Bad Medicine

" The desire to take medicine is perhaps the greatest feature which distinguishes man from animals."

-- Sir William Osler

"I firmly believe that if the whole material medica could be sunk to the bottom of the sea, it would be all the better for mankind, and all the worse for the fishes."
-- Oliver Wendell Holmes

When I first encountered the above quotations by famous 19th century physicians, I appreciated their wry incrimination of the ineffectiveness of "modern" drugs (such as mercury and arsenic), but not for their applicability to today's pharmaceutically-saturated healthcare environment. Now, as my own medical practice and philosophy mature, I find myself increasingly referencing them as I build a healthy skepticism of the prevailing medical notion that a person needs drugs to become well.

I just returned from a medical conference in Keystone, Colorado, ostensibly an osteopathic conference, but functionally a mainstream medical seminar for busy primary care providers. There were a variety of lectures on diabetes, hypertension, cholesterol, kidney disease, osteoporosis, hormone replacement, etc.-- a potporruri of the most commonly treated chronic diseases in a general practice setting. The review was beneficial, but as the lectures progressed, an all-too-common theme emerged: the only thing that can cure illness in your patients is _________. (Fill in the blank with any of the latest and greatest drugs, most of which were being aggressively marketed by all manner of slick pharmaceutical reps loitering just beyond the room divider.)

For instance, a respected nephrologist (kidney doctor) gave an excellent review of the diagnosis and treatment of chronic kidney disease, but by the end of the lecture, I counted five--five!--drugs that absolutely all patients with Stage 1 kidney disease must be on to prevent progression towards more severe disease. The thing is, most patients at this mild stage have no symptoms; it's typically diagnosed incidentally or caught with routine screening tests. Can you imagine a otherwise healthy patient walking into a routine check-up, feeling just peachy keen, and walking out with a handful of five prescriptions, with the total monthly cost being upwards of $200? It's a totally ridiculous thought, and yet it was what this intelligent doctor was advocating to a roomful of earnest and gullible physicians. In her evidence-based paradigm, the most proven intervention to slow the progression of disease was to throw a fistful of foreign, man-made chemicals into the ailing human organism.

I believe this inclination towards pharmaceutical intervention stems from a modern faith in the supremacy of human scientific endeavor over nature. And who can discredit the enormity of human industrial achievement? We invented cars, rocketships, computers, iPods . . . not to mention surgery, antibiotics, vaccinations and the hundred other proven medical advancements that have enhanced and prolonged human life.

But the human body is divinely different than any human-created machine; it can heal itself--diagnose, repair, restore, regenerate, and all without needing any conscious command or program from its user. It happens spontaneously. Why? Because that is how God--or for the less devout, mother nature--designed us.

Generally speaking, the human body has a healing system that, when nurtured, can overcome disease on its own without the aid of external forces. Dr. Andrew Weil makes an irrefutable, evidence-based case for this natural healing paradigm in his eloquent and easily understood book, Spontaneously Healing. A Harvard-trained M.D., he powerfully challenges the pharmaceutical-based medical culture that our Western healthcare system endorses. It should be required reading for all physicians. As it is, I stumbled across it accidentally after already completing my formal training. But its crystal-clear precepts speak more profoundly to me than anything else I digested and regurgitated in my medical education.

Dr. Weil suggests that a physician's most powerful tool in promoting health and healing is not through external intervention, but rather through accessing and activating the human body's intrinsic healing system. This activation can occur through many forms: modern drugs, osteopathic manipulation, transcendental meditation, acupuncture, herbal supplements. The common thread is not the mode of intervention, but rather the internal, spontaneous healing that the intervention activates.

The unfortunate subtext of modern medical care--that science knows better than mother nature, that unnaturally engineered chemicals are necessary for proper functioning of the human body--transmits directly to patients' expectations, perpetually reinforcing itself through most patient-physician interactions. People are accustomed to paying lots of money for expert advice from a well-trained physician, whom they implicitly trust to guide them towards a quick fix. When the doctor hands them a brand new, cutting edge drug sample, they think they've received the ultimate in modern medicine. "Take these," the doctor recommends, "every day for the rest of your life, and you will be well." The patient is impressed, the doctor has the satisfaction of providing an expert service, and everyone is satisfied. And thus the cycle perpetuates.

But there are problems: that fancy medicine will cost big bucks once the samples are gone, siphoning finite health care dollars that could have otherwise been spent on preventive or emergency care; it will have known toxic side effects on the patient's resilient but delicate physiology; it will have potentially lethal interactions with other medications that patient is concurrently ingesting; and it will further reinforce to the patient's mind the necessity of external drug therapy.

Because the doctor will spend precious time explaining the indications, administration, and side effects of the medicine, he/she will not spend adequate time on the most important medical advice the patient needs to hear: lose fifty pounds, exercise frequently, consume more fruits and vegetables, watch less television, eat less salt and trans fats, and meditate daily. These natural, risk-free, non-pharmaceutical interventions, if emphasized and followed, will cure the patient's diabetes, hypertension, high cholesterol, arthritis, obesity, depression, and kidney disease at a stunningly higher rate than any other combination of drugs, all at a minimal cost.

Why don't physicians devote more time to advocating these natural lifestyle remedies? The reasons are legion: lopsided medical education, academic disdain for natural therapies, financial and social pressures from the pharmaceutical industry, an over-reliance on technology, time constraints (much faster to write a prescription), a false belief in better compliance with drugs than lifestyle interventions (if counseled properly with good follow-up, patients will implement lifestyle interventions at a high rate), medical-legal and quality control measures that evaluate physician performance on easily quantifiable parameters such as prescriptions written versus more nebulous measures such as lifestyle counseling, and on and on. Embarrassingly, I'm as guilty as the next doctor in reaching for the prescription pad all too soon; I suffer equally from all of the above mentioned blockades that are endemic to the system in which I practice. And fairly, I believe that many of these medications are beneficial and safe. But I also believe that, in most cases, they should not be the primary intervention. They should be a last resort, pulled out only when natural remedies are clearly failing.

I may eventually launch a crusade against the whole system; you may see me one day leading protestor chants from the sidewalk of a major drug company, dressed in a symbolic skeleton costume while brandishing a large pill bottle that reads "Danger: Poison." But for now I just want to provide quality health care (as opposed to medical care) for my patients, who come to me with great needs and great trust. My practice has already changed; I now make an increased effort to emphasize to my patients the natural lifestyle interventions that will allow their own healing systems to function optimally and restore them to health. For the most part, I've found that my patients react very favorably to these ideas--they've just never heard a doctor profess them before.

I have had one passive act of defiance, however: I didn't visit a single one of those parasitic drug reps at the conference. You can go pawn your cheap desk clock to some other gullible doctor who's willing to sell his soul to Merck and Co. But not me, sucker. I've got better things to do, like go activate somebody's intrinsic healing system through my positive karma and mystic energy fields.

Or cranial technique. Or placebo. Or whatever it takes. Because the cure doesn't come from the intervention.

It comes from within.

To be continued . . .

Let There Be Light!

A very curious thing began happening to me a few weeks ago: I began craving sunlight.

Initially, this was a subconscious phenomenon. I found myself staring at pictures of sun splashed beaches, and salivating over photos from our trip to Costa Rica. I lingered at windows where filtered sunlight radiated ephemerally through bleak winter skies. Amidst these yearnings, I did a number of unusual things: painted one of my windowless exam rooms a sunny yellow and the other a vibrant green; spent $100 on a poster of a luxuriously verdant golf course; cancelled a half-day's worth of patient visits when I briefly glimpsed sunbeams glinting off the ubiquitous snow.

Negative things were happening as well: an infuriating insomnia (see my preceding post); a unsettling nervous tension; a pervasive restlessness. I found myself dreading my job (which I actually like), and I had the unnerving sensation that, as I walked into the hospital out of another dreary gray morning, the door sliding closed behind me was a stone rolling shut across a tomb.

Last Sunday night was another sleepless night, which dragged into a bleary-eyed, frantic Monday morning. By that evening, as I sat in my windowless office, completing a dishearteningly large stack of charts and documenting a series of disconcerting patient encounters, an epiphany struck me: I had not seen ray of sunlight all day. In fact, I had barely seen a drop of sunlight all month.

And not only that, but I was acutely (if mildly) depressed.

That realization first depressed me even further, but by the next (sleepless) morning, I began to fit the pieces together: could the insomnia, the anxiety, the depression be a consequence of decreased sunlight exposure? Could I be suffering from a variant of Seasonal Affective Disorder (with the appropriate acronym S.A.D.)?

Could the decreased sunlight exposure be causing my body to produce less endogenous melatonin, which thus threw a wrench in my normal circadian rhythm, which caused the insomnia, the restlessness, the anxiety, the depression, and so on?

Why have I not gotten any sunlight? For starters, this interminable Wyoming winter has left our town blanketed in snow, subzero temperatures, and a gritty gray haze for the last six weeks. (In fairness to Worland, everyone here says it's been an unusually bitter winter, just like it has been for Colorado.) Also, I've never spent a winter at such a northern latitude--not a whole lot further north than Greeley or Provo, but enough to stretch out the nights and shorten the days more than ever before. (Ty and Jeff: could this be why the Russian soul is so deep and dark, because they're so far north they never see the sun?) Next, my office and exam rooms have absolutely no natural lighting; the nearest window is through a door, around a corner, and down a hall, and I've rarely had the chance to escape my close confines, if even for a minute, during sunlight hours. Lastly, I've spent the last six weeks seeing patients either miserably sick with the flu or suffering from their own seasonal depression, both of which are insidiously contagious.


My illumination (or lack thereof) had the ring of truth, so Tuesday I put my theory to the test. I cancelled a lunch meeting and walked outside into cold but bright noon day sun. With hat, gloves and jacket on, I leaned against my car, closed my eyes, and turned my chilly face towards the sunlight. A warmth crept through my eyelids and under my skin, and in a few minutes, I had to smile and then laugh, an unforced, radiant joie de vivre that felt like exactly the medicine I needed. This chuckling and sun-soaking continued for a a few minutes, until the staring lady in the adjacent car nervously strapped her frightened child into the carseat and sped out of the parking lot. :)
The rest of the day and week have gone much better, as I've made a point to be outside with direct sunlight exposure as much as I can. More than anything else, the weather has lightened, even to what I might dare call a February thaw. (Please don't snow again!!!)

And I don't think I have S.A.D. What is Seasonal Affective Disorder, anyway, other than a name some psychiatrist gave to the observed phenomenon that some people get sad and anxious when they don't get enough sunlight?

What I find most interesting is that my body and subconscious mind figured out this problem long before I became aware of it, and even prodded me towards a "cure" through my sunlight craving. This is a perfect example of the natural, spontaneously healing that our bodies are capable of, and which can cure most human ailments. But that's another post . . .

I don't need medicine. I don't need counseling. I just need dang sunlight.

Another week in Costa Rica should do the trick.

Insomnia

Sleep should not be difficult. Sleep should be easy. Infants sleep instinctively for eighteen hours a day, no training required. Bears and chipmunks do it for months at a time. It is a basic, nightly, perfunctory activity. What do you do at the end of the day? You go to sleep.


Not me. These days, I go to bed, but not to sleep. I no longer possess this capacity. Sleep's mystery eludes me like a dream. (But I don't have those any more, either.) In fact, it's been over a month since I've had a night of continuous, restorative, blessed sleep.


I feel tired--extremely tired--as I turn out the light and my head hits the pillow. Then the all-night wrestling match with my brain begins. I cuddle with Elizabeth. I practice deep breathing. I pray. I utilize mental relaxation techniques. I even try counting sheep. But my brain continues to whirr and hum. I glance at the clock. It's 11:15, 12:46, 2:20, 4:00, 5:49, one sleepless minute rolling into the next, and then all too soon there's my alarm clock, crackling with the local country station into my sleep deprived ears. Time to wake up and exercise! But is it waking up if you never fell asleep in the first place?


I've had this insomnia problem ever since high school. I came to refer to myself as an "Insomna-maniac." It comes in spurts. I'll go months with regular, restful sleep, and then suddenly I'm swept into a vortex of insomnia that engulfs me for weeks at a time. I've blamed late basketball practices, snoring roommates, school stress, midnight snacking, weather patterns, residency hours, jet lag, anxiety. I've tried benadryl, nyquil, melatonin, herbal teas, relaxation techniques, ocean waves, diet restrictions, prayer. It's all pretty much useless.


The common denominator in these spells seems to be a pattern of relentless, purposeless brain activity. Ever see a freshly caught fish thrashing around helplessly in the bottom of a boat? That's my brain. Once, I lay awake all night with an old John Denver song playing an endless loop in my head. Why? Sure, I liked the song "Matthew," but after 30 repeats, hadn't I had enough? A few weeks ago, I annoyed my lovely wife when, at 3:00 am, I rolled out of bed to scratch down the lyrics to what seemed to be a brilliant, humorous song that I'd spent the last several hours composing. Strangely, it wasn't nearly as brilliant a few hours later. Often, it's anxieties that keep me awake, which is weird, because I rarely feel anxiety during the daytime. Maybe that's what's really going on: I've learned to suppress anxiety in my waking mind, and so it punishes me all night long. If I spend more time pulling my hair out in the day, could I get at least a few hours of sleep at night?


I used to fight these episodes, throw pillows at the wall and clocks in the trashcan, often panicking in the middle of the night when it became apparent that the sleep bus was passing me without stopping. But I've since learned to accept my fate: I let my brain have its fun, focus on my physical rest, and passively let the night slip away into morning.


The only sustained period of time in my whole life that I've not had insomnia problems was as a missionary. The highly regimented schedule, the exhausting work,

and undoubtedly some divine intervention let me sleep like a baby for two years. But otherwise, I hit these spells at least a few months out of every year.


My daughter, Joy, is the ultimate sleeper. She's out like a light within seconds of hitting the pillow, and she sleeps like a rock for 11 hours straight. Sometimes, in the middle of the night, I'll wander into her room and watch her peaceful face in blissful sleep, and I feel vicarious contentment and a simultaneous envy. I think wistfully, "If only it were so easy."


To sleep, perchance to dream . . .

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.

Eclectic Playlists

I have a pretty eclectic taste in music.

By eclectic, I don't mean "cutting edge" or "unusual." Rather, I mean that my musical tastes cut a broad swath across most genres of popular music. Country, rock, folk, Motown, New Age, 80's, rap, classical, Christian, alternative, oldies: I like something (but not everything) from each of these groups.

To some, the very idea of music being popular stigmatizes it, rendering it unlistenable. Others pigeonhole themselves as liking only a certain type, quarantining themselves from all others.

But give me a good tune, some vocal talent, and some meaningful or clever lyrics, and I'll probably like the song. Throw in a good memory or two associated with it, and I might download it onto my iPod

I've put nearly 3,000 songs on my iPod in the last 6 months, mostly transferred from my own CD collection. I've got playlists ranging from John Mayer to John Denver, from Sting to Stevie Wonder, from Norah Jones to the Dixie Chicks. They all get about equal play.

I've recently started downloading a few songs from iTunes. The first fourteen will give you a good idea of how widely my taste ranges.

• Just My Imagination by the Tempations
• King's Highway by Tom Petty & the Heartbreakers
• I'll Be Your Baby Tonight by Bob Dylan
• Islands In The Stream by Kenny Rogers and Dolly Parton
• Karma Chalmeleon by Culture Club
• Love Will Turn You Around by Kenny Rogers
• Heaven Is A Place On Earth by Belinda Carlisle
• Tunnel Of Love by Bruce Springsteen
• The End Of The Innocence by Don Henley
• Heads Carolina, Tails California by Jo De Messina
• Hook by Blues Traveler
• Love Will Come to You by Indigo Girls
• Ghost by Indigo Girls
• 1979 by Smashing Pumpkins

Maybe my musical tastes are not as sophisticated or selective as others are. Basically, the only important question I ask about a song is, "Do I like it?" I have no other pretentious qualifying conditions. To me, that freedom is liberating; I can't stand being limited by artificial boundaries, in music or anything else.

So if you see me lip-synching to Belinda Carlisle or Boy George on my iPod, know that I'm in my own little piece of, well, heaven on earth.

The Dastardly D's

My daughter's kindergarten class learns a new letter every week.

This week, I choose to highlight the letter D. Every Foster boy worth his salt should know by heart the "D" song, which showcases all of the dark, dastardly, demented connotations of words that start with the letter D. While still in late childhood, I set these D words to an ingeniously hypnotic cadence. I consider this D song a brilliant prologue to my future poetic and musical genius. (Substantial props must be given to my brother Matt, who helped round out the piece. But the glory is still mine.)

So here is my challenge: post a comment, and attempt to reproduce--in exact order--the 9 D's that are strung together in this seminal song. The winner will receive an official recognition on my widely read and immensely popular blog. International fame is sure to follow.

And here's a secondary challenge: attempt to add unto the 9 known D's with your own (meager) contributions.

Hint: it begins with "Death, doom, destruction . . ."

Waste no time; immortality awaits.

Intestinal Fortitude

During a big college football game this weekend, I watched a quarterback receive a vicious hit. As he lithely bounced back to his feet, the announcer commented on his "intestinal fortitude."

I reflected upon that curious phrase, and how it has come to have its current meaning in the lexicon of sports. I now bless you with my ruminations.

Intestinal fortitude: the phrase means "courage," "mental toughness" or "resiliency." But what do any of those things have to do with the healthiness of one's intestines?

What if the announcer instead had exclaimed, "Look at his tenacious colon!"?

Or, "My, what a durable duodedum!"

Or, "How about those hardy bowels!"

Similarly, we say a fearless person has a lot of "guts."

Is this some vestigial linguistic phenomenon, belying a medieval belief that a person's courage and constitution originate from the belly? That strength of soul is drawn into the body through the umbilicus?

I guess if personal valor depends upon abdominal girth, then the Mick's the bravest of us all.

From a physician's standpoint, I'm all in favor of intestinal fortitude. To that end, eat a high fiber diet, avoid processed meats, and get a screening colonoscopy after the age of fifty to make sure you don't have a developing cancer. If you do these simple things, then perpetual intestinal fortitude will be your likely destiny.

You may then be able to go and take a lickin' from a 300-pound linebacker, though it is unlikely you will quickly bounce back to your feet; unfortunately, despite the vim and vigor of your entrails, his whole body fortitude will undoubtedly far surpass your own.

So while you may take the hit, he'll probably knock the--shall we say, tar-- out of your fortitudinous intestines.

God and Science

TIME ran a cover story last week entitled, "God vs. Science," as if the two subjects were exclusionary. It promised, "a spirited debate between atheist biologist Richard Dawkins and Christian geneticist Francis Collins."

Instead, it presented a polite, thoughtful defense of faith and science by Dr. Collins, and a histrionic, scattershot retort by a belligerent Professor Dawkins. In the end, Dr. Collins bludgeoned poor Professor Dawkins with the weight his own circuitous, post-modern, relativistic philosophy.

The whole dialogue is worth reading, but here is a characteristic exchange between the two:


Dawkins: (attempting to explain away some of the universe's mysteries) . . . there could be something incredibly grand and incomprehensible and beyond our present understanding.

Collins: That's God.

Dawkins: Yes. But it could be any of a billion Gods. It could be the God of the Martians or of the inhabitants of Alpha Centauri. The chance of its being a particular God, Yahweh, the God of Jesus, is vanishingly small . . .


I got the feeling throughout the debate that Dr. Dawkins is an intelligent but close-minded man who has risen to some degree of popularity by advocating a narrow-minded philosophy to his like-minded scientific colleagues, but that in Dr. Collins he finally met his match. When confronted with a man whose scientific credentials and brilliance dwarf his own, Dawkins was reduced to pathetic attempts at mental bullying, leaving him conspicuously flailing in his own philosophical quicksand.

Their dialogue immediately conjures to my mind the Book of Mormon debate between the prophet Alma and his atheist antagonist, Korihor. In fact, Collins' and Dawkins' respective arguments veer so closely to their Book of Mormon counterparts that it reinforces to me the modern-day applicability of the Book of Mormon.

I believe that the whole dialectic revolves around two key points:

1) You cannot prove that God exists.

2) You cannot prove that he does NOT exist.

And yet while irrefutable scientific proof of God will always remain elusive, all things in nature, including human nature's hardwired longing for the divine, speak of design and thus a Designer; of creation and thus a Creator; of good and evil, and thus of God.

Absolute proof? Not there.

An abundance of otherwise unexplainable evidence pointing towards a higher power? It's all around us.

I believe that the existence of God is self-evident in the extraordinary order and exquisite design found in nature, in the human body, in physics and chemistry. He is also found in our collective, eternal longing for divinity, expressed through acts of altruism, through poetry and music, and through family relations and love.

Could the incomprehensible complexity of the human body have evolved through random collisions of molecules and purposeless mutations of DNA, even if it had 10 billion years to do so? Possibly, but extremely unlikely.

Isn't it infinitely more likely that a rarely seen but divine force has gently molded creation towards it present state, leaving conspicuous tracks for even the least educated to observe, and thus to begin to build faith in a higher power?

It's Occam's razor, baby. The most likely explanation for the world we inhabit is the presence of a Creator, a being who wants us to observe His works, seek His love, and exercise our faith. He will always reward that earnest effort, no matter what denomination or religion the seeker professes.

It's not "God vs. Science;" it's "God through Science." His presence is all around us, patiently waiting to be discovered and worshipped.

Free Time

What is free time? For most of the past seven years, it has been a concept completely foreign to me. Every minute not spent as a slave to medical school or residency seemed to be consumed with every other responsibility I had been forced to set aside: husband, father, church member, neighbor, citizen. Even vacation was not really "free time," as I oxymoronically felt obligated to maximally recreate and forcibly relax for an allotted time, until the realities of life encroached upon me again. And in every nook and cranny of every conceivably "free" moment, there was always the pressure of impending or deferred commitments, unaffectionately referred to as the loathsome "longitudinal curriculum."

I have not suddenly, entirely burst out of that oppressive cavern. But now, I have found myself with hours, even days, WITH NOTHING TO DO. Days where nothing is due or overdue or soon-to-be overdue. Hours where the kids are in bed, the house is clean, and I find myself wondering, "Well, what should I do now?"

My answer so far has been varied. I've read books and poetry. I played way too much Weboggle. I've gotten mesmerized by the computer mystery game, Riven. I've posted lame entries on my blog. I've watched football games, played flag football, exercised. I've gotten captivated, frustrated, and re-captivated by "Lost." I've done yardwork, gone hiking, played with my kids, planned with Elizabeth.

Fun stuff, all. A lot of it, however, is a complete waste of time. Now, I don't believe that wasting time is always a bad thing; a certain amount of brain-disengaging activity can be relaxing, and even healthy. (Re: Weboggle). But as these free minutes and hours and days and weeks and months pile up, what will be the sum result of all of my "free time?"

Deep inside me, I have long had some big-time goals: writing a Steinbeckian novel, becoming a rugged mountain explorer, making a difference in politics, investing wisely and expertly, serving whole-heartedly in the church.

Is this what free time is, the moments given to us to expand, give voice to and flesh out our deepest desires? I would guess that only a small percentage of history's great one's arrived there through sheer innate genius, like Mozart. The rest arrived there through the diligent application of above-avergage gifts, like Lincoln or Edison.

I've begun reading a biography of Teddy Roosevelt, a truly remarkable American. He was blessed with ordinary gifts but extraordinary courage, resolve and ambition. He pushed himself, forced himself, towards greatness in politics and life.

Do we all have the seed of greatness within us? If so, do we nourish it, water it, cultivate it in our free time?

Or do we sit back and play yet another game of Weboggle? (Thanks, Ty and Dana. Hey, I got all the way up to #3 one night! That's greatness, isn't it?)

Football Weather

The blaze of autumn leaves. Crisp, frosty mornings. The scent of apple cider on the stove. And football, baby. Football.

These are the signature flavors of autumn, my favorite season of the year.

On the heels of wins by both BYU and the Broncos this weekend, I thought I'd jot down my thoughts about this autumnal, violent, and thrilling American game of football.

First of all, I had a wave of nostalgia on Saturday while watching BYU beat the snot out of San Diego State. The calico pattern of the autumn scrub oaks on the snow-capped Wasatch mountains, set against a brilliant Cougar blue sky, brought back the excitement of Cougar football. In fact, my very first Cougar game, back in the fall of 1992, was against SDSU. (I believe that was the game where Marshall Faulk ran for 299 yards and 6 touchdowns against us. Ouch!) After several down years, BYU seems to have found the winning touch again, led chiefly by the cool excellence and precision of their quarterback, John Beck. Fui Vakapuna has not only a great name, but moreso a ferocious aggression and a nasty habit running over people: the man simply cannot be stopped by mere mortals. Add to that mix a stout defense, and the Cougars are set to run the table in the Mountain West Conference and get themselves into a quality bowl game. It's disappointing that they lost 2 of their first 3 games on the last play, due largely to their own implosions. But now they're gelling, and all I can say is, "Rise and shout, the Cougars are out!!!" (Unless they lose their next game. Then they stink.) :)

The Broncos similarly stunk it up in their first game of the year, but have now strung together a number of good wins. Tonight's win against Baltimore wasn't pretty, but it was impressive. The defense is setting records every week (tied for fewest touchdowns ever allowed in the first 4 games of the season). The much-maligned Jake Plummer--who will never get a fair shake in his fickle city inebriated with a false memory of John Elway's invincibility--put together a few great drives when he had to. In the rain. Against arguably the league's best defense. On national TV. To stage another 4th quarter comeback.

To the city of Denver, I say this: get over John Elway, and stand by your man. For now, that's Jake Plummer, who had a career year last season, leading you to the brink of a Super Bowl. He's not always been pretty this year, but he's winning games. In fact, his Bronco's winning percentage is better than John Elway's ever was. Cut the man some slack.

But back to the season at hand: warm some apple cider on the stove; go rake a big pile of leaves and jump in them; breathe in deep the brisk, frosty mornings; cheer on your favorite football team--as long as they're the Cougs or the Broncs.

Savor autumn--the best season of the year.

Ethical Dilemmas

Every day, I encounter some dilemma of medical ethics.

Usually, it's a small thing: a patient demanding an inappropriate medicine; confidentiality issues involving sexually active teenagers; end-of-life care for elderly, demented patients.

Occasionally, I have been intimately involved in gut-wrenching, life-altering family dramas: removing ventilator support from a beloved mother who barely survived her own suicide attempt; administering chemically-castrating medication to a sweet (but potentially pedophilic) retarded teenager at his mother's request; whether to perform heroic (but futile) resuscitation to an essentially brain-dead child whose mother cannot let her go.

Nationally, medical ethics are all over the front page of the newspaper: Terry Schiavo, stem cells, organ transplantation, universal healthcare, cloning, physician-assisted suicide, emergency contraception . . . the list goes on.

When I first delved into medical ethics, I found it very frustrating that there did not seem to be a right answer. And in fact, there rarely is such clarity. Rather, in a true ethical dilemma, there are two "true"ethical tenets competing against each other: one valid tenet, "right" within its own sphere, infringes directly upon another "right" tenet when it is fully exercised. Abortion is the classic example: who can deny that a woman should have the right to control her own body? But conversely, who can argue that killing a fetus is a moral act? One trumpets choice, the other reveres life. Both are right; both have limits.

At some point in your life, devoted reader, you will confront your own ethical dilemma involving your (or a loved one's) health care. A framework to consider such dilemmas could be helpful. Here's a primer on fundamental Western medical ethics, founded on four basic tenets:

1) Autonomy: individuals have an inherent right to make their own choices in regard to their healthcare.

2) Beneficence: healthcare providers are bound to do good, or what is in the patient's best interests.

3) Non-maleficence: healthcare providers are bound to do no harm, or to refrain from what would be against the patient's interest.

4) Justice: a society must distribute healthcare goods and services in a fair and equitable manner.

Here's a brief case to cut your teeth on:

************************************

Transfusion Error

A 70 year-old woman is rushed to the hospital in shock and semi-comatose. She is found to be hemorrhaging internally due to an unintentional overdose in blood thinners. She survives after being resuscitated with fluids and a number of blood products.

When she is removed from a ventilator a few days later, she asks a nurse what happened. The nurse responds that she almost bled to death, but that she's okay now. The patient states, "Well, at least they didn't give me any blood." The nurse cautiously asks, "What do you believe about blood products?" The patient responds, "Oh, honey. People that get transfusions go to hell and suffer for eternity. I'm glad that's not me."

The nurse leaves the room and calls the physician. Should she tell the patient the truth, even if it were to cause her unbearable emotional harm?

********************************************

This is a classic confrontation between Autonomy and Non-Maleficence. Which is paramount--our duty to respect her autonomy and tell her the truth? Or our duty to respect her well-being and avoid undue harm?

Theories are great, but you're a man or woman of action. Something must be done. What would you do? How do you justify your action? Please post a comment with your opinion.

(Remember, the good thing about medical ethics is there's no right answer--except for mine, of course.)

Small Town Roller Coaster

Here's a picture of one of Worland's many thrilling attractions, the "Screaming Dragon" Roller Coaster at Six Flags Over Worland . . .

Just kidding. You may be surprised, but there's nothing quite so spectacular as a roller coaster in these parts. There is, however, a kiddie park with a twisty slide.

But major theme parks aside, we have ridden a roller coaster of another sort in our first six weeks here, both enjoying and struggling with the realities of small town living. This weekend provided a stark contrast in our feelings for Worland.

Friday was supposed to be my day off. Since I had to drop Joy off at school anyway, I thought I'd stop by the hospital to finish a few things up. Four frustrating hours later, I stumbled home for a late lunch, my head reeling from a number of difficult, stressful, and wholly unexpected encounters: drug-seeking patients, complicated referrals, very abnormal lab results, scheduling issues, difficult families, delinquent charts, etc. It was the curse of the small town doctor visiting me for the first time: the inescapability from patients and problems.

Luckily, I had something to look forward to that night: Elizabeth's and my first Worland date.

But, boy, was that a bomb (or a fire), as driving down the main drag, we saw the venerable, ancient Worland Community Center engulfed in smoke and flames. We spectated there with the other half of Worland for a bit, then headed to a very lousy (but free) meal at a local Mexican restaurant. With the meal stomached and the Community Center burning to the ground, we then looked for something fun to do.

But nothing came to mind. We could have gone bowling, or . . . what else? We couldn't think of anything else, so we drove in the country around town for a hour, burning gas and talking, which was fun. But looking out from the edges of town across the barren desert stretching endlessly in every direction provoked a feeling of intense isolation for the first time since we've been here. We came home feeling bored, lonely, and stuck. We comiserated for the rest of the night, as both of us vented some negative feelings about the town that we've been politely withholding from each other.

But Saturday morning, something great happened. We met two new friends who have kids with similar ages to ours at a local park. The kids played wonderfully together while Elizabeth and I played tennis with the other couple . . . and we had a wonderful time. The weather was perfect the courts were fantastic (a very cool astro-turf court with light layer of sand over it that plays like clay), and we were very evenly matched with a fun and friendly couple. Then, we got to go home, and I enjoyed a Saturday full of great football games.

Overall, I love living here. And other than a few hours on Friday night, I haven't felt deprived of any big city conveniences. There are downsides to living anywhere, but a few good friends, some nice amenities (minus a community center), nearby mountains, and a strong church make this a most desirable place.

Now if we could just get a decent restaurant . . .

A Developing Philosophy

As the new doctor in Worland, I was asked to write an article for the local newspaper explaining what a "D.O." means. It was interesting for me to express in writing my developing philosophy of medical practice--to "fling my banner to the wind," as A.T. Still once did.

I have benefitted greatly from both osteopathic and allopathic training, and I find my resultant personal philosophy to be an interesting mixture of both, coupled with a heaping dose of my own feelings about medical ethics and end-of-life care. Throw into that cauldron some natural medicine philosophy from Dr. Andrew Weil, and you have the healthy soup (chicken noodle?) that I want to offer my patients.

While I deeply appreciate all of the wonderful mentors and teachers I have had that have contributed to this philosophy, I must admit an ecstatic feeling of liberation that I can now more fully express, without the sometimes restraining oversight of preceptors, my own philosophy about the practice of medicine. Not that I do anything too radical. In fact, I do my best to adhere to national consensus, evidence-based guidelines. But I believe there are far too many needless prescriptions handed out and surgeries being done; I believe that people need to take responsibility for their health by practicing healthy habits and preventative care; and I believe everyone needs to understand their own mortality and the limits of modern medicine, and to accept the end gracefully when it comes.

Here is a reprint of my article:

Hello, Worland! Thank you to everyone here for helping my family feel so welcome.

I am Dr. Mark Foster, DO, and I have just joined WMC Clinic’s family practice with Drs. Jamey Jessen, MD, and Kjell Benson, MD. Some of you may wonder why I have the title “D.O.” after my name rather than “M.D.” I hope to explain the important similarities and differences in the space below.

D.O. stands for Doctor of Osteopathy. Osteopathy is a distinct branch of American medicine, founded in 1874 by Dr. Andrew Taylor Still. Dr. Still was a classically trained frontier doctor who became increasingly frustrated with the inadequacies of 19th Century mainstream medicine (known as allopathic medicine), some of whose toxic remedies included arsenic, bloodletting, and mercury bathing. When three of his own children were taken by spinal meningitis while he looked helplessly on, Dr. Still first became despondent, then resolute towards finding a better way to practice medicine.

A devoted anatomist, he was inspired by the miraculous structure of the human body and its capacity for self-healing. He noted how the healing systems of the body worked better when the musculoskeletal system was in proper working order. Through experimentation, he devised a system of “manipulations” to restore the proper functioning of first the musculoskeletal system, and secondarily of the entire human body. He felt that a physician’s responsibility was not just to treat disease, but more importantly to find health. He named his new philosophy of healthcare “Osteopathy.”

Initially, Dr. Still’s intent was to separate from mainstream allopathic medicine. However, through the early twentieth century, Dr. Still’s successors at the helm of Osteopathic Medicine accepted and then practiced the breakthroughs of modern medical science: antibiotics, insulin, surgery, pharmacology, etc.

Today, osteopathic physicians practice with the full scope of modern medical advancements. There are D.O.s that practice in all major medical specialties in all fifty states: cardiologists, neurosurgeons, pediatric endocrinologists, and family medicine specialists. D.O.s prescribe medicines, order CT scans, perform surgeries, deliver babies, give immunizations, and practice medicine in much the same way that their M.D. counterparts do, with a few important distinctions: D.O.s are trained in performing musculoskeletal manipulations; and D.O.s adhere to a unique philosophy of healthcare.

As a D.O., I practice in accordance with the American Osteopathic Association’s refined Tenets of Osteopathic Medicine (2002):
1 A person is a product of dynamic interaction between body, mind, and spirit.
2 An inherent property of this dynamic interaction is the capacity of the individual for the maintenance of health and recovery from disease.
3 Many forces, both intrinsic and extrinsic to the person, can challenge this inherent capacity and contribute to the onset of illness.
4 The musculoskeletal system significantly influences the individual’s ability to restore this inherent capacity and therefore to resist disease processes.

In short, I believe that if you take care of your body, your body will take care of you, and so I emphasize healthy habits and preventive medicine. When things go wrong in spite of this, I believe that medications are sometimes the right answer, but that often they are not. The purpose of my training is to know the difference. Finally, I am able to perform a range of manipulations if your musculoskeletal system needs some special attention.

Above all, I am devoted to you as a patient, and to discovering with you how to optimize your health and happiness. I am honored to work with Drs. Jessen and Benson, and to help complement their continued delivery of compassionate, patient-oriented healthcare to Washakie County. Feel free to come and visit!

The Most of It

We went camping as a family this weekend in the Bighorn Mountains, next to beautiful pine-covered West Ten Sleep Lake. It drizzled a bit in the evening and then got quite cold at night.

Fortunately (or unfortunately), all four of us slept in one little tent. Fortunately, because it actually remained quite toasty with all of the body heat. Unfortunately, because one little man who shall remain nameless (Grant) is a piggly wiggly who squirmed and kicked and whimpered all night long, keeping the rest of us from sleeping hardly at all.

At about 3 a.m., Elizabeth and I were still awake due to Grant's antics, crammed together with Joy into the left third of the tent, with Grant himself comfortably sprawled across the other two-thirds of it. While having a whispered discussion of our sad plight, we broke into a muffled hysterical laughter, acknowledging the power of one little man to make three other people so miserable, and to look so cute doing it. We christened him, "The Ultimate Bed Hog," and laughed for a good while before reverting to our prior state of sleepless misery.

At about 4:30 a.m, I had had enough of lying with my face crammed against the wet tent wall, so I thought I would just get up, restart the fire, and think for a bit. After blowing the buried embers back into a warm blaze, I took a short hike down to the lake. The skies had cleared and there was no moon; the unfiltered starlight bathed the whole scene in a surreal hue of pale violet. Across the lake, a granite rock face spilled down into the water, surrounded on every side by towering pines. Not a single man-made light or structure could be seen polluting the wilderness beyond.

I was suddenly struck with a triple epiphany (not a melancholic one). Number one: the pure joyous beauty of a pre-dawn mountain lake for its own sake. Here was nature, devoid of any hidden metaphor or attached meaning; it was what it was, and probably appeared the same way it did a thousand years ago. That I happened to be there at this moment to enjoy it was a happy accident . . . but its essential being was unaffected and would continue on unaltered (hopefully) for another thousand years.

Epiphany number two: the striking resemblance of the scene to the mountain lodge where we stayed on Grand Mesa last year, while working in Cedaredge. (Only ten months ago???) Our hearts broke with the rapid, unexplained dissolution of what had seemed to be the perfect opportunity, not so much because of the job, but because of the location. We felt that in the Grand Mesa, we had found one of the hidden jewels of Colorado, and then it was uncerimoniously stripped away from us. So now, to be five hundred miles away and peering out over a pine-carpeted mountain lake every bit its equal in sublime beauty, I felt somewhat of a prayerful vindication: thank you for our new perfect opportunity.

And number three: the setting from a favorite Robert Frost poem, "The Most of It," seemed to vividly materialize before my drowsy eyes. I first read this poem in a frenzied rush while composing a response essay for my AP English exam. I have since returned to it many times, savoring its powerful, somewhat dispassionate imagery.

It narrates the story of man shouting across a stony, wooded lake, pleading with the cold universe for some sign of love or validation. Instead, he hears only his echo, and then a crash into the water across the lake. Eventually, a large buck reveals itself, pushing through the water before emerging onto the rocky shore right in front of him, then crashing off into the woods, and "that was all." Here it is in its entirety:

The Most of It

by Robert Frost

He thought he kept the universe alone;

For all the voice in answer he could wake

Was but the mocking echo of his own

From some tree-hidden cliff across the lake.

Some morning from the boulder-broken beach

He would cry out on life, that what it wants

Is not its own love back in copy speech,

But counter-love, original response.

And nothing ever came of what he cried

Unless it was the embodiment that crashed

In the cliff's talus on the other side,

And then in the far-distant water splashed,

But after a time allowed for it to swim,

Instead of proving human when it neared

And someone else additional to him,

As a great buck it powerfully appeared,

Pushing the crumpled water up ahead,

And landed pouring like a waterfall,

And stumbled through the rocks with horny tread,

And forced the underbrush--and that was all.

While meditating on these three epiphanies, the eastern sky began to pale with the first inkling of dawn, and a deep tiredness crept over me anew. I stumbled back to the campground, threw a few more logs on the smoldering fire, and lay down on the dirt next to it. An hour later, I awoke to the crisp, salmon-colored skies with my left arm totally numb from having slept at an odd angle.

As my family slept peacefully a dozen yards away, I arose, shook out my hand, and stoked the fire to life again. From neighboring camps, the rustlings of morning creaked and yawned to life.

Life is many things, I thought: beautiful, uncomfortable, tiring, inspirational--human interpretations of what it should mean. But this mountain morning did not reveal itself to me with any secret meaning. It simply was. And that was all.

Melancholic Epiphanies

Sometimes, when life has beaten you down, a wry voice enters the mind, and in laconic prose declares an incontrovertible truth: the melancholic epiphany.
Tonight was not at all melancholic. On the contrary, after a difficult day at work, Elizabeth and the kids threw a great 32nd birthday party for me. We played games, opened gifts, wrestled, danced, laughed, and then had my perennial "Funfetti" cake: multi-colored cake, white icing, and Cookies & Cream. Mmmm . . . delicious.
And oh-so-rich. So rich that approximately thirty minutes after devouring the sweet morsel, a profound lethargy crept upon the entire family--a post-prandial, hyperglycemia-induced, glucagon-mediated stupor. We lay prostrate on the bed. The kids needed to brush their teeth, the dishes need to be done, this blog post needed to be written, but our listless bodies lacked the vitality necessary to overcome the birthday cake inertia. At this point, my lovely wife sighed, looked at me, and stated, "I guess we ate a little too much cake."

When a birthday cake takes down an entire family, when the much anticipated big-game ends in a humiliating rout, when the opportunity to express your truest self ends instead with your foot firmly inside your mouth, when your chance to display your technical prowess results in a convincing display of ineptitude that winds up in the local paper, when you're the new family in church and were asked to say the opening prayer on Sunday (but forgot) and so you arrived five minutes late to hear your name echoing through the empty foyer, when you venture to the local retail store to buy your son a much anticipated new trike as a reward for his improved behavior only to have him throw a spectacular eardrum-shattering tatrum in front of thirty of the local citizens, when your best efforts to care for a patient end in a tirade against you by a confused mother, when you loan your brother a truck that's never caused you a single problem and within three weeks it needs $1,000 worth of repairs . . . well, then, you're ripe for a melancholic epiphany. :)

If you're having trouble formulating these feelings of betrayal, humiliation and despair into coherent thoughts, then visit www.despair.com. They will formulate your thoughts very well for you, and give you ample cause for a sardonic belly-laugh.

In all reality, life is good for us. Very, very good, in fact. I feel more at ease and healthier and more content than I can remember in a long time. I love Worland, I love my wife and kids, I love my job. But the past week has provided some potent reminders (see above) that life is a constant battle to stay between the shores of pridefulness and humiliation.

So be thou humble, or be thou humiliated.

(Hey, that's a good one . . .)

What recent melancholic epiphanies has the cement mixer of life blessed you with? Share them with the world (or at least with the five or six other people that read my blog) by commenting below.

Wonderful Wyoming

The Grand Teton Range

I have spent many years ridiculing the barren desolation of southern Wyoming, but now I feel I must publicly admit the error of my ways.

The Wind River Range

(Picture taken by yours truly)

Make no mistake: the stretch of southern Wyoming along I-80 is pure desolation. But as Wyoming folks are fond of saying, they're glad it's so ugly down there because it keeps outsiders from discovering the awesome grandeur of the state up here.

One of the things that makes Wyoming so great is that it is so sparsely populated: ranked 9th in size but 50th in population. You can go for miles and miles and not see any people or dwellings.

Ten Sleep Canyon

(30 miles east of Worland)

Last weekend, we drove back from Utah over Teton pass and then down along the Wind River Range, through the Wind River Canyon to Worland. Though I'll always be partial to Mt. Sneffels and the Colorado Rockies, they've got nothing on the Wyoming Tetons when it comes to sheer majestic power. In fact, between the Tetons, Yellowstone, the Wind Rivers, and the Big Horns, Wyoming holds some of the most beautiful terrain not just in the USA, but in the world.

Worland itself, while a great small town, is not particularly scenic. However, there are two gorgeous canyons less than half an hour away; the Big Horn mountains are only forty minutes away; the Wind Rivers and Yellowstone are only two hours away; and the Tetons are only four hours away. In other words, a spectacular array of wilderness beckons within a short drive, and there's hardly anyone else you have to share it with.

The Wind River Canyon

(30 miles south of Worland)

So Wyoming, I apologize. You're more beautiful than I ever imagined. I hope to make it up to you by exploring and relishing your wilderness for many years to come!

And to any friends or family who may be reading this, you will always be welcome to come visit us and explore our new beautiful state.

(But shhhhh . . . don't tell anyone else about it!)

The Wind River Range (again)