Grand Rounds

Tomorrow I start ER chief. That's right, you guessed it, that means there's going to be a lot of ER bitching going on really soon. So while I get worked up why don't you go enjoy this week's Grand Rounds.

Dear Bluedude Please Consider This

Recently, I wrote a post about being names in a lawsuit which was brought forth by a patient I had cared for in the past. The patient had a bad outcome and felt that this was due to the medical care he/she recieved or did not recieve. I've written similar posts about others before and usually what happens is that a med-mal discussion begins to brew in the comment section. It did this time as well and I put an end to it early, honestly, because I'm tired of hearing about it and arguing about it.

So why am I writing this post? Well, I've observed that the readers who are drawn to medical blogs are either people in the field or patients who have chronic disease and do a lot of research on the web about their own disease. These readers like to pick physician's brains or are interested in hearing something that validates their pre-concieved notion about their prognosis or other concerns. Of course, there are the occasional readers who are just interested in medicine as a field. But I digress.

Whenever one of these posts gets written, and this discussion begins, there is always one or two comments from readers who are truly convinced that their physician made a mistake, or missed something or just plain didn't know. This time the reader goes by the name "Bluedude". As they say "if you live in a glass house don't throw stones" so I will be happy to address him as "Bluedude".

Bludude writes:

"My father died very suddenly, and it was revealed that his doctor, also personal friend, missed the spot on his lung on the xray. We are not a litigious family and people do make mistakes. But what infuriates me is the way each doctor consistently stood up for each other, and my dad's friend kept reassuring my mom that there was no way he could've been diagnosed by the xray. Everytime he said that, it made me angrier and angrier. If doctors make a mistake, which they will, since they're only human, please don't lie to my face. Also, we asked the oncologist, and he just kept stating he didn't have a chance to review it. Be honest, be remorseful; show that you care about this patient, at this time. There would be less law suits if doctors didn't circle the wagons so readily."

This is not the first time I recieved this kind of response. I believe that Bluedude really is upset by what he believes are "physicians covering up for each other". I do understand how the situation can appear to be as such but please allow me to offer some counter-arguments you may have not given any consideration to. The reason I am going to do this here is because if I were the one being confronted by this family memberI would probably not point this out, in fear of being misunderstood, further worsening the situation and infuriating the complaint or because it would simply take wayyyyyy too much time and the person with whom I am having the discussion does not have the approprate background knowledge to begin to understand the full ramificaions of what I am saying. Especially when they are angry and more closed minded. I believe this phenomenon occurs because on television decisions seem much more straightforward. X-rays always tell the truth. CAT scans are perfect, an MRI, undeniable! If only things were that simple in REAL LIFE medicine. Please don't forget that television shows are aimed at the general public and have to be extremely simplified. A shame, since the general public gets most of their impressions about medicine from a very simplistic version.

Here is my response:

Dear Bluedude, My deepest condolences on the passing of your father. I do understand how you came to believe that your father's physician made a mistake and, inferring from your response, he ultimately was diagnosed with lung cancer (I am not sure of this, however, you do mention an Oncologist being involved).

First, please allow me to discuss a personal story:

My father, then 49, continued to complain about chest pain radiating to both arms for about two months. He continued to return to his PMD with the same complaints however all the EKG showed nothing. I was still a student in college and did not understand medicine and certainly not interested. His doctor repeated an EKG on each occasion which (according to him) did not show anything.

When my father, finally, was reffered to see a cardiologist he went straight to cardiac catheterization (after the Cardiologist saw his EKG) which showed severe obstructive disease of the arteries to his heart. He needed an immediate triple bypass surgery.

For a long time we were very angry at our PMD for what we believed was ineptitude at reading an EKG. We never sued him although we didn't return and changed PMDs soon afterwards.

Now, after having studied medicine I do understand that what he was looking for was a CHANGE in the EKG. Which is medically legitimate. Although, I certainly feel a stress test was in order earlier I do understand that what he was doing was appropriate, if for example, he did not think the pain was truly cradiac.

Now, let's discuss your father. You believe that his doctor "missed" a spot on your father's CXR. OK. But have you thought about this:

1. Are you sure that the spot was truly lung cancer? (in your case it may have been but I am just making a point)

2. Was that same spot there before and therefore there really was NO CHANGE on this Chest-X-Rays from previous ones, something that would go against this "spot" representing a cancer?

3. If this WAS cancer, was it what really caused his death? Cancer usually causes a slow deterioration, therefore, dying suddenly is more uncommon (not to say it doesn't happen). Could your father have died with lung cancer, instead of, from lung cancer?

4. Where was this "spot" on the x-ray. Could other things have explained it in the medical history of your father, maybe it was an Aspergilloma (I know you probably never heard of this diagnosis but it goes to further point out that people not trained in medicine lack the knowledge needed). Maybe things he didn't ever tell you but did tell his physician. This may have caused your father's physician to choose observing this "spot" for growth as opposed to subjecting your father to a dangerous biopsy that would have caused his lung to blow and then really cause him to die.

Just understand that medicine is not as straight forward as it looks on TV. Chest X rays are imperfect, so are CAT scans (they sometimes show results which only cause further unnecessary workups- One, put the patients at further risk for procedure complications and are expensive). So are MRI's for that matter. Medicine takes EXPERIENCE and association of SYMPTOMS WITH results.

You can always second guess your physician. That doesn't mean you have any clue about what was really going on OR what were his considerations at the time. He may have only been trying to protect your father from a painful and unnecessary workup. You've never seen a complication from a procedure cause a patient's death, I've seen many. So has your father's physician.

5. Finally, By the time a mass appears on a CXR (if it is lung cancer). The disease has usually allready metastisized and the cure rate is EXTREMELY low!!!Meaning, chances are that even if he did pick this up and did subject your father to a painful workup and chemotherapy it would not have changes the ultimate outcome.

Furthermore, most likely your father's physician never even saw the x-ray, the radiologist who read the Chest X-ray may have missed it. Your PMD usually only recieves a report of the reading.

I've tried having this type of conversation with others who have similar beliefs but it's really too emotional for the other side and their view is too narrow and set on blaming someone. Again, I am truly saddened for your loss. I don't know if anyone is to blame after all but I'd like for you to consider that maybe nobody is to blame and everyone lost someone they loved (including your father's physician and good friend) because everyone dies sometimes and life is unfortunate and cruel in that way.

Happy Thanksgiving Everyone

I'm thankful my residency is over in 7 months. I'm thankful I'm no longer a second year or an intern. I'm thankful my residency is almost over. I'm thankful for a wonderful healthy girl and a loving wife. I'm thankful my residency is over in 7 months. I'm thankful for a beautiful world full of beautiful sights and gorgious women. I'm thankful my residency is over in 7 months. I'm thankful I'm a third year resident. I'm thankful that interns do my scut work. I'm thankful for not doing one guaiac exam myself this year, not one. I'm thankful my residency is over in 7 months.

I'm thankful my residency is over in 7 months.

Happy Thanksgiving everyone.

Sincerely,
Joe

I'm Getting Sued

Or Shall I say "We are getting sued".

It's about a patient I've cared for as a resident who had a bad outcome. The lawsuit is by no means a surprise. I had a feeling it would head in this direction from the beginning.

I know you don't want to hear me bitch about this. Neither would I, so I won't do any of that. I would like, however, to document a few things that I can take away from this lawsuit that may, still, make me into a better physician or, at the very least, prevent me from being sued again.

For one, when things with the family appear strained, or tense, make a strong effort to document everything. Everything that they say and all of your responses. This does, however, become difficult because it will eat up a lot of your time.

Two, when the situation is heading in the wrong direction make a strong effort to document everything. Today, the impression is that an unfavorable outcome is automatically the physician's fault.

Three, get the family involved early. In fact, a good question to a patient when admitting them is if you can discuss the situation with the family. I suggest calling the family on admission so that they understand what is really happening. Try not to commit any HIPAA violations in the process.

Never say that things are looking "great" or "good" or "wonderful". You may use words like "Better", "Improving" or "Heading in the right direction" but make sure to mention that the overall situation is still bad. This will cushion the shock if something doesn't go as planned.

Never ask about a DNR the first time when speaking to a family even if the patient is crashing. They will become paranoid that you are not doing your max to cure their loved one. People really are distrustful of doctors these days. That is real! Wait at least 24 hours before asking about a DNR.

I have to face how this makes me feel. The truth is that I have no idea what exactly went wrong. I've had a chance to look through the chart and I am still unsure. But it doesn't mean I'm a failure or that I made a mistake. And even if I made a mistake I was hoping to take some lessons away from the experience. Unfortunately, I can think of other cases where I did make a mistake but the only thing I can really learn from this case is how to prevent myself from being sued. Which won't make me into a better physician by any stretch of the imagination.

I'm mostly nervous about having someone look at all of my decisions under a microscope. Can my judgement really withstand that sort of scrutiny? We all make decisions and many times those decisions are based on instinct.

Since that case I've been a better doctor. That's the simple truth. Much more careful about every single decision I make. Many of my decisions are based on my own welfare and not necessarily the patients. They are based on what someone may say in court. They are based on my need for future employment and malpractice insurance. I do, however, feel that ultimately the patients are better cared for and that is what counts.

Residency teaches more than just medicine.

It's My Blog, Whaddayagonnado?

I've been thinking about money lately. I think the reason is simple: I love money! There I said it. Finally, it's such a relief, I'm out of the closet.

Naturally, I've been doing a lot of reading about the topic. Mainly, reading about buisness and investing through various blogs that deal with...'buisness and investing'. I happen to find some of these pretty helpful. Not in that 'How can I help a fellow human being' helpful but more in the way of 'How can I make myself rich' .

Some of the most interesting things I found were quite discouraging. For example, did you know that had I not attended medical school the odds that I will be rich would have been much greater. Do you know how much compound interest can add up to given an extra ten years head start.

The lifestyle that physicians need to maintain can also add up to a lot of cash. Those Armani suits aren't cheap you know.

Now, I know most of you will say that my future salary should more than make up for the lost time. Possibly. But, don't forget that I am starting in the minus. Medical school loans will haunt me probably for the duration of my physical being. Should I die, I'm convinced the collection agency will find a way to contact me. they will ask that I work out an alternative payback plan. Maybe I'll be the collector's guardian angel, for a fee.

Recently, I read Rich Dad Poor Dad, and you might say it certainly made me think. There are also tons of blogs out there that deal with money and many of them will be popping up on my sidebar soon enough. Not so much so you can go and check them out but more so for me. I do recommend the rest of you residents spend some time reading up as well. We can all use a little education about money and it would be quite refreshing to take care of yourself, once in a while.

I apologize that the medical comedy you come here for has been noticeably absent recently but I have other things on my mind. This is a blog about a journey through residency and finance is certainly part of that journey.

Enjoy:
Wealth Junkie: A young man's journey to becoming a billionaire.
Phil Town, Rule #1: Attempting to teach a special method of investing. That is Rule #1.
Fat Pitch Financials: Currently covering 30 days to becoming a better investor.
Frugal For Life: Currently hosting the Carnival of Personal Finance.

Of Course, I take no responsibility for any of the advice on any of these blogs. I do however encourage learning about investing. This is certainly one course I unfortunately never attended.

If any of you know other sites I should be reading please metion them. I'm always open to suggestions.

Things To Do For My "Inner Child"

Recently, Misha (sorry no address) wrote a response to one of my posts:

"madman--you sound depressed. I think you need a diversion. How about a post of things you promise to do for your inner child.....Kind of a "to do" list. Not important achievement kinds of things....crazy things...fun things....things you have never done. You are clever....I trust you can come up with some good ones"

I thought "Heck, I spend half my day day-dreaming anyways so why not actually write down what I would love to do. So here it is, a list of what the 'little me' would really enjoy doing and then things I promise to actually do: (Some of these will get me in trouble)

Things I Would Love To Do:

1. Fly in a hot air balloon
2. Take a submarine trip
3. Scuba Dive in the Sainai
4. Try Cocaine
5. Learn to Tango really well
6. Perform in a play
7. Take a home renovation course
8. Make love to Adriana Lima
9. Meet Some of My Readers in Person
10. Fly a plane

Things I Promise to Actually Do:

1. Take a submarine trip
2. Scuba in Sainai
3. Perform in a play
4. Meet some of my readers
5. Learn to tango
6. Make love to Adriana (If she lets me)

I guess that's a big "If"
Have a great weekend

The COTV

Over at Charles. And...He placed me first, I love you Aiden!

Possibly the Most Hysterical Thing I've Ever Read In a Medical Journal

I feel so badly pouncing on this when really it's so much more ideal for the blogs of my emergency physician friends. the Annals of emergency Medicine October 2005 issue published an Article titled "The Next Generation of Emergency Medicine Reality Television". It's possibly the funniest thing I've ever seen in a Bona Fide medical Journal (if you consider EM medicine???). Props to Jeffrey Freeman who wrote the piece. Truly Mad my friend, I love it. Please excuse me for publishing it here. I have no money, really, I promise, none. Forgive the EM joke, that's mine, figures right?

As any emergency physician knows, it is normal to ride through the hallways of the hospital doing CPR atop the chest of a dying patient while shouting out orders to nurses at the top of their lungs—at least on television. And, while miracles occur in emergency departments (EDs) every day (such as a specialist coming in to see a patient), they are not always sufficiently dramatic for prime time. Like it or not, the American public learns more about emergency medicine from the television than from their personal experiences. ER has just finished 10 seasons; Trauma: Life in the ER has finished 7. Since it's only a matter of time before these shows fade from the airways, a replacement will soon be necessary. In this era of reality television, something that will grab the public attention and let them feel the true grit of today's ED is needed.

The following are reality television proposals for the next generation of emergency medicine viewers:

The Resident—A powerful and omniscient residency director starts with 12 emergency residents and each week fires one resident and gets all the remaining residents to work the extra shifts vacated. The last resident working gets hired to a large contract management group, but not as a partner.

Joe Emergentologist—Ten patients compete for the attention of Dr. Joe, the only physician working in a small rural ED. Each hour, Joe transfers off 1 patient to an alternate facility. Imagine the patient's surprise when it's finally revealed that Dr. Joe is only a moonlighting first-year dermatology resident, with no experience in any ED. Will the last patient standing still accept the loving care that Dr. Joe offers when they find out the truth?

Waiting Room Survivor—Twelve patients are stranded in an isolated, barren waiting room, and triage is closed. Who will survive? Without water or food, they have only their wits and the will to survive. Each week a patient is voted out of the waiting room. As they form tribes and win challenges, they struggle for the ultimate goal: any available treatment room.

ER Jeopardy—In this game show variant, 3 emergency physician contestants try to guess a patient's diagnosis, but the answer to every question is another question. Categories of answers include such puzzlers as: “What Language Is That?,” “Nominal Aphasia,” “Geriatric Confusion,” “In2bated,” and “Toxic Delirium.” Losers get sued, and the winner gets no actual cash or prize, but does get to come back for another shift and the satisfaction of a job well done.

The Mole—A high-volume ED, and one of the staff is sabotaging patient care. The Mole changes lab results, erases orders, and gives wrong doses; each week another abbreviation is cut from the list of accepted abbreviations. Can the emergency physician find the Mole before another patient calls their attorney? Sponsored by the Institute of Medicine.

Patient Extreme Makeover—A team of top-notch support services: social worker, physical therapy, occupational therapy, and dental hygienist, take a frequent ED visitor each week and work their wonders. Consultants are called in for bariatric surgery and laser tattoo removal; clothing is donated from the local thrift store. The patients return after their complete makeover with a new chief complaint, and the ED staff can't recognize them until they ask for Dilaudid…

The New Price Is Right—Forty-five million uninsured audience members are invited to the television studio ED waiting room, where 4 contestants are chosen to possibly win some medical care. To win, they've got to guess the price of industry-sponsored drugs and medical procedures. Those who guess closest are invited to a final showcase, where they try and guess the complete cost of their medical treatment before succumbing to their disorder. “Come on down!”

The Simple, Poor Life—Two consultant physicians, both from fabulously wealthy subspecialties, are sent to live and work in an ED for a month. Each week they are given a different job, from unit clerk through transport and housekeeping. Can they get through one last shift without getting their clothes dirty? A laugh a minute…

Who Wants To Be a Millionaire?—Two physician CEOs compete for an ED contract, trying to underbid and underpay their employee emergency physicians without going over the contract price. Three lifelines are given: “Noncompete clause,” “Restricted access to billing information,” and “Call a Friend.” Winner gets a million dollars and retires early from medicine.

American Idle—Each week, 12 patients wait hours for lab and radiograph reports while their medical conditions deteriorate and inpatient beds are unavailable. Radiologists and audience members can text message their vote for favorite patient to be admitted.

And finally, Fear Factor—This could be the ultimate ED program. It's apparent that the potential for an endless series of reality-based episodes of pain, terror, and inedible food is available. Just like a career working shifts in any ED.

Note 1: If anyone wants to consider hiring an emergency physician as television producer, please contact the author immediately.

Note 2: JCAHO has reviewed this article and would like to remind emergency physicians who shout out orders while performing CPR while riding stretchers down hallways, that for verbal orders, please verify the order by having the person receiving the order “read-back” the complete order. Thank you.

Some Completely Useless Random Thoughts

Well, like I stated in the previous post, if you have nothing original to write about then you should just avoid posting. I think that not posting is a legitimate choice. No one expects that you post every day. Although I know some people who can, Maria, I am by no means aiming to do just that. So I post when I have something to say or when I want to link something I find interesting.

Today, I have nothing medically related to write about. I haven't written a post on future intern either, although that's not too far away, she's too cute for me to share right now. So What I decided to post about, which I realized I never do, is actually what's going through my mind. As boring as this can be these actually are things that I think about and can give you a good uderstanding of my ADHD affliction. They are not medically related.

These thoughts are totally random. Read on if it interests you otherwise come back some other day, maybe I'll think of something worthwhile.

I like to go through the 'blog's of note' that blogger picks every month. Sometimes I find blogs with truly exceptional writing or concerning subjects that I know nothing about but would interest me. For example, out of this month's batch I think that this blog about animation is quite interesting. Although I am a big fan of Pixar and Disney, animation is not a subject I could discuss intelligently. I'm happy blogger found it and maybe I'll give it a read once in a while.

This other blog about Taxes also really interests me. I am making a really big effort to investing in understanding finances and taxes are a huge part of this education. I read in a book that said we spend from January to May working just to pay off our taxes. Five months just to pay taxes. I don't know about you, but that scares me. I never really thought about it that way. I'm also trying to establish a few buisnesses on the side right now. I think today's physician has to know about investing if he/she intends on living comfortably. I really hope to avoid the excessive work that most internists find themselves trapped in. The only way I'd succeed is if there is money coming in from other places. Maybe my background in buisness can help me here.

Another blog called about camera tossing looks really cool. I really don't have much to say about it other than that.

The rest of the 'blogs of note' are more personal and people post about their life etc. Although I do much of that here I usually don't find that it interests me too much. If anything, this blog deserves an honorable mention for the coolest logo.

Which brings me to my next point: Please change your blog wallpaper from the standard ones that Blogger offers. I know some of you are afraid to mess around with the Template but this is really not very difficult. You can do what I did and just start another fake blog with your same current template and mess around with that one. When you figure it out then do exactly the same changes to your blog. I know you shouldn't judge a book by it's cover but I think it just makes your page look a little bit more cool.
Tip: A good way to start is to find a wallpaper you like and look at the "source" code. You can find that by scrolling down from "view" at the top menu on Explorer. I learned a lot from doing this.

I'm afraid my life will go by and I won't notice. It's already happening.

I miss being single. I'm thrilled that I'm married.

I'm really tired of using Mad House Madman as a name but I'm afraid most of you will completely butcher my real last name, it's spelled incorrectly. This is the curse of my life. It's gotten so bad I've stopped correcting people. Really, everyone at the hospital has been mispronouncing my name for three years now. I never bother to correct them. I'm tired. My real first name is Joe, short for Joseph.

I'm from Israel where there were terrorist bombings every day. Innocent people died. This went on for decades and the world didn't care. Not until September 11th. So now when there are attacks in Moslim countries, and Moslims die, deep down I don't know if I feel badly for them. I feel guilty about that but it's the truth.

I find it outrageous that this country is not outraged by the war in Iraq and by the administration that sent our kids into a warzone on false pretenses. They are dying there and I can't understand how the idea that there will be democracy in Iraq is worth their lives. I don't really believe that the democracy will survive ten years after we pull out. What are we doing? What did we do? You say that they didn't know that there were no WMDs? since when do we accept ignorance as an excuse? Especially when it lead to so much damage. I voted Republican in the first election and Democrat in the second.

I don't know how long I can keep being a physician. I give myself ten years and after that, if past performance is any indication, I will move on to something else.

I wish blogging was worth something. I guess it is because I'm interested in how people respond to what I write and what they have to say. But it's not worth anything financial, only personal.

I wish they featured my blog on 'blogs of note' when I started, it would have made getting a readership much easier.

This post wasn't edited at all, so excuse the poor writing. Shortly, I'll get back to writing medical related posts. But words on a [age can never describe the person writing them.

Have a great weekend, you deserve it.

Not the Way to Blog

This Jackass ripped my post off and didn't even link back. I'd report him to MSN but they can't do anything. Give me a break.

So, as you can see, this "some guy's blog" is calling you out Jackass. And I wrote him a great comment to boot. I guess that's as good as it's going to get for this violation.

Really people, if you have nothing original to post, either don't post or make sure you give the credit to the person who wrote it.

Thanks to a friend for informing me.

SoundPractice interviews Chris Rangel. Another Interesting Interview

I recently discussed the podcast interview with Grunt Doc and now Chris Rangel takes center stage at SoundPractice. I don't know why I like to blog this stuff but I find it interesting to actually hear what people think and how they interview. I particularly like blogging surprises.

So you ask, are there any surprises? Yes.

First, Dr. Rangel was asked if he'd do this again and he did the same song and dance that Grunt Doc did except, in the end, he said "No". It took a while but it finally came out. So I'll save all of you the long pause, Would I do it all over again? The correct answer is actually "Hell No!". I agree Dr. Rangel.

One great question: Do you think the public is sympathetic to the pressures of medicine? He says no but I'm not sure. So are you?

And...Rangel used to be a hospitalist. Maybe he can throw a few tips my way. I'm really torn between going to outpatient versus staying in the inpatient setting.

What's the best blog he ever read? Well...I can't give the secret away, you need a reason to listen to the interview.

I'm thinking more and more about interviewing as well. I'm getting some requests from other sources to interview but I keep wondering what they're expecting to hear? I'm not a very pensive human being. Would any of you like to hear my voice?

Grand Rounds and Congratulations Maria

Grand Rounds 2.07 is up and Rita from Msspnexus does a great job of weaving the whole thing into one great story. I wonder where she got that idea from?

While you're surfing why don't you go on over to Intueri and congratulate Maria on her blogs' five year anniversary. Wow...that's sticking to a hobby. She's a great writer so have a look around. There's more than enough reading for you to do today.

Oops, I Found a Vacation

I guess you could say I’m playing hooky. My program is under the impression that I’m at a private prestigious cancer center doing an Oncology elective. The prestigious chiefs of Internal Medicine at the prestigious Oncology center are under the impression that I’m doing my elective at my home institution. No one bothered to check and so I ‘sorta’ forgot to let any of them know. Oops.

Which leads me to my next thought, what do I do now? If I wasn’t looking for a job this would easily become time for a little R&R, maybe a nice ride to Montreal to meet up with some friends and visit strip joints. But I’m looking for a job and that obligates me to looking over my resume and writing a cover sheet. And I’m having a hard time coming up with a cover letter that indicates that I'm the perfect man for the job.

My indecisiveness is nothing I like to flaunt. I don’t even know what I really want. I think I want to be a hospitalist. The thought of taking care of really sick people for the rest of my life doesn’t appeal too much, but then again, the thought of teaching students does. And then what would I teach them? If I only took the time to read some medical journals, well, that would help.

I believe my whole life I’ve been cursed with a plague of insecurity. Once again this transition, I fear, will bring out the worst in me. Residency is over and I’m clueless and extremely apprehensive about what comes next. Raving about what extremely great qualities I offer on a cover letter feels like a big joke.

I know bums with less of an inferiority complex.

Selective Hypocrite Memory

The Mad House Madman drives down the lane with three seconds to go. He pulls up short. Look at how high he can get up in the air. Oh my god, is that a plane? Is that a helicopter? Why no, it’s the MHMM….The shot for the game is….GOOD!!!!! (The crowd roars)…

That’s the way I preferred to remember it. So when my best friend asked me to fill in for a missing teammate on Monday night I figured I still had that touch. It’s only been, what, twelve years since high school? I mean, I was on the Varsity team you know.

I learned a lot that night. Memories are better left unvisited because the truth can sometimes be ugly, not to mention embarrassing. Not only had I discovered that my stamina rivals that of a nursing home gomer, but I also discovered that I can’t shoot, and I don’t mean I can’t hit the shot, I mean I can’t SHOOT. I had actually forgotten the technique for shooting a basketball. I forgot the TECHNIQUE. Do you know what this means? In short, AIRBALL!!! Can you hear it? “AIRBALL…AIRBALL…AIRBALL…AIRBALL”. All in all, four of them “AIRBALLS”.

But it was deeper than that. It was the realization that no matter how late I stayed to stabilize a dying patient, or to comfort a grieving widow, there was one thing I surely wasn’t doing much of recently, exercising. Wasn’t exercising. Five minutes into the game I was huffing and puffing so hard you’d have thought I was trying to blow the house down.

What a hypocrite! Here I am telling these poor sixty and seventy year olds with multiple horrible disease processes that they need to exercise more and I can’t even last ten minutes. Me, barely 31. Shameful hypocrite!

Reality has set in. Three years of residency have taken their toll on my bronze greek god of a body and my youthful gorgeous exterior (Memory is selective). I can save the life of a man having a heart attack but I can’t hit a shot to save my own.

Somewhere, Micheal Jordan is quietly weeping.

The Tangled Bank By Charles?

Charles is hosting the Tangled Bank. I, of course, had no idea.