Thursday, December 13, 2012

Some Collected Thoughts

My life is a walk down the hospital floor.

Hello Bev. How was your weekend? Hey Dr. Ryan (Ryan is the nurse who teaches me all about effective pain meds.) Your Broncos are doin' a ton better since I last saw you! This makes Ryan grin. I still have a weird feeling talking about life outside the hospital is like talking life outside the mission. Foreign and distant...yet comforting. Usually I can say hi to one or two people on my hallway trips. The before and after is rounding, writing orders, double-checking my orders, tracking down consults, eating an apple--today it was Anna's homemade granola--taking a quick leak, and more rounding. But, the more I say hi, the more I feel at home. Funny how that works.

I've collected a few kernels of random knowledge and observations in the past week that feel to good not to blog about. First, the price of my hide. My co-intern taught me today that a wealthy father living in India will advertise his daughter for as much as 300,000 American dollars if he can catch a future physician son-in-law. The dowry.  Now when he told me this I was fishing through patient records and returning a page

Uh..that's amazing, I said, trying not to sound cliche. Wait! What did you say! 300,000? How much was your dowry?

He never did tell me. But his wedding in India lasted 14 days and cost 60,000 American dollars. In the words of a not-so-culturally-sensitive-American blogger, Holy Cow!

I'm ball-parking his dowry at 150 grand. And he said India is packed with wealthy. I don't know why this fact catches me off guard. You just read and hear so much about the poverty side. Their 1% might be the wealthiest in the world.

Second random kernel: And this one is good. I work at the hospital across the street from the most famous McDonald's in the world. It's the one, get this, where a woman ordered coffee in the drive through and subsequently spilled it on her legs, resulting in the famous lawsuit which won her millions and placed "caution hot" messages on our cups. Her story is interesting. She succumbed to multiple surgeries and infections, not just some coffee burns. But still, she should've been more careful.

Awesome kernel of the year: The Phoenix Suns, once mighty now flighty, recently offered to their fans against the Dallas Mavericks a money-back guarantee if they were not satisfied with the ballgame. Suns fan, yes, I am.

Final kernel: Dr. Mason. Dr. Mason is a dermatologist here at the Albuquerque VA. He is old. He wears a bow tie to work And around his waist is a black fanny pack. Inside this pack rest his accoutrements of the trade: a magnifying glass, a light, some pens, and some other small knick-knacks. He dons no stethoscope. And he walks around the halls between seeing patients holding his gun of liquid nitrogen. This past month I had the immense pleasure of working with him every Friday afternoon in dermatology clinic. In his old age he can breath fresh life into medicine. He makes patients smile, he heals their ailments, and he makes my heart warm. Just last Friday I walked in with my helmet on. Now that's a fancy helmet, he said. He then looked back at the desk where his helmet sat, turned upside down. It was from the 70's. It was, in fact, purchased in the Univ. of Arizona bookstore by his son who was at that time a wildcat. I offered to trade my new for his old, on the spot. But he declined, sadly. I love to collect items from people I admire.

Now Mason is a man who understands the art of medicine is more than treatment. It's conversation as well. Intelligent conversation. Take this pearl he shared with a patient suffering from dandruff:

Now what head and shoulders do you use? What color is the bottle? Is it the new blue head and shoulders? Awww, that's a good one. It's got, awww, selenium in it. The white bottle has, awww, zinc pyrithione. Now if you walk into Walgreen, look for this white bottle. It's $7. Now, awww, right next to it is the Walgreen's brand for $3.50. Grab the Walgreen's one and you're set. Now, to get the action, you need to command your bathroom for a while. Walk in five minutes before your shower and apply shampoo to your affected spots. Let it sit for five minutes. Keep command of the bathroom. Then get in the shower and scrub the stuff off. That's how you use head and shoulders for dermatitis.

That is medicine! And cost-effective at that. If we had more Mason's, we could get every state on health exchanges with no trepidation of how we'd save enough to pay for it. He effectively cuts the cost of medicine by %50. Head and shoulders above the rest...

One more unforgettable note on Dr. Mason. We had a certain encounter together with a farmer his age, complaining of lower leg red spots. They were in the distribution of the sock line. Mr Angus was his name, go figure. While Dr. Mason explained the condition, he raised his own pant legs and began to show off his shins. He then explained what he used on his shins. A certain hydrophilic ointment. The two old men, relics of the clean America of decades ago, sat there in their western manliness, showing off their ankles to each other, talking about lotion application. And both were animated like kids under the Christmas tree discovering a new present. It was classic.

I'll try and remember Dr. Mason. A man who does more than just write scripts for medication. he converses. He conserves. He confirms. He compliments. I'll miss working with him and how he always said to the patient after we saw them, "Now, awww, put some of Dr. Spencer's medicine on the spots on you'll be set." Just like him, to pawn off the credit on the next generation. I'll miss him, but I might run into him out on those Albuquerque bike trails on some Saturday morning.

As for tonight, time to sign off. A physician told me to walk out tonight at 10:00 to witness the Gemini meteor shower. That gives me fifteen minutes to make some hot chocolate to brave the thirty degrees. Anna is in Utah for her Grandma's funeral.
See Obituary About A Wonderful Saint
So I finish with one of her best quotes of the week: "Men love women...women love love animals." That got me to thinking, no wonder we men eat like animals sometimes at the dinner table, we just want to make the women and kids in lives smile :)

Thursday, November 15, 2012

I'm Back!

Hello Blogging world! Wow, it's been a long time... Quite a bit has been happening in our neck of the woods that I wanted to write about:

The BIGGEST thing is THIS little dude/dudette...we're having a BABY! As you can tell from this ultrasound, this isn't new news. I'm 32 1/2 weeks along with a due date JANUARY 8, 2013. But even with the last 7 months to digest the idea, I still get pretty giddy when I think about it...giddy in the excited-little-girl sense and the how-I-get-at-the-top-of-a-roller-coaster sense. I'm scared stiff and I've never felt more inadequate, but I also can't stop smiling :)  I'm just glad I have a studly partner-in-crime! I know... gag, cheese, whatever, but Spencer really has been remarkable through this--I never could have asked for more support, more excitement, more indulgence, more back rubs, more sympathy for all the funny symptoms, more runs for Little Caesar's crazy bread (my weird craving), etc. etc. etc. Thanks love!

Enough cheese. 
The ultrasound above was at 28 weeks. Here are 2 more: 

20 weeks (No, we didn't find out the gender. We're hanging on for a surprise)

and here's our gummi bear at 10 weeks (thanks to my awesome brother-in-law who did this one for us while we were visiting during the summer!)

I've been lucky in having a really nice pregnancy. Of course, I was pretty nauseated the first few months--but who isn't? I was lucky to not throw up much. And even now at 32 weeks, when I keep hearing horror stories about how miserable the last trimester is, I still feel great! I hate bending over and I waddle like a duck, but nothing to complain about....knock on wood.

This was my belly at 27-ish weeks. I don't have any recent belly shots, but just triple that belly and add an almost-impossible-to-hide "outie" belly-button and you'll have the idea...

In other news, we've also moved! We are now in Albuquerque, NM. I LOVE LOVE LOVE it! Our apt feels double the size of our other with 20x the amount of light and "home-ish-ness." It's in an actual neighborhood--one where I don't hear about shootings and drug busts just around the corner. And, we had an actual autumn for the first time in 5 years! I've never been so thrilled to see colored leaves or feel a high of 75 rather than 100 by October. I'm trying to soak in every minute of it!

Spencer likes what he's seen of Albuquerque, but most of that has been inside the walls of the hospital. He is doing his intern year and has a brutal schedule: lots of night call, lots of 14-16 hour days, lots of bringing the pager home at night. He's maintained a great attitude, though, coming home with all kinds of stories about funny patients, great co-workers, "tender mercies," and interesting tidbits he's learning. And when things get bad, we keep telling ourselves that this is just for a year...Radiology is NOT supposed to be this crazy. (Sorry for any reading this who are staying in internal med!)

Here he is at his medical school graduation. It was a VERY proud day for both of us!

It feels like there's so much more to write about and more pictures that I could post, but I've probably gone on long enough! I'm going to try to be better about blogging now and keep it up when the little tyke gets here... I hope all's well with all of you!
Until next time... 

Friday, October 12, 2012

What NOT to say to a war vet: "Hey, Where's your helmet?"

Yesterday after my hospital shift I walked through the double-door exit to sunshine. The fall wind, blowing leaves off trees, welcomed me with a hug. Let Freedom Ring!! I looked around at the happy people outside --everyone looks happy outside to me when I spend 15 hours in a hospital-- and walked to the bike rack. I spotted my blue trusty, locked and ready to ride. Right next to my bike stood a large, sweaty, black-haired gentleman with over-sized gym shorts and a cheap VA Vet t-shirt. Seeing as all people outside hospitals are happy, I asked in a non-threatening, jovial tone, "Hey, where's your helmet?" See below for edited dialouge:

Man in oversized shorts: "Who the f--- are you?"

Man in wimpy doctor clothes (me): "Oh, sorry man, I didn't know you were in a bad mood, just having a conversation."

He continued locking up his bike, ignoring my comment. So I apologized, again.

I quickly fumbled for my bike lock keys in my pocket as I felt dangerously close to this dude. And images of crazy veterans doing crazy post-discharge things kept playing in my head. And I was the victim of all the images. But before I could get my key in the lock he stood up and asked, "What unit are you in?"

Me: "What unit am I in?"

Man: "Yes, what UNIT are you in?"

I stared at him, blankly for a few seconds then said,

 "Um, the unit of the human race?"

Man: "Yea, the unit of f------."

Me: "Um, okay, but aren't you part of that unit?" (At this point you might not think that a wise thing to say to this huge, emotionally revved up dude, but I was not thinking)

He walked up into my face, raised his shoulders like a man ready to plow through the offensive line and cremate  the quarterback, and said, "I'm part of unit 504 of the fifth division, Whooohaa!" Then he walked away.

I stood. I stared. My arms stood straight as fence posts by my side. And the best part, my heart rate was a cool 49, like I was on sunset beach in Oahu. I was strangely calm. Honestly, I didn't think he would do much to me physically, and even if he did, I was in front of a hospital. So no worries.

A few says prior to this Anna wrote letters to soldiers as part of a church activity. She came home and asked, "So, what do you say to a soldier you've never met?" All I can tell her now is one thing she should never say: "Hey, where's your helmet?"

Thursday, May 17, 2012

Aphorisms and Stories while Driving Ms. Patsy

I pulled into Patsy's driveway, yesterday. It was a burning day, above 100. And at noon, you could've fried a rock. But the driveway was shaded by a desert willow and neighboring sweet sycamore, so there was respite while I walked up to her front door. The door was swinging open before I made it to the knob. Patsy was ready.

"I can't stand being late. And I hate dirty cars. I cleaned off my car this morning until my feet got too hot," she stated firmly.

In the year I've known Patsy I've never heard her complain, once. She says things as they ought to be said, all the time. And that's a very comfortable person to be with.

One time in her front room she was showing me her family pictures on the wall. "Isn't this great?" she asked, in a way that was more of a confirmation than a question. "My grandson, right here," she said pointing to a specific portrait, "once asked why he wasn't on the wall. Well, I said, 'Did you serve a mission? Did you graduate high school? Did you get your Eagle Scout? Then there you go.'"

In the year I've known Patsy I've also never seen someone love family or friends more. She lives for her family. "In 60 years of family reunions, I've missed only 5. One of those my husband died right before. When I get back to heaven I'm going to get after him for that one?"Patsy spends any downtime in a conversation talking about her family. Family is the energy that keeps her heart beating. At times she simply breaks down while talking about her family. But she weeps for only 10 seconds before she's right back at it, telling it how it is.

"I'm a boob, and so is my sister. Have been all my life. After my stroke in 2006 they tried to put me on one of those pills for depression. I took one and couldn't stand it. I said, 'Here, take your pills back I don't want any of that.'" And that was Patsy's brief exposure to antidepressants.

"But I never cried when my husband died. Eileen, my good friend, asked at church, 'Patsy I can't believe you, how are you not crying?' Well, I knew God was watching over me. Six months later Eileen's husband died. Then she believed me."

Well, yesterday we hopped in her black Nissan Altima so I could drive her to the cardiologist and chiropractor. She quit driving last September. At 97, that was probably a good time to quit. Patsy is quite nearly see-through, her collagen is so thin and stretched. But she's like the hammer in your shed that keeps on pounding even though the wood around it is all decayed. And she hits the nail on the head every time in all she does.

You see, she's had a lot of practice pounding away at life. Her husband died while she was young, leaving her with five kids to raise. And she raised them all by herself, never remarrying. She worked two jobs. "My kids never knew boredom. If they ever told me they were bored, I put them right to work. And one thing I learned early, if you can't beat 'em, join 'em. And join she did. Her kids have been paying her back for her love in these later years. Just the day before yesterday her oldest son took her out to lunch for mother's day. She spent the lunch telling her son why his son, her grandson, didn't come to talk to her at a wedding reception last week. "I hate that he didn't come talk to me, in his nice suit and standing on the other side of the reception hall all night. I can't stand that." Again, Patsy doesn't complain, she just knows what's right and wrong. And she's a missionary of right and wrong.

But there is a streak of evil in Patsy that came to light as we pulled onto River Road towards Northwest Hospital. I mentioned how the Rillito River used to run when the Mormons were the only ones farming the land with the Indians. And now with all the people we've dropped the water table so the river is a wash 364.8 days of the year. And that got Patsy reminiscing. And one of the things she remembered back in her day was goat's milk.

"Have you ever tried it?"
"Nope." I said.
"Well you should, it's good. One time I brought over my best friend. She said she doesn't like goat's milk. So I put out two glasses of milk and told her one was goat's milk and she was to try them both to see which she liked. Well she loved the other one. But they were both goat's milk. I tricked her."

Patsy disclosed her trickery with a straight face. I laughed.

We pulled into the hospital parking lot and scored the sweetest spot, right next to the entrance. I have beef with handicap tags but when you have one you feel like royalty. I parked the car, turned it off and told Patsy to wait while I ran around to open her door and lift her out. Well I'm a skinny knuckle so when she first pulled up I came right into the passenger door on her lap. I made a mental note right then to get my LA Fitness membership that night. If anyone saw a 97 year old lady take me down I'd never get over it, I thought. But I'm over it, because the cardiologist said Patsy is the strongest woman he has ever seen. He saw her all of ten minutes and she was out the door before I could even get into David McCullough's Truman biography.

Perfect bill of health, with a blood pressure average sitting around 130/80.

Patsy grabbed my arm and smiled as we walked to make her next appointment. She makes annual visits to her cardiologist. 97 years old. Annual visits. Unreal.

Our next stop was her second cousin. "Kissing cousins" she called it. He is a chiropractor. We pulled up to his office and their he was, the Doctor, out sweeping the front of his office in long-sleeve shirt, tie and slacks. In 100 degree weather! Having never seen a physician sweep his own office porch, I felt like I was back in the '40's. And the inside was decorated to match, with Normal Rockwell paintings all over and wallpaper trim up high on the walls, you know, the flowery type that makes it look like Grandma's house. And there was Grandma, sitting at the reception desk! It was a great office. And Patsy was the only patient, so she received prompt treatment. I'm still neutral when it comes to how I view the effectiveness of a chiropractor. Glorified massage is where I tend to think the practice calls home.

But the visit was nice, Patsy gave hugs to everyone, happy her shoulder felt better, which she swears it does, and we headed out to the car for our drive home. On the way home Patsy told me more stories. And in between stories she handed out gems of life. If I live by these gems, I know I'll live a good life like her. She's a person who you can't help but feel better about yourself for being around her. She walks and talks in a way that just makes you want to give the world a hug, at least the ones who deserve it, and to beat the lazy ones with a stick until they start working to deserve a hug.

We pulled into the driveway and Patsy had one more request.

"Come in and help me get the lid off my ice cream."

Clever Patsy.

Back in the car again, headed home.

Monday, May 14, 2012

Grandma's and Facebook

My Grandma Hansen is a wonderful woman. She's lost most of her ability to carry on a linear conversation for longer than a couple minutes. But despite her lack of linear conversations she is becoming quickly famous for her one-liners.

While sitting at a state park eating a picnic with family on Friday, she saw two men walking back from the trailhead.

"Oh, two men out together. You don't see that too often," she said, while chewing watermelon.

The two men looked back and smiled understandingly at me and Anna. I still find myself laughing alone in the car when I think about that...

Also, I think the new "timeline" on facebook is fantastic! Anna and I just evaporated thirty minutes of our life scrolling back through memories. And I saw photos of myself I've never seen before. Amazing. Imagine how the church will use this medium for family history in the next few decades.

I of course sent out more friend invites. Now I'm not addicted to my total friend count like Roger Clemens is to HGH, but it still feels like I need to do it simply because Facebook suggests. I'd hate to offend...

And I sent messages. "How are you doing?" I asked an old co-worker. I realized she might be offended (I really do hate to offend) because I didn't look at her facebook to see how she was really doing. I could've looked there in the first place to know exactly how she was doing.

Thursday, May 3, 2012

BYU Police Beat For Winter Semester

Suspicious Activity

Feb. 16 – A suspicious man was reported watching an aerobics class. When officers arrived, the man said his fiancĂ©e was the teacher. She confirmed his statement.

Feb. 21 – A suspicious car was reported outside the Ellsworth Building. The two people in the car were reading the scriptures.

Feb. 24 – A call reported a female student standing on the bridge over East Campus Drive. The caller was worried she would throw something at cars passing. When a police officer found her, the student said she was taking a break from studying and looking at the stars.

Feb. 29 – A girl taking pictures of a man in his underwear between the HFAC and the MOA was reported. Police arrived and could not locate the individuals.

March 16 – A male was found sleeping on the third floor of the JKB at 5 a.m. He said he had fallen asleep the evening before and had not meant to sleep all night. The man was informed of the building rules on remaining in a building after hours.

Criminal Mischief

Feb. 24 – Graffiti was found on the control box at the outdoor track by Helaman Hall. It said, “My heart is over at your service. Shakespeare.”

March 27 – A number of egg attacks were reported on campus between 6 and 7 a.m. A woman walking was struck in the leg with an egg. A group of military cadets also reported being egged. Legends Grille had eggs thrown at its exterior. The individuals who threw the eggs were reported to be driving a silver vehicle. The drivers were located and charges are currently pending.

Jan. 5 – Somewhere between 1970-1985, a piece of art valued at $218,000 was stolen from BYU campus. After being stolen, the “Silver Chalice” was sold between a number of different art dealers before finally landing in Switzerland with Count Thyssen-Bornemisz’s collection. BYU negotiated with Thyssen-Bornemisz’s estate and the piece of art was returned to BYU.

Feb. 24 – BYU Bookstore security caught a student stealing two textbooks. During the police investigation, it was found he had stolen books from the store before. Police officers accompanied him to his residence and recovered three more textbooks. The total value was about $660. He was cited for a class B misdemeanor for retail theft.

March 23 – A teaching assistant at the Talmage Building reported the Oreo cookies on her office desk were missing. She told the officer the door is always locked except for janitors. There were four cookies, worth 50 cents.


Feb. 28 – A smell of marijuana was reported in May Hall. The officers brought a K-9 unit with them, who located which room the smell was coming from. The residents were not home when police arrived, but, after being called by police, they returned home. The residents would not allow officers to enter the room. Police got a search warrant approved and entered. They found marijuana residue, drug paraphernalia and tobacco in the room. The situation is currently under investigation.

March 8 – A Provo police officer found five BYU students smoking marijuana in a van parked by a local business around 4 a.m. During investigation, the officer found out these students had connections to the drug bust in May Hall. They were cited for drug possession.


Feb. 8 – A complaint was received from the JFSB about mysterious flyers posted on some professors’ office doors. One flyer’s message was, “Cosmo likes this,” with a thumbs-up sign. The other one said, “Cosmo doesn’t like this” with a thumbs-down sign.

Verbal Altercation

Feb. 8 – Two male individuals were reported having a verbal altercation in the Smith Fieldhouse. One of them was a student, the other was not. They were arguing about a girl they both knew and dated.

Animal problem

Jan. 14 — Three student custodians at the Testing Center reported seeing two wolves running toward the Former Presidents’ Home.  After thoroughly surveying the area with spotlights, officers could not confirm the presence of wolves on campus.  The officers returned to ask the custodians if they were sure the animals were wolves, to which one custodian responded, “For sure, they were really big.” One of the students then said he wanted to wait for the wolves so he could scare them away.  The officers suggested they get back to work.

Feb. 21 – A live hamster was reported in the Cannon Center. Officers responded and were unable to locate the hamster. The call is believed to have been a prank.


Jan. 31 – Some children in Wymount Terrace called the police, saying they did not have any parents at home. Police arrived and found a 5-year-old and a 3-year-old home alone. After many attempts, the mom was contacted. She said she was on her way home and would never leave her children home alone again

Feb. 12 – A husband resident of Wymount Terrace reported a missing wife. He told the officer his wife had not come back from grocery shopping. During the interview, the wife walked into the room.

Wednesday, May 2, 2012

These Is My Words

Pontiac Vibes are great SUV's. We packed two mountain bikes, two road bikes, camping gear, a week's worth of clothing, food, two bodies, and a 24-pack of diet coke, with room to spare. With four cylinders it also gets great gas mileage. And so we packed for our week-long vacation! We are tucking in the corners of our Tucson experience this month and it's mildly stressful changing jobs and moving, so we were looking forward to the break. Tucson bid us adieu on Saturday afternoon pushing 100 degree weather.

Saturday afternoon/night: We pulled into Thatcher, tired and hungry. We walked around to find Mom and Dad lounging on the porch and admiring their newly updated backyard with their colonial wall and arch. Dad asked me to copy a design in a Tucson garden, which I did on my svelte MacBook. But I think I'll continue to stake out my financial future in medicine, not architectural design.

And the backyard looked lovely. We watched the sun fall through the arch, on the horizon and barbecued with Mykol and Sally. We then lounged on the grass in the back, enjoying the cool breeze and checking out constellations with more Mac products. And Dad shared stories of his piratical youth, fighting barbed wires and jumping off motorcycles. Check out the scars on his legs sometime. After that we desserted with Angel Food Cake. Yes. That has to be what manna looked/tasted like. The mystery is in the name. Fueled, we competed in Mexican Train Dominoes. We all enjoyed ourselves. Poor Anna counted her dots all night to a hefty total, so we talked after about how much we like card games.

We finished the night watching "We Bought a Zoo." I kept thinking what Jason Bourne would do to his child yelling at him. Hmm.

Sunday: A good, hot day. Anna and I went for a morning walk around the desert loop of neighborhoods, cotton fields, and desert plains. Dusty and sweaty, we showered and dressed for church. My dad is bishop in a singles ward so Anna and I felt twenty years older than everyone else, even though everyone is about our age. It's a great ward. My dad is a great Bishop. After church we napped, read books, and ate dinner. We read some more after, chatted with the parents, and crashed on the pull-out bed, exhausted after a day

Monday: The sun beat us up. We packed the car and pointed it east to Morenci and beyond. We turned north into New Mexico and then crossed back into northern Arizona. Soon we were in the White Mountains: Alpine, Eager, then Greer, our destination point! Greer is a great nook of a town. Mostly cabins it fits snugly in a canyon headed nowhere. Flanked on the east and west by mountains, you drive south for about five miles on a road, passing roadside cafes, lodges, cabins, a firehouse, and small grocery stores. The road is lined by a white gravel bike path and the Little Colorado River. If you've ever been to Breckenridge, imagine that but downsized and without a ski resort.

We pulled into the Greer Mountain Lodge, checked in, grabbed some travel guides and searched out our unit. Our cabin faced a small fishing pond. Inside we found a big room with a fridge, gas stove, microwave, walk-in closet, spacious bathroom, and satellite TV. We were pleased. We unloaded the car and changed into biking gear for a mountain trail ride in the afternoon. We were rusty, but excited to be out in the mountain air. After a killer climb we found a dirt road to ride. At the end of the dirt road we came across a Caterpillar operator smoothing the road. He shut off his engine when we pulled up and kicked his legs up on the dash for a rest, swigging out of a Gatorade bottle.

I asked him where the road leads to. He said to a fork, where we can go left to Big Lake or right back around to Greer on a highway. How far? I asked. He said, Ah, maybe two or three miles. Enough of a ride for you two to get back before the sunset to enjoy a beer. Anna and I smiled at him and then at each other, thanked him for the directions, and rode back home. I think working out in the country would be a good life.

We got back to the cabin and grabbed some dogs, marshmallows, chips, and wood. We drove a couple miles north of Greer to a campsite and made our bonfire. I loaded it up with pine needles scattered across the forest floor. Smells and memories of fathers and sons outings lifted up into our minds with the smoke. Well, for me, anyway. Nothing like a good bonfire to throw pine needles on. We read "These Is My Words." by the light of the fire. When the flames shrunk we killed 'em off with water and packed up the car. Anna, afraid of setting Greer on fire, returned to the pit to spit on it. She did, my girl literally spit into the smokey remains. I love that woman.

Tuesday: We thought it would be a nice day to take it easy. So we woke up late, went for a walk through Greer, and admired cabins. Greer is green, and with the Little Colorado it makes for some picturesque real estate. Someday, just maybe, Greer would be a good place for a cabin. My preference would still be Pine or Strawberry, AZ. After our walk we drove to the nearest roadside cafe for some greasy good breakfast. Eggs. Hash browns. Dry toast with butter and jelly from little plastic boxes. I always feel like a clover trying to spoon out all the jelly. For drinks the waiter asked if we wanted any vodka. Seems like they like to drink in Greer.

After our meal we went back to the cabin to read and lounge. I hiked the mountain across the field and river from our cabin. At the top I saw remains of last year's fire, the largest in AZ history, started by two good young men from Benson, AZ. They did all we did to our bonfire last night, but they didn't have Anna for the finishing spit. Hence, widespread destruction.

I hiked back down to our cabin where Anna was doing what is probably her favorite two things at once: knitting and listening to a book on tape. She looked at me and asked if I was ready for our drive up to Big Lake. We sat lakeside and read and napped. On the way back home we counted over 15 elk.

We made another big bonfire to finish the day. Marshmallows...

Wednesday: We woke up, packed the bags, bid adieu to Greer and drove up to Snowflake for a temple session. After that we picnicked in a park and drove into the evening to St. George to hook up with Anna's family for two days of biking, playing with kids, and more sleeping. I think one of the highlights of those two days was getting to know Richard Scarry with Anna. She flipped open the book and fell back into her childhood. (This is a tangent but one thing ebooks cannot do is look inviting to someone nearby. When I see someone reading an ebook I have no impulse to ask what they are reading or to look over their shoulder. But if someone opens a real book, it's as if the book's cover act as arms, gesturing a welcoming hug for you to sit up close and cozy with another reader and partake in its contents)  I also loved spending time with the Johnsons and Birks. The Boyers are a good and patient family. Ironically that tries my patience sometimes. Take one evening after dinner: the clan was deciding about a walk up "fat man's revenge." They spent almost five minutes being nice to each other and respecting each other's opinion while they tried to decide what to do. The way I grew up it was: "This is what we're doing." "Let's go, nope you can't stay behind." "You should have thought about it before we left." This might sound like a harsh difference, but it required no patience on my part when I was young. No patience but I got real good at practicing the refined art of complaining. But how can you complain with family who always make sure they are doing what the other person wants? The problem is if you don't have patience you are left standing in a quagmire of indecision :) Honestly, though, my glass is always half-full with my native and married families. I just might not always act that way. I'm a Hansen so my love comes out way overdue in most cases, usually when the people I love are asleep and I can't tell them at the moment.

We spent the nights playing some games and talking health care policy. I came out of those talks thinking it's all the lawyers' fault.

All in all, it was a great week. We played and slept a lot in some great warm weather. Life is finally more enjoyable with the summer heat arriving. I can't see why Anna disagrees. Those are my words...

Tuesday, April 17, 2012

Sunday School Thoughts

Our Gospel Doctrine teacher opened the lesson talking about his "Newt Gingrich" tie so I was zoned out from the beginning. Not a good start, and I had reviewed the lesson. But as he continued on the tie I just couldn't help myself and I started daydreaming. (It helps to daydream with windows in the room)

I looked out and saw the saguaro on a hill. I imagine those cactus engaged is some great discussions. Their conversation of their alien milieu is almost decipherable from our vantage point with a little daydreaming. You can almost see different ones saying different things:

"Oh, thank heavens."
"Here, give me a hug."
"I surrender!"
"You should really turn down that path."
"Give me a high-five."

They carry on in their succulent ways, I'm sure making fun of us humans the entire time.

"So why do we turn our tents to the temple?" asked our teacher.

I was back in the lesson. But then he talked about his subscription to an archeology magazine-and the arguments therein about biblical times- and my eyes drifted back to the windows.

Outside I could see so many nice cars. I think our Protege and Vibe might be the cheapest ones in the lot. And the fact that they are missing handles, hubcaps, and mirrors solidifies my argument. We do live in so much abundance. But we all have so many worries. I pondered why. And if we could quantify them, would they be more than our ancestors over the centuries? I think so. I think we worry because we have no hands in the dirt. We don't plant that seed that grows into a tomato that gets picked, washed, and placed on our omelet. We've turned all those jobs over to others. And not just food, but water, electricity, security, funds, all of it, outsourced from our home office and field into the hands of others. We have so much, but we have no control. And we worry, worry, worry. That's how I see it during Sunday School, anyway.

"Young people are so smart with computers. I'm old, I don't get it," pipes an older sister.

Evidently the discussion drifted to genealogy and challenges therein. But I sat thinking about her comment, and relating it to my previous train of thought. Really, are we young gunners so smart. I wonder how we would survive if dropped in 1940, 1950, 1960, or even 1970. Would we know how to handle the draft? Would we understand the concept of calling a travel agent to purchase plane tickets? Would we be able to write cursive and make our words mean something powerful and important in an application? Would we know how to grab the public bus downtown? Would we really know how to change our own oil? Would we know how to live without so many freezer foods? Would we be smart enough to go on a hike with an old-fashioned compass? Would we know how to read a map? Better yet, would we know how to fold up that map when finished reading (okay, if you can do this consistently I would vote for you as President of the United States of America). Would we know how to make a collect call? Would we know how to handle a nuclear threat? Would we know how to work a full day without looking at our watch but looking at the job? And would we know how to have a pen pal? Would we know how to go on a date and what to do on a date without so multimedia options? And don't know if we young ones are so very smart, I know I'm not.

Tuesday, April 10, 2012

Firefight at the Old Folk's Home

Monday morning came peacefully. I could hear the birds, only, breaking silence. It was cool, with a wispy cloud screen overhead. Such serenity really can only be found on El Rancho. And that's where I was for the day, spending time with Grandma while Susan accompanied Grandpa into Tucson for his heart procedure.

With a backpack full of books and twenty dollars on the kitchen table from Grandpa for lunch in town, Grandma and I were set. But you can always get more books, so in the morning Grandma wanted to visit the public library. She held my arm and introduced me to all the librarians. One lady gave Grandma a letter she left in her previously returned book. Then this lady showed us to Grandma's favorite aisle of books. We browsed, me silently and Grandma out-loud, naming each and every author and title on that aisle.

After she selected four books we left, setting off the scanner, which is okay because everyone knows Grandma never has her card but she's good for the books.

Then we went for some basic groceries. Grandma held my hand, claiming it needed "warming" as we strolled the aisles. We grabbed milk, yogurt, and fruit. And we were having a great time. I kept wondering why I don't come out to spend more time with Grandma. She makes me feel like a million bucks, all the time. And she's always smiling. And she has great stories, like the time she was called as Relief Society President, "When I hated relief society."

After the grocery store we went to the drive-thru at Wendy's. I was beginning to concern myself with the fact we spent the morning walking around town and Grandma was not drinking. So we loaded up on liquids and headed home. I knew also I needed to keep Grandma near a bathroom. Intake and output, probably the two most important geriatric priorities of the day, in my mind.

Back at the Ranch we spread out lunch on the table. I had to remind Grandma to eat and drink and she got a little impatient with me so I asked if I could take the trash out and burn it. Grandma endorsed the idea enthusiastically, so I left for five minutes to take the trash out behind the wood pile, throw it in the metal trash bin, and set it aflame. This is always my favorite chore at Grandma's house.

After five minutes of watching the flames I went back inside, and there was no Grandma at the table. But there was a half-eaten sandwich and an empty glass of water. Success! I found Grandma in the back bedroom talking to her cats. I asked if she wanted to finish lunch with me and we returned to the kitchen. I had just sat down when I smelled smoke. I jumped up, rushed to the kitchen window, and saw flames creeping down to Grandpa's garage, where he had two cars parked and two dune buggy's, as well as enough gas to blow us to Tucson.

I think I said something like, "Oh, crap. Oh no," with my voice wavering. In a split-second decision I decided not to tell Grandma and I ran outside with my cup of water from lunch. I ran to the flames approaching the garage and felt an overwhelming depression as I saw three more lines of flames, one heading into the woodpile, another across the barbed wire and south of the property, and a third heading east into the wash. I could NOT believe this was happening to me. My mind was racing and I could not think, so I looked in the garage and found the most plastic and flammable tarp you can imagine and raced back to line #1 (garage line) to flap it out. You can guess what happened to the tarp. So I started using my feet, but my scrubs started to catch aflame, so I ran back to the house, thinking maybe I should call the fire department. But that far out, who would come? And are they a volunteer crew? Pro Bono might not be bueno today.

I saw the house hose. It was five feet long, a good hundred-fifty too short. But in one of many tender mercies of the day, there were two buckets right by the door. I cranked the faucet and filled both buckets and ran back to the fires. I had to prioritize. I was about to lose a huge mesquite and wood pile. I was also about to lose ground on everything south and east. But I knew I had to finish line #1 (garage). And I did. Thankfully, the garage, and dune buggy survived by two feet. I ran back to the house and saw Grandma walking out with her slow, shuffling walk.

"Oh my," she said in surprise at all the smoke in her yard. I wasn't sure how she was going to react. Luckily, she looked down and saw the hose running so she grabbed it and started watering the flowers by the door. I ran up to Grandma and placed my buckets on the ground in front of her.

"Okay Grandma, everything's okay, the trash fire got out of control but I've got it under control." That was a complete lie. But I needed to keep Grandma in control.

"Oh, okay," was her response.

"Grandma, you fill the buckets up, I'll run and take care of the fire, and come back for you to fill them up again, okay?"

This was our plan. I ran back to the spreading lines and began to gain some control. I eventually put out the mesquite tree and line near the wood pile, which I came within five inches of losing. Every time I ran back to Grandma, she was there waiting with hose. She filled buckets and watered flowers while I fought the fire.

The third line on the south was difficult because I had to negotiate a barbed wire fence. At this point I was wondering when the neighbors were going to arrive. That's a testament to their confidence in Grandpa and his controlled burns I guess, because they never came. I eventually put out the third line and fourth line which was spreading down into the wash.

And there was Grandma, faithfully filling buckets in 90 degree weather, wearing sweats, a sweater, and a wool cap. I made a mental note to make sure she drink a few cups of water when this was all over. I eventually filled up a wagon with water and gave Grandma a big hug, thanking her for saving the day. I was close to losing control but Grandma saved precious time having the hose ready. After I made sure the four lines were out I went back to Grandma and told her to get some rest inside.

"No, I'll just sit right here and wait. By the way, this will be our little secret."

I felt like crying, but didn't want to be the first firefighter in the world to do that, especially on my first one, so I gave Grandma another hug. She stood up and we stood staring at the smoke and ashes, side-by-side. I put my arm around her, sharing the moment of victory and wiped the sweat off my forehead and the tears out of my eyes. But I think the tears were more for having an AWESOME grandma than for avoiding near tragedy.

I spent the next hour spot-checking, putting out flames that would pop out of a yucca or piece of wood on the ground. The wind picked up, reminding me that while Grandma saved the day, it was divine assistance that made the difference.

Funny how family has been talking about getting the grandparents off the ranch and into a safer, more comfortable living environment. I guess it's not time yet.

Wednesday, April 4, 2012

What John Wesley Powell Felt Like?

I cannot imagine walking real estate not previously traversed by norte americano humano sapiano, but to feel, to really feel what it would be like to do so seems exciting. My imagination leapt outside it's weedy and rusty playground and fired me up Monday morning.

Anna and I went for a hike in the Tortolito mountains. The trails, recently opened, cross through a minor mountain range north of Tucson. The range, lower in elevation and a little distant from the more popular Catalinas, is probably overlooked by locals and visitors. But thanks to Marriott, the modern day bank-roller for studs like John Powell, we could ride the coattails of the rich right into some high desert that was more virgin than I'd ever seen. Because his kingdom built a Ritz-Carlton right at the foot of the mountains and supplied funds for trail--really good trail--building.

The range also houses a perennial stream, a stream that runs ALL YEAR LONG. You're more likely to get eaten by a shark than jump over a perennial stream out here in the desert.

In the mountains, wildlife is there. The plant variety is enormous-- not to mention the quantity--and the trash is none. With 65 degree weather, a slight breeze as a companion, and no clouds, we forged through the Aspen Loop trail. The area was home to ranging Hohokam Indians from 500 AD through 1300 AD. I would've stooped in search of arrowheads but I didn't want to hold up Anna. My goal in life is to get Anna to like arrowheads. The last time I mentioned them she said she didn't need any bottled water :)

So, we hiked. And my imagination was going. And I felt like I would want to be a modern-day Powell, laying out new maps for a growing and blessed nation. I just don't think I could do it with one arm...

Thursday, March 29, 2012

More Tucson Thoughts

-A few Saturdays ago I rode home from the hospital and passed 9 yard sales, in 4 miles. It's an exercise in discipline for me not to brake, spin my bike around, and hit the pedal back to the tables of possible treasures. This makes me feel adolescent because I stand up to pedal faster, leaving my backpack flapping from shoulder to shoulder, rapid-fire. But I didn't stop...I think because my mind caught hold of a thought and held onto it like angel food cake.

How many other countries have yard sales embedded as a social norm? I can strike off Israel, Brasil, Ghana, France, Mexico, and Egypt because I've been there over weekends, never seeing yard sales.

-Over the past couple years a few physicians disclosed their salaries to me. They also disclose offers they've received to relocate. One physician was offered seven figures to pick up and move from Phoenix to a practice in New York. But the physicians don't move for money. And they all commonly say the same thing: "Enough is enough. You get to a point where you are comfortable and you don't need more." Just seeing how much Peyton Manning signed for ($96 million for five years) made me wonder why you rarely hear athletes say, "enough is enough." They are always bartering for more.

-I finish my neurology clerkship today. In one lecture we learned about treatment for Alzheimer's. The current treatments do not cure, but prolong the inevitable--a form of mental life support. If it were me being treated, would I want to prolong the inevitable? My knee-jerk reaction is to answer, "no." This probably has to do with imagining the strain I would put on loved ones. However, rarely do I see loved ones less angelic than when they are caring for their Alzheimer's loved one. No judgements here, just observations.

-I read this in my textbook: "Essential tremor often responds briefly but dramatically to ethanol consumption, which may be a useful diagnostic feature." I always find it interesting when medicine and The Word of Wisdom intersect in a most perpendicular way.

-Racism. If someone criticizes the church for withholding Priesthood from those of African descent, and it's a criticism based purely on race--with no subjective bias against the church--then they should always be willing to discuss, at the same time, how America withheld the right to vote from those of African descent until the 15th Amendment. And if they truly have no church bias, they won't object to the comparison, for sake of discussion.

Monday, March 19, 2012

Eat Your Spinach

Mom always told us to eat our spinach. It will make us strong. We believed. We ate. And we walked away from the dinner table to gather our capes and plastic swords to battle the bad guys down the hallway. Good thing only my sisters lived at the end of the hallway because I ate a lot of spinach. Dad always said I would grow hair on my chest if I ate sardines.

"Now these will put hair on your chest," he said. I can still remember his smile as he bit the heads off at the dinner table, making my sisters run back down to the end of their hallways where I would later confront them with my spinach-bolstered no hair on my chest.

Okay, so this blog entry has a point. Spinach. I love you Mom, but maybe moms have been known to be wrong about a few things--propagating healthy rumors that are nothing more substantial than rumor.

Knuckle cracking. Known as "KC" in the literature. Has Mom ever told you it will give you arthritis? Well I finally came across an elegant (elegant in every sense of the word) study by a physician who found KC does not cause arthritis.

For fifty years he diligently knuckle cracked his left hand at least twice a day. Yes, 50. He refrained from cracking his right hand during this time, and any crack on the right was unintentional. How he did this for fifty years amazes me because I always feel unbalanced if I crack only one side of any part of my body. But he cracked unilaterally, and diligently. And then he imaged his hands and compared the two, finding no evidence of arthritis in either hand, in fact, both hands showed similar joint space findings.

You can check out his paper here:

Monday, February 27, 2012


The first change I noticed was the direction--I was driving away from downtown and my usual route to the hospital. Into the foothills of the west, on a road called Sweetwater, I drove. Wishing I was biking instead of driving to the Cottonwood clinic, I was otherwise stress-free this morning. I listened to NPR on the radio recapping last night's Oscar Awards ceremony. After an eight mile drive on a route Anna and I frequently road bike, I saw a sign indicating Cottonwood's entrance. I turned right and after a few small curves and turns I arrived at a gate with a keypad and speaker. I pushed the "push to talk" button and waited a couple seconds before a pleasant-sounding lady asked my business. I told her my business, a medical student on a rotation assigned to follow Dr. Onate. She opened the gate, instructing me to park and walk into the first building on the left.

I parked, gathered my pencils and notebook, clipped my ID onto my shirt, checked for outstanding nose hairs in the rear-view mirror and got out of the car. It was a breezy morning and every tree in the clinic was dancing. I love that. I walked into the first building on the left and announced who I was. I was given another ID by the receptionist and also told where to find Dr. Onate's office.

"Follow the path past the Lodge, the tennis courts, the pool on the right, and the garden. Onate's clinic is the last long building on the far end of the campus."

"Great," I said.

I walked outside and headed east down the path. The grounds are well-kept at Cottonwood. The walkways are straight-edged and cut through gravel landscape. Every five feet is a tree of some variety. After fifty feet of walking I passed saguaro, rosewood, texas rangers, pine, queen palms, ocotillo, oak, mesquite, and mountain laurels--which happened to be in bloom with their intoxicating grape-smelling flowers. It was the kind of landscape you find at a Sedona or Scottsdale resort.

The campus buildings are constructed of rough-hewn stone, the color of sand. The windows, doors and rooftops are a light blue. The buildings blend with the background mountains and sky. Walking east I passed various staff, starting their day. There was no rush in their walk, at least not the rush you see in the hospital halls of University Medical Center.

I passed the Lodge, tennis courts, pool, and gardens and found the last building on the lot. I walked into the middle door into the reception area. Inside I saw three teenagers sitting--or rather laying sideways across plush armchairs--reading magazines and chatting.

I walked up to the reception desk and introduced myself. The receptionist was the first person I saw on campus who looked really busy. Normal busy for a Monday she told me. She said Dr. Onate was waiting for a medical student and that I must be the one. I was. She led me to his office. Inside Onate was sitting, chatting with a fellow psychiatrist. He smiled and extended his hand, which I shook.

Onate was wearing a dark, Quick-silver button down, untucked, with dark corduroys and black shoes. His skin was bronze and he had a badger-streaked goatee. He was short and well-built. He did not look like a physician. Then again, most psychiatrists don't look like physicians in my book. But Onate had something western about him. I later found out he grew up in Clifton, Eastern Arizona. That explained his mannerisms and look. You can tell if someone is from the copper country.

Onate, like most psychiatrists, enjoys his work. He walked me around the campus, showing me the various buildings and their purpose. We passed through some in-patient units and he stopped occasionally to speak with counselors or nurses about specific patients. Evidently it was a busy weekend. Patients were sneaking benzodiazepines, "cheeking" pills, pretending to use the bathroom to put on hairspray, staying out late at night at the lodge, and upsetting roommates. Nothing unteenager-like there, I supposed.

After the tour we returned to Onate's office. He gave me a seat and I sat. I looked out his window at the blowing queen palms and pines with the clouds passing quickly by under the blue sky. I mentioned he had a better view than any I had seen during medical school. He agreed his location was prime. I wanted to tell him I'd wager his job was probably better than any I'd seen also, but I held that comment in my head and told it to go away. Maybe at the end of my rotation I'd tell him my thoughts on his job.

He showed me his schedule of the day. We were to see three patients and then he had a meeting after lunch. "I'm usually out of here by two," Onate said. That thought I held in my head about his job being the best in medicine almost slipped down to my tongue and out my mouth, but I again held it back. I'd wait and see patients with him first.

We walked out the office together, down the hall to the reception area. We passed your typical office pictures on the wall: An eagle with the word "Dignity" on the top, mountains with the word "Respect" on top, and two ducks necking with the word "Love" on top (they were doing some sort of hugging with their necks, I never really knew what "necking" referred to so I'll just think that's what it means). Onate called for patient 1 and a skinny, young blond guy popped out of the chair he was lounging in. We three walked back to Onate's office.

After introducing patient 1 to me and asking his permission for me to sit in, we all sat down and began the session. Patient 1 wore a blue hoodie, skinny jeans, and converses. He hair was gelled mildly, teepee style. He had aviator sunglasses hanging from the neck of his hoodie. He sat back in the chair and clasped his hands together.

Onate asked how he was doing.

Every day is a struggle, patient 1 said.

Onate: You have the past, the present and the future.

Patient 1: My life is shit, all I do is remember my past. It haunts me, you know what I mean, and all the debt, and survivor's guilt, and pain. It comes back to haunt me and my head does a three-sixty, you know what I mean? Then I think about the future and what's going to happen and my anxiety goes up and I feel like I'm surrounded. He says this while drawing an imaginary circle around himself. And I'm trying to get out, he says, imitating the breast stroke in the air.

Onate: Well, that's why here we are just trying to get you to focus on the present.

Patient 1's story came together a little for me. He's from New York. At his rocky bottom he was living on the street, trying to find a way to his next Heroin fix. His last one was July 4. Out with a bang, he said, smiling at me. I smiled back and looked down at my shoes. Onate said he looked a lot better this week. He was able to talk more--provide more insight into his "present." He was leaving Sunday and wanted to get things ready before his discharge. I wanted to ask patient 1 his plans once out of here. Would he go back to New York? What would he do after his next relapse? Would he end up on the street again? After this session I didn't feel much hope for patient 1. He seemed fragile and unsure. And he was leaving Sunday. After a discussion about his medications, Onate told him thanks and patient 1 got up and left. Onate charted. I looked out the window in wonder of what it would be like to be a patient here.

We gathered patient 2 from the reception area just like patient 1.

Onate: How are you doing?

Patient 2: I've been having more paranoia and acid flashbacks, I presume. I would say flashbacks because it's quite natural to have, coming off drugs.

Onate: Have you tried Seroquel?

Patient 2: It causes me to go crazy, and I'm not exaggerating, it actually makes me crazy. I don't think I'm psychotic, to be honest, and I think that comes from the Seroquel.

Patient 2 is a skinny 17-year-old who has already suffered a heart attack from cocaine use at 15. He's from London. His chart says he studies Fundamental Art. Reviewing his chart before we met patient 2, Onate asked if I knew what Fundamental Art was. Who knows, I said. I wondered if patient 2 knew.

I learned from patient 2 Cottonwood has a liaison set up in London where it's "well-represented." He was targeting two treatment centers: Cottonwood and one in South Africa. Mode of therapy won him over to Cottonwood. Tell me how this sounds to a struggling kid:

Adapted from the Cottonwood brochure:
Cottonwood's compassionate team created an individual plan in which the patient always comes first...a plan that includes these treatment modalities:
Group Therapy
Individual Therapy
Trauma Therapy
12-Step Meetings
Equine Assisted Counseling
Expressive Arts Groups
Challenge Course
Rocks and Ropes
Psychoeducational Lectures
recreation Therapy
Tai Chi

Sounds like Sedona or Scottsdale for a couple's weekend get-away. And why not? Wouldn't the patient benefit that much more from equine therapy than a stable couple looking for some fun on their stability like a cherry on top?

Patient 2's issue today, other than paranoia, is depression

Patient 2: I don't know, I might be depressed, actually, when does depression start? I might be but I should just give it time. Can I not have something for emergencies, like a benzo--it calms my body.

Now that's Fundamental Art

Onate: You're in a drug treatment facility.

Patient 2: I'm aware of that, he says without sounding britishly snobby (which I didn't think was possible)

Onate: We try and stay away from addictive drugs. Are you open to something else?

Patient 2: Yeah, it won't help, but I'm open to it.

Onate and him agree to start an anti-depressant, a selective serotonin re uptake inhibitor. These are good drugs. Serotonin helps with sleep and a sense of feeling rested and focused. It helps to recognize thoughts for what they are, rational or irrational. I like the choice for patient 2.

I felt some anxiety when patient 2 was complaining about not getting benzos. I imagine he put down a few ten thousand dollars for his month here. As his physician I would feel tempted to make sure he was pleased with his stay--to ensure a good "customer feedback" form was in order. To make sure patient 2 returned home to London and had nothing but good things to say about Tucson. I told Onate after this visit with 2 my thoughts about treating to please and he said no, it wasn't a challenge. Onate asked if I found 2 depressed. I thought not--too talkative, too forward-looking, too engaging. I knew depression to be a black hole for everyone around and 2 didn't leave me feeling drained as some deep depressive patients have.

Patient 3 was talkative. She had long, blond California hair and she wore tight sweats and a hoodie. She could have come straight out of your typical high school pep rally.

Patient 3: I still feel out of body doctor. I feel like my dreams are very, very...I don't feel like I'm sleeping. I dream I'm on a horse with Hulk Hulgan. What is that? I want to change my dosage from night to morning.

Onate: Okay, we don't like to make many changes to your drug regimen. You're very talkative today so let's slow down. We have time.

After some discussion it was agreed to increase 3's Lamictal from 25mg to 50mg. The max dose is 200.

Patient 3: And can I have my razor back?

Onate: You're switching subjects, again.

Patient 3: It's my birthday coming up on the 10th.

Onate: Oh, that's good, he says, smiling

Patient 3: Maybe I'll get a tofu cake, with some recyclable candles. When she says this she smiles, and I think her side profile looks like Joaquim Phoenix, stoned, in Walk the Line. That lazy smile thing going on where the eyes kind of drift aimlessly.

Cottonwood probably hosts many birthdays. The average length-of-stay is 30 days. Some stay 45. And adolescents stay 90. Patients see a psychiatrist once a week and a personal counselor daily. The days are filled up with therapy from the list above. And the final week is "family week." This is what it sounds like, therapy with the family. Another expensive proposition. But Cottonwood, as I'm learning, spares no expense.

After seeing three patients, it was noon. Onate walked me to the cafeteria and we stood in line for food. The cafeteria looked like it belonged in a nice Marriott. The head chef served us--the menu today was top sirloin or fish stir fry. A hot meal, gourmet, cost five dollars. The salad-bar was 4 dollars. The cafeteria served patient and practitioner alike. The patients never sat at the same tables as the staff. But bread was broken together under the same roof. I liked that. I liked the top sirloin.

I spent lunch sitting at a corner table with 5 physicians. Two windows behind me poured the sunlight onto my table. I struck up a conversation with a physician who came out here to work from New York. He is here to stay. We talked a little about religion. He mentioned how one needs to break his heart to find happiness. I couldn't help but ask if he had read The Book of Mormon. He had not. But we both agreed our path to happiness involves focusing less on self and more on others. Any religion that can do this is a good one. I agreed, to a point only. I hope to talk to him about authority next time we share lunch at the same table. He is a good man. And like most staff at Cottonwood, he smiles a lot.

After lunch I was released. I strolled through the campus thinking how nice it would be to bring Anna on a date here. If every treatment center possessed these resources up in the hills where the dove sings every morning, the world would not be so telestial. But we are by design in a telestial world so the stay for patients at Cottonwood is, appropriately, temporary. Pretty soon every patient has to step back out into the unknown future and start that breaststroke, blindly, through the air, trying to find safety.

Sunday, February 19, 2012

Maybe Romney Ain't So Bad...

A Presidential Candidate

I have pretty much made up my mind to run for President.
What the country wants is a candidate who cannot be injured
by investigation of his past history, so that the enemies of the
party will be unable to rake up anything against him that
nobody ever heard of before. If you know the worst about
a candidate, to begin with, every attempt to spring things
on him will be checkmated. Now I am going to enter the
field with an open record. I am going to own up in advance
to all the wickedness I have done, and if any Congressional
committee is disposed to prowl around my biography in the
hope of discovering any dark and deadly deed that I have
secreted, why—let it prowl.
In the first place, I admit that I treed a rheumatic grand­
father of mine in the winter of 1850. He was old and inexpert
in climbing trees, but with the heartless brutality that is char­acteristic
of me I ran him out the front door in his night­
of shirt at the point of a shotgun, and caused him to bowl up a
maple tree, where he remained all night, while I emptied shot
into his legs. I did this because he snored. I will do it again if I
ever have another grandfather. I am as inhuman now as I was
in 1850. I candidly acknowledge that I ran away at the battle
of Gettysburg. My friends have tried to smooth over this fact
by asserting that I did so for the purpose of imitating Wash­ington,
who went into the woods at Valley Forge for the
purpose of saying his prayers. It was a miserable subterfuge.
I struck out in a straight line for the Tropic of Cancer because
I was scared. I wanted my country saved, but I preferred to
have somebody else save it. I entertain that preference yet. If
the bubble reputation can be obtained only at the cannon’s
mouth, I am willing to go there for it, provided the cannon
is empty. If it is loaded my immortal and inflexible purpose
is to get over the fence and go home. My invariable practice
in war has been to bring out of every fight two­thirds more
men than when I went in. This seems to me to be Napoleonic
in its grandeur.
My financial views are of the most decided character, but
they are not likely, perhaps, to increase my popularity with
the advocates of inflation. I do not insist upon the special
supremacy of rag money or hard money. The great funda­
mental principle of my life is to take any kind I can get.
The rumor that I buried a dead aunt under my grapevine
was correct. The vine needed fertilizing, my aunt had to
be buried, and I dedicated her to this high purpose. Does
that unfit me for the Presidency? The Constitution of our
country does not say so. No other citizen was ever considered
unworthy of this office because he enriched his grapevines
with his dead relatives. Why should I be selected as the first
victim of an absurd prejudice?
I admit also that I am not a friend of the poor man. I regard
the poor man, in his present condition, as so much wasted
raw material. Cut up and properly canned, he might be
made useful to fatten the natives of the cannibal islands and
to improve our export trade with that region. I shall recom­
mend legislation upon the subject in my first message. My
campaign cry will be: “Desiccate the poor workingman; stuff
him into sausages.”
These are about the worst parts of my record. On them I
come before the country. If my country don’t want me, I will
go back again. But I recommend myself as a safe man—a man
who starts from the basis of total depravity and proposes to
be fiendish to the last.
Mark Twain

Tuesday, January 31, 2012

NBA...Jane Eyre...Moms...Absolutes

Okay, if you enjoy the above as I do then sit back down on your chair to collect yourself and stop looking around for the nearest person to share this spectacle with. I love athletes who work from their core. Blake echoes Rafael Nadal on the court. He's not quite the consistent tiger Nadal is, but close. If you need some more bum-from-the-chair-raising highlights, google last weekend's Australian Open final highlights between the Tiger and Djokovic. Tennis has surpassed the glory of Sampras and Agassi.

But if you need to study, like I do tonight, I need to recommend the soundtrack to the recently released Jane Eyre movie adaptation. It is the right stuff.

For other thoughts, I had a lecture today about medicare reimbursement. For an emergency physician to stop a nosebleed he will apply and bill for a "nasal tampon." This minor procedure nets him $80. So if moms earned more than a nickel for every nosebleed they stopped, they for sure would be millionaires.

Also, I love absolutes, but sharing my thoughts tonight on two absolutes will have to wait until another post because it doesn't fit into the mood of tonight's words...

Sunday, January 29, 2012

The Lavender Rush

We jogged out of Sabino Canyon, dusty and tired. We switched leads because of the beans we ate for lunch. Blackett's Ridge is wonderful. You can summit the high desert ridge under one hour and jog back down for the completion. It elevates you above the city into deer and bobcat country. You see hikers serious about the hike, not your typical flashy, flesh-showing, lower- elevation hikers who are mad their friends decided on a hike instead of LA Fitness. And you see no trash, which settles your urbanely agitated mind. So within this setting I had another teaching moment from the great head-master, Nature.

On the way out of the canyon Anna noticed the sunset and its colors. I said I love the sage color of the sky. I meant lavender. But that is okay, I justified; lavender is not one of the primary colors. Still, I had a box of many colors in elementary school. I needed to review my colors. Mixing sage for lavender is not elementary for me, my dear Watson.

The sunset's purpose was understood, for me. I was taught humility again. I don't know it all. I won't know it all. And unless I review and practice, I'll forget it all. The problem is, when I learn something I quickly think I know it all. And I stop asking questions. It's easy to know what I see, but what about that I cannot see? Maybe that's why we have seasons; we forget what so recently passed, we need reminders. So here's to a lavender sunset. I'll miss this desert...

Tuesday, January 24, 2012

Ron Paul

Politics...not my best subject to discuss if I want to pretend I know anything. But I do know one thing, after the republican debate Monday night, which I watched on a comfortable Jet Blue, I would vote for Ron Paul. He is smart. He is efficient. He gives concrete detail. And he is the only one who would conform with the following statement given by the First Presidency of the LDS church during WWII:

“‘. . . the Church is and must be against war. The Church itself cannot wage war, unless and until the Lord shall issue new commands. It cannot regard war as a righteous means of settling international disputes; these should and could be settled—the nations agreeing—by peaceful negotiation and adjustment. "

So while Romney and Gingrich want to make our stick we carry bigger ( I'm not sure where Santorum stands) Ron Paul wants to make our hearts bigger. Sounds cheesy, but I believe him when he says it. And it is that stirring of belief, generated by a politician, that makes me want to vote for him. Looking back, I can't remember ever feeling a "stirring" for any politician I've seen speak. And I guess that's my litmus test of whom to vote for: an inner stirring.

Monday, January 16, 2012

A few thoughts, not out loud

- I enjoyed a particular talk at church yesterday. When I walked up to the stand to thank the speaker I extended my hand and said, "Thanks so much for your talk, I needed to hear that and it meant a lot to me." I saw the two other speakers in the meeting right behind the one I had thanked. Did I need to thank them as well? And if I did not, would I seem ungrateful for their words?

- Sometimes I feel there is a specific mood at church that lingers in every meeting. Yesterday it was a general gloom. Maybe it was the rain outside. Maybe it was the late afternoon and we were all adjusting to new meeting times. I just wanted to stand up and say, "it's not that bad of a life." And maybe it was just me that needed to hear it.

- When I'm turning left from the median of a busy road, I think it should be against the law for opposing traffic in the lane next to the median to yield. The far lane of opposing traffic never seems to catch on quickly enough. But you hate to wave to the good Samaritan who stopped in the near lane and mouth to him: "THANKS, DON'T WORRY, JUST GO AHEAD," while you wave him on. That just seems rude. So under forced gratitude, I always turn left. It's the "white-knuckle" turn of possible death.

- Tucson was re-baptized today. It rained all morning and in the afternoon the clouds cleared. Anna and I drove up to the sweetwater trail head and watched the unfolding of the sunset. The air was clear and crisp. The clouds were huge, with dark undersides and cottony-white tops. The mountains were lavender, sage, purple, red, rust, and blue all at once. And the desert smelled like desert, with the saguaros standing proud over their domain. To top it off, the desert doves were singing the tune of nightfall. Sometimes I hate scenery like this because all I can think about is how it will all be gone in a few minutes.

- The other day at a tumor board meeting in the hospital, a physician was introducing a patient case.
"The patient was a woman. Fairly...rotund."
The pause he gave between "fairly" and "rotund" was more insulting than if he had just said "fat." I committed at that point to use the word "fat" when I present patients who are well-nourished, no stranger to the knife and fork, obese, large, or rotund. "Fat" is the most concise, understandable, and efficient adjective and is also, in my opinion, the least condescending. Plus, I need more of it...

A Short Story

I lie thinking, my right leg propped against the back of the couch. I think about sleep. I whisper the word “rest,” out loud as if he were a friend; a friend arriving with solutions. And before I know it he has arrived. I welcome him inside and fall asleep...

I am awakened by a low rumble. I quickly recognize the sound is my neighbor James opening his front door. Morning. I count the seconds before I hear his door close. James requires seven seconds every morning to close his door. Why does it always take him so long to close his front door? It annoys me. I lift my left arm and weakly twist my wrist to read the time on my watch. 6:32 a.m.

I then hear a window slide open. This would be Alex. She is a quiet, Venezuelan lady, recently divorced. She lives below me. Her domestic noises never annoy me. Alex often leaves a hot plate of arepas on my doorstep. Sometimes I catch her in the act:

“Arepas!” she says, in a commanding tone. “Eat soon while they are warm and put on top with, how do you say it...asour cream?”

“Yes Alex! Sour cream. Thank you so much.”

I see few arepas these days. That is okay, Alex is an observant neighbor. She knows something has happened to me and I should be left alone.

After my wedding, I told an old friend from high school my wife and I found “a nice little garret” to rent in a safe neighborhood. He then promptly sent me a copy of A Tale of Two Cities. On the front page he wrote, “To the best of friends, in the best of times, in his little garret with his wife.” I can see that book on the bookshelf right now. Seeing it elicits a painful feeling and I look away. 6:34 a.m.

I stretch out my legs with that wonderful feeling of increased blood flow, and I smile. Like the smile of a tired runner leaning on a friend after a marathon. The smile of survival, curved with pain. 6:35 a.m. I begin to wish it were last night again so I could sleep. Better yet, I wish it were tonight so I could sleep and be one day closer to something, anything.

The morning is bright. The light shines through the shutters and lands in a neat arrangement of parallel lines on the floor. I stare at them for some time. I look at my watch again. 6:44 a.m.
In the past this was my favorite time to go for a run or ride my bike. My shoes have not moved from the closet and my bike has not shifted a gear for many days.

I manage to sit up on the couch. I stare blankly across the front room, bare except for a card table decorated with a half-finished puzzle. I force my arms to push me up off the couch. After the light-headedness of standing clears I walk to the kitchen. I pick the glass Pyrex up off the counter and measure out two cups of water. I place the Pyrex in the microwave for two minutes.

Okay, two minutes to wash my face, brush my teeth, throw off my pajamas, and make sure my backpack has, who am I kidding? I have no where to go today. Or tomorrow.

Today I have no plans. In fact, I have no plans for the next three months when, theoretically, I re-enlist for my last year of medical school.

I let the microwave hum away as I walk back to the couch and sit. I sit and watch again the planks of light on the floor and listen to the soothing hum in the kitchen. But my thoughts are harrassed with memories.

I remember the money wasted in recent days. I think of the time wasted. Addiction is a slave-driver of the worst kind. And I am learning why some men give up family and health in the name of addiction. These men are not selfish. They are imprisoned. I am the latest convict.

The money does not bother me as much as the time. I can always make more money. But I am troubled with time. I heard once after fifty you start counting. I am twenty-eight, and I am counting. Tears well up in my eyes as I look down the hallway of my apartment, forcing myself to remember my wife as she used to look in the morning, fresh after sleep.

“Hey honey. How are you? Did you sleep okay?” she asked every morning.

She was always courteous and positive. Early in our marriage it gave me wonder. How could someone be so nice all the time? And then I learned more about her. Courtesy and optimism were her weapons, forged during a difficult upbringing. She often repeated her favorite motto: “Your future is as bright as your faith.”

I smile as I remember.

Every night I could count on her warm greeting when I arrived home: “Hey honey, did you have a good day? How was it today?” She would then skip up to me and give me a hug. There was little variability is this nightly ritual.

I cannot remember the sound of her voice.

I do remember my hot water in the microwave. I get up off the couch and walk to the kitchen. I open the microwave door, grab the Pyrex and pour my water into a mug. I then get two packets of hot chocolate from the cupboard. I tear them open and empty the powder into the mug, followed by four packets of sweetener and a caramel candy. The caramel was my wife’s idea. And a good one. I take my cup back to the couch and sit down.

I had forgotten to turn the heater on last night and I realize I’m cold. I rest the mug on my lower belly and let the coursing blood warm as it flows near the cup - An old boy scout trick I learned on a camp-out. It feels good.

I sip my chocolate and think over the past few months. Little measurable progress. I attend my counseling sessions and complete the proffered exercises. But addiction remains. I have not touched the guitar. My diary is dusty. The New England Journal accrues, unread, in my mailbox. I no longer enjoy my daily run. And I have stopped attending church. When I look in the mirror these days I force myself to look past my reflection. My eyes sear me with shame.

I sip more chocolate. I prefer it hotter but I have no desire to reheat. The parallel planks of sun on the floor begin to widen. The day is moving on. And I am going nowhere with it.

I feel time pass; literally feel it pass through my chest. In its wake is guilt. I begin to think of my last binge.

Not long ago addiction belonged to my patients. It belonged to those faces on street billboards. It was always compartmentalized safely outside my life. Now it is mine.

As the morning light continues to slide across the carpet, I feel the need to knock myself out. I am tired of the guilt. I gulp down my chocolate. I wipe the corners of my mouth and lay the cup on the floor. I stand up and walk to the kitchen drawer to grab my keys, wallet, and glasses. I can’t see the prices without my glasses.

As I pocket my stuff I make a quick calculation: A few thousand dollars left from student loans and five hundred dollars credit on my charge card - six hundred after last night. I have sufficient. I leave the kitchen, but not before turning on the radio. My wife used to make fun of me for having a radio on that I ignore. “What did that commentator just say?” she would quiz. I never knew. I just like background noise. I walk past the dining table and notice its contents: my phone, a copy of Hunger Games, a Gatorade bottle, some scattered pens, a dirty bowl and a napkin scrunched up in a ball. I think about grabbing my phone, but why bother?

I walk to the front door and my phone rings! What irony in my meaningless life. It vibrates off the table and falls to the floor. That is enough for me to ignore it. I turn back to the front door but as I reach out for the knob, I hesitate. I cannot remember the last time I answered my phone. This morning I will. I quickly rush back to the table and inadvertenly kick my empty cup on the floor. It flies up and crashes into the wall, waist high. The handle breaks into pieces. Agitated at my clumsiness, I look at my phone. Gracie is calling.

“This is Ruben,” I say. I use this introduction to pretend I am too busy to note who is calling.

“Hey Ruben.” she says. “What are you doing now?”

“Just getting stuff ready for the hospital,” I fib.

“Do you work today, Ruben?”

“Always, Gracie. How is the Wii working out for you? Are you past the level you were on when we last spoke?”

“Yeah! I got me a new game. You kill aliens, it’s fun.”

I imagine Gracie saying this with a fat grin on her face. The grin that shoves her cheeks up into her eyes.

“So, what’s up?” I ask impatiently.

“Ruben, I was wondering, can you walk me across street to work today? It’s scary right now. And with cold people are crazy driving.”

Gracie has a habit of forgetting to say “the” in her sentences.

A few months ago I spent three consecutive weeks walking her to work. She fears the walk. Luckily, work is not far; a convenient walk of five minutes even for someone obese like Gracie.

In an odd way I feel glad for her call. Family and friends have since stopped calling and Gracie’s timing is penetratingly encouraging. I agree to walk her to work. “Okay, Gracie. Are you ready?”

“Yeah, I wouldn’t call you if not ready,” she says, chortling.

“Okay, let’s do this, I’ll meet you like last time at your front door?”

“Should we Ruben, it’s cold?”

“Let’s walk. It will be good for us.”

With meeting details arranged, I close my flip-phone. Besides receiving a call, it feels good to hear someone say my name, even if it is just Gracie. I walk to the bathroom and grab my hat off the floor. I am not worried about leaving in sweats and a stained jacket. I look at my watch: 7:48 a.m.

I descend the stairs of my apartment. The sun touches my face. The warm sensation is familiar and foreign at the same time. It is cold, but not too cold for Gracie to walk. As if to validate this conclusion I breathe out into the air. No visible breath. Warm enough to walk.

Once downstairs I glance up at my apartment, avoiding eye contact with two people walking past. I walk across the parking lot to the other buildings in the complex. Gracie lives in the far north building with her husband, Steve. Steve’s job begins at 5:00 a.m. He walks two miles to work every weekday. At four miles a day, that is twenty miles of walking in the week. I am impressed.

As I walk to meet Gracie I remember an amusing incident. She found out one evening I was driving my wife to the airport the following day. She asked, “Can I come?”

My wife and I looked at each other; we smiled in meek condescension. I said to Gracie, “sure, but we have to leave by 4:30 in the morning.”

Gracie asked no follow-up questions and we thought she would forget the conversation. The following morning my wife and I both received texts from her at 3:30 a.m.: “Hi, ready to go. Call me now.” She came with us to the airport that morning. Every time we went to the airport after that morning my wife and I jokingly asked each other if we should invite Gracie again.

I hurry past building 900 and 1100 to reach Gracie’s apartment. She has a security alarm sticker on the front door I find amusing because her front porch is full of stuff - easy to steal. Nice stuff too. Cables, satellite dishes, chairs, a dresser, and more.

I knock on the front door and wait twenty seconds. I ring the doorbell, perhaps the only doorbell in the complex. No answer. I am frustrated and slightly angry. Why would Tiffany call me to walk her to work? It’s the easiest thing in the world. She needs to grow up. She needs a life.

These thoughts make me look down at my feet in personal rebuke. “Needs a life, Ruben? Look who is talking.” Tears well up in my eyes. I look up quickly as the doorknob turns and the door swings open revealing a smiling Gracie. She shines through my wet eyes.

“Hey, Ruben, you got here fast.”

“You excited for work?” I ask.

She makes a sound that resembles a starting car. I take that as a “no.” Her sounds confuse me sometimes and I am never quite sure how to proceed with the conversation.

“How’s Steve, Gracie?”

“He’s at work. He has a headache.”

“Is he still on his medication?”

“Yeah, but he don’t do nothing but watch TV all night. Course he has a headache.”

I am pleased Gracie makes the connection between excessive television and headaches. Maybe she will understand her doctor’s advice to learn about diabetic-friendly diets.

She steps outside and turns around to close the door. After the door is shut she looks down into her handbag. She pauses for five seconds. I ask if everything is okay.

“Yeah,” she mutters. Then she opens the door and steps back inside her dark apartment. She reemerges five seconds later and closes the door. “The alarm,” she says, “forgot to set it.”

We walk side by side through the complex out to the main street. We chat about a few things. Mostly I ask about the Wii. She seems to enjoy it more than anything right now. She is also reading a mystery book, she says.

“You like to read Gracie? That’s great.” I hate how condescending I sound. “Does Steve read as well?”

“No, he don’t. He just watches TV all night like I told ya.”

We reach the main street and turn north on the sidewalk. We pass a bus stop where two men are waiting for the bus. One is sitting with his head down, staring at the side-walk. The other is standing beside the bench with both hands in his pockets, trying to keep warm. Maybe it is a little cold outside. Neither one looks up as we pass.

We reach the cross-walk and I look over at Gracie. I sense her anxiety. But with me by her side she presses forward once the signal shows the blue man. Half-way across the street the orange hand begins to flash and Tiffany picks up her pace. I easily keep up with her and we reach the other side with time to spare.

“You don’t have to go on. I’m okay now,” she says. Her work is just across the parking lot.

“Oh, I don’t mind I’ve come this far.”

We continue on together cutting a diagonal path across the parking lot. Behind us the shallow winter sun is rising at its southern angle. The light from it hits our backs, casting tall shadows from our bodies. There I am, slim and tall. And there is Gracie, next to me, her shadow resembling a pumpkin with legs. As we walk I look at our northwest-pointing shadows.

“What if we could trade places with our shadows, Gracie?”

“That’d be cool! But why would you want to do that?” she asks.

“Because then we would all be the same. We wouldn’t have to worry about putting on a happy face for anyone. We could simply exist and function efficiently. And it would equalize all of us. One people, one color.”

I don’t expect Gracie to respond. We walk on for a few moments in silence before she suddenly stops. She swings around, her abdomen striking my thigh, and then extends her arms up and out. Her head is bowed. She looks like a three-year-old waiting for a hug from Father.

“Thanks for walking me, dude!” Gracie then gives me a hug. I can see her saliva-stained shirt come up into my neck. I look up and away and hold my breath.

“Great!,” I say. “Have a good time at work and thanks for calling.”

“No problem. Same time tomorrow?”

I think for a few seconds before responding. “You bet Lauren, best way to start the day.” As the words leave my mouth I realize I mean it.

We part ways. I turn around into the sun to walk back home. I notice my heart feels warm. My shadow is gone. And for a moment, I forget my addiction.