Author Archives: drcharles

Is Thanksgiving Actually a Misguided Holiday?

auroraI used to think of Thanksgiving as the supremely humble, agenda-less holiday most deserving of our celebration. As an American adaptation of harvest festivals found in other cultures, it seems at once natural, secular, and modest.

Yet as I called a lovely woman a few days before the holiday to inform and counsel her that she has cancer, the notion of millions of others “giving thanks” rang hollow, selfish, self-referential, and arrogant.

The turkey on her table was unexpectedly as rotten as the necrotic mass in her pelvis, and her many arriving guests were suddenly interlopers in her nightmare. Perhaps there is a better way to frame the loaded notion of “giving thanks” that does not presuppose blessings, special entitlements, and personal good fortune.

The act of giving thanks necessarily involves a transaction between an actor and a receiver. Giving thanks is a reaction to something bestowed. This problem of agency is what makes Thanksgiving fundamentally flawed.

An unseen God known via faith can be thanked, but to do so takes a egotistical leap over the woman with cancer. What has she received from this same God? Instead, giving thanks seems most appropriate for the transparent exchange, such as that which occurs between human actors helping one another.

So what notions would be most honorable, most worthy of our sacred celebration? The best abstract ideas I could come up with would be reverence, humility, wonder and awe.

Reverence for humanism, the natural world on Earth, a newborn child’s silky head, the brilliance of the stars, and the capacity of love.

Humility that grasps our frailty, our inherent flaws, and the acceptance that every action we commit, even those considered altruistic, is ultimately self-serving.

Awe at the enormity of the universe from galaxy to gluon, the stubborn and heroic perseverance of life, comets from the Oort belt grazing the Sun, and the beauty of snow flurries falling as we exalt in the pleasures of sharing pumpkin pie.

If we were all equally blessed, or if there were some rational justice that determines who suffers, then we should say “thanks.” Otherwise I think a good prayer before the feast should focus on the ideas of reverence, humility, and awe… and to give thanks to those who journey along with us.


Food Truck Examining Room, an Evolving Concept

Given that our health care system has become a bloated carcass of once honorable intentions, I think a fundamental redesign of the examining room is in order.  For beyond the doctor and patient, the physical room which contains their ebullient repartee is the next logical target for improvement.  Here is one radical idea that may need only a few tweaks:

doctor food truck idea

Food Truck Family Practice Idea: click to view larger

The foodtruckexaminingroom will roam from town to town across the United States, stopping in major cities and small towns with main streets in order to provide excellent medical consultations.

The charge will be $25 per “visit”, with home made food gifts strongly encouraged. A medical “plan for your local doctor with malpractice coverage” will be generated from each visit, and will be thoroughly excellent.

The nerve center of the truck, and the heart and soul of this new concept, will be a very casual exam room inside the truck. There will be two chairs, a table, optional wine glasses, and a plush 1970’s style shag rug. A Norman Rockwell will be on the wall, a subtle and ironic nod to the midcentury demise of the “real” family doctor. Perhaps a bring-one-take-one-used-book-shelf will invite the free flow of subversive leftist literature.

A wine rack will be on the wall, highlighting the virtues of moderation and zinfandel.

Please rest assured there will be music gently streaming in the background, ranging from such therapeutic artists as Chopin, James Brown, and The Alabama Shakes. A nice, toothless, fluffy (and occasionally smelly dog) named Babaganoush will smile and purr gracefully at each patient, inviting intimacy and reducing anxiety from the start. For an additional 50 cents, “Baba” will roll around on your back, simulating a low cost sort of medical massage.

The truck will strive to park under shady trees in warm weather, and to maintain an alternate, open-air exam “area” with folding chairs. This area will have little to no privacy and so will be an optional, flagrant violation of HIPPA standards. A discretionary campfire, with a “Saturday Sausage Sizzle” (TM – trademark, all rights reserved) will mesh seamlessly with America’s entrenched tail-gating and RV culture.

On the top of the foodtruckexaminingroom will be perhaps the most important engineering feats – a mobile greenhouse growing organic kale, herbs, tomatoes, and mint for mojitos and tea. It will be fertilized periodically with excrement from the 500 pound, fully operational chicken coop. Free range chickens will be let out during the day to wander around eating local bugs, and will produce about a dozen organic eggs per day, which will be given to the first 12 patients of each session.

A beehive will be maintained on the roof as well, with honeybees diligently avoiding Bayer’s neonicotinoid pesticides, and Monsanto’s GMO crops, to bring us delicious honey, always on tap directly from the hive.

The rear of the truck will be retrofitted with a freezer for chocolate ice cream, the exclusive and happily restrictive diet that will be recommended for all willing nonagenarians.

The exercise zone will be fairly minimalistic, purposefully demonstrating that one really needs to just move around. The tai chi manual must be returned before sunset.

I am currently seeking investors and start up venture capital for this concept. I believe it to be scalable, yet inherently resistant to the mind-numbing, evil tendencies of big corporate paradigms and six sigma cannibalism. This concept will be “intuitive” and “quite natural” for patients willing to step inside the food truck and get some healing. Please allow me to clarify any questions you may have, and I would happily entertain suggestions for improvement.


A Review of Chronic Resilience, a book by Danea Horn

book_cover_smallAuthor Danea Horn has written a book entitled Chronic Resilience in which she describes “10 sanity-saving strategies for women coping with the stress of illness.” I read a copy of the book and highly recommend it.

The stresses of being ill and suffering from chronic illness are manifold. Just today I listened to a woman in the examining room whose fear, anxiety, and sense of isolation with her medical problems were as distressing as the many unpleasant feelings of pain, dizziness, and dread. I did my best to listen to her, validate her concerns, and offer her constructive medical solutions – but I found myself also mentioning Ms. Horn’s book. Even in the first few pages of her disarming introduction, in which she describes her own congenital problems, you can sense her warmth and sincerity, and the toughness that she might lend to a besieged fellow patient and life traveler.

The ten guidelines within specifically address the many challenges of chronic disease, and give tangible means of coping with and overcoming the many adversities. Her approach is instrumental in moving past the initial feelings of ‘why me?” and on to an empowering sense of control recaptured. Ms. Horn effortlessly draws from her readings of other empowering authors, notions of spirituality, and the existential reckonings of her own lifetime to synthesize a holistic and wholly effective worldview of illness.

Instead of relying on broad strokes of clichéd and unspecific advice, Danea includes actual exercises in her approach. Similar in my opinion to the highly respected concept of cognitive behavioral therapy, these practical assignments function like homework to drive home and reinforce the positive methods that can promote resilience.

Ms. Horn shares her own experiences in a witty, candid way that fosters trust, establishes credibility, and engages the reader. But she is not content in any way to simply make this a book about her own life, but rather includes intimate portraits of nine other women whose struggles have been met with courage and grace. There is really nothing more powerful to convince and inspire the human mind than the sharing of human story. Through the lens of these women’s tales, we see ourselves as capable of facing our own trials, strengthening our own resolve, and ultimately transcending the cruel frailties of our shared human condition.

As we are all imperfect creatures, there is a lot to be gained from reading this book whether you have a major chronic illness or not. I found the book to be uplifting, inspiring, and compelling. I found ideas to improve my own approach to daily life, and ways to cultivate a healthy sense of wellbeing, even in times of sickness and despair. As a family doctor I found myself thinking of several patients that this book would be perfect for, and I intend upon recommending it to them.

Thanks for a noble guidebook through good mental health in the face of chronic disease, Ms. Horn. May your life’s work continue to make the world a better, more resilient place.


Vomiting, Diarrhea, and Our Place in the Universe

I’m not sure I can live up to the promise of this post, but as I crouched naked on my hand and knees this weekend, crippled in the 6th hour of profuse diarrhea and vomiting, a few thoughts came to me.

First, how woefully miserable it is to feel sick. Not just sniffly-nose-nasal-congestion-sick, but rather the kind of sick that if it went much longer you might question your will to keep suffering.

I felt a tight, painful clench in my trunk that would not ease; a foul urgency to sit on the toilet as liquid poured out; that familiar burst of saliva and welling nausea as I scrambled to clean one end before the guttural retching ensued on the other; the hot splashing of acid on the palate, and the awkward stare of the spinach from the toilet bowl that just moments ago was floating in my intestines; the exhaustion; the light-headed flop back into the stale bed; the pounding of my heart, craving more fluids with which to pump, but my stomach blockaded by a pervasive and perverse sense of nausea and pain.

God bless the sick.

As I slowly recovered, there were many thoughts. First, there is no greater pleasure than not being aware of your own bodily existence. Tragically we are unaware of these moments, since they are imperceptible by nature. But to lie still in a bed, or to read a book in a hammock, not beset by the gurgling and bloating of bowel, the burning of stomach acid, the congestion and difficulty of breathing through mucous, the constant nudging pain of a bad back, the pulsing of a migraine… to be free of the alarms of internal machinery is heaven. Perhaps there is a fasting monk on a mountaintop who knows what I mean.

And for as much grandiosity as I’ve already written, I know that my brief “suffering” was small, as is my very existence. Have you seen the photo that the Cassini spacecraft snapped last week of the pale, blue dot that is our Earth? Cassini Saturn Earth Isn’t it absolutely magnificent? How have the people of the world not stopped everything, laying down their baskets and bayonets and briefcases, to begin the Age of Aquarius?

Because unfortunately, when we are in our life, we are in it. We are billions, programmed to compete, stuck on this little blue dot, howling at each other. Because the struggle is actually much easier than the big picture. How luxurious it is to be grounded in misery, our bowels and bile and wars and petty atrocities tethering us to the moment. Having seen ourselves on this pale blue dot, should we choose to keep being boorishly human, or to seek an enlightened state of relative harmony, peace, and understanding among our similarly diarrhea-plagued brothers and sisters?

As a kid I imagined that once aliens reached our planet, all the different tribes of mankind would unite at last, albeit in self-defense, but finally aware of our common bonds. Yet looking back from Saturn should really be that kind of spark, too. But it fails to trigger our survival instincts, appealing instead to lofty notions of beauty, imagination, and awe. And then we go right back to diarrhea and taxes. Is there comfort in blood, muck, and cruelty? Are we shackled by double helices to be forever self-absorbed and self-serving? And when I wish to see beauty and transcendence in the Cassini spacecraft photo, am I instead glimpsing Life’s unmoored scream into the bitter cold vacuum of radiation and godstuff?

It’s hard to bring this post to any kind of sensible conclusion, but If I were to narrow it down to just two sentences it would be these. If you are currently feeling well, be aware of it, and be humbled by the Universe. And learn more about oral rehydration therapy.


Diagram of the Human Body Using Etymologies

etymologyanatomyThe origin of a word is fascinating, and the etymology of a word’s evolution tells a story.  You can almost picture syllables and letters marching like armies through distant lands – Old England, Low Germany, Ancient Greece… or rising up from a dark, primordial world of shapeless magic to take form and structure.

I’ve changed the anatomic names of the human body on this diagram to tell the story of each organ’s epithet. As a primary source I used Online Etymology Dictionary, which is a labor of love created by Douglas Harper using the best classic sources. The fantastic 3D anatomy rendering is from Zygote Media Group. I found some of the derivations and etymologies quite thought-provoking, while others such as “knee” are simply stated. I had to do a lot of work with my “something broken” to compose this diagram, so please enjoy!

Brain – from the Celtic bhrag-no, or bran, “something broken”
Skull – Dutch schol “turf, piece of ice”
Hair – from PIE ghers– “to stand out, to bristle, rise to a point”
Eye – from Proto-Indo-European (from here on abbreviated as PIE) “to see”
Ear (Pinna) – from the Proto-Indo-European “backbone, dorsal fin”
Cheek – Old English ceowan “chew”
Nose – PIE nas, “nose”
Mouth – Old English muþ “mouth, opening, door, gate,”
Throat – Old Norse þrutna “to swell”
Neck – PIE knok– “high point, ridge”
Chest – from PIE kista “woven container”
Breast – PIE root bhreus– “to swell, sprout”
Heart – Old English heorte “heart; breast, soul, spirit, will, desire; courage; mind, intellect”
Aorta – Greek aorte, term applied by Aristotle, literally “what is hung up,”
Lungs – Proto-Germanic lungw, “the light organ.” It is speculated that this derives from the fact that lungs of a slaughtered animal float in water, while the heart, liver, etc., do not.
Esophagus – from Greek oisophagos “gullet,” literally “what carries and eats”
Stomach – Latin stomachus “stomach, throat,” also “pride, inclination, indignation”
Liver – PIE leip– “to stick adhere; fat”
Gallbladder – from PIE root ghel– “gold, yellow, yellowish-green” and PIE bhle– “to blow”, “to blow yellow, green”
Pancreas – Latinized form of Greek pankreas, from pan– “all” (see pan-) + kreas “flesh”
Kidney – perhaps a compound of Old English cwið “womb” + ey “egg”
Intestines – Old English hropp, literally “rope”
Spleen – from Greek splen, associated with “violent, ill-temper”
Ovary – classical Latin, ovarius, “egg-keeper”
Uterus – PIE root udero, “sticking out”
Vagina – PIE wag-ina – from root *wag- “to break, split, bite”
Penis – from Latin penis, “tail”
Thigh – PIE teuk– from root teu – “to swell”
Quadriceps – Latin quadriceps, “having four parts”
Leg – PIE root meaning “to bend”
Knee – well, basically Latin genu “knee”
Calf – Old English cealf – “young cow”
Ankle – PIE root ang-/ank– “to bend”
Foot – Proto-Germanic fot, “foot”
Toes – from Proto-Germanic taikhwo, “fingers”
Shin – Proto-Germanic skino, “thin piece”
Arm – PIE root ar – “fit, join”
Shoulder – West Germanic skuldro, shield
Biceps – Latin biceps “having two parts”
Elbow – Old English elnboga, from ell “length of the forearm” + boga “bow, arch”
Hand – Old English hond, hand “hand; side; power, control, possession”
Finger – PIE penkwe, the root meaning “five”


Hail the Sunshine Act (?)

Do you want to know if your doctor has been eating pizza for lunch that was purchased by Pfizer as she listened to a drug rep describe a new medication? Do you want to know if your endocrinologist has been paid $1,500 to give a brief talk about a new injectable diabetes medication to his colleagues as they gobble down filet mignon? If the answer is “yes,” then you are in luck.

As the August 1st, 2013 deadline to start reporting information about these sorts of transactions approaches, doctors and hospitals are reevaluating whether a free tray of chicken salad wraps is worth the scrutiny.

The Sunshine Act, a provision of the Affordable Care Acclownsinmedicinet (aka Obamacare), requires companies that make drugs, medical devices, and biological medicines to report payments and items of value given to physicians and teaching hospitals. (specifics outlined by NEJM and AMA)

Additionally manufacturers and group purchasing organizations must report certain ownership interests held by physicians and their immediate family members. It seems like physicians who own stock in a publicly traded pharmaceutical company do not have to report these shares, as they are generally available to everyone and are considered an “exempt” interest. But other terms of ownership and investment interest must be disclosed, including the dollar amount.

A transfer of anything between a company and a physician that has a value above $10 must be reported. Cumulative gifts totaling $100 or more over a year must be reported.

One way a sneaky physician might find a loophole in this regard would be to ask the drug rep who comes to the office for a lunch time meeting to bring just one hot dog, valued at $9.99. This would fly under the radar… at least 10 times per year – but if the total cost of the hot dogs brought into the doctor’s office exceeds $100 for the year, said hot dogs must be reported. One could then log on to the Medicare website and see how the 11 hot dogs your doctor ate over the year totaled $109.89, which carries multiple degrees of shame.

The Sunshine Act will expose or stop many physicians from making additional money through relationships with manufacturers that represent a conflict of interest.

It will also represent another dreadful use of the word “sunshine,” and makes for great irony as our government increasingly operates in darkness.

The threat of public shame and public misunderstanding will also create fear among physicians, and new treatments and medications will go unnoticed without the occasional lunch used by drug reps and physicians to communicate.

I’m looking forward to less patients assuming I go golfing for free, or thinking I get taken to Las Vegas for a free convention every year.  This has been outlawed for some time.

Office morale will plummet in many locations that used to host drug reps for lunches, occasionally or daily. The medical assistant who used to look forward to getting a free eggplant parm with arugula salad once a week (as her doctor learned about a new blood pressure medication) may now be upset. A lot of mom and pop restaurants will see fewer business lunches purchased by drug reps, and more fancy dinner venues will see a decline as well.

In any other facet of the American economy, the “business lunch” is revered as an opportunity for communication, networking, and an exchange of new ideas. In medicine it has been cast as a seedy chance for manipulation, kickbacks, and brainwashing, and is now subject to the sanitizing UV radiation of “sunshine.”

If we as physicians are to be held to such monastic, ascetic terms of engagement with the business community, then fine. I’m all for keeping drug reps carrying trays of chicken nuggets away from the office.  I’m all for those few specialists and physicians who are much too cozy with pharmaceutical companies getting the public scrutiny of their speaking fees and other arrangements. BUT THEN EVERYONE ELSE BUTT OUT, TOO.

Insurance companies paying CEO’s hundreds of millions, malpractice clients and their lawyers getting paid millions, overpaid health care administrators emulating corporations, and third party profiteers of all stripes… EVERYONE OUT.

The examining room should be about a doctor and a patient, with the unfortunate reality of the economic exchange feeling no more corrupt than payment for a bag full of groceries.


Senile Miosis

The pupils of the eye become smaller as we age,
shrinking to a mere third of their robust, youthful size.
You knew this, even if you were not aware
of the vanishing look in your grandmother’s window,
the reptilian ooze of warm blood over the cliff.

Open wide. Please. Open wider,
so that we might forget the collapsing,
the narrowing portals of grace,
the cold neutron stars,
in to which we are crushed.

In this gaping sun filled array
of gently swaying green,
wide opening pink petals,
and blue azulejo sky,
I lament the constriction of your pupils
more fervently than you can imagine.
For all things that shrink from the sun
might never have been here at all.