Author: wellthy

When asked, “How are you doing?” my answer was always, “Fine!” Not wanting to complain is one thing.  Denial is something else.  For a long time, I hid from my illness by denying its effects on myself and my family.  Denial is a potentially fatal mistake.

As a physician, I knew to look for denial and, in life threatening instances such as heart attacks, to quickly confront it so that it did not jeopardize my treatment or my patient.  I thought I was pretty good at rooting out denial and removing it from the equation.

As a patient, I’ve discovered three things.  Number one is that a clever patient can hide his/her illness and thus deny it, and number two, that denial has protective qualities of its own. The third thing I already knew.  Having a patient advocate with you at office visits is helpful both to the patient and his physician but that denial can be so complete that it can be missed even by a loving spouse.

I’m the clever patient who hid the extent of my illness from my doctors, my spouse and myself.  By carefully timing my medications or even taking extra pills, I looked good whenever I saw my doctors.  Since I looked good, they told me I was good; and, rather than pay attention to how I really was, I convinced myself and others that I was “fine.” 

Doctors are always under the gun.  They have limited time with their patients and patient charting.  If their electronic medical record (EMR) does not prompt them to ask a question, they usually won’t.  In my case, the EMR did not ask about activities of daily living (ADL) so my physicians never asked.  Renee knew I was worsening as she was starting to take on more of my ADLs but either supported my denial or just didn’t bring it up as no one ever asked her.

Meanwhile, my condition quietly worsened.  Eventually, my self-deception was penetrated by the most unlikely of sources, my insurance company. It was then that I realized, for the first time in 40 years, how protective denial could truly be.  I had been taught that denial was a bad thing, and, as a physician, we had to recognize and treat it.

Forced to look at how bad I really was led to depression and the addition of depression to Parkinson’s led to me giving up.  I’ve made lots of excuses for my weight problem; but, in reality, I think it was a direct result from my quitting life and withdrawing to sleep and eating.

Once the veil of my denial was penetrated and I was forced to look at how much function I had lost, I had two choices.  I made the wrong choice.  The right choice was to fight this damned disease.  I’m back in the fight now.  I’ve started in a program called “Rock Steady” and am learning to box and exercise again.  I’m actively working on reducing my weight.  I’m working on the depression as well.  While I can’t reverse the damage from Parkinson’s, I can learn to live with what I have.

I’ve also stopped denying other’s offers of help.  Yes, I’ve accepted Renee’s help dressing and bathing.  I even have accepted that I have to give up cooking.  Maybe, given time, her bathing and dressing me will become fun (wishful thinking).  I let others hold the door for me, and, in a grocery store, I now use the scooter.  I even answer the question, “How are you doing?” honestly.  This morning, it’s not so good.  I’m freezing a lot and have come close to falling twice so far.

Researching dirty jokes is a great way to counter depression.  It’s impossible to stay depressed when you are laughing.  Renee is my editor and hearing her laugh at my daily jokes is marvelous.  Writing helps as well.

If you or a loved one are in denial, please see your doctor or counselor.  Denial must be handled with great care.  Like most things, it can be good, bad or a combination of the two.  Regardless, it needs to be recognized and dealt with; and the consequences of dealing with it have to be addressed.  Unfortunately, I had to get sick to learn this lesson.

Here are your jokes for today:

The seven stages of grief – Denial, Anger, Bargaining, Depression, Acceptance, Saturday, Sunday.

If lawyers are disbarred and priests are defrocked, then…

Electricians are delighted

Corpses are decrypted

Cowboys are deranged

Models are deposed

Underwear models are debriefed

Dry cleaners are depressed, decreased and depleted

Jilted women are debrided

HVAC technicians are deducted

Tennis linemen are defaulted

Florists are deflowered

Students are detested

Hostels are debunked

Spies are debugged and detailed

Corporations are deformed and delimited

Celibate people are delayed

Chauffeurs are derided

Record keepers are described

Plumbers are dethroned

Clerks are defiled

Traffic cops are defined

Naturists are denuded

Election officials are devoted

Accountants are decertified

Builders are deconstructed

Confused people are demystified

Intelligence officials are declassified

Interpreters for the deaf are designed

Road builders are degraded

Waiters are deserved

Horses put out to stud are desired

Castles are demoted

Organ donors are delivered

Anything certain is depending

And if you found this funny, you’re probably demented, defective and in denial

https://upjoke.com/denial-jokes

Well, my trip to the past is almost over.  The practice continued to grow.  Growth cycles were directly related to season of the year and how busy we were. The longer the wait time, the slower the growth.  As the growth slowed, wait times diminished; and, as wait time diminished, growth again accelerated.

It made sense.  When wait time was low, I could spend more time with the patient.  The more time I spent with a patient, the more referrals I received from that patient.  During the early years of the practice, I would freak when wait times diminished (growth slowed or reversed).  I drove Renee crazy.  I thought I did something wrong and didn’t know it.  Renee started charting numbers of patient seen monthly to show me the natural flow of the practice.  I finally relaxed.

The insurance companies and our government finally killed the practice.  Overhead continued to rise.  Maintaining the EMR was expensive.  Office staffing was expensive.  Replacing aging equipment was expensive. Taxes, snow removal, electricity and water were expensive.  Reimbursements from Medicare and the insurers decreased significantly.  Insurance company interference in patient care increased.  No matter how many patients I could see in a day, income per patient finally fell low enough to make it impossible to stay independent.

I swore I would never sell my practice.  I swore the big hospital-owned corporations buying private practices would be the end of medicine as I knew it.  I was right!  I also had no choice.  I sold to Amita.  Working for Amita was better than I expected.  They gave me plenty of time to see patients.  The other big hospital corporations would have given me 10 minutes per patient.  Amita gave me 30 minutes per patient.  I was actually having fun.

Unfortunately, my back worsened requiring extensive surgery.  My recovery was slowed by the ever-worsening Parkinson’s.  Two years ago, I was forced to retire.  I hate retirement.  I also became a full-time patient.  I hate that role as well.  I had given up and was waiting to die when I got Covid.  Covid kicked my butt.  It also woke me up.  Jeremy came from Atlanta; and Lisa, sick with Covid as well, called twice a day checking on us.  It warmed my heart.

I called on my friends, Will Power and Milo, and they showed up immediately. Covid cleared, Jeremy left, Lisa got well.  Will and Milo hung out.  Their job, to get me back on the right track.

There are plenty of stories to tell.  It will become obvious that my style of treating people was unique and not for everybody.  I was the kid who owned a pool company at the age of 15.  I was the young man who tended bar and short order cooked.  I was the boy who went to Mexico and came back a man with a goatee.  I was a little of each of them and of other characters.  Most of all, I was the 13 year old who told Dr Perlman I was going to be his partner.  Years later, I called him and told him I loved being a family doc.

One big difference between me and my cronies was you wouldn’t catch me with a tie on. Not at home nor in the hospital or office.  I wore polo shirts and sometimes jeans.  It took 20 years for my fellow doctors to learn that ties spread germs.  It took another 10 for dress codes to relax. 

Did you ever wonder why a man would put on a tie? I’m sure some brilliant woman decided that if she put a pretty noose around her husband’s neck and tightened it enough to slightly compromise the blood supply to his brain, she could better control her man.  The word spread and women around the world started dragging their men around by the tie.  “Honey, put on that blue tie and choke yourself almost to death.  We’re going out with the Segals and were going to have fun!

Oh yeah, the rest of this book will review the lessons I’ve learned since becoming chronically ill and how they would have influenced my practice of family medicine had I learned them earlier in life.  I would become a mentor and offer my knowledge to a young MD but you may have noted that too many of my mentors died.  Giving up the knowledge you have must kill you.

Here’s your joke for the day.  Actually, it’s not a joke.  I’m so fat that the post office offered me my own zip code.

I think its time to get my act together.

I must be boring you.  My readership is way down.  As stated before, the one topic that increases my readership is sex.  So, what facet of sex do you want to read about today?  How about senior sex since most of my readers are older than sixty.

Sex in the 70s usually goes like this:

Husband – “Fuck you.”

Wife – “No, fuck you!”

After five minutes of back and forth FUs, the couple finally reach a climax, husband yelling FU until exhausted, wife retiring to her room to calm down. 

Unfortunately, it’s no joke.  Most of our generation is suffering from hormonal and physiologic changes which cause all kind of problems.  Most of our generation are uncomfortable discussing anything about sex. 

Oh, you thought this was going to be a scientific discussion.  What do you want to know about?  If you have a topic you’d like to explore, write me or simply do an internet search.  As usual, the internet is full of information and products to sell you. 

There are pills to increase the males’ ejaculate, erection, orgasmic pleasure.  There are pills to prolong both the male and female sexual experience.  There are all sorts of toys for girls and boys.

There are pictures and movies portraying every sort of sex act you could conjure up in your mind and some you couldn’t imagine.  There are men who dress like women, men who are women and every permutation of the sexes imaginable.  Is any of it normal?  Is all of it normal?  Is normal up to the individual?  Is normal up to society?

Some things are for sure.  Orgasms are healthy.  Orgasms are for procreation.  Orgasms are for recreation. Orgasms are free (usually).  Orgasms are misunderstood.  Counseling is available but seldom used. 

It’s time to change our attitude and discuss our problems.

Here’s you joke for today:

How is life like toilet paper?

You’re either on a roll or taking shit from someone.

What’s the difference between a tire and 365 used condoms?

Ones a Goodyear. The other is a great year.

Beer Bottle: “You break me, you get one year of bad luck!”

Mirror: “You kiddin’ me? You break me, then y’all get seven years of bad luck!”

Condom: “Hahaha… (Condom walks off laughing)”

Here’s a link to a great site.

49 Best Inappropriate, NSFW, Dirty Adult Jokes To Tell Everyone In 2021 (scarymommy.com)

My kids will tell you that the Segal motto is, “Go big or go home.”  I went big.  The practice grew and I decided to rent the adjoining office space.  Sixty-five hundred square feet of medical office space and only one doc!  What was I thinking?  I still couldn’t find a doc who would care for my patients the way I wanted them cared for. 

Enter the era of physician extenders.  I started teaching physician assistants, P.A.C.s; and, in doing so, found Jack and Maki.  By hiring the two of them, I freed up some time.  You’d think I would spend that time at home, wouldn’t you?  You would be wrong!  “Milo” fell in love with teaching and research.  Big Pharma took notice and speaking engagements and research projects put “Milo” on the stage, literally.

My biggest gig was at Rosemont Convention Center where I was the opener for the grand masters of asthma treatment.  I had 650 people in front of me and the stage was mine for 45 minutes.  I was great!

My favorite lecture was on the treatment of influenza.  At a dinner conference in Elgin, I played the role of the flu of 1918.  Again, I was great.  I held the audience’s attention for an hour, then we got drunk and sang Christmas songs late into the night.

I loved teaching.  I liked being on the stage.  I liked the applause, and I liked the added income.   I didn’t like being away from home: but, to be a national speaker for Pharma, you had to travel, so I did.  I was appointed to Glaxo’s national speakers panel and developed expertise in the management of asthma and copd.  I found myself sitting at the table with the Gods of Asthma care and holding my own.  I impressed myself! I impressed other pharmaceutical houses and, for a short time, flourished. I was addicted!

Over a ten-year period, Pharma actually listened to its physician advisors and things were good.  As Pharma became hungrier for profits, things changed and my relationship faded away.  My opinion of Pharma has changed with time.  They are no longer my friend.  They are not your friend, either.  When you see their commercials touting their newest medications, turn off your TV.  No matter what the commercial says, you probably don’t need what they are selling.  If you do, your doc will tell you.

Now, a true story. Once upon a time, a kindly old lady came to see me.  She had 36 bottles of pills in a bag.  She had seen ads on TV and in magazines telling her how good the pills were.  She had pills for her breathing, her heart, her joints, etc.  As I took bottles out, she would explain why she was taking it.  She would start off with, “It’s all natural.”  I would explain that it was manufactured, not naturally occurring.  As we got to the bottom of her bag, I found prescription meds prescribed years ago and being refilled by other docs she was seeing but hadn’t told me about.

Despite all the pills, she related that her breathing/asthma was getting worse.  In the bag, I found two bottles that contained echinacea.  When asked, she admitted to being allergic to “ragweed.”  Echinacea is ragweed!  She didn’t know it, but she was poisoning herself. Her suffering was directedly tied to her buying into commercial and advertising pieces found on TV and in magazines.  She got well when she stopped taking her pills.

“But doc, it’s all natural,” is a statement I hear all too often.  My poop is all natural! I put in the freshest organic foods I can buy and it’s processed the way God meant it to be. I don’t think you want to take swallow it, do you?  Remember that the next time the ad implies that its good for you and safe because it’s “all natural.”

Looking back in time, I realize bigger is not better.  I realize I was addicted to being a family doc and to teaching.  My office was the small, private stage I performed on daily.  Pharma put me on a much larger stage.  My ego prevented me from seeing the damage done to my own family by never being home. 

Funny, as a family doc, you would think I would have been better at being a family man.  Oops, I’m getting on the should have, could have, would have train.  That trip goes to nowhere!

Here’s your joke for the day.

Just after my wife had given birth, I asked the doctor, “How soon do you think we’ll be able to have sex?”

She winked at me and said, “I’m off duty in ten minutes – meet me in the parking lot.”

Man: Doctor, all five of my boys want to be valets when they grow up!

Doctor: Wow! That’s the worst case of parking son’s disease that I have ever seen.

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 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.”

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.”

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!”

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!!”

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?”