THE THREE MUSKATEERS

I’m a lucky man.  Two of my best friends from my childhood, Abe and Robert, married Linda and Annabelle, who subsequently became the other two of my best friends.  Together with Renee, the six of us travel together, commiserate together, and share in life’s events good and bad.  (Abe asked me if I was enjoying my journey through the past.  I am.  Of course, I’ve conveniently left off the bad stuff.)

Robert’s mother and mine were best friends and neighbors at the age of three.  It was only natural for Robert and I to spend a lifetime together.  I think Abe came along when I was 16 and got my license.  Abe lived in Richmond near the corner of Stewart and Commonwealth Ave. Commonwealth was the name of my high school fraternity.  Why I’m telling you this is a mystery to me.  All I know is that street sign disappeared one night.  I wonder where it could have gone.

As an adult, having childhood friends that you see regularly keeps you young.  Following the kids and grandchildren through life brings its own sort of happiness and pride.  This article is for Robert’s youngest daughter, Paula, who is graduating from VCU with the title of PMH Nurse Practitioner.  Congrats, Paula!

When Renee and I got married and moved to Illinois, it opened a can of worms.   Our parents, who lived in Norfolk, were none too pleased.  We were young, stressed and newlyweds.  I had a solid background in Psychiatry, so I set up an appointment with Michael Bresler, PhD.  Counselling was extremely helpful; and, ultimately, Michael opened a satellite office in LZFTC. (Michael is another mentor of mine who is dead.  I’m starting to think I’m dangerous!) Eventually, he was replaced by two of his students, Ron and Ginny, who worked out of my office until I retired. As a family physician, having psychologists on site was invaluable. 

Now for my story and a joke.  In residency, I met a psychiatrist extraordinaire!  Harry was a little crazy and he knew it.  Being crazy and knowing it is what made him so good.  Most psychiatrists (people in general) I knew were crazy but didn’t know it.  Since they thought they were normal, they recreated their patients according to their warped sense of normal. When their patients spoke, they sounded just like their psychologist/psychiatrist occasionally spewing forth  psychobabble.

 Harry, on the other hand, helped his patients find their own sanity.  Renee and I sat with Harry at Ron and Ginny’s wedding.  I turned to Harry and said, “Harry, there are times when I’m not certain whether you are the patient or the doc.”  Harry answered without hesitation, “I get confused also.  When I’m not sure whether I’m the patient or the doc, I look for my diploma.  If it’s behind me, I’m the doc.  If it’s in front of me, I’m the patient!”

Paula, I don’t need to tell you how rocky life can be and how stress affects people.  When you are not sure what your role is on any given day, ask one simple question.  Where is my diploma?

Now for the joke that unfortunately is probably real.  An old psychiatrist and a young psychiatrist get in the elevator at 8 am every day and go up to the fourth floor.  The young shrink goes to his right and the old guy goes to his left, each opening their offices and getting ready to see their patients.  At 5 p.m., they get in the elevator to go down to the first floor and then to go home.  The young guy is exhausted. The old guy is as fresh as if he had just awakened. After a month, the young shrink decides to ask his older companion how he does it.  The old guy looks at him and says, “You don’t listen to them, do you?

Paula, you are going to be tired by the end of the day because you are going to listen to your patients.  Listening to your patients is going to make you into a great practitioner.  Your patients are going to be lucky to have you.

One more joke:

I complained to my psychiatrist that everyone hates me.

He said “Don’t be ridiculous! Everyone hasn’t met you yet.”

THE COST OF CARE

The ad in the paper read, “LZFTC – $15 school and sports physicals.”  I’m not kidding you.  Office visits ran $22 – $32 dollars.  Everything was cheap.  Most office fees were less expensive than today’s copays. On one Thursday during the summer of 1985, I saw 106 patients.  I started at 7:30 a.m. and locked the doors at 8:30 pm. The last patient was discharged at 9:45 pm.   Most of the patients were seen for sports physicals. The last patients to be seen were football physicals.  Boy, did those kids stink!  They came from their first practice and had been told that they couldn’t play tomorrow if they didn’t have their physicals documented.  One kid stunk so badly that I sent him home.  I couldn’t handle it.   He was my first patient the next morning.

For the most part, I loved sports physicals.  They were a fantastic chance to do some real preventative medicine, talk about VD and unwanted pregnancies.  Of course, none of my patients were sexually active (lol).  None of them drank or did drugs (lol).   So, how could the cost of a sports physical soar from $15 to $150 or more?

In the good old days, everything was on paper.  We collected far less information at the front desk.  My notes were short and sweet.  They included the pertinent medical findings, the diagnosis, and the treatment plan.  All of the information fit on 1/2 of a page of paper.  I wrote anything important in block letters. I wrote the diagnosis and charges on another piece of paper and the patient went to the front desk and PAID, sometimes in cash but mostly by check.  For those of you who don’t know what cash is, ask an elder.  Transactions were straight forward.

The invasion of the insurance aliens screwed up everything.  They promised you better care at a lower price.  You got worse care at a higher price.  They threatened me. In previous articles, I’ve written about the Suits who came into my office and demanded that I sign their contract.  They sat in my office, demanded my signature on their contract or they would take my patients away.  Big, brave doc that I was, I threw them out.  OOPS! They won and everybody I know lost. 

I take that back.  I took care of one of the insurer’s hotshots. He did quite well for himself.  Like a character in a spy movie, “G” came to me at the end of the day and warned me that my name was on a “burn” list.  I had a successful blog that focused on the insurers’ attack on doctors and patients and the ever-worsening effects of giving in to them.  Frankly, the world had just demoted me from doctor to provider and I was pissed.  I turned “Milo” loose and he started writing some pretty inflammatory stuff.  He published the annual salaries of the CEO’s of the big three, as well as the value of their bonuses and stock options.  In response to “Milo,” Big Blue threatened to cancel all of my contracts.  I would have gone bankrupt immediately.  Obviously, I pulled my blog and all of my articles and did not write again until I retired.

The golden days of medicine were over.  Prices soared and profits crashed.  Patients who would never think of leaving their doctors left their “provider” every time their insurance changed.  Instead of being PAID for services rendered, providers were reimbursed by insurers according to complicated contracts that nobody could understand.  My billing staff grew from one biller to five FTEs.

The next big attack on the doctor/patient relationship was the dread REFERRAL/PRIOR AUTHORIZATION.   During the early years of practice, I wrote an order and it was done. With the onslaught of REFERRAL/PRIOR AUTHORIZATION, I wrote an order and then everyone waited to see if the insurer would pay for it.  The whole medical complex geared up to process more paper; and, once again, the cost of providing care went up and the quality of care went down.  Insurers are clever.  They never tell you that you can’t have a procedure/test /medication, they tell you they won’t pay for it. 

The insurers’ battle plan worked and PAPER WORK clogged the pipes.  The answer was obvious.  Everyone had to buy computers and modern medicine became modem medicine.  As the world became engrossed in the promised benefits of the ELECTRONIC MEDICAL RECORD (EMR), the doctors and medical staffs that used the EMR became helplessly enslaved.  The companies that made EMRs sold customized versions to hospitals and their physicians, insuring that EMRs would not talk to each other.  Software upgrades became dreaded events requiring expensive training and fixes as the EMR companies never got it right.

I learned to be an efficient clicker.  Unfortunately, the computer proved to be a success at billing and collecting money, further insuring its place in medicine.  IT DID NOT IMPROVE PATIENT CARE.  IT DID NOT IMPROVE PROVIDER TO PROVIDER COMMUNICATION.  WE GOT SCREWED, AGAIN.  I dreamt of putting the defibrillator paddles on my computer and yelling, “Clear!”  I wanted to kill it.  I secretly hoped we would be attacked by ransomware.

Towards the end of my practice of medicine, I spent an inordinate amount of time satisfying the computer.  I gave up newborn hospital care because the computer program used by the newborn nursery was a bottomless pit.  Thirty minutes of patient time was followed by 45 minutes of computer time.  My notes were full of useless, but computer required, information.  By the time you got to my diagnosis and plan, your hair had turned grey and you needed a nap.

My specialists’ reports were even worse.  I learned to read their notes from the back forward.  My rheumatologist’s notes were the only one that could be called excellent.  Her notes told you what she thought, what she was going to do and what she wanted you to do.  How she got her computer to obey her commands remains a mystery to me.  When I reviewed her chart note, it was like looking at notes doctors used to write back during the golden years of medicine.  Perhaps there is hope for the future.

Your joke for the day is:

My grandad asked me how to print on his computer…

I told him it’s Ctrl-P. He says he hasn’t been able to do that for ages.

A husband and wife are trying to set up a new password for their computer.

The husband puts, “Mypenis,” and the wife falls on the ground laughing because on the screen it says, “Error. Not long enough.”

THE CATS IN THE CRADLE PART 2

There are times when I look back into the past and think, I couldn’t have done that, could I?  Then I realize that, by the grace of God, I did it and survived.  Taking a journey back into my past has been good for me.  On my journey back in time, I’ve chosen only the best of memories.  I’m sure there were some bad ones, but time seems to have erased them.

I’m sitting in my kitchen looking at one of my most prized possessions.  On a square piece of marble sits a gold-plated business card that reads:

LAKE ZURICH FAMILY TREATMENT CENTER

STEWART B. SEGL, MD

                    HOURS

Mon – Fri 7:70 a.m. – 8:30 p.m.

Sat 9 a.m. – 5 p.m.                                                         504 S. Rand Road

Sun 11 a.m. – 5 p.m.                                            Lake Zurich, Ill          60047

While it seems impossible, Renee and I did it.  Remember, not only did I work those hours in the office, but every day started with hospital rounds and most days ended with the same. 

I had a kitchen in the office.  I slept on a reclining chair in the X-ray room. Sometimes, I showered in the hospital as I was so tired at the end of evening rounds that I went to sleep in a call room.  During the early years, I found time to start a family.  Erin, Jeremy and Lisa came along and my life fractured.

Being in the office was never work.  Realistically, it was a love affair.  I was in my element, with my people.  My patients were my life.  I had kids pouring in the front door.  I did magic and they loved it!  I had kids who faked being sick just to see me.  I joked around a lot and found that being myself, rather than a doctor caricature, worked.

One of my life-long patients and friend recounted the following story:  She was a young, single smoker and I had talked to her multiple time to no avail.  Previously, I had shared with her how I quit.  I wore shoes with tassels and would sit cross legged and hold the tassel as if it was a cigarette. Finally, I told her, “Look, I don’t care what you hold between your fingers as long as it’s not a cigarette.  Play with your buttons, with your pen or boyfriend, just not a cigarette.”  She chose the boyfriend option, got rid of the cigarettes and replaced them with a husband and 3 children.

My 3 children lived in Buffalo Grove, not in the office with me.  Sure, they dined in the backroom with me, visited for lunch and dinner, but they had a life outside of LZFTC.  My love affair with LZFTC started to die.  When I was in the office, I wanted to be home.  I wanted to spend more time with my kids than with yours.

I had created a monster, and that monster needed to be fed and I was the food.  I cut the hours but that did not help.  The staff and I just stayed after we locked the front doors, catching up with the backlog of patients waiting in the lobby.  I promised the kids I would be home soon only to find them sleeping when I finally got there.

I hired new docs but could never find one I could call partner.  One doc wanted me to pay him more than I made.  I had some great docs; they were just not as dedicated to patient care as I was. 

Not having a schedule was a killer.  If the kids had an event I needed and wanted to be at, I couldn’t call my patients and cancel because we saw walk-ins.  I started being called away on hospital emergencies.  Yep, I’d go to the front desk, tell them that I had to go to Good Shepherd to see a patient, then drive fast to the Buffalo Grove field my kid was playing on or to the auditorium where my kid was in a play or recital.

My love of LZFTC was smothering my family.  I opened a home office in the basement.  On weekends and after hours, I would see patients in my basement.  Sometimes, I’d be dressed in a wet bathing suit.  I called it, “Reversed House calls.”  As I realized that my house calls were a further intrusion on my families lives, I ditched the home office.

Often, Renee had to be mother and father.  She also was office manager, accountant, head chef, shopper and, let’s not forget, wife and lover.  She carried much of the burden of my absence.  Sometimes, I wonder how much damage I did to all of them by feeding my monster, LZFTC.

Would I do it all over again?  I truthfully don’t know.  Like the song says, “When are you coming home, dad? I don’t know when, but we’ll have a good time then….”  Listen to Harry Chapin sing, “The Cat’s in the Cradle.”  It’s a perfect description of my life.

In retrospect, the Parkinson’s came with a blessing.  If not for the Parkinson’s, I would still be in the office.  I really expected that I would die seeing patients.  If I had stayed in the office, I’d be singing the same song, only I’d be singing to my grandchildren.  As is, my family has spread out over the East Coast, making spending meaningful time with all of them difficult.  And, oh yes, just like the song, they now are busy with their own lives.

Whether they learned from my mistakes or it just worked out that way, they spend far more time with their children.  THEY SEEM TO BE HAVING FUN.  I asked Renee if we had fun and she didn’t answer me.  When she doesn’t answer, the answer is really NO!

Here is today’s joke.

One day, a wife was preparing breakfast for his husband, when he suddenly burst into the kitchen and started instructing her.

“Careful!” he screamed. “I said careful! Oh my god! Put in some butter as well, will you?”

The wife was confused but she did not say anything. But the husband continued his rant, “You never listen to me. We need more butter! And where’s the salt? You never put enough salt!

“Why don’t you listen to me? Turn them. Hurry up! Are you crazy? Have you lost your mind? And where’s the salt? Just put the salt! You always forget them! Salt! Salt!”

Now his wife was really mad at him. She snapped, “What is wrong with you? You think I don’t know how to fry a couple of eggs?”

The husband calmly replied, “I just wanted to show you what it feels like when I’m driving.”

LZFTC, THE BEGINNING

It’s Thursday night around eight.  I’m working at the office laying floor and ceiling tiles.  A young family eating TCBY yogurt strolls in.  “Do you know anything about the doc whose opening this office?” the young father asks.  I reply, “I hear he is great.  Treats all ages and all diseases on a walk-in basis.  Also lays tile in his spare time.  Hi, I’m Doc Segal.  We’ll be open soon.”  That’s how I met my first patient.

John Jung called the next day.  My office was a union job and the union workers were threatening to walk.  It seems someone was working on the office at night.  When I told John it was me, I thought he was going to have a heart attack.  I explained that money was tight and the workers were making very little progress.

When the workers found out the doc was the culprit, they stopped everyone else’s work and finished the center.  Apparently, they liked the fact that I’d get my hands dirty and it didn’t hurt that I did good work.  The build out was only part of getting LZFTC open.  Renee and I had to equip and furnish it.

The “Milo” in me showed up again.  In this case, Milo performed well.  Sometimes he’s too cheap, cuts too many corners and creates problems. The furniture in the lobby came from a restaurant supply house.  The seating was to be banquets in a new restaurant that never made it off the ground.  The sphygmomanometers (BP) were rescued from an old hospital that was being demolished. They were made during WWII.  Every room was different as we pieced together the office from the remnants of prior docs’ practices.

Oh, yes, I almost forgot.  There were curtains.  Do you remember the curtains? I Ioved the curtains.  I was an ER doc and needed fast access to my patients. I was soon to transition to a family doc and would need walls. I had one private room with 4 walls and a door.  That room was used for pelvics and sensitive private matters.  The doorbell was located on the wall above this room.  If the front door opened, the bell rang.  If you held the door open, it buzzed.  During one pap smear, the bell kept buzzing, a continuous irritating noise. The patient asked me what the noise was and jokingly I told her that the camera’s zoom lens must be stuck.  We laughed, the buzzing stopped, and all seemed well.  In the news that evening was a story about a Northshore gyne who was drugging and abusing his patients.  I never used that joke again.  I also had the doorbell fixed. 

I’m getting ahead of myself.  First, I needed to assemble my staff.  I interviewed Kathy in my family room on Chaucer Way.  She was an X-ray tech by training but was to be my “everything.”  Then came Barb and Beth, both dynamos.

Kathy was a great “everything!”  She ran the front desk, purchasing, X-ray and roomed patients when she had nothing else to do.  There was no task Kathy couldn’t do and do well.  She also tolerated my off-color sense of humor.  One hot summer day we were very busy.  I was in a curtained cubicle examining a teenager when I heard Kathy tell me that Bob Chinn had called and he had a shipment of blue crabs.  Did I want some?  I excused myself and went to the hall phone to call Renee.  I must have shouted into the phone, “Renee, Chinn’s got crabs.  Take care of it,” The waiting room erupted in laughter.  If you haven’t eaten blue crabs, you should get some.

I had two occurrences that put me on the map.  The first was an interview with a reporter from the Pioneer Press.  I told the reporter, in no uncertain terms, that my office was not an emergency care center.  I was a family doc!  The next day the headlines were, “Emergency Center opens in Lake Zurich.”  I demanded a retraction and they printed one, in tiny letters at the bottom of page six.  The mistake brought in lots of people to my front door and I grew to be thankful for it.

My next big break came when a young father of five called.  His family was too sick to come in (with the stomach flu), could I call in some meds.  I told him I would make a house call.  I got lost going to his house and stopped several times to get directions.  (GPS didn’t exist then).  The word quickly spread that Dr. Segal made house calls.

My family of patients grew fast.  LZFTC and my grand experiment proved successful from day one.  All you had to do to be successful was give the patients what they wanted.  First, you had to ask ten questions and respond to the answers.

The day I opened I realized that I had re-created Dr. Perlman’s practice.  If you build it, they will come.  And they came.  And I miss it!

Here’s today’s jokes:

My teacher complained that my handwriting was too sloppy!

Well, if only she could see that I’m a doctor now!!

During an international gynecology conference, an English doctor, Dr. Jack Mehoff, and a French doctor, Dr. Connie Lingus, were discussing unusual cases they had treated recently.

“Only last week,” Dr. Lingus said, “a woman came to see me with a clitoris like a melon!”

“Don’t be absurd, “Dr. Mehoff exclaimed, “It couldn’t have been that big. My God, man, she wouldn’t be able to walk if it were.”

“Aah, you English, always thinking about size,” replied Dr. Lingus. “I was talking about the flavour!”

PROGRESSS

Yes, Albert Einstein College of Medicine opened many doors.  I considered a psychiatry program in Stoney Brook but remembering the kids whose fathers were psychiatrists, decided to give my kids a break and go into family med. 

Many of my friends from medical school were from Chicago and every one of them wanted to go back to Chicago.  When stoned, they all talked about the great Chicago dog (Flukeys), Little Italy, Greek Town, Wrigley Field and the Cubs and, of course, da Bears.

Renee had just moved back from Chicago stating that the weather was not fit for human habitation, but I wanted to see Chicago, so she came along.  I interviewed at Lutheran General Hospital.  It was a new program with a great deal of promise and a seemingly dynamic director (boy, was I wrong).  As previously stated, my residency sucked; but, with the help of mentors who saw my potential, I successfully finished the program.

The experience had changed me.  I had two options: one being to take on an ob/gyne residency and deliver babies and the other was to become an ER doc.  I felt sorry for the obstetricians.  Bad babies were born to good people.  It was a fact of nature.  When a bad outcome occurs in medicine, docs often gather in what’s called an M&M (Morbidity and Mortality) conference to do a sort of autopsy on the case, learning what went right, what went wrong and how to change the outcome in future cases.  Obstetricians were like hungry sharks, attacking each other and drawing blood.  I had witnessed enough blood letting to know that I wanted no part of it so off to the ER I went.

I found my next mentor in the ER at Northwest Community Hospital; and like so many of my mentors, he too is no longer with us.  From an article written about him on his death:

“Dr. Stanley M. Zydlo, the longtime head of emergency medical services at Northwest Community Hospital in Arlington Heights, was the driving force behind creating the first multicommunity system of paramedics and emergency medical technicians in the country.”

“Stan was a man way ahead of his time. He saw the potential to save lives, and he made it a reality,” said former Palatine Mayor Rita Mullins. “He has saved so many lives with his idea and his tenacity to carry out that idea.”

In a way, he saved mine.  While working in the ER, I noted that 90% of the patients I saw were not emergencies.  They really should have been seen in their family doc’s office.  Stan, realizing the same thing, started opening “treatment centers,” which today would fall under the category of outpatient, urgent care centers.  He put me in his flagship center and it was there that I found my way back to family medicine.

I devised a ten-item questionnaire designed to explore why the patients came to the ER/TC instead to their doctor’s office.  I asked every patient one of the ten questions and recorded their answers.  I figured I would use the data to improve the patient care experience at Stan’s facilities.

My first child, Erin, was born. My world could not have been more perfect. My future with Stan looked great so Renee and I decided to stay in Illinois.  On our first family vacation, a road trip to a Wisconsin resort, we drove through Lake Zurich and a new shopping center caught my eye.  A professor at The U had told the class that, “if you ever want to guarantee your success, open your business next to a McDonald’s.”  Here was a new McDonald’s looking at a new Burger King and no medical center in sight.

Milo stepped up to the plate and hit a homer.  I signed the lease and took it to Stan’s ER corporation.  My presentation was awesome.  I offered them the site for their next treatment center in exchange for them making me a partner and unit director.  They agreed!

A few days later, Stan met with me in private.  He told me that the board was going to make me unit director but NOT offer me a partnership.  As my mentor and friend, he told me to keep the lease and open my own office.  And that’s how Lake Zurich Family Treatment Center was birthed.  My office was the first hybrid practice, blending family medicine and urgent care, in northern Illinois and maybe, the country.

The only problem was Renee and I were broke and banks kept turning us down.  I had a lease and a structure under construction but the word on the street was that my new concept was faulty, and I was going to bankrupt.  Yep, you guessed it!  Time for God to send me a mentor.  (By the way, they are still alive.)

The Village Bank of Lake Zurich turned me down like all the rest.  Unlike all the rest, the President and Vice President, Ron and Jack, called and invited me to a board meeting.  They actually sprung me on the board without warning.  As they put it, “let the board turn you down to your face.”  Milo showed up and I got the loan.  LZFTC was going to be a reality.  I will be forever grateful for the faith and friendship offered to me that day.

Lake Zurich became my home and I miss it!  So, if you are my former patients and you see Ron Spiekout or Jack Reck on the street or in a restaurant, make sure you thank them.

One more story for today.  The Jungs were to be my landlords. I went to their office in Chicago to negotiate the lease.  Boy, was I a fish out of water.  John, the father, sat behind his desk smoking a cigar.  John was the “good cop” offering all kinds of concessions.  Jim, the son and “bad cop”, kept telling his dad why he couldn’t give me those concessions.  The room filled with smoke as he puffed away at his cigar and the two of them deprived me of oxygen, negotiated back and forth between themselves and ultimately handed me the lease.  They turned out to be the best landlords anyone could have.

When John died, I told Renee, “We are screwed.  Jim is going to be a hard ass!”  As it turned, like father like son, Jim assumed John’s persona and took good care of us for the 34 years we lived there.  Eventually, Jim’s daughter joined him and assumed the bad cop role.  Parroting his dad, Jim would say, “We gotta take care of the doc,” and he did!

Here’s your joke for the day:

A woman walks into a pet store and is perusing through the various animals when she comes across one of the most beautiful parrots she has ever seen. She’s taken aback by the tropical beauty of this bird; and when she looks on the price tag on the cage, it says $50. The woman turns to the man at the front counter and asks, “Why is a bird this beautiful being sold for this little?” The man looks up and says, “Oh, that bird was originally kept in a house of prostitution; and, boy, does he have a mouth”. The woman takes the words to heart but buys the bird anyway. She buys it and takes it home with her. She puts the bird in the living room. Suddenly the bird squawks “NEW HOUSE NEW MADAME!” The woman is put off by this but she figures that in a few days the bird will get over it. Her daughters come home from school and the bird speaks again “NEW HOUSE, NEW MADAME, NEW GIRLS!” Again, the woman is put off but she assures her kids that the bird will grow out of its old habits. The woman’s husband gets back in from a day at work. The parrot takes one look at him and squawks; “HI, GARY!!”

ALBERT COLLEGE OF MEDICINE

First a story.  Jack barges into my office, laughing so hard he was crying.  After a minute or two he calmed down and asked me:

Jack: “Did you tell So and So that the treatment for prostatitis is sex three times a day for weeks?”

Me: “Probably, why?”

Jack: “They are in room three complaining that three times a day is causing stress at home and work.”

Me: “Tell them I said it would be ok to cut back to twice a week since they were doing so well.”

Jack upped it to three times a week and everyone left happy.

Continuing my journey:  Portsmouth was boring, New York was not!  Foreign grads were required to do a fifth year of training called “The Fifth Pathway.”  I thought I was lucky to be accepted at the prestigious Albert Einstein College of Medicine.   Little did I know that the Bronx-Lebanon Hospital was in a war zone.

Actually, being from a relatively small city in Virginia, I was not ready for New York.  Renee and I had just gotten married.  I stayed with a friend’s Italian family in an Italian neighborhood in Newark.  Mrs. M. was a phenomenal cook.  Her two boys and husband had different food likes and M. often prepared 3 meals in 1 night.  I was in hog heaven.

One night, at the dinner table, I proudly announced that I had found an apartment and we’d be getting out of their hair.  When I told them that it was in Secaucas, I thought they would die laughing.  Secausas was surrounded by pig farms; and, when the wind blew in the right direction, it stunk.  I was so excited to find a place, I overlooked the fact that it was a three story walkup in a city that fined you if you didn’t litter.

It seems like every time I needed a special person to enter my life, God sent him/her. The next person to bless my life was Renee’s Uncle Arnold.  We were broke!  I sold my coin set to buy Renee a diamond.  Renee had to give up her job as Director of Speech Pathology to follow me to NY.  Arnold lent us $15,000.  I thought I was rich.  Arnold would call regularly, offering us more money.

“Renee, Uncle Arnold has lost his mind.  He’s so rich that he can’t imagine us living on $15,000 for a year.”  Looking back in time, I am amazed that we did!  Uncle Arnold’s loan provided us with the ability to survive in New York and move on to Illinois.  We were so excited when we were able to pay him back in full.

The first day on the job (I was essentially an intern) the police sat us down to give us a battle plan.  The streets were dangerous!  We were to travel in bunches if possible.  If we felt threatened or at night, we could run the red lights.  If trapped, run over whatever is in your way. The list got more absurd.

In fact, there were shootings in the ER.  I never started an IV.  My first patient pointed to a vein in his thumb and told me how he would kill me if I blew his vein.  I handed him the needle and he started his own IV.  We treated alcoholics with IV alcohol.  In other words, we gave up on them.

Week one, I took the train. I quickly realized that, at Fifty Second street, all humans got off and I was left with the inmates of the South Bronx (Fort Apache).  I switched to driving my car.  I certainly did not need a cup of coffee in the am.  The exhilaration of driving fast through a war zone caused my BP and pulse to soar.

My favorite story was about a woman who had seen the OB resident a week before and wanted her birth control changed.  She said her husband hated it and it hurt.  There was no note in her chart, so I set her up for an exam. Apparently, the resident had walked away from the patient to take a phone call; and, thinking she was done, the patient walked out with the speculum still in her vagina.  I removed the speculum and told her we would start her on the pill.  She was happy when she left and thanked me repeatedly.

Sundays in New York were precious!  We would drive to the lower eastside to “Pickle Heaven.”  You could smell the pickles 2 blocks away. I still have Gus’s Pickles shipped to me on special occasions.

The name on my diploma, Albert Einstein School of Medicine, opened all doors and ultimately brought to Illinois.  My Family Practice Residency at Lutheran General was not fun.  There are no good stories to tell. There were several mentors who stepped up and made sure I learned to use the tools I needed to practice medicine. I was in the second class in a new Family Practice residency program and we were treated as second class citizens on each rotation.

The obstetricians had only taught a handful of FP residents and did not think family docs should be delivering babies.  I explained to them that I was stubborn and going to deliver babies whether they taught me or not.  Dr. Robert Turner took it on himself to teach me and hone my skills until I could do a c-section on my own.  I loved delivering babies and came very close to being an ObGyne. One of the gynecologists was quick to point out that the day he delivered the baby was the baby’s first birthday.  He threw a party.  Dr Pepper gave his infants an “I’m a Pepper” tee shirt.

I loved delivering babies from my first experience in the Bronx.  The residents stayed in the call room while the women in labor screamed.  I kept asking the chief resident if we should check on our patients.  He said that the patients screaming was a form of birth control, letting the dads know how painful delivery was.  He told us that, when it was time to deliver, we would here the patient call to God. “Dios Mia” meant deliver the baby.  He was right.   My love of seeing these babies in training and in practice were some of the best highlights of medicine.

I got kicked off my surgical rotation after telling the surgeon I assisted that I WAS BORED.  He asked what I thought and I responded with the truth. You should never ask for my opinion if you are not ready for the truth.

 I had not done my homework; otherwise I would have known that he was the chairman of the department and famous for his neck dissection.  Oops!  Dr. Singh Hahn stepped in and saved the day.  Dr. Lack was my mainstay and one of the smartest individuals I’ve ever met.  He has become a lifetime friend; and, if ever I need encouragement, I call him.

Dr Abzug was director of the ER.  Every year, he stole 1-2 residents and turned them into ER docs.  He taught me the art of emergency medicine.  I started working in the ER at a local hospital before I graduated and spent 3 years as an ER doc working for another mentor, Dr. Zydlo.  More about him later!

I was very lucky to find a group of docs who believed in me and took it upon themselves to arm me with the knowledge and skills I needed to care for my patients.

Here’s your joke for the day:

A lady called her gynecologist and asked for an “emergency” appointment.

The receptionist said to come right in. She rushed to the doctor’s office and was ushered right into an examination room. The doctor came in and asked about her problem.

She was very shy about her emergency problem and asked the gynecologist to please examine her vagina.

So, the doctor started to examine her. He stuck up his head after completing his examination.

“I’m sorry, Miss,” he said, “but removing that vibrator is going to involve a very lengthy, delicate and expensive surgical operation.”

“I’m not sure I can afford it,” sighed the young woman. “But, while I am here, could you just replace the batteries?”

FIFTH PATHWAY

First an oldie but goodie.  When Jack (physician assistant) worked for me, we would have fun.  He brought out the child in me and we played to the audience/patients.  Somedays, especially when we had long waits, the audience would get feisty.  To lighten the mood and ease our distress ourselves, we might put a bogus chart on the intake wall.

Nurse (too busy to realize what was going on):  “Jack….Jack…..Jack Meehof.  I guess he’s not here.”  When everyone stopped laughing, she would get the next patient.  Invariably, the mood would change for the better. Now, on to my journey.

As medical students in Mexico, we had the option of spending our fourth year of medical school in Mexico or in the states.  My Uncle Oscar was the head pharmacist at Portsmouth General Hospital and convinced the hospital administrator to take the responsibility for providing me with the clinical rotations I would need. In Portsmouth, I found two extraordinary mentors.

The hospital administrator dumped me on two, old, head nurses.  They were amazing.  Their skill sets and knowledge base was as good as most docs I had ever worked with.  What they said was law. No doc dared mess with them.  They taught me medicine from the nurses’ point of view.  I ended up being a major supporter of the nursing staff.  I understand how handling bedpans, cleaning patients’ rumps, assisting with urinals, passing meds and a host of other bedside duties affected them while acting on doctors’ orders, monitoring vital signs and trying to appease self-absorbed A-hole MDs.  Bedside nursing is difficult.  It is also crucial for both the patient and medical staff’s wellbeing. Without the help of nurses, nothing would get done and people would die; yet, they are often taken for granted and even belittled by docs and by patients.

In the office as well as in the hospital, I retained my nurses’ skill set including rooming and discharging patients, as well as cleaning up after myself.  In my surgical suite, I disposed of my own sharps in order to reduce the chance that my nurse would prick or stab herself.  New hires and hospital nurses were amazed that a doc would pick up after himself. I think all med students should do at least a month’s rotation with an old school RN.

Portsmouth Naval Hospital was next door to Portsmouth General and I was able to access their classes and seminars.  I sure was lucky to get a high draft number.  My “Milo” character could never tolerate their rules and regulations.  The one tolerable thing was the officer’s mess.  For $3 I got a 10-ounce prime rib, twice stuffed potatoes, salad, drink and dessert. I also got berated daily for not being in a proper dress uniform.  The look on the officer’s face when they found out I was non-military was precious.

More important than a great education, PGH brought me home, to Norfolk  and my parents’ home.  Simultaneously to my moving back, Renee moved back to Norfolk from Chicago.  I had dated Renee’s sister off and on, had fallen for Renee’s mother so one of the first things I did was visit Cynthia (Renee and Dale’s mom).  To make a long story short, I asked Renee out hoping to make Dale, her younger sister, jealous.  Little did I know that, within the year, I would marry Renee and live happily ever after! (I get a few brownie points here.)

By offering to provide my fourth year of training, the hospital administrator, nurses, and docs not only built a sound foundation on which to grow my practice but introduced me to my future wife as well. 

I’ve told the following story multiple times.  It is so important I will tell it again.  There was an ancient, retired doc who wanted to teach.  The medical hierarchy believed that his knowledge was so old as to no longer be relevant so they would not let him teach.  They did allow him to eat lunch with me and other students that rotated through.  His mentoring skills had been honed over 50 years and his ancient knowledge base was incredibly useful.  I used many of the things he taught during my years in practice. In his world, doctors had been placed on pedestals.  He told me that, to be effective, you had to get off the pedestal and stand with your patient.  He brought humor into everything and was the reason my office demeanor was what it was (I don’t know how to describe it).

I learned to listen to my elders and assess for myself, the knowledge they offered.  In some cases, old is much better than new.  I would love to teach but now I’m the ancient one; and the authorities definitely don’t want the knowledge I possess in the hands of new docs.  Towards the end of my practice, I realized how powerful a tool the computer had become. Simultaneously, I realized that I was becoming increasingly dependent on the computer and that no data existed showing any improvement in patient care and outcomes.  If not careful, I would become an excellent typist and a middle of the road doc.  Unfortunately, the electronic medical record has become ubiquitous and is enslaving medical personnel around the world.

I fervently believe that, to improve medical care, we need a purge, much like the purge we use for a colonoscopy; only instead of getting rid of excrement, we need a big dump full of computer programs.  In Shem’s book, “Man’s 4th Best Hospital,” the doc does an excellent job taking care of the patient’s problems only to hear the patient say, “Doc, you sure are a good typist.” More on the invasion of computers and the destruction of the medicine I knew it in the near future.

Here’s your joke for the day:

The crowd was tense with excitement as the final three Samurais faced off.

After a long day of competing, it was the final round of competition to find who was indeed the master swordsman.

In a final challenge, the three men had to show their prowess and concentration by slicing the finest of targets, a mere fly.

The first Samurai steps up to the stage and a fly is released.

Bzzzzzzzzzz Bzzzzzzzzz ‘Zing’

With extreme precision, the Samurai slices the fly in half; the crowd erupts.

The second Samurai fearlessly steps up on stage and another fly is released.

Bzzzzzzzzz Bzzzz ‘Zing Zing!’

With two cuts of his sword, the second Samurai cuts the fly into not two but four pieces.

‘Amazing!’ Screams the crowd. Such a feat has never been seen before.

The quiet descends for a final time in the stadium as the third Samurai calmly steps on stage; the tension is paramount as the fly is released.

Bzzzzzz bzzzzzzz ‘zing!’ Bzzzzzz bzzzzz

With the swing of the sword, the fly simply flies off, seemingly free from its fate.

The crowd is dejected.  One man can’t help but disappointedly ask, ‘Is that it? You couldn’t even kill it!’

The third Samurai raises his finger, “Ah, yes, he may live but that fly shall have no children’. In an alternate, less politically correct version, the third Samurai is Jewish and he says, “Circumcision is not meant to be lethal.

MEXICO PART 2

I’ve told you a half truth.  I love Mexico and the experience of living there played a major part in making me who I am.  The other half truth is that I HATED Mexico.  How’s that possible?  It’s easy because there are actually two Mexicos, the safe and protected community I thrived in and dangerous and corrupt Mexico I traversed on a regular basis to visit friends, shop, gas the car, etc.

Allen G. set me up with legal insurance as soon as I got there.  Legal insurance provides someone to sit in jail for you if you got arrested and an attorney to defend you.  I bought a second set of papers under an assumed identity ($25 US) just in case I had to leave the country in a hurry.  I kept a 50 peso note in my right pocket, a 200 peso note in my left pocket and a $20 US bill in each of my shoes.  Paying off a corrupt policeman looked like you were doing the Hokey Pokey: you put your right hand in you took your right hand out, etc.

Cops loved to pull you over and hit you up for a bribe.  “You got de marijuana?”  On occasion, they would drop a bag of marijuana in your car and then threaten to arrest you for it.  Marijuana was everywhere.  A thirty gallon garbage bag full of the best stuff was $15US; you heard that right, $15.

My neighborhood had a private-police force whose sole purpose was to keep the local, state and federal police out of the area.  We tipped them regularly and gave $50 Christmas presents.  After Christmas, they would stop by to show us a rocket launcher, new body armor or some other weapon that they cherished.  We were safe at home unless the neighbor’s guard got frightened.

My teachers were real SOBs.  They spoke fluent English but made you do everything in Spanish.  Asking them to talk in English was taken as an insult.  It was their country, and the language was Spanish. Often, we had to learn two sets of medical facts: the Mexican facts and the US facts.  Yep, every professor had some part of the body named after him!  Once learned, Mexican facts needed to be unlearned.

My three roommates and I had a maid.  We overpaid her at $16US a week (yep, $4 a man) and our neighbors were unhappy as the word spread to their workers.  She washed our clothes by hand on a scrub board.  She also serviced one of my roommates.  Her dream was to marry a rich US doctor and get out of Mexico.  I hope she made it.

I slept on a giant waterbed in the master suite.  I had a rubber tree growing in the middle of the bathroom and out the roof.  Due to that damn tree, I had to open the shower door and put my feet in the shower in order to sit on the commode.  I painted one entire wall with black board paint and would put my notes on the wall and lay in bed memorizing them.  One night, I had crumbled up maybe 15 versions of my term paper and thrown them on the floor, figuring she would pick them up in the morning.  When I came home the next day, the maid had not only picked them up but had ironed them and put them in a neat pile on my desk.

Weekends were spent at various parties and occasionally in the red-light district (boys will be boys).  Do you remember “Gunsmoke” with Matt Dillon and Kitty?  The red-light district looked just like the Dodge City on Gunsmoke, including hombres on horses and horses tied to hitching posts.  My policy was to window shop only.  There wasn’t a condom large enough to protect my whole body from whatever diseases those women carried.  Bartering with the hookers was fun until we’d get thrown out.  One of my gang had a quick shooter.  He would haggle with the whore long enough to put a smile on his face.  She’d get angry, demand payment and call the bouncer over.

Last story for today.  On holidays, we would go to the central market to buy fireworks.  Mexican fireworks often have the power of a stick of dynamite and were GREAT!  The merchant who sold fireworks was usually scarred from head to toe.  He would demonstrate his product, rockets, by lighting them while he held the stick in his hand.  Mexican fireworks were great if they worked.  The failed fairly often.  One Fourth of July, a rocket backfired in our back yard taking out a large amount of glass.

The only time our private police force showed up ready for trouble was that Fourth.  Early in the morning, my roommates and I climbed up on the roof, jumped onto my neighbor’s roof and tiptoed to the far side of his house. Then we jumped onto his neighbor’s roof (our good friends and medical students) and assaulted their house by shooting our smaller rockets and M80s down their chimney.  It sounded like a war zone. 

We were lucky we didn’t get shot.  I was lucky I didn’t get shot!  Milo engineered the whole thing.  God blessed Milo.  I miss that side of me; but, alas, everybody grows up sooner or later. (I’m really old, I used “alas” in a sentence).

Here’s your joke of the day:

The boy went into the mall to get a job. He told the management that he was the world’s best salesman. They gave him a job as a seller but expected profits from day one.

On Saturday evening, the manager came down and asked how many customers he had served today. The boy said he had helped one customer. The director was disappointed with the boy and said he already had sellers today who had done much better than him. The manager asked the boy how much the sale was worth, and the boy answered “$93,100.25”. The manager was very confused and asked the boy what he had sold.

The boy: “I started off with a $0.25 fishhook which got him looking at the fishing poles. I set him up with the $100 bait master and asked him where he was gonna fish, I told him about that great lake down south but told him he’d need a car with all-wheel drive to make it up the rough terrain so we got him into the $33,000 SUV we had on the lot, when he asked about boat rentals I thought I had lost him, but I ended up selling him the $60,000 Riverking Pro to top it off.”

The manager steps back in disbelief and says, “Wow, you sold that all to a guy who came in for a fishhook?

“No,” the boy said, “The customer came in and told me had to buy tampons for his wife. I simply told him the weekend was already wrecked so he might as well go on a fishing trip.”

MEXICO

Imagine you are 22 years old, you’ve packed everything you own in your car and you’re saying good bye to your parents.  Your destination is Guadalajara, Jalisco, Mexico.  Your plan is to drive to Arkansas tonight, find a hotel and sleep. Then onwards until you ascend to Guadalajara.

You have the name of a family friend’s son who lives there and nothing else.  Crossing the border is a trip.  Mexican customs empty your car.  You pack again.  There is a long stretch of desert highway you have to traverse before hitting the Mexican equivalent of the Grand Canyon.  You are traveling at 110 mph when way off in the distance your see something in the middle of the road.  You slow down.  The little thing is getting bigger.  It’s a fucking tank!  You slam on the breaks and stop 10 feet from the barrel.  I truthfully don’t know how I didn’t piss myself.

Yep, it’s the Mexican MILITARY and they are hunting for bribes.  In my case, they wanted underwear, jeans and toothpaste.  (On future trips, I coated my underwear in chocolate). They left the electronics.  Go figure!  They were quite nice after taking what they wanted.  They even warned me that there were “bandits” in the mountains.

The mountains were more frightening than the military.  In some places, the road narrowed to 1.5 lanes with frequent switchbacks, animals, buses, trucks, pot holes, and troop carriers.  No lights and no signage made traveling after dusk particularly perilous.  Obviously, I made it, found a hotel and slept awakening to a whole new world.

After 5 years of Spanish classes, I could read but not speak Spanish.  Day one I set out to find Allen and Judy Goodman.  They took me under their wings and showed me the ropes.  I registered for 3 months of extensive Spanish classes and for medical school.  Allen graduated and I took over his house lease, moved in and found roommates.  RIP, Allen.

Our next-door neighbor was a wealthy Mexican Industrialist.  His home was a compound with Mexican barbed wire (broken glass embedded in concrete), gated entrance and an ancient partially blind and deaf armed guard.  The old man liked us but nights were potential problems as he had trouble identifying us in the dark.  Lucky for us, Don Jorge was to become a good friend; and, by the way, he had a phone!  The only one on the block.  (To get a phone, you had to buy the poles and wire them to your house.)  At the time I lived in Mexico, there was no middle class.  Either you lived with the rich or with the poor.  We lived with the rich.

Mexico was a life altering experience.  It took all the swagger out of “Milo” and taught me that the way Americans think is not necessarily the only way to think.  The first lesson was embedded in the language.  The words for why and because are pronounced the same.  When you ask the question, why, you answer yourself, because.  Simply put, you stop asking why which leaves simply accepting whatever comes your way.  Once you’ve learned acceptance, life actually gets easier. (I’ve had problems maintaining acceptance.)

Once you’ve seen poverty like I witnessed in Mexico, you are more appreciative of what you have.  My fellow students and I were sent to remote villages to practice medicine.  We were dressed in our white uniforms, placed in the back of a truck and driven down dirt roads to our destination.  By the time we arrived, we were covered in dirt.

We were given a building with a dirt floor, dirt walls and thatched roof and were told to sweep it out and set up our clinic.  The town folks brought in whatever medications they had and we organized their leftover meds into a pharmacy of sorts.  We then proceeded to see our patients.  A typical patient might come in with a mayonnaise jar filled with the worm that came out of him/her in the morning.  Worms are awesome.

One day, I was invited to lunch at one of the town elder’s home.  Lunch was soup and bread.  They had one piece of meat and it was on my dish.  Despite the poverty, Mexicans find happiness in the simplest of things.  They are a warm and giving people who make the most of what they have.

On a road trip back to the states, my water pump blew.  My roommate and I pulled over in front of a dirt hut and waited for roadside assistance.  The family greeted us and offered the use of the hut for shade, water and food which we graciously refused.  Eventually, the “Green Machine” installed a new water pump.  As they filled my radiator with disgusting water from a rusted oil drum, I told my friend, “I don’t want that crap in my car.”  That’s when one of the little kids dipped his cup in the barrel and drank it up.  This poor family was giving us their drinking water.  It was truly a humbling experience! I will always be grateful for the gifts Mexico gave me.

Renee knew me when I was a cocky, privileged Wahoo that she would never fall in love with.  I met her again when I returned from Mexico, a changed man that she quickly fell in love with.  What started off as a disaster, not getting accepted to a US medical school, turned out to be one of the best things that ever happened.

There are thousands of stories about my life in Mexico.  Most are so unbelievable that, even though I lived through them, I find it hard to believe.  I’ll tell you some from time to time but enough for today. 

Here’s your joke of the day.

A Mexican is strolling down the street in Mexico City and kicks a bottle lying in the street.

Suddenly out of the bottle comes a Genie. The Mexican is stunned and

the Genie says, “Hello master, I will grant you one wish; anything

you want.”

The Mexican begins thinking, “Well, I really like drinking tequila.”

Finally, the Mexican says, “I wish to pee the finest tequila whenever I want a drink.

The Genie grants him his wish.

When the Mexican gets home, he gets a glass out of the cupboard and

pees in it. He looks at the glass and it’s clear. Looks like tequila.

Then he smells the liquid. Smells like tequila. So, he takes a taste

and it is the best tequila he has ever tasted.

The Mexican yells to his wife, “Consuelo, Consuelo, come quickly!”

She comes running down the hall and the Mexican takes another glass

out of the cupboard and fills it. He tells her to drink it. It is

tequila.

Consuelo is reluctant but goes ahead and takes a sip. It is the best

tequila she has ever tasted. The two drank and partied all night.

The next night the Mexican comes home from work and tells his wife to

get two glasses out of the cupboard. He proceeds to fill the two

glasses. The result is the same. The tequila is excellent and the

couple drinks until the sun comes up.

Finally, Friday night comes and the Mexican comes home and tells his

wife, “Consuelo, grab one glass from the cupboard and we will drink

Tequila.”

His wife gets the glass from the cupboard and sets it on the table.

The Mexican begins to fill the glass; and, when he fills it, his wife

asks him, “But, Pancho, why do we need only one glass?”

Pancho raises the glass and says, “Because tonight, Mi Amor, you

drink from the bottle.”

UVa

The day I got my acceptance to The U (University of Virginia) was a glorious day.  I thought things just couldn’t have been better.  In fact, things got even better as my best friends called me to let me know they were accepted as well.  I called Dr Perlman and told him I was on my way, four years of undergrad work, medical school and residency, then I’d join him.  Each step along the way, I’d call Dr Perlman with an update.  Little did I know, when he retired due to poor health, how closely my life would parallel his (he was a grad of the University of Virginia, as well.) 

Party!  From day one, The U was one big party. Freedom!  I was free to do whatever I wanted and my childhood feeling of immortality was boosted by copious amounts of alcohol and some weed.  The first year my roommate and I didn’t get along, so I moved in with Abe (my Richmond friend) and slept on his couch. We joined a fraternity and Abe became my brother, best friend and lifelong mentor.  Abe is a true mensh: a person of the highest integrity and honesty and has helped the “Milo” in me stay on the straight and narrow road ever since.   

Nonetheless, “Milo” was lucky to survive college.  Occasional weed became daily weed. Alcohol flowed freely with wild weekends, road trips and girls!  At first, we had to take road trips to neighboring girl’s schools, as the University was an all-male school. We’d rent a U-Haul truck, outfit it with a keg of beer and mattresses and drive to Mary Washington to party.  Looking back in time, I can’t believe the shit we did and survived.  I think my bad back comes from jumping off the roof of my frat house tied to a rope and swinging across the street and back.   

One of my favorite memories was the night my date and I got wasted and semi-passed out in a frat brother’s room.  My date was on Dean’s bed and Dean wanted to use his bed so he sat down next to her and put his hands on her shoulders.  In my drunken stupor, I pleaded with Dean to leave her alone but he ignored me.  He sat her up and just as they were face to face, she puked (really heaved) directly in his face covering him from head to toe.  She also trashed Abe’s car, the hotel room and, yes, me! 

Another memory that holds its place in the top 10 of my memories was spring break in the Bahamas with “J”.  “J” and I got second degree sunburns riding motorcycles around the island. We got separated one night; and, when I got back to the hotel, I found that every fire extinguisher on the hall had been emptied and were lying on the floor.  “J” was in our room yelling, “I’m on fire! Put me out!” A few more drinks and he was out.  Thank God there were no security cameras. 

Frat life was grand.  I’ll never forget attacking the frat house across the street with M80s and rockets of all sizes.  One of my brothers was a marksman with his sling shot.  He was great at punching out the windows in their house with cherry bombs.  Of course we are all in our 70s and I doubt many of my brothers would admit to what we did. 

So, what about school? As I previously mentioned, I was a gifted “crammer.”  I skipped most of my classes and I still have nightmares about not being able to find my classroom the day of the test as I never went to class.  I did go to my psych classes and met my next mentor, Dr Phillip Best there.  Dr Best stoked my interest in research and eventually set me up in my own rodent lab.  A frat brother and I did research on the hormonal cycles of mice in a controlled environment. 

Picture this: Dave would pick up a mouse and put her in my left coat pocket while I was doing a vaginal smear on the mouse I had in my right hand.  By the time I put my mouse in its cage, the one that was in my pocket had climbed up to my shoulder, crossed my back and was heading down towards my hand.  It was a blast.  Unfortunately, our results sucked due to an unreportable variable.  Dave, the mice and I would get stoned every day and we didn’t dare report that little indiscretion. 

I was in trouble.  I had a whole semester’s grade tied to my project’s outcome and it looked like I had failed.  Dave and I spent days in the library looking for a statistical test that would make our data significant.  Hallelujah, we found it.  Dr. Best saw through our ruse but gave us A’s for our ingenuity.  I learned a valuable lesson.  I learned how to manipulate data to make it say what you want it to say!  (Milo at his best.)  To this very day, I don’t trust data that I haven’t personally vetted.  And yes, medical research became part of my daily practice of medicine. 

Despite eight straight semesters on Dean’s List, I did not get into The U’s medical school, nor did I get into any other medical school.  I have a reading disorder and have always had problems with standardized tests, the MCATs proved too much for me, scoring in the 14th percentile in English. 

My mother insisted that I stay in school, so I became an anatomy grad student at the University of Virginia.  My friends and brothers had moved on.  I was angry and, in retrospect, depressed.  I did not have a mentor.  The director of the program was an old school dictator and we didn’t get along.  After the first year, I was booted out and headed for Mexico.  Mexico was good for me.  I’ll cover Mexico tomorrow. 

Here’s your joke of the day: 

An old Jewish man rubs a lamp, and a genie emerges. 

“For freeing me from the lamp, I will grant you one wish,” the genie says. 
 
The old man instantly pulls out a map of Israel and says, “My deepest wish is that the Jews, Muslims and Christians in the Holy Land will live together in peace and fellowship forever.” 
 
The genie hangs his head and says, “Even with all my power, I cannot achieve such a feat. You must wish for something else.” 
 
“In that case,” the old man says, “I just wish that my wife would give me a blowjob.” 
 
The genie thinks for a moment and says, “Let me see that map again…”