The Karate Kid Within

Some modern psychologists propose that we all live out our lives according to an internal "script," a living, fluid drama/ action/ comedy wherein we play a pre-determined role as protagonist or victim . . . or the guy who gets pushed into the produce stand while the cops chase the stray dog through the supermarket. (Then the dog pees on the watermelons, and there's a close-up on your yucchy face.)

Our personal scripts work like this: we subconsciously piece together fragments of acquired stories--from folklore, family history, novels, plays, movies, etc.--and time and again our personal experience either reinforces or revises the validity of our script. If we figure out what our script is, then we can skip to the end and decipher how our lives will play out in real-time: will you be a hero or a villain? A martyr or a victim? A success or a failure? If we're really self-actualized, we can even change our scripts, mold them to conform to our best qualities and dreams, and thus shape our destinies.

What is your personal script? Mine closely mirrors the original screenplay of "the Karate Kid," which Elizabeth gave me as a DVD for Christmas.

Not only is this movie a tour de force of 80's pop culture (big hair, camoflauge pants, cheesy rock soundtrack), but it is an iconic representation of how I view my relationship to the world: the scrawny, slightly sardonic, good-natured and somewhat nerdy guy who gets the crap kicked out of him over and over again, only to be standing at the end on the winner's stand as the crowd cheers and the soaring music plays, holding the trophy and the beautiful girl. (That's you, Elizabeth.)


That sounds like yours truly, doesn't it?

Ending of my script:

"You're okay, Mark-san," confesses Bad Johnny through his nose, freshly bleeding from my indefensible Flamigo Kick.

--Cut to credits--

(Question: why "if done right, no can defense?" I mean, it's not like you can't see this kick coming from a mile away. I guess you've just got to snap it, man, like lightning. No way can you defense that.)

Anyway, I cannot overstate the impact this seminal movie has had on my childhood and life. Here's a few momentous events of my life that have followed the dramatic arc of my internal Karate Kid script:

• making the Chatfield varsity basketball team (after initially getting cut)
• my entire missionary experience
• getting into medical school
• wooing and winning Elizabeth's heart
• surviving and succeeding in residency
• the Worland opportunity rising out of the Cedaredge ashes
• pounding on my little brothers (OK, so this one was always the reverse script--the Johnny version--but it was always the sweetest, ending with Goose writhing on the basement floor like Daniel on the beach)

The scene pictured below, where Miyagi reveals the ways of the force to Daniel--"show me . . . sand-a floor. No no tt tt tt. Like dis. Show me sand-a floor."--is one of my all-time favorites from any movie. When they showed this scene in the MTC as part of a motivational meeting, my heart was bursting out of my chest and I was ready to walk on water. You talk about getting a bunch of Elders pumped to go memorize some more vocab lists!

Plus, this movie provides a terrifying example of pure evil; the Sensai of the Cobra Kai was one bad dude. Has any Hollywood line ever been uttered with more pure malice, more dripping venom, than "Sweep the leg."? (Of note, he does not say, "Sweep the leg, Johnny," as many of us like to recite. Rather it's simply, mercilessly, brutally, "Sweep the leg.") In spite of Miyagi's heroic goodness, I have a feeling that Sensai would have whooped his hiney if they'd had a throw-down in his home dojo.

But back to the script. In more serious terms, I do actually find motivation and meaning in stories like the Karate Kid, Rocky, Star Wars, Hoosiers and Seabiscuit (too intense), and so my personal script is probably better entitled, more generically, as "Markie the Underdog." (This is different from the B-movie classic "Markie the Wonderdog." Not me.)

So now I pose this question to you: what is your personal script? What stories give meaning and perspective to your life and challenges? (Hopefully not Dumb and Dumber.)

Now, fade out of this post with a triumphant refrain ringing in your ears:

"You're the best . . . around.

Nothin's ever gonna keep you down.

You're the best . . . around.

Nothin's ever gonna keep you down . . ."

Winter Fun

(At the Blossoms of Light show at the Botanical Gardens)

As some of you may know, we have two very cute kiddos. I thought I'd devote this post to them, along with a few fun (and random) photos from our Christmas break in Denver.

First, the Joybear (aka, Ski-Girl): Yesterday she and I went skiing, and we're both ecstatic about the results. For years, I have harbored a dream of skiing down the slopes with my diminuitive daughter by my side, and for the last four winters, we've made a significant commitment (time and money) to put her in ski school. In the end, this has taught her some basic skills, but mostly has helped her to not be afraid of (and to actually enjoy) skiing.

Yesterday, that dream came sharply into focus. When we first hit the slopes, I was worried that she wouldn't want to ride the lifts, that she'd break down crying, that the run would be too steep, or that she would get too cold too quick. But no! She braved the cold, rode the lift like a pro, and hit the runs with gusto. In fact, after I held her back on the first run, she wanted no more of that, and I spent the rest of the morning cautioning her to stay under control. (Over-protective Daddy's are such a drag!) By the end of the morning, we took the big lift to the top of the mountain and skied all the way down, including a couple of blue runs. She fell only four times all day, and didn't cry once. (I'm succeeding in convincing her of the glory of a good biff.)


(Joybear on the mountain top . . . in front of Mom and Dad's house)

Joy also has written and illustrated two "books" now, one about "Numbers and Names" and one about our goldfish, Foxy. They have recognizable plots and meticulously colored pictures. We're helping her with spelling, but otherwise she's doing it all. For being only 5 1/2 years old, we find that pretty amazing. So look for her in Borders soon! (We may have to get her her own blog, too . . .)



Next, the Grant Guy (aka, Monkey Boy): This is one funny boy, and for the most part, he knows it. We (I) allowed him to watch a few clips from Nacho Libre, and now if he doesn't want to do what you ask him to, he responds by crossing his arms and saying in his best faux Mexican accent, "I'm not listening to you. You're crazy!" This started as pure defiance, but has evolved into a surefire way to get Mommy and Daddy to laugh, and thus defuse the situation.

Streaks of his old man (that would be me) frequently surface as well, particularly his intentional annoyingness and humorous pesterings. For example, after a recent difficult day at work, I came home and needed to cuddle with Elizabeth on the couch for a bit. But Grant would not allow it, as he wanted Mommy and Daddy's full attention. He resorted to every trick in the book--whining, making messes, being silly, etc. When those didn't work, he settled on his oldest trick: relentlessly climbing over, onto and around us (and if it were possible, through us). I was distractedly repelling him with my off hand, sharing the day's drama with my patient wife (who is also my wife-patient), when his climbing suddenly mutated into furious head-butting of my shoulder. Stunning in its ferocity, this escalation got him what he wanted, his daily wrestling match with Daddy on the living room floor. The house reverberated with our growing collection of manly epithets, such as "Are you a man or mouse?", "Fight like a man!", and "I will squeeze you like toothpaste!" Mommy, realizing that both of her attention-seeking males had engaged their pestering behavior on each other, wisely utilized the commotion and fled the room.



(Sledding in Denver)

Like all parents, we love our kids and have a special bias towards them. As I watched them playing together this afternoon, I reflected on what our family is . . . and what it will be in the near and distant future. (We had a vivid ultrasound this week that showed a rapidly developing fetus . . . looks like a boy.) It seems like their spirits have been a part of my life for forever already. Can I remember what life was like, what I was like, before Joy and Grant came along? These are two (three) special kids that we've got, and they are going to keep life fun, exciting, busy, challenging, sometimes annoying, and ultimately fulfilling for . . . well, eternity.

Dr. Foster's Fun Flu Facts

[This post is a copy of an article I've written for the local newspaper about the dreaded (and misunderstood) influenza virus, pictured to the right.]



Recently, I diagnosed the first case of influenza virus that WMC clinic has seen this winter. By the time this publishes, the Bighorn Basin will likely be seeing flu season hit full stride. As a local physician, I have witnessed a lot of misunderstanding about what the influenza virus is and what can be done about it. This article is an attempt to clarify a sometimes confusing topic.

First of all, the word "flu" is often used in a generic sense to mean any sort of winter illness. People often call cold symptoms "the flu," or they refer to the symptoms of vomiting and diarrhea as the "stomach flu." In this case, they’re using "flu" to indicate a general viral infection. However, when physicians talk about the flu, we are referring to a specific respiratory infection caused by the influenza virus.

Why is that distinction important? Influenza virus causes seasonal epidemics, is highly contagious, and causes predominantly respiratory and systemic symptoms. For example, a stomach virus may cause nausea, vomiting and diarrhea; these also may be present in a true influenza infection, but typically these symptoms are secondary. Likewise, a common cold may cause congestion, sore throat, productive cough, and low grade fevers, and yet not be the true flu.

The influenza virus is different, as it may cause all of those symptoms, plus the additional severe systemic symptoms of fever, chills and general malaise. I call it the "getting-hit-by-a-truck" sign: when you have the flu, you have respiratory symptoms plus you feel as if a beet truck just plowed you over—achy, feverish and sicker than a dog.

If you develop these symptoms within the next few months, you should contact your health care provider within the first twenty-four hours of onset. A simple, rapid test can be done to distinguish if your symptoms are caused by the influenza virus. If caught within the first two days, then a medication can be prescribed to lessen the duration and severity of your symptoms. Also, medication can be prescribed for household contacts to help prevent them from contracting influenza.

If you miss that window of opportunity at the onset of symptoms, then most likely you will need to wait seven to fourteen days for your body’s immune system to get the upper hand and eradicate the virus and its symptoms on its own. At this point, resting for several days in a row, drinking lots of fluids, and controlling the symptoms with home remedies and over-the-counter medications is your best bet for relief and a rapid resolution of symptoms. Either ibuprofen or acetaminophen are quite good at reducing the achiness and fever of that come with the flu. A variety of cough and cold medicines may alleviate some of the respiratory complaints. Some steaming bowls of Mom’s chicken noodle soup may help as well.

The best treatment, of course, is prevention. Influenza is spread by contact with an infected person’s respiratory droplets, so frequent handwashing, hand sanitizing, avoiding being coughed upon, and not sharing cups or utensils can help to prevent transmission. I also highly recommend the influenza vaccine to everyone over the age of six months, but particularly to:

• Young children aged six months to five years
  
• Pregnant women
  
• People over age fifty
  
• Healthcare workers
  
• People with other chronic medical or respiratory problems
  
• . . . and anyone living or working with any of the above! (Basically, all of us.)

If you haven’t gotten your flu shot yet, there is still time, although it may not have the full chance to gear up your body’s immune defenses prior to the onset of flu season, as this usually takes two to four weeks.

Hopefully, I am wrong and the flu season will leave the Bighorn Basin alone this winter. But if it hits as expected, then at least you will have some practical knowledge of what influenza is and what you can do about it. Feel free to call our clinic with further questions.

Now, go wash your hands!

"People Aren't All They're Cracked Up To Be"

A friend of mine, also a family practice doctor, once stated, "I went into family medicine because I wanted to work with people. Problem is, I found out that people aren't all they're cracked up to be."

Like my friend, I too felt drawn to family medicine because of a deep-seated desire to help people in need. Overall, I'm very happy and fulfilled in my career. But people in need are often tough customers, especially when their needs are illegal.

Today was particularly tough in this regard. I have a young man who arrived as a new patient at my clinic the week before Christmas; he had had several confrontational visits at our ED in the preceding weeks regarding narcotic pain medicine. He had so many "red flags" concerning his drug-seeking behavior that if I were a bull I would have charged; I probably should have never agreed to see him in clinic. However, I felt compelled to give him a chance: first of all, because I feel that it's part of a family doc's responsibility to try and manage these patient's needs as outpatients so they don't over-utilize our (expensive) emergency departments; second, the kid seemed harmless enough; third, I had a silly thought that maybe I could develop a therapeutic relationship with him and help him overcome his narcotic addiction. So I gave him the tough talk, gave him a 2 week supply of pills, and then had him come back to sign a narcotic contract, which we did yesterday.

Within 24 hours, he harrassed and infuriated the local pharmacy, which summarily fired him as a patient, and then several documents from other regional EDs were faxed to our office regarding threatening and drug seeking behaviors, all of which violated his contract with me. He then showed up at our office, feigning contrition and innocence. After a thirty minute (and deftly navigated by myself, I must say) conversation/confrontation with him, his tone and demeanor abruptly shifted from apologetic and incredulous to sinister and threatening. As he escalated his behavior, I found myself quite uneasy in the room and scanning around for a safe exit should he become violent. (I had brought the clinic manager into the room who was also edging towards the door.) When I finally moved to show him the exit, he lashed out verbally with vague threats of violence and lawsuits from his "connections." He also unintentionally disclosed some information that revealed to me that he must be in cahoots with another of my chronic pain patients who I otherwise wouldn't have suspected--some sort of nefarious Worland Oxycodone Drug Ring. (Mafia, beware! This kid has got connections!)

Luckily, violence was avoided, and if I had the luxury of retreating into an anonymous metropolitan suburb, I probably wouldn't worry much more about the encounter. But in a town of 5,000, it is known by, well, everyone where the new doctor lives, right across the street from the hospital. I felt quite unsettled at the thought of some sort of retaliation against myself, my family, or my clinic. For the first time since we've lived in this quiet idyllic town, I felt unsafe in my own environs.

After a discussion with our clinic manager and my nurse, I decided to file a police report with the town sheriff, who is a basketball buddy (ahh, the joys and pains of small towns . . .) and who offered to place a patrol watch on our home for the next few days. He also told me they are in the process of investigating several other leads on a burgeoning illegal prescription drug trade in our town.

Hopefully, this druggie will skip town (he doesn't actually live here) and never come back when he finds out we're not going to play his game. Maybe my report can be a small part of cracking down on Worland's version of a very serious national prescription drug problem.

Or maybe I'll go home tonight and find my tires slashed and my house ablaze.

The uneasiness I feel reminds my of a wonderful novel by Annie Dillard called The Living, set in the late 1800's in the frontier Pacific Northwest . The last third of the book is a drawn out psychological confrontation between the care-free, jaunty hero of the book, Clare, and his nemesis, the evil genius Beal Obenchain. Beal, a backwoods hermit, threatens out of pure malice, to motivelessly kill Clare, not because he means to actually do it, but rather because he wants to exert psychological dominion over Clare; he wants to destroy his happy-go-lucky lifestyle with the sinister pressure of imminent death. Due to the general lawlessness of the region, Clare has no policing authority to turn to for assistance, and he settles into a disquieting paranoia. Eventually, he accidently stumbles upon Beal's dead body near some railroad tracks, and he feels the heavy weight of Beal's threats lifted from him with a rush of near ecstasy. The malicious evil force that has held him captive has died; he is free again to live without fear.

Obviously, my minor narcotic drama of today does not amount to this sort of psychological gamesmanship. But I feel violated, endangered, threatened by a few loose words from a kooky addict. Everyday, I open myself up to this sort of foolishness by being in my profession and attempting to reach out to people in need.

This is only one of a dozen other high-intensity, semi-threatening encounters that I've had with the dregs of society. And I'm not disillusioned about people in general. I will always believe that most people are good and decent at heart. I hope I will always feel compelled to put my best talents and efforts in the service of my fellow man to alleviate suffering and bring peace.

But I've also experienced enough to have a competing voice within me constantly acknowledging the reality of humanity's darker side, a jaded voice that warns me to be wary of reaching out to the distressed when I'll most likely be snakebitten in return.