talking to George and examining his abdomen Dr. West sent George to Mercy Hospital, where he was immediately admitted to the Med-Surg floor. Upon arrival his nurse, Nurse North, took down all his vital information, put the orders as written by Dr. West in the computer. Lab personnel appeared within ten minutes and drew the ordered CBC, CMP, amylase and lipase levels. Five minutes later the patient was taken to X-ray where an upright Chest X-Ray and Abdominal X-Rays were performed.

When George arrived back in his room he was seen by Dr. South, a surgeon, who talked to George and examined him. Dr. South learned that George had suffered from Peptic Ulcer disease for years and had stopped taking his medication six months before because he felt fine and he didn’t think he needed it anymore. When Dr. South examined George’s abdomen there was rigidity and diffuse tenderness, suggestive of generalized peritonitis. Dr. South then reviewed the labs, which were on the front of the patients chart and revealed a White Blood Cell Count of 18,000 and hemoglobin level of 12. The chemistries revealed a slightly decreased bicarbonate level of 21.

Dr. South then went to the X-Ray department where George’s films were being examined by Dr. East, the Radiologist. They examined the X-Rays together and both immediately commented on the presence of free intra-peritoneal air under George’s right hemidiaphragm.

With all this information, Dr. South diagnosed a perforated peptic ulcer and George was scheduled for immediate surgery. He was in the Operating Room within the hour, after he had received preoperative IV fluids and antibiotics. The operation went smoothly and George returned to his room, where Nurse North received him. She checked his vital signs every hour for the first six hours and checked on him frequently, inquiring if he had any pain, checking the urine output and his dressing. Dr. West and Dr. South came by in the evening to check on George and be sure he was stable after surgery and that nothing unexpected was happening.

On the first day after surgery, Nurse North helped George out of bed and he walked in the halls. His urinary catheter was removed and he seemed to be progressing through his post-operative course uneventfully. He was able to start eating on the second day after surgery when he was also walking independently.

However, that night, he developed pain in his left chest. Dr. West and Dr. South were called. They examined George at his bedside, and evaluated the EKG and Chest X-Ray that had been obtained while they were on their way to the hospital. Dr. West noticed an abnormality of the left lung suggestive of atelectasis. He consulted Dr. Central, the Pulmonologist, who came to see the patient, despite the late hour, who concurred with Dr. West’s diagnosis. Respiratory therapy was ordered and the remainder of the post operative course was smooth. George was discharged home on the fifth post-operative day and was back to normal within a few weeks.

Wouldn’t this fantasy be nice? Could a world where hospitals were allowed to efficiently care for their patients; where family doctors attended to their patients in the hospital; where consultants responded quickly and instituted therapy expeditiously, where nurses were given the means to spend time with their patients, possibly exist?

Conspicuously absent from this scenario are case managers, hospitalists, insurance companies, CT Scans, admitting personnel, and LTAC’s. Also missing is SCIP, core measures, endless forms, and mountains of paper that nobody but the hospital billing department ever examines.

Medical specialization has increased to the point where there are surgeons who describe themselves as foregut specialists. Family doctors are given disincentives to attend to their own patients in the hospital, even though nobody knows their patients better.

Medicine has become complex over the last decade and our diagnostic and therapeutic skills have soared on the wings of new technology. Patient care has improved with the superior diagnostic accuracy and complex procedures are often performed in less invasive ways.

But, has something been lost?

N.A.P.

2011-04-05T18:37:00.000-07:00

Today marks the birth of a new political party, one that’s perfectly suited to the troubled times we live in. Kicking off the presidential campaign for 2012 is the National Apathetic Party or NAP. Long overdue, this new party will appeal to all the voters who believe they lack a voice in government today.

NAP’s party platform is built upon the slogan “Who Cares”. These two words sum up the sentiments of the vast silent majority that has been kicked around by Republicans, Democrats, Tea Partyers, Libertarians, Conservatives, Marxists, the Far Left, and the Far Right. At a recent debate NAP Chairman demonstrated the power of the party platform by missing the event completely. When later asked the party’s position on tax reform he answered “Who Cares?”. When queried about the war in Afghanistan he gave the party line response “Who Cares?”.

NAP is currently diligently working to obtain the necessary 50,000 signatures on petitions that will allow it to be listed on the 2012 ballot. Unfortunately, party leaders concede that anyone that actually signs these petitions is immediately disqualified from being a part of NAP as such intense involvement demonstrates a total lack of apathy. Indeed, such enthusiasm would spell doom for NAP.

A recent fundraising event was deemed a great success by NAP leaders as nobody attended, signifying new heights of apathy. When Washington DC reporters sought commentary from NAP leaders no individual was available leaving political insiders in a fog and scratching their collective heads over the mysterious power and momentum that the party is generating.

Bill O’Reilly commented on “The Factor” that the National Apathetic Party could be the great unknown in the upcoming 2012 election, but lamented that party leaders had not responded to requests to appear on his show. He went on to say that calls to NAP headquarters went unanswered and that a recorded message stating that their phone lines had been disconnected and e-mail accounts closed.

“The level of apathy demonstrated by NAP is truly extraordinary and I’m fearful that the movement will surpass the Tea Party and weigh heavily on future campaigns”, O’Reilly commented. This was during a segment of his show when, for the first time, he had no one to interview, as the NAP representative failed to appear, apparently due to lack of interest.

If you are interested in joining NAP, check out their website at www.apathy.org. “Who Cares?” T-shirts and bumperstickers may be purchased on that site. But, don’t be surprised if no one responds to your queries. Because, the people of NAP are dead serious about their apathy.

Ancillary Income

2011-03-27T17:51:00.000-07:00

Economic times are tough all around and the practice of Surgery is no exception. Falling reimbursement and a large population of uninsured patients make it difficult to make ends meet. In the true American spirit of entrepreneurship I’ve decided to expand my business. Of course, saving lives and stamping out disease will remain the primary focus of my practice, but it’s time for me and for my partners, Coastal Surgical Group, to look for new revenue streams.

Let’s start with something obvious, but, nevertheless, important and in great demand. Recent years have seen an explosion in the area of Bariatric Surgery, that is, weight loss surgery. The most popular, because it’s a quick and safe operation, is the adjustable gastric band. This simple device is wrapped around the upper stomach and then inflated to constrict that part of the stomach and create small pouch with a narrow opening. The patient feels full after consuming a very small amount and, over time, loses weight. This surgery is unique because the band is adjustable. A small fluid filled reservoir that sits just beneath the skin allows the band to be inflated or deflated, thus allowing more or less food to pass.

Currently bands are adjusted in accordance with the patient’s ability to eat or symptoms that may develop if the band is too tight. However, I think there is a huge market to attend to those individuals that desire the band to be deflated for specific events. For instance, if portly Uncle Jack is going to his niece’s wedding, shouldn’t he be allowed to enjoy the large buffet, featuring all the lobster and prime rib he can eat? And, what about the open bar? What about poor Sadie, who has already lost 20 of her 400 lbs? Shouldn’t she be rewarded with a night out at the “Golden Corral”? Thousands of our largest citizens are suffering under the torture of these devices. At $200 a pop, a huge market exists for the canny individual that seizes this opportunity.

Another new source of income could come from office souvenir shops. If you go to Disney World or Universal Studios or even your local art museum, the last part of the visit features a mandatory walk through the “Gift Shop”. Shouldn’t a postoperative visit include a similar venue? After all, undergoing surgery can be quite a ride and a souvenir of the journey certainly should be offered. Coffee cups featuring the Coastal Surgical logo, pens with blood red ink or gallbladder shaped wine glasses are only a few of the items that could be offered for sale. Plush stuffed organs such as liver, pancreas or spleen would undoubtedly be hot sellers. Samples of actual organs, salvaged from real operations could be offered as collector’s items, much in the way sea shells or various geologic wonders are sold now. Who wouldn’t want the complete endocrine system, freeze dried and mounted for display on the living room or dining room wall.

Of course, post cards featuring images from actual surgeries would be available. And the usual coffee table tome, designed to impress the boss’s wife would be on sale. “Colons and Hemorrhoids I Have Known: a Pictorial History of Coastal Surgical Group” is already in pre-production.

Beyond such souvenirs, extra income could be proffered from selling advertising space on the backs of scrub suits and/or white coats. Currently, I wear embroidered scrubs that feature my name and Coastal Surgical Group above the shirt pocket. There is plenty of space on the right side of the shirt and on the back to add announcements or logos.

“Miranda’s Massage”, if tastefully designed could be worn on Mondays; “Joe’s Diner” Tuesday and so on. I envision seven separate sponsors, one for each day of the week. There would have to be some discernment, however. “Evan’s Slaughterhouse” would probably not be appropriate, unless the price was right.

Finally, the most lucrative untapped market is in the area of internal tattoos. Think about it; how many people do you know that have said “I always wanted a tattoo, but I really wouldn’t want to display it or it’s too painful or I’m afraid of needles. The obvious solution? Why, internal tattoos, inscribed on the stomach or liver or elsewhere. The bearer would have the quiet satisfaction of knowing he had a tattoo, just like his friends, without any embarrassment should he meet that special someone years later and her name happened to be Lucy, not Sheila. Sheila would be safely tucked away inside on his stomach, instead of prominently displayed on his shoulder and Lucy need not ever know.

A few cautions however. For the man who tattoos a naked image of his sweetheart on his stomach; that svelte 36-24-36 figure would take on new dimensions after a very large meal when the stomach is stretched to massive proportions. General anesthesia would be necessary, but the latest minimally invasive techniques would be employed with minimal discomfort and no down time. I daresay that these internal tattoos would be less painful than their traditional cutaneous cousins.

But, the wearer wouldn’t be able to see it, you object. No worry. Everyone that purchases an internal tattoo would receive a portfolio featuring his or her tattoo and, as a bonus, surrounding organs in 4x6, 5x7, 20 wallet sized and a 16x20 suitable for framing. Additional packages would be available.

Unprofessional you say, not dignified? These are difficult times for health care with no relief in sight. These few suggestions are fully in keeping with the American free market system. So, stop by Coastal Surgical Group, get your hemorrhoids checked and pick up a souvenir mug on your way out.

Monsters and Heroes

2011-03-19T17:07:00.000-07:00

In the practice of surgery it is common for individual surgeons to try to establish a niche, an expertise that sets the surgeon apart from his colleagues. Some General Surgeons become expert in bariatric surgery, which is weight loss procedures, while others may specialize in surgery of the head and neck. In the spirit of increasing specialization I’ve decided to concentrate my surgical practice in the area of tending to the powerful and famous.

I must clarify this, however, by stating that I don’t refer to such trite and mundane figures as Presidents, royalty, sports stars or movie stars. These media driven figures offer no special challenge to a surgeon’s quest for greater challenges; the search for endeavors that tax ingenuity and skill. The individuals I plan to offer my services are the truly powerful: superheroes such as Spiderman and Superman; along with the elite of horror: Vampires, werewolves, and Frankenstein’s Monster. Such powerful individuals present special challenges which my unique skills and innovative talents are particularly well suited.

For instance, let’s start with Superman. Here is an individual, a refugee from the now annihilated planet Krypton. On Earth he displays near invincible superpowers, extraordinary strength, invulnerability to all weapons, defiance of gravity and many other traits. But, is he immune from disease? Does his reported highly dense molecular structure eliminate the possibility of gallstones or an enlarged prostate? I doubt it.

But, surgery on such an entity poses problems never encountered in the typical residency program. After all, how can even the finest surgeon begin to operate on a being that is impervious to knives, bullets, nuclear weapons, fire, and everything else? This issue actually was addressed in one of the Superman stories. The obvious solution was to have Kryptonite in the OR to diminish the invulnerability of the Man of Steel. From my perspective, however, this method lacks the necessary refinement inherent to most operations. It would be far better to incorporate Kryptonite into the surgical instruments that would be utilized during any operation. The smaller amounts of Kryptonite would make for an operation that is more controlled and safer for the patient.

What about other superheroes? The Fantastic Four, composed of Reed Richards with his ability to stretch to amazing lengths, his wife Sue Storm, who can become invisible and generate force fields, Johnny Storm, capable of becoming a human torch on command, and Ben, aka “The Thing”, super strong and composed of solid rock, each would require special precautions and instrumentation should they need surgery. And, with the way they are out and about, fighting evil Dr. Doom and such, they are high risk to suffer serious trauma. I’ll bet they can’t get health insurance, even under the impending Obamacare. But, I digress.

Surgery on Reed Richards probably would require a very sharp scalpel to compensate for his extreme elasticity; a laser could be more appropriate to cut through the elastic tissue. However, once the injured or diseased organ was repaired/removed, reconstruction would be greatly simplified. The problem of excessive tension on a repair or anastamosis becomes moot in such a being.

Sue Storm’s special powers would require that she be maintained deeply under anesthesia throughout the procedure. Should she become “light” it’s possible that any level of consciousness could trigger a reflex activation of her powers and she could become invisible. I don’t know about other surgeons, but I would find it particularly daunting to try to operate on an invisible patient. Of course, during residency I did have the pleasure of operating with a surgeon who was nearly blind, but that is not germane to the current discussion.

Johnny Storm in the anesthetized state presents no particular difficulty. For my purposes, however, I would need to exercise caution if I were to use fluoroscopy during an operation on him. This is because I have a habit of yelling “Flame On” when I want to fluoroscope. It would be a pity if the OR crew was incinerated because of a lack of caution or slip of the tongue.

Finally, there’s “The Thing”; lovable creature whose skin is solid rock. Once the incision was made utilizing a jackhammer or, perhaps a diamond tip saw, I suspect the operation could proceed unhindered. If, however, his internal organs were also silicon based, surgery in the usual manner may not be possible. A mason or stonesmith may be better equipped to deal with such a situation.

There are a host of superheroes that developed their prowess after being infected, exposed or inoculated with some type of radioactivity, cosmic power, powerful serum or other transforming material. Spiderman, The Incredible Hulk, The Silver Surfer and Captain America fit into this category. They present the common problem of protecting the surgeon and OR crew from contamination originating from the patient during the surgery. Current gowns, masks and gloves are no match for gamma rays and other types of radiation that likely is percolating through the veins of these sometimes reluctant heroes. The obvious solution is lead lined garb. However, such OR dress could greatly encumber the surgeon and lead to suboptimal results. These patients seem to be perfect candidates for utilizing robotic surgery. The robot’s multiple arms would be safe from any noxious agents and the operation could be carried out with minimal fuss. Once again, however, adequate anesthesia would be absolutely essential as the robot bears a striking resemblance to some of the more dastardly super villains.

There are numerous other superheroes that present other potential surgical concerns, but I think I’ve covered some of the more important modern day heroes. It’s time to move on to the other end of the spectrum: Monsters.

Folklore, books and film are filled with tales of werewolves, vampires, zombies and such. Just as with the superheroes, monsters would require specific modifications of traditional surgical procedures should an operation become necessary.

Vampires are all the rage these days. Vampire novels, movies paraphernalia and clubs are encountered on a daily basis. Are these forlorn creatures monsters, heroes or both. I am not here to render judgment; vampires actually would pose few serious impediments to surgery.

They live on blood, so nutrition is not an issue. Apparently, the blood can be consumed enterally or parenterally. They are universally described as pale creatures suggesting they are chronically anemic and would well tolerate hemoglobin levels that are very low. Indeed, after being NPO for eight hours before surgery it’s likely that they would have very low circulating blood volume and low blood pressure, diminishing the likelihood of serious blood loss, even during the most complicated operation. Opinions on the effect of sunlight vary, but it would be prudent to operate in a room without windows to minimize the risk of the patient disintegrating into dust halfway through the procedure. Protection of the OR crew must also be considered. An accidental needle stick causing mingling of vampire blood with the surgeon’s could lead to transformation of the surgeon into a state of being undead, like the vampires. I don’t know about other surgeons, but my disability insurance doesn’t cover such an occupational hazard.

Werewolves present an entirely different set of challenges. Tradition has been that werewolves can only be killed with a silver bullet, although more recent research suggests that it is necessary to completely dismember the subject to completely eliminate their existence. Thus tradition suggests that silver instruments would be most effective for such creatures. Elective surgery should not be scheduled during a full moon, unless a qualified veterinarian is standing by.

Moving on, “The Blob” was a creature that came from outer space with a taste for the consumption of humans. Any attempt to undertake surgery on such an entity should entail caution. This beast would have no remorse at consuming the surgeon, nurse or scrub tech. Surgery could only be performed using hypothermic technique. Such lower temperatures render “The Blob” compliant and eliminate the danger of being consumed. The anesthesiologist would be vital in such a situation, as he would be charged with keeping the patient’s body temperature low enough to prevent untoward complications, but not so low as to kill the patient. IV access might be an issue, but I suspect a catheter placed anywhere into the patient would be adequate.

Zombies would not present any special challenge. They are dead already, their flesh is rotting and, in general, there are no operations that are actually indicated in this patient population.

Finally, no discussion of Monsters would be complete without Frankenstein’s Monster. A being born of dead body parts, knitted together and then instilled with life that originated with the powerful electrical charge of a lightning bolt. It has been stated, at least in film, that “The Monster” cannot be killed; that having been created from dead body parts, his life goes on indefinitely. Surgery becomes straightforward in this situation. Rubber gloves protect the surgeon and crew from any electrical surge, as they already protect us from the electrical charge of the cautery. Any injured parts can be replaced from the local morgue, although neurosurgery may require some delicacy to prevent radical alteration of “The Monster’s” sweet personality.

There are other heroes and monsters that live among us, in literature, film and politics (monsters only). Surgeon to such famous and powerful beings may not be financially lucrative (is any surgery financially lucrative these days?), but the experience, publicity and subsequent fame should be fodder for books and TV appearances for many years. And, when it becomes time to retire, a tell all book would sell millions, if not billions of copies. “Does Dracula really sleep with a nightlight?”

Education and School

2011-03-05T15:23:00.000-08:00

I just finished reading an eye opening book, “Weapons of Mass Instruction” by John Taylor Gatto, a retired school teacher. Mr. Gatto takes the reader into the world of schooling; examines the origins of our modern system of compulsory schooling and classrooms and blows the lid off the vast industry that is “school”. His principal point is that all this schools has absolutely nothing to do with education.

An education is the process whereby an individual learns. Information is processed, retained and then applied to life situations, to better the individual and, at some point, better society. School is the compulsory incarceration of individuals for the purpose of forced indoctrination into a curriculum established by a panel of individuals with varied motivations; the education of students being nowhere near the top of the list.

Mr. Gatto’s thesis is that the United States, by the nature of its origin and its political and economic system was a great cauldron of imagination and innovation that flourished until the post Civil War era brought compulsory, regimented schools, modeled after the existing Prussian system, which led to the stifling of this innovative nature that had allowed the United States to achieve remarkable growth. Such a system was promoted by the fabulously wealthy and influential industrial leaders of the day in an attempt to provide a steady stream of workers for their factories and consumers of their products.

The book looks at some of our present day leaders in business, industry and politics, pointing out that the success of these leaders had nothing to do with school. As a matter of fact, school does far more to quash original thinking than to motivate.

I thought about what I read in this book and examined my own education. At this point in my life I would be considered to be a very successful surgeon and a marginally successful author. Neither of these endeavors has anything to do with school. Was school important? Of course, but not for my education. School was important as a means to an end; a necessary process that allowed me to become a surgeon. The education of a surgeon currently requires 12 years of elementary and secondary school, 4 years of college, 4 years of medical school and 5-6 or more years of surgical residency. Certain high achieving individuals probably could find a pathway that would knock off 3-4 years, but the path still is very long.

But, when I examine all these years of school and try to remember what I learned, it becomes apparent that most of the time spent was completely wasted. I remember going to elementary school, but I can’t remember anything that I actually learned in the hallowed halls of Lincoln School. What I do remember is a stream of teachers who appeared to alternat between boredom, anger and rare enthusiasm; teachers that often seemed to wish they were somewhere else or doing something else; teachers that spent far too much time trying to fit round pegs into square holes, berating, ridiculing and humiliating those unfortunate students that couldn’t or wouldn’t conform to their arbitrary set of rules.

I remember poor Ken, a classmate with obvious emotional issues, who struggled with the simplest tasks, and was made to suffer under the tyranny of a series of unsympathetic “teachers”. Cal who was always in trouble for being disruptive; always on the brink of being relegated to the oblivion of “special class”, but who could also create amazing drawings that revealed a talent that shined through his behavioral issues. Round pegs both of them; but both stifled and possibly irreparably harmed by their forced incarceration in “school”.

Later years weren’t much better. Of course, I was “smart” and sailed through school with minimal effort. But did I learn anything? I’m sure I did, but as I think back to those years there are two things I learned; information I can recall even today, neither of which had anything to do with school.

Away from school, one of my greatest interests was horse racing. I made my first bet at age nine and, unfortunately, it was a winner and I was hooked. At the time I thought that betting on horses could be a bonanza; actually making money from being smart. Being the inquisitive young man that I was, I set about learning everything I could about the subject. Tom Ainslie was the authority on horse racing at that time and I read his books cover to cover, along with several others. I learned the origins of thoroughbred and standardbred racing and even wrote my tenth grade term paper on the history of thoroughbred horse racing. To this day I can name the winners of important races, the origins of the sport and still use the unique style of thinking that goes into evaluating a horse race almost every day in my practice of surgery.

Shortly after I discovered the joys and frustrations of the track I discovered something else that only brought me laughter and good cheer: the Marx Brothers. My older brothers and friends talked about the antics of Groucho, Harpo, Chico and sometimes Zeppo after attending the summer film festival held at Saratoga State Park. After a while I had to see what all the fuss was about. After seeing “Horse Feathers” I became an ardent fan.

Once the interest was kindled I was compelled to learn everything possible about the four boys. “The Marx Brothers Scrapbook”, “Groucho and Me” and, my favorite, Harpo Speaks” gave me a lesson in history, vaudeville, movies, the Roaring Twenties and the Great Depression, from a bit of a biased perspective. In particular Harpo had special appeal for me, probably because, like Harpo, I wasn’t much of a talker. The silent Marx Brother made his presence known, however, managing to join the highest echelons of New York literary circles, as a listener. While I can remember almost every detail of Harpo’s life; I can’t recall one iota of information specific to any high school social studies class.

In college I discovered English literature and Charles Dickens has always been my favorite. I love almost all his work, but maintain a great disdain for “Great Expectations”. I suspect my strong negative feelings for this book are the result of being forced to read it in the ninth grade. It’s not that the reading was torture; rather it’s the way I was required to examine the book, with every bit of soul, humor and irony removed, the product of a school curriculum that eliminated anything that could possibly spark interest in a young mind.

School for me was playing within the system to advance, while, all the time, pursuing my own agenda outside of the rigid structure of the school building and syllabus. Finally, after twenty years in “school” I graduated medical school and started training in surgery. All the years of education came into play, while all the years in school became irrelevant.

Years of playing the horses taught me how to think and approach medical dilemmas in a unique and effective way; Harpo Marx demonstrated the importance of being a good listener, while literature gave me an outlet away from the rigors of surgery. It is unfortunate that school does so little to educate and serves merely as a necessary gauntlet to traverse on a journey to a specific goal. Education is what prepares us for life; school prepares us for nothing.

I would recommend that everyone pick up a copy of “Weapons of Mass Instruction” by John Taylor Gatto. You won’t be disappointed and you will our schools in a way that will open your eyes and leave you more than a little angry.

Dinnertime

2011-02-18T17:49:00.000-08:00

Lorraine ate today and it was a moment worthy of celebration. Two months ago she was in surgery having a dead segment of colon removed. Now, after ventilators, dialysis, multiple trips back and forth to the OR she is able to eat. And it’s not just tolerating tube feedings or a few liquids. Steak and a baked potato; well, really chicken, green beans and mashed potatoes, but still a major hurdle overcome on the long road to recovery.

A thousand miles away my mother was able to eat with a fork for the first time in more than a year since she suffered serious head trauma and it was a reason to rejoice.

Everyday, three or four times, more or less, we sit down or belly up or stroll through the park, consuming the food that keeps us going. We take it for granted, this ability to eat, but for the very sick and badly injured, eating a normal diet, consumed in the normal way, is often the final step of a long journey.

When a body becomes very sick and its defense mechanisms are turned on to the max, the intestines, at that moment a non-essential organ, are shut off; the body utilizes all its reserves to stay alive. Keep the heart pumping, send blood to the brain, but, those bowels, they’ll be OK, at least for a short while. A failing heart, severe infection, or a bleeding body will usually have an associated paralytic ileus, a fancy word that means the bowels have been turned off, at least for now. That explains why people suffering heart attacks have nausea, or the badly injured, even if there are only broken bones, may vomit. This phenomenon may be transit, lasting only a few moments or may persist for weeks.

During such times, normal eating becomes impossible, food languishes in the stomach until it is rejected by an act of vomiting; nutrition must be supplied by alternative routes. If there is no external source, the body starts to consume itself. Glycogen stored in the liver is consumed, fat stores are depleted and muscle is metabolized, our reserves are mobilized to keep vital organs functioning. Modern medicine, however, provides alternatives to such consumption. The individual that cannot eat can be fed intravenously, receiving thousands of calories, fluids and complete nutrition via Total Parenteral Nutrition (TPN). If the GI tract is functional, but the patient is unable to eat, enteral feedings can be provided via tubes that pass through the nose into the stomach or directly through the abdominal wall into the stomach or small intestine, a bit more natural and physiologic than TPN but still a far cry from normal eating.

Normal eating. We take it for granted; I’m hungry, what’s in the fridge or pantry or down the street at Millie’s Diner. It seems our lives are built around the act of eating. We plan our meals for the day or week. Almost every new relationship starts with a shared meal or drink, “let’s do lunch” or “I’ll meet you for dinner”. In the OR, the director spends most of his or her time ensuring that the staff has “lunch” even if it’s 9:00 am or 4:00 pm.

Eating in all its shapes and forms is essential to our being, just as breathing and sleeping are important to an individual’s survival and sex is important to the survival of the species. I have to say that we spend far more time on food and eating than we do on sex, perhaps a reflection of the relative importance of each endeavor.

The mechanics of eating; the consumption and digestion of food and drink certainly cannot be considered attractive, despite attempts to make such activities appear more refined. Our food is placed before us, on plates, in bowls, poured into glasses and mugs, ready for intake. We take up a knife and fork, or spoon; we raise a glass to our lips and receive our fare into our mouth.

The steak is chewed, the pasta slurped, the beans crushed and then it is all washed down with a fine red wine. Each bite is savored by thousands of sensory receptors in our tongue, combined with our olfactory cells to convey taste to our brain; the tongue also provides the sense of texture and temperature providing the complete package of gustatory splendor; the pleasure of eating.

Each organ that participates in this orgy of sensation plays a vital role. Starting with the eyes and the nose we look for a pleasing appearance and aroma; both prepare the consumer for the pleasures of the repast that is forthcoming. Our lips, incredibly sensitive organs that are essential to eating and for demonstrating affection receive the first sensation of temperature and texture as the food passes into the mouth where the tongue mingles the sensations it receives with the aroma already received to convey the complete sense of taste to our brain. Powerful jaws and teeth tear and crush, mix and masticate, turning the once palatable dinner into a paste of appropriate consistency to be propelled to the oropharynx. Parotid, submandibular and numerous minor glands add saliva to soften and dilute the conglomeration, easing its passage from the oropharynx to the hypopharynx and finally propelled, by the coordinated action of several pharyngeal muscles, into the esophagus where the ingested mass begins its long journey through our body.

The stomach churns and mixes and further dilutes before delivering our once irresistible meal to the intestines for more complete digestion, leading to eventual absorption or expulsion. Our meal of steak, pasta, beans and wine is transformed into fat on our hips, muscle on our arms, sugar in our liver, along with a number of other essential elements for our body, or passes out of our body where it returns to the earth and may eventually be consumed again and the journey repeated

Such a complex process, repeated over and over and over. It’s amazing that we never tire of eating, although we often seek variety: Italian, or Greek, or French, but even if we’re stuffed to the gills we manage to find room for that seven layer chocolate cake. Eating may be our greatest pleasure; the act frequently performed in the public eye; shared with any and all.

Therefore, it’s time to stand and applaud Lorraine’s return from death’s door to the realm of the healthy and whole. Every ingredient that is necessary for a body to eat and digest has resumed proper function and soon she will be home with family and friends, enjoying a dinner at home or out. Although at this moment she may not appreciate it, the ability to eat is a great gift; one that should be cherished.

Form Police

2011-01-15T12:59:00.001-08:00

I’ve been thinking of giving up my life as a surgeon and joining the opposition as a member of the Form Police. Now, you’ve probably never heard of them, but the recently passed healthcare legislation has a provision for the establishment of a review panel that will ensure that certain standards of care are maintained. In order to monitor these standards a cadre of healthcare professionals is to be recruited: the Form Police.

First a bit of background for the uninitiated. In the course of providing medical care for the sick and injured it is necessary that certain items be properly documented. When I started in medical school, thirty years ago, such documentation consisted of a complete, thorough history and physical, appropriate orders and daily progress notes. Upon completion of a hospital stay the patient was given discharge instructions, prescriptions and a discharge summary was generated, documenting the pertinent information relative to the just completed hospital admission. All these items carried a single purpose; to create a clear and concise record of an individual’s hospital stay so that other healthcare providers, (I believe they were called physicians and nurses in those days), at future dates, could review the events, which facilitated future care.

If surgery was performed, the surgeon would sit down with the patient and explain the procedure and document, in the progress notes, that the procedure had been explained to the patient, including all risks, benefits and alternatives. The nurse would then obtain the proper consent, based upon the doctor’s order and the surgery would proceed.

During surgery the circulating nurse kept a record of events, who was present, the procedure and any other pertinent information. The anesthesiologist generated his record of time the surgery started, medications administered, patient’s condition at fifteen minute intervals and any unexpected events. The surgeon dictated an operative report immediately following the procedure; the patient spent an hour in the Recovery Room (now the Post Anesthesia Care Unit of PACU), where another record was generated and then the patient returned to his hospital room or was discharged home.

But, times have changed. Our benevolent government, as part of its self proclaimed mandate to eliminate medical errors, has instituted a variety of protocols designed to optimize, standardize, epitomize, quantify, enhance and beautify many aspects of patient care. We have been given SCIP, the Surgical Care Improvement Program. This is a program that was instituted to ensure that appropriate prophylactic antibiotic protocols are followed as well as proper prophylaxis against deep venous thrombosis. There are other aspects to the program, but these are the two that are most pertinent to surgery.

Prophylactic antibiotics are given prior to elective surgeries to help minimize the risk of infection. They are most appropriate for procedures that involve placement of foreign material in the patient, such as a total knee replacement, or in cases where some contamination is unavoidable, such as colon surgery. The antibiotics are given preoperatively and for a brief period after surgery, usually stopped within twenty four hours after the surgery has finished. Instruction in proper prophylactic antibiotic regimens is part of every surgical clerkship in medical school and is repeatedly drilled into the heads of surgical residents.

Similarly, prevention of deep venous thrombosis (DVT) is an important part of the care of the surgical patient. Practices such as early ambulation, utilization of anti-embolic stockings or pneumatic compression stockings and administration of various blood thinners are all in the armamentarium of weapons for the fight against DVT. Such prevention is important because DVT’s can be life threatening if they lead to pulmonary embolus, which is a blood clot breaking off from a major vein and traveling to the lungs, which can cause sudden death. Once again, instruction in DVT prophylaxis is part of medical training at every level.

But, now we are being monitored; which is OK. The hospitals, however, have been given significant financial incentives to be sure that the SCIP protocols are properly addressed. I would have no problem with this if the personnel that have been delegated the task of monitoring SCIP were properly educated, so that they would be able to understand that patients that are on preoperative therapeutic antibiotics do not fall under SCIP. Such patients are being treated for active or presumed infections and are on scheduled antibiotics. Also, patients that are found at surgery to have an active infection, such as a perforated appendicitis will remain on antibiotics for a longer period of time than the SCIP prescribed twenty four hours and also fall outside SCIP’s purview.

Likewise, patients that have undergone surgery and have the potential for bleeding in the immediate post operative period may not be appropriate candidates for some of the powerful anticoagulants utilized for DVT prophylaxis. Intermediate measures, such as stockings, which carry fewer risks of bleeding and may be nearly as effective can usually be instituted, particularly if they are applied before surgery, which is, of course the hallmark of true prophylaxis.

But, I digress. All this bureaucratic insanity generates an enormous amount of paper. Endless forms that are designed to document compliance with the rapidly reproducing protocols, require constant monitoring to maximize physician compliance and hospital profits. The amount of paper is becoming so enormous that last week, after signing a stack of forms that made Mt. Everest look like a gentle hill outside Austin, I found my poor patient at the bottom of the pile, crushed to death. Of course such an event required even more forms be filled out and signed.

And so, we will have the “Form Police”. This elite squad of enforcers will be directly under the auspices of the Dept. of Health and Human Services. The team, composed of physicians, nurses, lawyers and health care administrators will be charged with the task of disciplining wayward healthcare professionals who are noncompliant with the current form requirements. Neatly outfitted in light brown uniforms, with a blue “FP” on the sleeve and shiny black boots, the Form Police will have the authority to make immediate judgment and mete out appropriate punishment to noncompliant individuals.

It is expected that first offenders will be let off with a simple warning, an admonishment to refrain from such dereliction of duty in the future. Repeat offenders will receive “Form Detention” which will put them in a room by themselves where they will be required to read the entire “form” manual, write “I will fill out all forms properly and in a timely manner” 1000 times on the blackboard and pass an exit exam before being allowed to return to their healthcare position.

The rare person that persists in “form” negligence will undergo a thirty day period of rehabilitation, during which the finer points of “form” etiquette will be driven home via twenty four hour, nonstop “form” video and audio. Completion of this “Form Boot Camp” will be mandatory for all multiple offenders and may be repeated as often as necessary until the healthcare provider achieves adequate levels of compliance.

Finally, incorrigible, unrepentant, hardcore “form” violators will be sentenced to three months of solitary “form” confinement. During this time the latest methods of persuasion, developed jointly by the CIA, Israeli Secret Police and Pre-school Monitors, will be utilized to give the offender one last opportunity to comply with proper “form” protocol. Those deemed incapable of rehabilitation will expelled from healthcare permanently.

And so it’s good-bye surgery, hello Form Police. I figure that the income from extortion alone will far exceed the meager reimbursement I now receive for saving lives and stamping out disease. And I will be performing a great service for all humanity.

Parking in LA

2011-01-11T20:06:00.000-08:00

Last week I was in Los Angeles for a few days on vacation. My wife and I played the part of tourist, took a personalized trip around the city perusing the walk of Fame, Grauman’s Chinese Theater, the Hollywood Hills and went by many stars’ homes. There was also a VIP tour of Universal Studios where we were treated to a gourmet lunch, front of line passes to all the rides and a personalized visit to a soundstage and backlots, all expertly shepherded by Donna, a truly amazing guide.

But, the most memorable thing about LA was the maze of parking options we were required to negotiate. I need to point out that we live in Houston where the city sprawls for miles and miles and every little shop has its own parking lot. Los Angeles, however, has primarily street parking, parking meters and confusion. I did not enter this fray unprepared; I did my research online and was ready to deal with this situation. One frequent LA traveler reported that after 5:30 pm paying the meters was not necessary. Of course I assumed that this included all the meters around this vast urban area. I quickly learned how mistaken I was.

On our first full day we had dinner at a wonderful Japanese restaurant called Ajasai, featuring the freshest sushi I’d ever had. We parked our rented car around the corner at a metered spot; the sign clearly stating that after 5:30 one did not need to pay the meter. There was a lot more on the sign, lettering that ran the down the pole almost to the curb, which I didn’t bother to read. I wish I had taken the time, but, I assumed it was all some legal disclaimer. The internet had said that meters didn’t apply after 5:30 pm and, if it’s on the internet it must be true, right?

Well, after our marvelous dinner we walked back to our car and were greeted by an empty spot. Only then did I notice the sign, just above the sidwalk that said “Tow Away after 6:00pm. Taxi Stand, except on Tuesdays.” Of course, this was in small letters at the bottom of a totem pole of messages and regulations. My wife’s first thought was that the car had been stolen, but, no, it had been towed. $150.00 later I had the car out of hock and back in my possession and for the remainder of our trip I took to reading the parking signs posted on each meter.

Least prevalent were the simple posts “Metered Parking from 8:00 am – 5:00 pm”. More common were “Metered Parking 8:00 am-5:00pm, No Parking Tuesdays and Thursdays; space reserved for Vampires after Dark, except for Full Moons when the space is reserved for Werewolves”. Several streets had a separate sign for each spot. One said: “Metered Parking Mon/Wed/Fri; No Parking Tues/Thurs, All day Parking allowed on weekends, except Holidays”. Two slots down the sign read “Metered Parking Tues/Thurs, Meter charges doubled on Holidays and Weekends, except from May 15-September 1”.

Another noteworthy sign read “Parking Only Allowed on Even Days, No Parking when Raining unless One of the Passengers or the Driver is a Standard Poodle, Please leave Proof of Poodlehood with the Meter”. We saw far more dogs in LA than children, although I really didn’t see many poodles; Shih-Tzu’s were most common. The city really seemed to be going to the dogs.

Some of the ritzier areas had special parking spots. The highest end stores had signs bearing images of Bugattis, Rolls Royces, Maybachs or Ferraris along with rules that stated, “No Parking Anytime, Unless Vehicle Appraisal Greater than or equal to $250,000”. We saw this sign all along Rodeo Drive.

The finer restaurants all had valet parking and the competition for available spaces was fierce. Cars could be seen slowly circling the block in search of the elusive parking space. When a space would miraculously appear a dozen cars would rapidly appear and spectators were treated to an impromptu demolition derby. Improv still lives.

I don’t know if we’ll go back to LA. Despite our adventures in parking we did have a wonderful time and there are certainly more unique California venues to explore. We certainly won’t be bored, even if most of our time is spent reading signs posted at the parking meters.

The Visitor

2010-12-24T10:29:00.000-08:00

This is a strange place, I thought, as I stared into the darkness of my solitary room. I’m not sure this is the place for me. I opened the curtains and stared into the darkness outside and then went back to the bed. There was nothing in the room except the bed, a large TV that didn’t’ work and two books in the drawer next to the bed. The first was a fat and flimsy phone book. I thumbed through its pages, but the lists of names and places seemed like a foreign language and had no meaning. I looked at the other, with its black cover and its simple title, “Holy Bible”. Inside was a stamp, “The Gideons International”.

I opened it up to the first page “In the beginning, God…Let there be light”. I stopped at this point and went to the window and opened the curtain. Rays of light pierced the black horizon and I saw the outline of a large tree which became sharper and filled with color as the light rose in the east. This God must be wonderful to create such a world. I closed the book and left my room and went outside into this new world.

I felt a cool nip from a brisk wind as I stared at the tree that I’d seen outside my window. Its leaves were a bright gold and, as the wind blew, I saw several of them carried on the breeze. They settled on the ground with silent resolution as I walked on, following the last leaf to its resting place far away from the mother tree. As I walked I saw many buildings and vehicles and the air became filled with a foul smell as I walked past a large black building that was sending its smoke high into the morning sky. I guess this world is not as wonderful as I thought. And I went back to my room.

I sat on the bed and read more of the book.

“Now the serpent was more crafty than any other beast of the field that the Lord God had made”.

And I read how the beautiful Garden was spoiled and I cried. This
God must have given something more. He wouldn’t allow his creation to exist with such despair. And I read on. So many of the people were cruel and hateful, but a few remained true to God. And then I read the answer:

“I am the Lord your God, who brought you out of the land of Egypt, out of the house of slavery.
You shall have no other gods before me…”

I read those commandments over and over. These are words that will cause the ruin of Satan and surely will allow the world to return to its original beauty. And so I went out again, filled with hope that the laws of God were all that the people of the world needed.

I walked for a while. I saw the people milling about, some smiling, some hand in hand and I was filled with joy. God’s commandments were all the world needed. But, as I walked along I glanced down a side street and saw a man strike a woman. She fell to the ground and he ran off with the bag she had been carrying. But the laws; what about the laws? I walked on. I saw a group of men and women beating an old man, laughing as they kicked him in the side. I ran to help the old man as the vicious mob left him lying on the ground. I stooped down and held his bloody face, but there was no life in him as I gently laid his head on the ground. God’s laws mean nothing to these people. And I went back to my room.

These people have forgotten what’s in this book. Surely they all must have read it. I read on and on.

“For everything there is a season, and a time for every matter under heaven.
A time to be born, and a time to die…
A time to love, and a time to hate…
A time for war, and a time for peace”

Maybe it’s not the time for God? I’ll venture out into the world again. And so I went out, again. The sun was high in the sky and people milled about as before. I passed a building filled with people, laughing, singing, a place of celebration. I went inside. There were men and women mingling about, all of them smiling and laughing. I stood at a long wooden counter and a man asked me if I wanted anything. I looked at him and smiled, but I didn’t say a word and he went away. I looked up at the large TV “…war in the Middle East seems to be escalating as Israel and Lebanon traded bombs earlier today…” I picked up the newspaper that was on the counter “…terrorist attacks in Europe have raised the alert level to red…” A time for war, but is there a time for peace? I left that place and went back to my room. The crispness of autumn had given away to the frigid snow of winter.

I continued to read.

“For unto you is born this day in the city of David a Savior, who is Christ the Lord. And this will be a sign for you: you will find a baby wrapped in swaddling cloths and lying in a manger…

‘Glory to God in the highest,
And on earth peace among those with whom he is pleased!’…

…he was called Jesus…”

And I read on. Surely this Jesus is the answer. His words bring strength and meaning to God’s laws. And so I went back into the world. Outside the ground was white with snow and bright colored lights were everywhere. The world is celebrating the news, a giant, joyful gala for Jesus. The people must be very happy that God has remained faithful to them.even when they are bad.

I heard all types of song, about the joy of Christmas and people wishing each other Happy Holidays and exchanging gifts. But, the songs carried a different massage. The music sounded joyful, but the words were empty. I heard about Santa Claus and reindeer and snow and trees and poor Grandma was run over by a reindeer and there was something about a “Grinch”. But nary word about God or Jesus. I guess was wrong to think that a holiday called Christmas would be about Jesus Christ. There must be some other Christ that is being celebrated.

In despair I went back to my room. I read more of the book.

“So they took Jesus and he went out, bearing his own cross, to the place called The Place of a Skull, which in Aramaic is called Golgotha. There they crucified Him…

…it is finished, and he bowed his head and gave up his spirit.

…go to my brothers and say to them, ‘I am ascending to my Father and your Father, to my God and your God’. Mary Magdalene went and announced to the disciples, ‘I have seen the Lord…’.”

And I read on and then I knew. God never gave up on his creation. His love is so great that He gave all that he could so that mankind would be free. Even though the world wallows in sin, God’s grace overcomes the evil and his love shines through. And, finally, I understood and I went back into the world. I still saw the wickedness and corruption, but I also saw hope and truth; truth that needs to be shared with all the world.

MERRY CHRISTMAS!!

At Night

2010-12-12T20:27:00.000-08:00

“I only need the pain med at night”; “I just take one a day, at night when I’m trying to sleep”; “I need something to help me at night”; I hear words like these over and over from patients. Something happens at night, lying in the dark waiting for the escape of sleep to overtake us. The pain of recent surgery often intrudes and seems more intense at these moments. The distractions of the daytime; other people, the humdrum light and noise of the daytime are gone and all the pain that has been buried during waking hours rises to the surface.

Our brain is amazing, the way it filters out wave after wave of unwanted stimuli, selecting only what’s important to capture our attention. But all this stimulation fades away in the night and we are left with only ourselves, our thoughts, dreams and pains. My patients fill out a history questionnaire as part of their initial evaluation; one of the symptoms they can check is difficulty sleeping. I think almost half my patients check this box.

Little children cry out in fear and their parents rush to comfort them; the darkness and solitude are fertile ground for the young imagination, calling up horrible monsters that prey on the innocent, but are frightened away by even the tiniest bit of light and a few sharp words from a loving parent.

The monsters of childhood give way to the demons of our later years. The worries of these supposedly enlightened progressive times creep out during the dark hours, robbing us of the tranquility that sleep promises. Perhaps the monsters are real; a prodigal child, a wayward spouse, financial burdens or disappointment over perceived failure, concerns that well up into our consciousness at a time when we yearn for the serenity and peace of sleep.

Charlie Brown of “Peanuts” fame would lie awake at night and ask questions out loud addressed to no one in particular or, perhaps, to God. The answers were never particularly comforting:

“Sometimes I lie awake at night and ask ‘where did I go wrong?’ And a voice answers ‘This is going to take more than one night.”-Charlie Brown in ‘Peanuts’

“Sometimes I lie awake at night and ask ‘Why me?’ And a voice answers, ‘Nothing personal, your number just came up’-Charlie Brown in ‘Peanuts’

Is God so arbitrary? I doubt it.

But, the night isn’t always bad. Triumphs and successes of the day bring a sense of joy and excitement that can keep us from the peace of sleep. It is far more likely that elation leads to celebration and sleep is banished for a while; our day to day struggles pushed back into the recesses of our brain, quietly waiting for the moment to emerge and send our joyful feelings crashing into the abyss.

The Bible speaks of rest as a reward, something given by God for work well done.
"Come to Me, all you who labor and are heavy laden, and I will give you rest. Take My yoke upon you and learn from Me, for I am gentle and lowly in heart, and you will find rest for your souls. For My yoke is easy and My burden is light." -Matthew 11:28-30

At the end of a long day or a long life God rewards us with His rest. Scripture presents rest as the ultimate gift from God. Over a six day period God created the universe and our world and on the seventh day He rested. Number four of the ten commandments is to remember the Sabbath day and keep it holy, which means set apart as something special, a time for rest.
So night is the time for rest, to be alone with God and with our thoughts; a time of reflection on the day’s events and a time to anticipate the days to come. So many times at night I think about the day that has just past, surgery’s that have been done, family concerns and any troubles. It’s a time to offer prayers of thanks and supplication. Personally, I think God listens best at such moments or, more likely, I can focus better at these times; the quiet darkness shielding my thoughts from unwanted intrusion.
And then there’s sleep. We drift away from consciousness, but remain alive. While we sleep amazing things happen. Although it has never been proven I think that sleep provides a time for repair: physical, mental and emotional. Body temperature falls, heart rate decreases, blood pressure decreases and vascular resistance falls. Our organs are bathed in blood that seems to circulate more slowly during sleep, allowing built up toxins to be released and disposed, focusing our immune system on potential invaders, repairing damages done and probably a multitude of other functions that remain a mystery.
Sleep is the time for dreams, our pent up thoughts and feelings released into a private theater that may be cryptic, vivid, heart-warming or terrifying. Sometimes in color, sometimes in black and white, Freud wrote a whole book on the interpretation of dreams. The Bible gave special credence to those that could interpret dreams and treated our dreams as messages from God. Daniel and Joseph were the premier dream interpreters of the Bible; they both suffered because of this skill, but were also rewarded. Most often our dreams leave us confused and often we forget them as soon as we awaken; leaving us with a vague recollection that something of importance may have transpired, but little more.
We may never remember a dream and remain oblivious to our environment, but we still yearn for sleep, for this time of physical, mental, emotional and spiritual repair. We cannot live without its benefits and yet it can prove to be so elusive. Lying awake, tossing and turning, counting sheep by the millions, downing pills and elixirs; searching for the elusive rest. Our world has become so complicated that moments to relax, do nothing and dream become fleeting until they seem lost forever.
Where can we find peace? As children the comforting word or touch of a parent was all that was needed. So, we come back to our parent, to God, our Heavenly Father. His word, His grace, His promise are all that we need to find rest. It is promised throughout the Bible and night is the time when we can feel His soothing touch and receive His peace.

Aliens Among Us

2010-11-29T19:31:00.000-08:00

I just read an article which discussed how the teenage brain is wired differently than the brains of other normal people. Apparently, there was a study done that proved this difference; a fact that has been obvious to parents for ages, probably since the days of Cain and Abel.

That teenagers function on a different level when compared to younger children or adults is more than the result of “different wiring”. No, it is the consequence of a much more sinister plot; a plan that could eventually lead to the end of civilization as we know it. Recent observations out of Roswell, NM have clearly demonstrated that during a child’s thirteenth year aliens visit and our sweet innocent children are replaced.

Every parent has had the experience. That sweet child that loved to be with Mom and Dad, be it a simple walk or a game of catch, suddenly can’t be seen with parents. But it’s more than this. There is no question that teenagers are not human.

For example, years ago I had a simple surgery scheduled on a fifteen year old girl, excising a cyst from her scalp. It was too big to do under strictly local anesthesia in the office, so I scheduled the surgery to be done in the OR utilizing local anesthesia along with intravenous sedation. The procedure started uneventfully; the area on her scalp numbed adequately and her peaceful snores indicating an appropriate level of sedation.

As I made my incision she became agitated and started to scream that someone was trying to cut off her head. I have to comment at this point that local anesthesia will eliminate most sensation, but pressure feelings and awareness that something is being done still are maintained. As she became more agitated the anesthesiologist gave her more sedation, actually enough to stop a charging elephant. My patient tried to jump off the table.

Needless to say the surgery was stopped, she was given general anesthesia and we finished the procedure without incident. At that time I chalked it up to a single paradoxical reaction. But, about six months later I had another similar occurrence. A minor procedure on a sixteen year old boy, once again under local anesthesia with IV sedation yielded the exact same outcome. This time we were better prepared and as soon as it was apparent that the sedation was not effective, general anesthesia was induced and we finished the operation without further mishap. After these two episodes I decided that teenagers were not like normal people and since then all operations on this subspecies of humanity have been done either with straight local anesthesia, that is, sans sedation, or with full general anesthesia. I have to add that, at the time, my own kids were all sweet, innocent toddlers and young children. They’ve since grown and I am older and wiser.

But, what is the underlying mechanism for this devious transformation? Prevailing theories are that rapid hormonal changes coupled with the growing social pressures of the teen years lead to the instability of the teenage specimen. This explanation is at best inadequate. No, there is much more to the phenomenon and the answer, undoubtedly, is alien invasion.

During the seventh grade, usually a few months after the start of the school year the exchanges begin. Our teenage children are snatched away as they sleep and transported to alien space ships hovering just outside the Earth’s atmosphere, shielded from any prying military probes. Exact physical copies of our precious children are created and, unlike Stepford, where the wives were replaced by docile, compliant androids, the replicants are programmed to disrupt the lives of all the sane adults and younger children they encounter.

Because they are artificial they have no fear of driving too fast, or drinking excessively and, being perfectly engineered machinery, they believe it is beneath them to fraternize with imperfect biologically based beings like parents or younger siblings. Instead they prefer their own kind, congregating at malls, particularly around the Apple Store or in arcades where other machines can be found.

Oh, they are devious, that’s for sure; pretending to be sweet and innocent for a moment, filling their forlorn parents with hope that their baby has been returned, but it’s all a trick. Once rewarded with spending money and car keys, they revert to their real selves, congregating together to prowl the streets in packs and wreaking havoc at every turn. Of course it isn’t all bad. These alien creations have remarkable central processors that can soak up Shakespeare or trigonometry like a dry sponge. When properly motivated they are capable of performing a Vivaldi Violin Concerto or winning Olympic Gold in gymnastics. Through all this we cheer them on, pray for them and hope, deluding ourselves into believing that these ‘replacements’ are truly ours.

Is there hope for humanity; will we ever be released from these thorns in our sides? I don’t know what happens to the real children as they are held prisoner on these alien ships, but most of them manage to escape shortly after they enter adulthood. The vicious, unpredictable beasts are dismantled and our children, now responsible adults, return.

So, if your teenager is getting you down, acting in bizarre ways and causing you to reach for the Ativan two or three times a day, relax. Just say to yourself: “They’re not human, they’re not human, just be patient, just be patient”.

In a few years it will all be over. But, until that time, keep a stiff upper lip, hide the car keys and keep the Ativan close at hand.

Jesus was a Wino...Like Me

2010-11-20T18:15:00.000-08:00

A few weeks ago, in the midst of some heated discussion in the OR, my assistant made an interesting, perhaps profound comment. I don’t remember the topic, but the conversation must have wandered into religion and somehow the person of Jesus came up. Sometimes we actually have deep and profound discussions while slaving over hot gallbladders; this must have been one of those times. Anyway, as the conversation heated up, she blurted out:

“Jesus was a wino…like me”.

It sounded funny at the time, and I don’t think anyone in the room really believed it. First of all, although my assistant enjoys a fine glass of Chardonnay on a regular basis, in moderate amounts only (except on the rare occasion when she is celebrating something, when she allows herself a bit more), she does not fit the definition of a wino. There are various definitions of “wino”, but an amalgamation of them all would probably be: “an indigent person, usually homeless, who drinks alcoholic beverages, usually to excess”.

But what she said in the heat of discussion actually contains a great deal of theology and, if examined closely, one can find the gospel. So, let’s deconstruct this simple phrase and uncover its truth.

Jesus refers to Jesus Christ, the remarkable figure on whom the various Christian religions are built. Over two thousand years ago he was an itinerant rabbi hiking around ancient Palestine, trailed by twelve disciples, whose purpose was to deliver the “good news”, a message of God’s love, hope and salvation for all His people; the Gospel. During his three year mission He had no home and it is well documented that he drank wine, although never to excess. He performed many miracles; the first was changing of water into wine at the wedding feast in Cana. But, whereas his disciples may have become drunk on at least one occasion, (they seemed to have a hard time staying awake at Jesus greatest time of need in the Garden of Gethsemane), Jesus never drank inappropriately. Drunkenness would be considered a sin and he lived a perfect, obedient, sinless life, which uniquely qualified him as the perfect sacrifice to satisfy God’s wrath and to take our sins upon himself at the Cross.

So, he does not meet all parts of the definition of wino. Homeless, yes, indigent, yes, drank wine, yes, excessively, no. But, what about the Gospel? At the Cross, the sins of the world were heaped upon Him and by this act of love we are saved. When the believer stands before God for judgment,
God will see the righteousness of Jesus instead of a wretched sinner. This is the heart of the Gospel. At the Cross Jesus takes all the sins of the world upon himself and we, the sinful winos, are cleansed. Jesus becomes the wino in our place.

“He made Him who knew no sin to be sin on our behalf, that we might become the righteousness of God in Him.” -2 Corinthians 5:21

In this sense one could say that it’s true; Jesus was a wino. Perhaps it’s better said, “Jesus became a wino…for me”.

But, what about “…like me”. Can anyone say that Jesus is “like me”? Jesus left heaven; separating from all his glory, and became human, assuming all the frailties and weaknesses of humanity. He suffered all the temptations that we suffer and more. He was offered bread when he was starving, but rejected it, preferring God’s word. He was offered all the world, but chose the promise of God and Heaven and, finally, He refused to put God to the test, holding on to His faith and rejecting Satan. These temptations make Jesus “like me”, except he succeeded where we all fail miserably.

“Jesus was a wino..like me”. The Gospel shouts from these words and, as a result, hope and truth are offered to all of us.