Tooth Fairy Inflation

What's the going rate for the Tooth Fairy these days? Go ahead. Make a stab.

Twenty-five cents? Maybe a dollar? If you're like me, your only frame of reference is what the Tooth Fairy used to give you, some twenty-five plus years ago. I was lucky to get a dime, if she remembered. (Hey, I'll cut my parents some slack. With six boys at home, the deciduous pearly whites must have added up quickly.)

But the question has suddenly become pressing, as now my kids are losing teeth left and right, up and down. We're down three teeth in the last month, with two more wiggly ones on the way. Joy's first one hung on by a literal fleshy thread for what seemed like weeks, and then it finally, mercifully plopped out. She was taking too much pleasure in grossing her doctor daddy out, anyway.

But late one evening, out it came, the first one ever in the family, and there we were. After the general excitement (and strange poignancy I felt about my oldest losing a body part) subsided, the next exclamation out of Joy's mouth was, "That means the Tooth Fairy is coming tonight!"

Now, I'm not entirely certain that Joy believes in the Tooth Fairy, anyway. She seems to have an innate skepticism about these things. (See this entry from two years ago: one of my personal favorites). She's been inventing pretend notes from Leprechauns and leaving them around our house, and she has the neighborhood kids all boondoggled.

But believing in the Tooth Fairy is now to her immediate and monetary advantage. So after her exclamation, Mommy and Daddy shot furtive glances at each other that silently asked the same question that started this post. (Sorry, I just wanted to throw in an utterly recursive link.)

A few minutes later, I slyly, desperately asked Joy, "Now, how much money does the Tooth Fairy leave under your friends' pillows?"

"Most kids get, like, five dollars," she said sweetly.

My jaw dropped, but I covered. "Five dollars? That's a lot more than the Tooth Fairy used to give."

"Really?" she asked. "How much did you get?"

"I think I used to get ten cents, maybe a quarter."

"Well, some kids only get two dollars. But some kids get toys and treats and books, or, like, lots of money."

I wasn't digging this newly affluent Tooth Fairy, which must be a reflection of the generally mid-to-upper class Denver suburbs, so I sought to tamper down expectations. "Two dollars still sounds like a lot to me, sweetheart."

"Yeah, I guess so," she replied.

And two dollars is what she got, after I had to make a late run to the ATM and then the store to get some change. Grant got two dollars last night after he popped himself in the face with a basketball and his loose tooth tumbled out in the bloody aftermath.

Two dollars still seems high to me, but we couldn't go lower than my daughter's conception of the lowest-going rate. Wouldn't that make our kids think they were less important? But we didn't want to give in to the Tooth Fairy Stimulus Package, either, with ever-escalating premiums and expectations. So we settled on two bucks, and to me, that still seems fair. Hey, it's a 2000 % increase over the last twenty-five years, which isn't bad at all.

Those of you who have kids or will soon have them, what do you think? What's the Tooth Fairy's rate in your area?

Making Peace with Barney

I used to be a hater. I used to curse and spit venom whenever I saw His Purple Cheery Chubbiness flash across the TV screen. The eery, vacuous smile. The fingernails-on-chalkboard of his chuckle-headed voice. The social propaganda. The ubiquity.

There was a Barney conspiracy afoot, a brainwashing of an entire generation, presumably to activate, as some future time, a latent hypnosis, and then Barney's indoctrinated childhood minions would be led like lemmings off of some socialist-worker cliff. I was on to it. Others recognized it to, and reacted with similar antagonism. Barney, it was said, must die.

But that was many years ago, before I had children of my own, before I was given a glimpse of the world through their small, innocent eyes.

Without fail, each of my three children, when between the age of one and two, has shown an innate affinity for Barney, despite our best efforts to the contrary. His size and giant, semi-lunar dentition don't seem to frighten them. They sing with Barney. They laugh and dance with Barney. My youngest, Justin, in particular loves Barney. In fact, one of his earliest words was "Bonnie," which means Barney and which has become a frequently repeated (as in fifty times an hour) refrain.

We do our best to ration his Barney exposure: no more than one thirty minute episode a day. But there are times when a little bit of Barney is just the right medicine.

Take last night, for instance. Poor Justin has had an upper respiratory infection for a few days, and last evening became feverish and fussy, pulling at his ears. We knew he had probably developed an ear infection, but it was late at night, and there wasn't much that could be done at that hour. (Today, I brought him into my clinic, confirmed the ear infection, and started him on antibiotics.) He was inconsolable and exhausted, and so were we.

Then, a lightbulb appeared over my head like a giant purple bioluminescent blob: Barney could comfort him. Thanks to the magic of On-Demand, Barney was soon chuckling and clucking his way across the screen, and little Justin was instantly pacified. We watched together as Barney saccharinely championed toothbrushing and the pure fantastic fun of visiting the doctor's office. (Okay, so I even felt a little subtle gratification that Barney held my profession in such high esteem.) Soon, Justin was sleeping peacefully in my arms as Barney sang away with unyeilding affirmations into the flickering shadows of my family room.

I'll admit it freely now: I've grown soft on the Gianormous Purple Dinosaur. I've come to find his message innoucous, and his demeanor, if not charming, then at least not nauseating. And I appreciate the comfort he offered my son in his moment of distress last night.

But B.J. and Baby Bop? If I see their vile visages one more time, then I may have to throw a brick through my TV.

Bono, Barack, and Steve Nash

You know the old question, "Who would you invite to dinner if you had the chance?"

For me, it's easy. Three dudes: Bono, Barack, and Steve Nash.

What a dinner party it would be! We have so much in common, the four of us.

• Bono and I could talk about our golden pipes and world-wide charisma.
  
• Barack and I could joke about our similar gangly frames and worldviews on globalization and the American Dream.


• And Steve Nash and I wouldn't have to talk much. We'd just head out to the driveway and shoot the three ball from deep and dazzle each other with our sweet passing. He and I are on the same wavelength.

Some people might dream wistfully of such a dinner, and yet never see it come to fruition.

Not me. The invitations are in the mail. The steaks have been bought. Now we'll just wait and see who shows up.

Who would you fave five (or three) be?

LOST In Space

"We have to go back, Kate. We have to go back!"

This post is a shout-out to what has become a semi-obsession with the only TV show I regularly watch, other than The Bachelorette. (Just kidding. I don't watch that anymore after what Suzie did to Veronica.) :)

Why do I love LOST so much? Let me count the ways:

• The writers. I don't know how they do it: an indecipherable plot (and I mean that in the most appreciative way) weaving in and out of different times and places; flashbacks or flash-forwards that always tie in the current action with distant plot lines; a cast of more than twenty major characters with interwoven histories; and a ridiculous amount of symbols and allusions from science, literature, religion, history, philosophy and art. But they have balanced all of these elements over more than a hundred hours of programming. They have kept and rewarded their audience's fragmented attention over six seasons, and yet each episode stands on its own as a captivating hour of television, each hour almost always paying off with a bizarre, unforeseeable twist, an "Aha!" moment that has become addicting. (Each episode I swear I'm going to see it coming, but I rarely do, and then I'm like, "Dude, that was sweet," as I munch on the final unpopped kernels of popcorn from my dark and suddenly spooky family room.)
• The production values are superb. Lush Hawaiian locale, authentic retro scenery from across a half dozen distinct time periods, funky sci-fi props, crisp editing, eerie score. You won't see anything look or sound better on TV than an episode of LOST.
• I identify with Jack Shephard, a frustrated doctor with major control issues who has leadership and greatness thrust upon him, all the while waging internal battles between faith and science. Plus, we both look really bad in a beard.
• I identified the Island with our time in Wyoming. (In fact, I came to call Worland, "The Island.") A magical, frustating, isolated, and timeless place overrun with warring factions, a menagerie of motives and mysteries.
  

It might be hard to jump into the show now if you haven't been following it. As I said, the plot is so complex, so recursive and tangential, that it might be impossible to catch up entirely without back-watching every episode, which are available at abc.com. But it's worth a try.

When I first got into the show in season three, I became frustrated because it seemed there were so many loose ends that they could never be tied up, like the producers were just messing with our minds to hook us into the advertising revenue of the next show. But now, as LOST reaches the midway point of its penultimate season, the loose ends are starting to be tied up and the diffracted plot seems to be funneling back into a semi-cohesive narrative. (However, I think some of the tie-ups are forced, and I don't honestly believe that writers/producers had even half of the over-arching plot worked out when they started in Season One.)

But now I've learned to accept and even relish the ambiguities of the show. The point isn't to figure it out. The writers aren't going to let you do that, especially because, like I said, I don't think even they know how things are going to turn out. The Island on the show is a character in itself, and I think it's a meta-symbol for life: something powerful, compelling, and indescribable tears us apart and and brings us together, thrills us and torments us, casts us off and then redeems us. The point of the Island and the show isn't to solve the mystery. The point is to dazzle your mind. At this point, I'm just enjoying the ride.

The genius of the show is in its complexity. I compare it to what you would find if you were an alien dropped into the middle of present-day Iraq. You would find factions of US troops, Iraqi soldiers, Al-Qaeda terrorists, Western mercenaries, Shiite loyalists and regular civilians, all with they own agendas and motives. You may (or may not) find weapons of mass destruction, nuclear reactors or chemical weapons, statues of Saddam and ancient Mosques. If you dug deeper, you might find Mesopotamian temples and artifacts mixed in with American trinkets and bullet casings. In short, you'd find one tremendous mileu of humanity, horror, and history, and it would be impossible to try and sort it all out and explain it to another foreigner in any concise way. In the end, the history you pieced together may not make any real sense or mean anything, but it would be a description of the untidiness and indecipherability of life, and you might best represent that as art through a hundred hours of programming over six years.

(One final thought: has any show ever generated a more loyal and intelligent fan base? You can enjoy just the pagaentry and drama of the show, or you can peel back layer after layer of allusions and symbols in a quixotic attempt to fathom the shows true meaning. There are dozens of high quality blogs and websites dedicated to deciphering LOST, and some of them are so detailed that it's like reading a college dissertation on each episode. Here are links to a few of my favorites:)

Doc Jensen: http://www.ew.com/ew/article/0,,1550612_20245769_20261566,00.html
Erica: www.longlivelocke.blogspot.com
J. Wood: http://www.powells.com/blog/?author=104

Dark UFO

Great Analogies

This is a cheap post I'm recycling from something I found online, because I lack the energy to create something de novo.

But it's very funny, so enjoy.

*Analogies you probably won't find in great literature*

The little boat gently drifted across the pond exactly the way a bowling ball wouldn't.

McBride fell 12 stories, hitting the pavement like a Hefty Bag filled with vegetable soup.

From the attic came an unearthly howl. The whole scene had an eerie, surreal quality, like when you're on vacation in another city and "Jeopardy" comes on at 7:00 p.m. instead of 7:30.

Her hair glistened in the rain like nose hair after a sneeze.

Her eyes were like two brown circles with big black dots in the center.

Bob was as perplexed as a hacker who means to access T:flw.quid55328.com\aaakk/ch@ung but gets T:\flw.quidaaakk/ch@ung by mistake.

Her vocabulary was as bad as, like, whatever.

He was as tall as a six-foot-three-inch tree.

The hailstones leaped from the pavement, just like maggots when you fry them in hot grease.

Her date was pleasant enough, but she knew that if her life was a movie this guy would be buried in the credits as something like "Second Tall Man."

Long separated by cruel fate, the star-crossed lovers raced across the grassy field toward each other like two freight trains, one having left Cleveland at 6:36 p.m. traveling at 55 mph, the other from Topeka at 4:19 p.m. at a speed of 35 mph.

The politician was gone but unnoticed, like the period after the Dr. on a Dr Pepper can.

They lived in a typical suburban neighborhood with picket fences that resembled Nancy Kerrigan's teeth.

John and Mary had never met. They were like two hummingbirds who had also never met.

The thunder was ominous sounding, much like the sound of a thin sheet of metal being shaken backstage during the storm scene in a play.

His thoughts tumbled in his head, making and breaking alliances like underpants in a dryer without Cling Free.

The red brick wall was the color of a brick-red Crayola crayon.

Pronunciation Woes

How do you pronounce the word BANAL?

Simple, right? Five letters, no combination vowels. I know what it means: boring, "drearily predictable and commonplace," as stated on dictionary.com.

But how is it pronounced? BAY-nal? Or is it bah-NAL? It's one of dozens of words of which I understand the usage, pass over without thinking when seeing it in print, and yet find myself reluctant to use in public due to pronunciation uncertainty, which reminds me of a quote that a college friend had on his wall: "Better to remain silent and appear a fool than to open your mouth and remove all doubt."

These are significant concerns for a logophile (word lover) such as myself, who, in all humility, absolutely rocks at word games such as Scrabble and Boggle. But in finally trying to resolve this conundrum, I came across a passage that helped me realize my concerns about BANAL are widespread and justified.

This is what dictionary.com has to say about it:

• Usage Note: The pronunciation of banal is not settled among educated speakers of American English. Sixty years ago, H.W. Fowler recommended the pronunciation (bān'əl, rhyming with panel), but this pronunciation is now regarded as recondite by most Americans: no member of the Usage Panel prefers this pronunciation. In our 2001 survey, (bənāl') is preferred by 58 percent of the Usage Panel, (bā'nəl) by 28 percent, and (bə-näl') by 13 percent (this pronunciation is more common in British English). Some Panelists admit to being so vexed by the problem that they tend to avoid the word in conversation. Speakers can perhaps take comfort in knowing that these three pronunciations each have the support of at least some of the Usage Panel and that none of them is incorrect. When several pronunciations of a word are widely used, there is really no right or wrong one.

Reassuring. Yet other words fluster me as well. Because I get virtually all my news from newspapers, magazines and the internet and rarely ever watch televsion news, proper nouns are often difficult to peg down. But I think this is understandable for the most part. How would anyone know how to pronounce "Mahmoud Ahmadinejad" or "Rod Blagojevich" except by hearing them? (These happen to be two collosal fools, by the way.)

I'm embarrassed to say that until about eighteen months ago, though I had read it dozens of times in print, I thought our new President's first name was pronounced BEAR-ack instead of bah-ROCK.

An example closer to home is the pronunciation of Ken Caryl Ranch, the subdivision where I grew up and where we now live. The name is derived from area rancher John Shaffer's two sons, Kent and Carrol, and I have it on printed authority from the official Ken Caryl history that the correct pronunciation is Ken Carol, as in Christmas carol. Yet most people, even longtime residents, colloquially refer to it as Ken Carl, as in Carl Weathers, or Carl Sagan, or Carl's Jr.

I use this name several times every day in common speech, telling someone where we live or giving directions to my new clinic. I had been hamstrung by the question, "Should I pronounce it the way it's used, or the way that's correct?" but I've settled on on saying it correctly, and I've noticed something interesting. Nobody flinches or acts confused when I say it this way, just as I (almost) don't notice when I hear it pronounced the colloquial way. Most likely, this is because most normal people don't give a hoot about things like this. But to me it seems that Ken Caryl, like BANAL, has two correct pronunciations. In fact, a couple of weeks ago in church, a respected speaker, who has lived in the Ken Caryl Ranch for twenty plus years, used both pronunciations within a minute when referring to the Ken Caryl Ward. He didn't blink, and I don't think anyone else noticed but me.

I'm sure some of you have similar pronunciation woes, or words that vex you. Let's hear them. (Just try not to sound like an idiot.)

Grey Matters

2%.

No matter the subject matter, those are poor odds.

For a novice writer like me, 2% represents the odds of signing a deal with a book agent.

That's one in fifty. For every winner, there are 49 losers who have their very souls crushed by the bitter tombstones of reality in the form of a dreaded rejection letter. Kind of like American Idol, but without the national humiliation.

But a little cautious optimism is in order:

Stephanie Meyer was rejected by nine agents before she was accepted. She has now sold over 40 million Twilight books.

J.K. Rowling was rejected by the first twelve publishers she approached. She went on to sell over 400 million Harry Potter books.

Based on those numbers, if I am rejected by twenty-five agents, I could end up selling well over 1 billion books. One can only hope.

Yes, I have written a book.

It is called Grey Matters, and there are no wizards in it. There are no vampires. It is about a doctor, a nurse and a dream. I think it is quite good. But then again, I wrote it.

I have sent it to agents. Against dismal odds, I maintain a vigilant hope that someone, somewhere will like my brain-child enough to take it home and feed it some good vittles.

And so I wait . . .

Below is my submission letter, which is a writer's only avenue to snag an agent's attention in one page or less.

Let me know if you'd like to ink a book deal.

(Six figures, or I walk.)

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Dear (Agent):

Thank you for considering this request to represent Grey Matters, my completed fictional novel.

Grey Matters is a contemporary medical romance/drama set in suburban Colorado in a large community hospital. Dr. Joe Rorke is an overworked medical resident; Kaitlyn Sullivan is a vibrant obstetrical nurse. Each is struggling with ethical dilemmas in their young careers when a mysterious mutual dream brings them together. Kaitlyn believes; Joe is skeptical. But the power of the dream overwhelms them, propelling them swiftly towards marriage and pregnancy.

Then for Kaitlyn, the dreams abruptly stop. For Joe, they continue, but transform into a series of ominous nightmares that portend grave danger for Kaitlyn and their unborn child. Joe's heroic instincts clash with his worst impulses of controlling behavior. His scientific mind battles against his subverted faith as he fights to protect his family against intangible doom.

Grey Matters is an insider's take on the complex world of modern health care. It delves into the gray areas that abound in medical ethics: what are the limits of modern medicine? Can saving a life conflict with "Do No Harm"? How do we judge quality of life for those unable to speak for themselves?

But first and foremost, Grey Matters is a love story, the tale of two modern medical martyrs whose dreary lives are set ablaze by a dream that is both irresistible and foreboding. Their romance poses questions about the gray areas we all face in relationships: how do we reconcile romance with reality, passion with pragmatism? Why do we project so much of ourselves onto those we love? When does holding onto love require that we let it go?

This commercial novel contains fifty chapters and approximately eighty-five thousand words. The story is based firmly in the real world of a modern hospital, yet intertwines elements of romance, suspense, fantasy and tragedy, exploring the relentless struggles between scientific empiricism and metaphysical belief. I am a practicing physician in Colorado. I have a particular interest in biomedical ethics, having served as chairman of our hospital ethics committee, as well as having been intimately involved in countless real world ethical dramas.

Prior to medical school, I graduated with a bachelor's degree in English in 1999. I have been writing essays, poetry and short stories for some time. I was published in a collegiate creative writing annual and have written medical articles for local newspapers. After my extensive schooling, I am finally at a place where I can pursue my creative impulses and share my stories. This is my first venture into novel length fiction.

Thank you for your consideration. I look forward to hearing from you soon.

Colorado Weather

I love Colorado.

No surprise there. But being away for two years has only sharpened the intensity of my love for this great state. I love the mountains, the people, the sports teams, the weather, and so much more.

So many things to love. But today let me focus on the weather. Start with the seasons: four distinct ones, but each varied enough that you don't get drubbed by monotony for months on end.

A brief tour:

• Summer: gorgeous blue skies, hot enough to make the pool inviting, but always cooling off in the evenings. The cool shadows of the mountains are only minutes away. Plus, you can count of raucous afternoon thunderstorms to tamper down the heat. There's camping, hiking, climbing, rafting, biking: a true outdoor paradise. I think summer is my favorite season here . . .
• Fall: especially this fall, we have had a nearly unbroken string of perfect autumn weather for two and a half months. Crisp, frosty mornings turning into bright sunny days. Sure, there's an occasional snowstorm in October, but then the next day the weather is back to sublime. Throw in the golden aspens, the football afternoons, the marshmallow roasts. I've changed my mind. Fall is my favorite season.
• Winter: when snow dusts the peaks of the Front Range, you know that winter is approaching, and that means one thing: ski season! As the tag line for the Colorado Ski Pass says: "It's why you live here." Bright, cold mornings on the slopes with fresh, uncarved powder stretching in front of you, snow caked on the branches of the pine trees, what could be better? Maybe a warm cup of hot chocolate (for only $6.50!) when you get back to the lodge. And even if you don't like the cold, you don't need to be disturbed by this season, as Denver weather throws in several stretches of thaws to break up the winter. It may snow two feet on a Thursday and then be sunny and sixty degrees by Saturday--in the middle of January. (This is in direct contrast to Wyoming, where about now the winter freeze sinks over the town, and snow that falls in early December doesn't melt until March. I think we found some perfectly preserved mammoth carcasses in our alley one year.) But I digress: winter in Colorado means skiing, sledding, snowmen, with enough variation and sunlight so that the cold doesn't wear out its welcome. Maybe this is actually my favorite . . .
• Spring: just about the time you realized that you've skied enough for one year, late March and early April rolls around. Denver will get some heavy snows in that time, but the grass starts greening, the trees start budding, and the brownness of winter gets chased quickly away by warm sunshine. The mountains come back to life as the rains shower gently and the snows melt. You plant your garden, pull out the lawn mower, and plan with intense anticipation all of your upcoming summer adventures. Spring brings the renewal of life and hope. I'd have a hard time saying this wasn't my favorite.

So I guess it's a four-way tie for my favorite season. Bottom-line: it's all great. I anticipate every approaching month here for what the weather will bring. Truthfully, I can't express how perfectly right it feels to back in our home state of Colorado.

Does everybody feel this way about their home state? Is it because in my impressionable youth the weather patterns and changing seasons were imprinted upon me, and thus they resonate so deeply in me now? I don't think so, because if that were true I'd still feel yearning for Missouri's 98% humidity.

I think it's more likely that we are just blessed to live in one of the greatest weather spots on earth. Those of us who live here (and especially those of us who have returned) know it.

Pan-tastic!

So Elizabeth and I had to wait forty minutes before there would be a table available for us at the restaurant Friday night. We took advantage of the time and strolled along the sidewalk of the fancy shopping center. We saw a kitchen store with some attractive window displays, and we went inside.

This is what we found:

• A rubber spatula for $18 dollars.
• A wine glass for $60.
• A box of designer hot chocolate for $40.
• And a set of pot and pans, similar to the one you see here, for $4,000.

That's right, four thousands smackers!!! You could by a decent used car for that same amount. Or a week long trip to Hawaii. Or enough food for a whole year for young starving college couple like Drew and Kristen (lots of Ramen).

This was not a store geared towards professional chefs or restauranteers. This was geared towards the affluent upper classes that permeate the environs of Highlands Ranch and southwest Denver.

My question is, who would ever spend $4,000 on a set of pots and pans? Who would have enough money to burn that they wouldn't consider driving to Target and buying the same set for $125? For those economists out there, that would be a $3,875 savings. I can think of a lot better uses for that same amount of money.

Big Sand Dunes!

I knew there was a reason they called it Great Sand Dunes National Park . . .

We had a blast. Perfect weather, blue skies, and lots and lots of sand.

Kudos to Elizabeth and Joybear for hiking all the way up to the top of High Dune. No easy feat when you every step you take slides halfway back down the hill.
And thanks to Grant and Justin for playing Sand Monster with me and tumbling down fifty foot sand dunes. Repeatedly.
Even after prowling the Visitor's Center and watching the movie and speaking with a Ranger, I still don't understand why these 700 ft tall, 30 square miles of pure, fine sand are sitting in a corner of the San Luis Valley. Sure, you can talk about winds and sediments and whatever you want, but last I checked there are lots of wind and sand in Wyoming, but no Sand Dunes.




Next time we're going in the spring when the creek is running, and we're bringing sleds!

The Art of Despair

Last year, I produced three Demotivators of my own. You may remember them. But probably not.

I've since added a few more. They're all included in this post for your perusal. Check them out.

Following them, you'll find a letter that I'm actually sending to Despair.com to see if I can make some money off of my latent cynicism.

Enjoy.

MIDDLE MANAGEMENT

When pulled in opposite directions by powerful forces,

an organization, like a rope,
snaps at its weakest point.

FARCE

If we continue this charade long enough,
we might start believing it's true.

HUMAN RESOURCES

For every pound of beef provided by a cow,
it produces in its lifetime
one thousand pounds of waste.




OBLIVIOUSNESS
You're spinning your wheels and going nowhere.
But apparently you're unaware of that.




SCRUTINY
It's a small world, after all.
Very, very small.




PEER REVIEWS
It's payback time.



COMMISSIONS
Another day, another dollar.
Sometimes less.

++++++++++++++++++++++++++++++++

5 October 2008

Dear Dr. E.L. Kersten et al,

I have been a fan of Despair.com for some time. I have yet to ever purchase anything, mind you, but that hasn’t stopped me from unethically cutting and pasting your Demotivators into various blogs and emails of my own. I prefer things that are free.

But for all the past glory of Despair.com, I think it is plain to see that your best days are behind you. Your recent Demotivators are charming, but hardly contain that same acerbic bite of yesteryear.

It’s obvious that you need someone to freshen your stagnant pond of despair. And that person would be me.

I am including with this letter five Demotivators of my own creation. I am certain you will find their quality and ironic conveyance of total despondency of the most superior quality. I am equally certain that you will then offer to pay me Big Moolah for the rights to these. Don’t even think about using them without compensation. Know that I’ve got lawyers up the wahzoo who are itching for some deep-pockets to sue.

And believe me, these are only the tip of the iceberg. There’s a whole lot more despair where these came from. In fact, I’ve got ten more already produced and ready for you. Look at it this way: I’m the engine, and you’re the vehicle. I’m like the creative slacker who cynically produces the latest dimwitted, assembly-line, lowest-common-denominator Hollywood blockbuster, and you’re the theater. I make the goods, you get it to the public, and we both make the aforementioned Moolah. It’s a win/win situation. Just as long as I’m winning a little bit more than you.

I’m serious. You don’t want to turn me down. It’s not every day that someone waltzes up and offer to save your lousy business from financial ruin. (Unless you’ve been on Wall Street the past few weeks.)

One final thing: I’ve got some great marketing ideas for you, new lines of Demotivators geared towards specific fields, such as healthcare providers, new parents, struggling artists, and middle managers, all veritable hatcheries for despair.

I mean, come on. Don’t you think it’s time you expanded beyond the disaffected college student market?

Email me or call.

Have a terrible day. :-(

Mark

My Boy

My son Grant turns five this week, and I'd like to wish my Little Buddy a happy birthday.

He and I had a wonderful opportunity to bond over the past two weeks. Due to our move and some free time in my schedule, he and I headed out to Southwestern Colorado to spend some time on "the Ranch," a friend's spacious and idyllic mesa in the middle of nowhere. My parent's joined us for the first weekend, and my wife and other two children joined us for the last, along with my brother and his wife and two children.

But in between, it was just me and Grant and a whole lot of wide open spaces. We stayed in a log cabin on a small lake in a remote corner of the mesa. At night, looking out the rear window, we could see by starlight the Lone Cone and the Delores Peaks towering on the horizon, and it was impossible to see any other signs of humanity. There were absolutely no city lights, no streetlights, no anything in any direction.

We would look to the stars and everything was crystal clear. No light pollution. If fact, it was only when we saw the slow drifting satellites in orbit that we felt reminded that we weren't the last two guys on earth. The Milky Way was so prominent that it looked like, well, spilled milk.

Grant and I had a deal. He had to let me write for four hours a day, but the rest of the day was his. And we had a great time. We cooked all of our meals together, chopped a lot of wood, played football and baseball and frisbee and horseshoes (we modified the horseshoe's rules, and Grant is very proud that I could never beat him, and believe me, I was really trying). We played chess, checkers, chinese checkers, puzzles and several other board games. We read lots of books. We tried to fly our new remote controlled helicopters, only to irreparably break both of them within minutes of take-off. We built campfires and roasted hot dogs and marshmallows. We went canoing on the lake. We fixed crooked signs all over the place. And mostly, we did a LOT of four-wheeling, at least 3 hours a day, I would guess, and probably rode well over two hundred miles in ten days.

We hunted for turkeys, and though ultimately unsuccessful, we saw several dozen of the sneaky rascals. We saw countless deer and birds and squirrels and rabbits. We saw an owl, a golden eagle, some prairie dogs, and too many cows. (This is still a working cattle ranch). We never did see any elk, though we know they were around.

The climactic moment came on our last day. We came zooming around the corner on our four-wheeler, and there, in the middle of the road, was a good-sized black bear, not twenty yards away. He was so startled that he literally jumped in the air, turned and stumbled away quickly thorough the scrub oak. He was gone within seconds, and to be honest, neither Grant or I felt the least bit scared. Of course, we had our snazzy four-wheeler and a trusty firearm to back us up.

In the end, I got some great writing done, and we had dozens of memorable experiences, but by far the best outcome of the whole endeavor was getting to spend an extended time with my son. He and I have battled mightily over the past few years, and particularly over the last few months, as he seems to have been fairly rattled by our move and to have acted out with attention-seeking behaviors and fierce tantrums.

But not on this trip. Almost without exception, he was perfectly behaved. We didn't clash even once, and I think both of us discovered how much fun we had together, how much we enjoyed each other's company. Quite honestly, by the end of the trip, I sometimes found myself forgetting that he was my son, and not just my hunting buddy.

He was extremely cute in a most unintentional way. I noticed for the first time how dearly he loves his stuffed animals, particularly his T-Rex and his Glow Puppy. Sometimes, I'd take a break from my writing and just watch him from the balcony, playing contentedly or even exuberantly by himself around the cabin, throwing rocks or jumping off stumps or collecting pine cones. Here was a four, almost five year old boy, and it seemed to me that the most important thing in the world for him was to be exactly where we were, doing whatever it was we happened to be doing.

Grant is a boy who, for good or ill, wears his emotions very prominently on his sleeve. But for two weeks, the tantrums and attention-seeking disappeared. It was just him and his Daddy on the Ranch, exploring and playing and four-wheeler riding. Other than missing Elizabeth, Joy and Justin, the world seemed absolutely perfect for both of us. And more than anything else, I knew he was happy, which made me overwhelmingly happy.

So here's to my wonderful five year old son!

Happy Birthday, Grant Guy! I love you!

Props to Craig and His List

No posts from me for a while, but no worry. I'm sure all six of my infrequent readers have yet to notice. ;)

Actually, to those who may care, we have successfully moved our family back to Colorado and are enjoying settling into our new home and a new routine.

Now, today I wish express my appreciation for that cyberspatial miracle known as Craigslist.com. Why? Because Craigslist has saved me money. Big time.

Ever wonder who Craig is? Check this link out and educate yourself.

In the past month, I calculate that I have saved more than $3000 by spending just a little over $1000 on some perfectly fine and (even exceptionally nice) furniture. This includes a gorgeous solid oak dining room table and china cabinet, bunkbeds, patio furniture and an office chair.

In each of these instances, I went to Craigslist, found the desired item within a 25 mile radius at a reasonable price, and then graciously (mercilessly?) negotiated an even lower price with the anxious sellers. I have been grateful for my Toyota pick-up, because it has made it possible for me to head out at a moment's notice to pick up the merchandise, which has allowed me to negotiate lower prices with the sellers.

In each instance, instead of feeling like I was being robbed by some money-grubbing retailer, I felt a strong fraternal connection to my co-barterers, like we were co-collaborators on a new utopian social experiment. They got money for something they didn't need anymore. I got a good item at a great price. Everyone went home happy.

How many things in life are consistently win/win for everyone involved? Not many, and so that's why Craigslist gets my props today.

If you haven't bought something on it before, give it a shot.

And if you've got some cheap furniture to sell, give me a shout. (Let's keep this Craig dude out of the loop on this one.)

Farewell to OB

For an unlucky 600+ babies in this world, the first thing they saw coming out of the womb was my ugly mug, which could explain all the crying.

Two of these infants were my own sons, although the first delivery I ever witnessed was that of my only daughter, who was born on the weekend before I started clinical rotations in medical school. When the doctor held up our new baby and asked me to declare her gender, my mind, which must have been stupified in wonder at witnessing the miracle of life, went blank and the answer to this most basic of medical questions eluded me. I stared at the doctor, at the baby, at my wife and finally the kind doctor relieved the palpable confusion and declared matter-of-factly, with vicarious shame, "Uh, it's a girl."

Well, I got better at identifying gender as time went by and the deliveries started to pile up. Before too long, the ins and outs and subtleties and dramas of a labor and delivery unit, which had seemed so intimidating, began to be familiar and even comfortable, though I never lost the wonder and awe of the event. Rapidly, obstetrics became my favorite aspect of residency. As the final groans and shrieks and splashes and cheers of yet another birth would crescendo down the hospital corridors at three a.m., it always seemed to bring a welling of (but not actual!) tears to my eyes.

I chose my residency in order to get extra training in OB, including the ability to do Cesarean deliveries. I felt that if I was going to be delivering babies in a rural environment, I needed to be able to handle not just the routine and uncomplicated births (which, honestly, rarely require the supervision of a physician, as women were delivering babies for a several eons prior to the advent of modern medicine--anyone could catch a baby), but also to handle the small percentage of births where the life of mom and baby hang in the balance. When things went south in a hurry, I wanted to have the training and confidence to be able to deliver via C-section, sometimes referred to in medicine as the "vaginal bypass" surgery.

I got excellent training in residency in Colorado, and was able to put that to good use for two years in my first practice in Wyoming. I also became aware that not only did I enjoy OB, but that I was (in my humble opinion) pretty good at it. I gave good care, developed a sharp clinical skill and intuition, had generally very positive feedback from patients and families, and earned the respect of my medical colleagues.

So considering all of that, how can I now walk away from OB?

I have a number of relevant excuses: the demanding call schedule, the emotional fatigue, the high risk of litigation, the difficult patients. The most accurate and understandable excuse is that, in order to accept the many lifestyle benefits of my new job in Colorado, sacrificing my OB practice would become a necessity. It would be essentially impossible, both politically and geographically, for me to practice full-spectrum obstetrics at a major metropolitan hospital: family doctors just don't deliver babies or do C-sections in that setting anymore, not to mention the fact that my new practice would be located at least twenty minutes from the hospital, which would be prohibitive.

The bigger and more poignant truth is that, having practiced OB for five years (including residency), I no longer feel willing to make the personal sacrifices required to continue it. Been there, done that, had some good times and bad times, now ready to move on. That sounds a bit crass, but it is probably the most concise summary.

I admit to very mixed feelings about this. I have invested a great portion of my time, youth, money and well-being to learn a rarified skill that will now turn fallow, likely never to be utilized again.

But there you have it. Who knows what the future will bring? Who, a mere three years ago, could have guessed that we would move to Wyoming, practice and move again in such a short time frame. Maybe in the future I will provide obstetrical missionary services in foreign countries, or moonlight in rural hospitals. Maybe I'll get to be the hero on the local news when by chance I happen upon a woman delivering in her car alongside the highway. Or maybe I'll miss OB so much that in another three years we'll move back to an environment where I can practice it again. (Unlikely.)

But for all of the endless memories, the triumphs and terrors of the labor deck, the privilege of participating directly in the miracle of life, I bid obstetrics a most fond farewell. I will miss it dearly . . . as I sleep uninterrupted through the night.

Empty House

When I pulled up to our empty Worland house late last Sunday night, I didn't expect any melodrama. I had helped move my family down to Colorado two days prior, and then had driven solo back up to Worland to finish my last week of work. We hadn't yet closed on the house, and so although it was barren, we still had ownership, and I had to check on a few things prior to heading over to a friend's spare bed for the night.

When I pushed open the garage door into the kitchen and flicked on the florescent light, a blast of muggy air greeted me, which brought with it a humid sense of deja vu. I recalled a similar rush of warm air almost two years prior when we had first walked into the house late on a hot summer evening. Everything looked almost identical and just as empty as it had then. I surveyed the vacant rooms, and unexpectedly a deep poignant ache began welling inside, which, once once I recognized it, became quickly a nearly unbearable sadness.

The strength of the emotion caught me off-guard. I had been so engrossed in the physical bustle of moving that apparently I had not dealt with the emotional aspect of it. But that is the way I typically handle big life changes: suppressing the emotions of the moment, only to have them surface at later times in unexpected ways.

But why did I feel so deeply sad? All in all, this move was a happy one, and in spite of my occasional misgivings about it in the preceding months, I had no doubt that it was right for our family; only days prior I had felt what can only be called elation as we crossed the state line back into Colorado. So why the sadness? Somewhere in the back of my mind, I was aware that the home wasn't the source, merely the vehicle, of the sorrow. The source seemed to be something vague and ineffable, something that brushed tangentially along the corners of the relentless pressures of time and the fragility of our lives.

I shook my head and began walking around the house, flicking on lights and checking closets. The squeaky floors, which had been a constant annoyance while living there, were somehow reassuring by being familiar. Every room seemed to resonate with a profound absence of what should have been there. Where were the toys strewn around the room? Where was the baby gate blocking up the hallway? Where was the pile of letters and keys and miscellaneous junk that inexorably coalesced on the corner of the kitchen counter?

I couldn't bear to be in any one room for more than a few seconds before feeling compelled by the aching sadness to leave, only to find the next room even more oppressive. We had done a number of major improvements, yet the physical parameters of the house seemed utterly unchanged by our two years there. It seemed as if by vacating the house so completely, two years of our lives had been erased, just like that.

I crept down to the basement and examined every room, searching for something, anything that we may have left behind, ostensibly in case we might have missed it, but secretly hoping for some shred of evidence that these two years of our lives had not totally dissipated into thin air.

And then I found it. There, beneath the laundry chute, something red and white, crumpled. Closer inspection revealed its true identity: a pair of Grant's dirty "Lightning McQueen" underwear. I picked it up and laughed out loud. How and why he had placed it down the laundry chute in the very brief interval between our "final sweep" of the home and getting into the car, I didn't want to imagine. But the concrete proof of existence it conveyed was most welcome. In that moment, it may have been the most appreciated piece of dirty underwear of all time.

But after chuckling to myself at the absurdity of my own emotions, the silence and emptiness in the house reasserted themselves as the dominant force of the evening. I would soon be gone again, and the house would continue existing with or without me. Underwear in hand, I hurried upstairs, closing doors and shutting off lights, and finally resurfacing through the garage into the cool night air. I stood by our front porch and glanced down at the pink rose bush that had exploded in colorful buds a few weeks before. Now, the browned wilted petals hung precariously to the stems or fluttered lifelessly to the grass. The grass itself was getting longer and ragged in some patches, brown and crisp in others. Weeds crept along the driveway. I looked up to the clear night sky, nearly untarnished by the relative paucity of city lights in Worland. Stars burnt coolly into the high desert air, constant yet flickering, unimaginably brilliant and unfathomably distant.

Two years. A new child. A new career. This home had been the arena where the dreams and heartaches and memories of our precariously short lives had played out. And now it lay undisturbed and empty, devoid of any trace of our time there.

And now not even tainted by a misplaced pair of dirty underwear.

Wimbledon Classic

This weekend I watched what will likely go down as one of the greatest athletic competitions of all time, as young, hungry and indomitable Rafael Nadal outlasted the venerable, invincible five-time defending champion Roger Federer in a five-set, seven hour thriller in the Wimbledon finals.

Anyone who follows tennis even casually (like I do) had been anticipating this rematch of last year's final for the past twelve months. As the number one and two players in the world, Federer and Nadal had been on a collision course for this championship rematch ever since Federer gutted out a five-set victory last year.

But coming into this year's final, Nadal had time and momentum on his side--not to mention a healthy knee which had slowed him last in last year's final. After all, Nadal had crushed Federer in straight sets on the clay courts of the French Open final just a few months before. But Wimbledon is a grass surface, and Federer has owned that surface for the past five years running like nobody else ever has in history. Going in, he had sixty five straight victories on grass to go with his five championships.

Not to mention that Federer, in his five year run of greatness, has maintained such a totally dominant physical and psychological edge over every opponent. He garnered the nickname Darth Federer when he wore black once in the final and appeared like a black-clothed tennis exterminating machine, completely unflappable and untouchable. To watch Federer has been to watch tennis played to perfection: perfect body control, perfect power, perfect temperament and perfect focus.Only one thing has seemed to be able to faze Federer in his unprecedented dominance, and that would be Nadal, who has been the Kryptonite to Federer's Superman, owning an 11-6 lifetime record against him, really the only opponent who has been able to consistently compete with and even outperform Federer over the past five years, though Federer's Wimbledon victory last year seemed to reassert his physical and mental superiority to Nadal, as well as to every other tennis player who has ever lived.
But Nadal was having none of that this year. In contrast to Federer's polished perfection, Nadal has the appearance of a raging wild beast, all sweat, sneers, stringy hair, grunts and fist pumps. For all of Federer's graceful precision, Nadal has equal amounts of pure energy and athleticism. And both have unparalleled competitive wills: the same brilliant fire that illuminates Federer also radiates from Nadal. In the Wimbledon finals, Nadal jumped to a two set lead and seemed poised to win in three sets. But Federer, regrouping during some timely rain delays, came back to win the third and fourth sets, setting up an epic fifth set that stretched beyond anything that Wimbledon's storied history had ever seen and into the deepening London twilight. In a fifth set of a final there are no tiebreakers, and so the match went into extra games, with the champion being whoever could string together two straight victorious games. Finally, Nadal broke Federer to take an 8-7 lead, and then he served out his final game to claim the victory as he collapsed along the baseline. When he arose, his face was streaming with tears of triumph and exhaustion. Federer graciously congratulated him as they both accepted their trophies.

Tennis is virtually alone in the world of sports in its intra-dynamics, a one-on-one direct competition, two competitors facing each other across the net, directly interacting, slugging it out and trying to beat each other. No teams, no court-side coaches, no timeouts (unless you're lucky with a rain delay). And in a five set match, there is so much time for momentum to build and ebb, so many turning points, so much endurance required. What made this final so singular was that it was a face-off of the two unquestioned best players on the planet, each at their prime (though perhaps Federer is on the backstretch of his greatness while Nadal is still coming off of first turn of his), with each playing flawlessly, relentlessly past all boundaries of normalcy, each refusing to lose, until finally Federer, in what could only be total mental and physical exhaustion, showed the slightest chink in his armor, and Nadal, the ursurper to his throne, rushed in with the dagger to finish him off.

It's hard to say at this point who is the number one player in the world, as the margin between victory and defeat was so razor thin. The edge would have to go to Nadal, but no doubt Federer has several more good years left, and still has the tools and the mental toughness needed to reclaim his throne.

I, along with tennis fans around the world, hope that over the next few years this rivalry, just like this match, continues to ebb and flow, back and forth between who has the upper hand, who is the world's greatest. It is a study in contrasting styles, of how competition can propel rivals to new levels of greatness, of grace versus power.

It is a thrill to behold.

Long live the kings!

Waiting for the End

I have a very pleasant patient who is slowly dying of end-stage emphysema. He is on very high levels of oxygen and a number of medicines, but there is no cure for his condition, no remedy that he is willing to consider. He will continue to experience a slow decline until he finally succumbs and dies.

I've been caring for him for the past twelve months, when I inherited him from one of my partners. Yesterday, he came to see me again, feeling generally miserable, short of breath, and utterly fatigued. We discussed his specific symptoms, which all revolved around his incurable underlying condition. Finally, his well-meaning, relatively healthy, and somewhat frazzled wife cut to the chase.

"Doctor," she asked, "how much longer is this going to last?"

"You mean until he feels better?," I asked.

"No," he answered for her, "she means how much longer until I'm going to die." He spoke this final word with impatience.

I paused for a bit, collected my thoughts, then said as honestly and compassionately as I could, "I don't know. It is very difficult to tell in these cases." They looked at me expectantly. "Based on where you are today, I would say probably six months to a year." I waited for a response.

"Six months?" His wife gave an exasperated little half-chortle. "That's what they told us two years ago!"

We all laughed at that for a bit, at the absurdity of living a life in suffering with the sole purpose of waiting around until one day you finally die. This sort of situation invariably raises the spectre, in my mind at least, of physician assisted suicide. First of all, it's illegal. But that doesn't mean necessarily that the idea is wrong. In fact, in specific cases such as this one, it is very hard to argue against it from a medical ethics point of view. (That may come as a surprise to some, but medical ethics is full of shades of gray, and because in our western medical-legal paradigm the principal of autonomy typically trumps all others, it is hard to build an argument that would preclude a rational patient with an incurable, agonizing disease to voluntarily take their own life.)

But this encounter did not devolve into an esoteric discussion of medical ethics. Rather, this was pragmatic, a patient suffering who wanted some sort of reassurance or comfort. I felt compelled to morph into Missionary Mark, to share in a non-denominational way some of my personal religious convictions, as I will sometimes do when religous patients come to me for comfort, and medicine has nothing else to offer.

I suggested to him that God appoints our times and seasons, when we live and when we die, and that the fact that he's still alive must mean that God still has some purpose for him. I encouraged him to try and view each day as a gift and to find meaning in it, even if that was only holding his wife's hand or writing a letter to a grandchild or appreciating a flower.

Then I raised my hands to the heavens, shouted "Hallelujah!" and asked him for an alms.

Not really. But I did feel some sort of spiritual inspiration, and my patient and his wife were noticably moved.

He will still suffer physically and emotionally, will likely die within the year, and I'm under no false pretense that my one minute sermon will dramatically affect his end-of-life care. But I did have a feeling of satisfaction that, rather than offering lethal doses of morphine, I was able to offer my terminally ill patient words of comfort and perspective.

Chicken Run

For the last nine months, we've been amateur chicken farmers. But due to our imminent summer vacation and upcoming move, we gave our eleven chickens away today. It's a rather poignant moment: the end of the Chicken Era.

Last fall, we joined ranks with another family in caring for eleven hens that were housed in a chicken coop on a ranch outside of town. It was a great opportunity for our city family to get involved in some real-life agri-culture (farm work, chores, getting down and dirty), not to mention to get some delicious farm fresh eggs.

Jim, one of the dentists in town, had a spare chicken coop sitting on his beautiful ranch, and he was gracious enough to lend it for our chicken endeavors, and so twice a week we headed out to his coop nestled in the cottonwoods by a pond to feed our frenzied feathered friends.

There were four Rhode Island Red hens, four salt-and-pepper Plymouth Rock hens, and four plain old white hens, prolific egg layers all, putting out sixty to seventy eggs a week between them. Due to the egg surplus, Joy and Grant got to start their own little business, "Foster's Farm Fresh Eggs." If they collected the eggs and took care of the chickens, they got to sell them and keep the profits. Quite a business, I must say. The kids are rolling in the dough. Even Justin grew to love going out to feed the ever-bustling, ever-interesting (to a one year old at least) chickens.

Eventually, we took over sole ownership of the chickens, and finally today we bequeathed them to another young family. The whole chicken business was quite a bit of hassle, especially in the winter when it was 28 below zero, but I must say that I feel rather sad at the close of this chapter. It started out on a whim, and ended up becoming an integral, earthy part of our Worland life, a vignette of what our future might have held should we have chosen to stay in Worland longer.

But hey, they still need eggs in Colorado, right? Do you think our new suburban neighbors would mind if we erected a chicken coop in the back yard? Would eleven clucking, stinky chickens be a problem?

Come on, Colorado. Time to put that "Locally Grown Food" movement to the test!

But in seriousness, I know there is a vestigial farmer in me. I feel him clamoring to be released whenever I've been tangentially involved in farming or ranching. We hope to own our own small ranch someday: some acreage, some horses, and--gosh durn it--some chickens!

Spontaneous Wipeouts

A young child is ambling on without a care in the world. Suddenly, through a mixture on incoordination, head-size disproportion, and just plain bad luck, they collapse in a heap.

Cue the crying.

Elizabeth and I refer to this sudden, catastrophic collapsing malady of childhood as the "spontaneous wipeout." Our children are masters of the art.

Joy may be routinely brushing her teeth, and suddenly she has fallen violently, wedging herself between the toilet and the trashcan.

Grant may be eating his breakfast cereal, sitting flat on his bottom, and suddenly, without any obvious impetus, he has toppled head first onto the hardwood floor, scattering soggy cheerios to the four corners of the kitchen and sustaining a large goose egg on his forehead.

Justin, being only a year old, can be forgiven his frequent falls, but I have no doubt he will soon be following--or should I say falling?--in his siblings footsteps.

New light was shed onto the origins of this phenomenon last week. Joy was standing still in the kitchen, not moving in the least, when suddenly she crashed through the screen door, ripping the screen out of its frame, scraping her foot and bruising her arm in the process. In my ultra-calm but deadly serious voice, I questioned from the couch, "So, Joy. What happened there?" She whimpered plaintively from the porch, "I don't know, Dad. I just went out of balance."

Ahhh. So that explains it. Going in and out of balance without a moment's notice.

In medicine, there is a condition known as Benign Paroxysmal Positional Vertigo, or BPPV. But this is not that, for this may be paroxysmal, but it is by no means benign.

This is the Spontaneous Wipeout. Who knew gravity could be so malevolent?

Breaking the Bad News

I don't have to diagnose patients with cancer very often, thankfully. But the last few weeks have brought a grim procession of cases where I've been the one that's had to break the news.

Two of these patients have been very elderly, very frail, and while a cancer diagnosis is always devastating, they and their families have met the news with a sense of resignation mellowed by dementia.

But two of these patients have been fairly young (in their fifties), otherwise healthy and brought into the doctor's office by fairly minimal symptoms. In both cases, I initially pursued a conservative work-up, but through a mixture of clinical intuition, defensive medical practices, and plain old blind luck, I ended up ordering special imaging studies. Both patients ended up having particularly large and aggressive tumors; both now face a horrifying gauntlet of major surgeries, radiation and chemotherapy, all of which appear unlikely to prolong their lives.

Ugh. It's enough to make me want to do an MRI of my whole body, just to be sure there isn't something sinister simmering in my tissues.

It's a little bit like hearing about a plane crash: when you see something so horrific, you suddenly feel vulnerable, even though your odds of suffering the same fate are exceptionally small. (Unless, of course, you fly on Great Lakes Airlines.) Compound that by paranoia by witnessing first hand the disaster several times in a short span.

When I'm faced with an x-ray report that reveals a likely cancer diagnosis, I feel devastated for my patients as well. I dread having to be the messenger, though I do appreciate the importance of my role in reliably and empathically conveying the information. Knowing I will have to answer a deluge of panicked questions once I break the awful news, I go do as much research as possible to try and educate myself and be prepared. But oncology is such a specialized field now with such specific diagnoses, treatments and prognostications, that whatever meager information I impart will be utterly insufficient. This is especially true when I am breaking the news of an as yet unconfirmed cancer, as you never diagnose cancer off of an x-ray, but rather under a microscope once you get a tissue biopsy. It's all a very hopeless feeling for me; usually the best thing I can do is convey the information, offer compassionate solace, extend an invitation to hope for the best, and then expedite a referral to an oncology center. It's not like treating an ear infection: easy diagnosis, excellent prognosis, concrete remedy.

It's more like dredging a lake for drowning victim: emotional paralysis until the awful discovery confirms your worst fears.

I guess that's why I've had a Tim McGraw song humming in my head all week:

He said, "I was in my early forties, with a lot of life before me
When a moment came that stopped me on a dime.
I spent most of the next days, looking at the x-rays
Talking 'bout the options and talking 'bout sweet time."
I asked him when it sank in, that this might really be the real end.
How's it hit you when you get that kind of news?
Man, what'd you do?

He said,
"I went skydiving
I went rocky mountain climbing
I went two point seven seconds on a bull named Fu Man Chu
And I loved deeper
And I spoke sweeter
And I gave forgiveness I'd been denying
And he said, some day I hope you get the chance
To live like you were dying."