Author: wellthy

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 4^th 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.

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.”

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.”

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 14^th 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…” 

Each time I sit down to write about my journey from student to doc and from doc to patient, I struggle to figure out how it all fits together.  Every time I figure out how the pieces of my life come together, I realize there is more to the picture and set about rearranging them again.  So, why is writing about my journey so important? 

According to Merriam-Webster, a mentor is “a trusted counselor or guide.”  Each of us has the capability of mentoring others.  At each stage of my life, I’ve been lucky enough to find a mentor who guided me safely through that stage and passed me off to the next mentor as my journey progressed.  It’s time to pay back all the gifted people who served as my guides and support by putting our story on paper.  It is my fervent hope that this book will both encourage my readers to mentor others and to find mentors of their own.

When I look back over the years, I realize that I traversed a minefield and only survived by the grace of God.  At the age of 17, my friend and I would take his 16 foot Boston Whaler out into the Chesapeake Bay and, occasionally from there, into the Atlantic Ocean.  No one knew where we were.  Our gear consisted of 4 lifejackets and a can of gas.  We didn’t have a radio or charts; we just hugged the shoreline.  Insane? Of course, it was but those were different times.  Parents didn’t hover.  Once old enough to have a real bike, I could go everywhere; and I did.  My range was approximately 5 miles but occasionally I went further. 

When I was 16, I got my first car.  Believe it or not, my range increased to 300 miles as I spent weekends in Richmond with my best friend and dated in High Point, NC.  I had no mentor during my early years.  I had parents who were very liberal and, metaphorically, blind.  My first speeding ticket was in a stock Olds 88 in excess of 100 mph.  My father had the speedometer shop first break the speedometer, then repair it, and then certify that it was broken.  The judge stated, “Mr. Segal, even with a broken speedometer, your son should have known he was going too fast.”  He took my license for 90 days.

 My second ticket was for running a stop sign.  My dad successfully fixed that one and the next.  My dad taught me how to fix things.  Thus was born my nickname, “Milo” (the fixer in “Catch 22”).

In today’s world, my parents would have been jailed for child neglect.  They were good, hard working parents of a different era.  The lack of guidance gave me a lot of room to mess up and get hurt.  It also gave me the confidence that I would need as life became more complex.  I was lucky to survive my pre-college years. 

My first mentor showed up in college. 

Enough for today.  Here’s your joke.

A wife arrived home after a long shopping trip and was horrified to find her husband of more than 10 years in bed with a beautiful, younger woman.

She was about to storm out of the house, but her husband stopped her. He wanted to explain the circumstances that le

d to them being in bed together.

“Before you leave, I want you to hear how this all came about. Driving home, I saw this young girl, looking poor and tired, I offered her a ride.”

He explained that she was hungry, so he brought her home and fed her some of the roast in the fridge that his wife had forgotten about. He continued:

“Her shoes were worn out so I gave her a pair of your shoes you didn’t wear because they were out of style.”

The woman was freezing from being out in the chilly weather for so long, so the husband gave her the new birthday sweater his wife never wore. He said:

“Her slacks were worn out so I gave her a pair of yours that you don’t fit into anymore. Then as she was about to leave the house, she paused and asked, ‘Is there anything else that your wife doesn’t use anymore?’ “And so, here we are!”

Is it luck or is it God’s plan?  I believe it’s a little of both.  Much of what happens to you is determined by the paths you take; and, often, the path you take is determined by a mentor.  Mentors are like traffic control officers, stationed at key intersections and sending cars left or right depending on road conditions and other variables.

In modern terms, a mentor is akin to your car’s GPS.  The AI (artificial intelligence) has multiple routes it can use; and, on any given day, at any given time, it will serve up the quickest or safest route.  Your choice is to follow the prescribed route or go it on your own.

I’ve been lucky!  I’ve always looked for mentors and listened to their wisdom when offered.  My first mentor was a family doc in Norfolk.  I’ve written about Dr. Perlman (Jerome) in the past.  Jerome listened to me and treated me like an adult even when I was just 6 years old.  My earliest memories of Jerome were lying over his lap while he shot me in the buns with Penicillin.  You could be fairly confident that, if Jerome made a house call, you got a shot of Penicillin in the butt.  One in each bun if you were really sick. Geez, I hated that shot.

My thirteenth year of life was a very bad year.  I was sick, not just the sore throat kind of sick, I was major sick.  I saw a lot of Jerome that year.  I remember pulling up to and parking in front of his office at 7 a.m.  My mother would go to the front door and put our name on the list and then walk next door to the Seven Eleven for her coffee.  The office would open at 7:30; and the receptionist, Jerome’s wife, would call patients up to be seen according to the order they signed in.

Jerome would ask questions, examen me and, ultimately, send me to Johns Hopkins in Baltimore to be diagnosed as my findings were complex.  That year I peeled from head to toe (scarlet fever), turned yellow (mononucleosis/hepatitis) and slept a lot.  That was also the year I decided that I would be a doctor and work with Jerome.

I talked to Jerome throughout the years.  As it turned out, my office ran like his.  My practice paralleled his.  He treated me like family and always listened to me.  I tried to do the same for my patients.  It was a successful formula and I thanked him many times over.  He was at the right intersection at the right time and I was smart enough to follow his path.  Jerome had Parkinson’s.  That was the one path I wish I hadn’t followed.

As always, there are stories to be told.  In college, I played hard and often was not prepared for exams.  I was gifted to be able to cram a large amount of knowledge into my head at the last minute and ace the test.  One year, I was far enough behind that I needed a little medicinal help.  I called Jerome and pleaded my case.  I didn’t want to buy anything on the street and had learned my lesson.  Jerome prescribed a small amount of speed and I had my friend’s mom fill it.  (She was sweet and didn’t even charge me.)  Needless to say, I got all “As” and even had a few pills left over.

Months later, my friend asked if I had any speed as he needed to cram for an exam.  I gave him the 4 pills I had left.  He really wanted to pay me for the pills and felt forever indebted that I would not accept money.  I couldn’t tell him that his mom gave them to me.  He, too, passed with an “A.”

Neither of us ever used speed again.  Both of us continued to party but learned to set aside some time for classes and homework.  Both became doctors.

More about mentors tomorrow.

Meanwhile, here’s a joke.

Today my mentor told me if I want to achieve great things, I’d have to make sacrifices.

Anyone know where to buy live chickens for cheap?

I NEED YOUR HELP!  It’s time to start working on my book. SInce I’ve started writing about the past, some of you have been reminding me of the stories that made us laugh together, cry together and form the lifelong bonds that I hold so precious.

I need more stories.  Frankly, I’ve forgotten many of them, not because they weren’t important, but because they were spontaneous custom-made interactions.  “B,” my car man, was in for a yearly physical (now considered unnecessary).  During his rectal I often remarked, “It’s time for me to replace my car.  While I’m checking your prostate, I thought I’d negotiate a great price on a 3 series.”  “B” would laugh and relax making the exam easier and I’d get a better price on a new car.  That joke served my patients well as it’s hard to remain tense while laughing.

Over the years, I taught medical students, nurse practitioners and physician assistants.  Students are usually stressed and uptight over their workload and the stresses associated with treating patients.  My staff would pour flattened Mountain Dew into a labeled specimen cup.  I’d ask the student if he/she would retrieve the specimen and I’d offer to teach them how to process the specimen and report the results.  Once I had the specimen in my hand, I would explain that, years ago, doctors would taste the urine and if it was sweet, diagnose diabetes.  I would then open the cup, take a sip and say, “Yep, it’s sweet.  She has diabetes.  Have a taste?

As uptight as everyone is today, you’d be reported for such a stunt.  But when I did it, one of two things would happen.  The overly enthusiastic student would reach for the cup or not.  If they reached for the cup, I’d explain that their job was to learn not to please.  That if something seemed wrong, it probably was wrong and they should defer acting on it until they had time to fully assess it.  If they didn’t reach for the cup, they’d look at me like I was insane, realize what was going on and relax.  A relaxed student learns faster than an uptight student.

So, if you have stories that you would like to share with me, send them to ssegal@lzftc.com.  As always, I promise to guard your identity. 

Here’s your joke for the day.

A man and wife are lying in bed…

The man says, “Hey, honey, do you want to make love?”

She says “Normally I would, but I have an appointment with my gynecologist in the morning, and that seems like it would be gross.”

The man says, “I understand” and rolls over.

After a few moments, the man rolls back over and asks, “When’s your next dentist appointment?”

Two of the hardest things for a physician to deal with are death and dying.  Telling a patient that he/she was dying was extremely hard.  Telling a patient that their child was dying was devastating.  Over my 34 years in practice, I had lots of patients try to die.  Some were successful, others were not.  All of these patients offered up a lesson to be learned.  Every time I had to tell a patient that he/she or a family member was going to die, part of me died. 

On two occasions, the dying patient’s lessons pumped me full of life, hope, and boosted my spirits at a time when I needed a boost.  In the “House of God,” one of the resident’s decisions backfired.  The patient got worse and death was eminent.  The resident, being unable to forgive himself, committed suicide.  In retrospect, all physicians will have cases that haunt them.  Cases where, if they had turned right rather than left, their patient would have done better.  Living with those decisions weighs heavily on every physician I have ever worked with and contributes heavily to the epidemic of physician suicide that is devasting the medical community.

Now for my two teaching cases.  “X” was in his 80s.  “X” was in the ICU with chronic liver, kidney, heart and lung failure.  He was breathing 4 times a minute (not compatible with life).  His children wanted to take him home so he could die in his own bed with his family at bedside.  I told his family that he probably would die in the car but that there was no reason not to take him home.  He was discharged to home with no further medical care.  Four days later, “X” walked into his kitchen and got a cup of coffee.  “X” lived another 18 months.  He took no medication.  At my suggestion, he saw no doctors.  His chronic lung and liver failure clinically persisted.  “X” lived by the grace of God.  Every time he did see a doc, he got worse.  One of the premises of “The House of God” was that the best medical care was no medical care.  “X” was living proof of that premise.  “X” taught me that nothing is for sure.  “X’s” story gave hope to many!

My second story is right out of the pages of a Steven King novel.  However, it’s true.  It really happened.  I always hated prom night.  There was always a disaster to be dealt with on prom night.  On this particular night, an auto accident put best friends in the hospital: one in the ICU and the other on 4 West.  Both were critical; the patient on 4 West died at 3 am.  At 7 am, I made rounds in the ICU.  “R” was alert and talking.  Before I could say anything, he told me that his friend, “D,” visited him at 3 am.  “D” told him that everything was going to be ok and that he would stop by from time to time.  “R” was ecstatic that his buddy was doing so well.  I was blown away!  I dreaded telling “R” that “D” had died but “R” took it well stating that “D” reassured him that everything would be ok.

I quizzed the nurses who verified that they did not tell “R” about “D.”  “R” had no visitors.  At a time when my spiritual being was lacking, living through this was like filling my tank with jet fuel.  This story has helped many over the years. 

The hero of the book, the “Fat Man,” teaches his interns that the best medicine is no medicine.  “FM” believes that the more he does for a patient the worse the patient will be.  Crazy, right?  My first patient with cancer had an advanced rectal cancer.  My surgeon refused to operate stating that the patient had zero chance of surviving; and, even if surgery gave her a few more months, they would be lousy months.  I was young and aggressive, so I transferred her to another surgeon at another hospital for surgery.  She spent 4 months hospitalized and then died.  Her death was horrendous and has haunted me ever since.

There are many more stories. Having been there and done it all, I now agree with Fats. Doing nothing is always a viable choice; and, many times, it is the right choice.

Here’s your joke of the day.

A college professor reminds her class of the next day’s final exam saying, “I won’t tolerate any excuses for you not being there tomorrow. I might consider a nuclear attack or a serious personal injury or illness, or a death in your immediate family, but that’s it, no other excuses whatsoever.”

A guy sitting at the back asks, “What would you say if tomorrow I said I was suffering from complete and utter sexual exhaustion?”

The teacher smiles sympathetically at the student, and says, “Well, I guess you’d have to write the exam with your other hand.”

Here’s a second joke.

There was an American wrestler from Texas named John, who throughout his high school career had never lost a match. As he went on into college, he continued undefeated. He became a national icon and symbol of American strength.

News began to circulate of a Russian wrestler who was fierce and unstoppable. As each wrestlers’s legends grew, a match was set up between the two, America versus Russia. The match would be held in Texas.

John began training immediately. Every day his coach would tell him, “This Russian has a move called the Mongolian Death Grip. No one has ever escaped the Mongolian Death Grip. DO NOT let him get you in the Mongolian Death Grip.”

The day of the match finally came. Just before each wrestler stepped onto the mat in front of the capacity crowd, the coach once again said, “Whatever you do, do not let him get you in the Mongolian death grip. No one has ever escaped the Mongolian death grip”.

Four seconds into the match, the Russian had the American in the Mongolian death grip. The coach buried his face into his hands and cursed John for not listening to his advice. All of the sudden he heard the crowd erupt in a chant of USA, USA, USA. He looked up and saw the Russian pinned by John. The coach ran out to meet John and embarrassingly told him, “I didn’t see… Once he had you in the Mongolian Death Grip I looked away. How in the world did you get out of the Mongolian death grip?”

With heavy breath, John told him, “Well, coach, that Russian grabbed me and twisted my body in ways I never imagined possible. I was wincing in pain when I open my eyes and right in front of me were two testicles. So I bit them.”

“What???” said the coach… “John I don’t think that is legal. You could be disqualified.”

“I don’t know about that, coach. But I can tell you one thing. You ain’t got no idea how strong you are until you bite your own balls.”

“The House of God” is one of the best books I’ve read. As mentioned previously, I’m actually reading it for the second time.  I think you should read it.  Of course, I’m biased.   It was published in 1978, the year I did my Fifth Pathway/Internship.  The story takes place at a Jewish-owned hospital/medical school established to educate young Jewish doctors as many teaching hospitals had Jewish quotas limiting acceptance to medical school.  Congressman Whitehurst, my district’s representative, informed my parents that the reason I did not get into The Medical College of Virginia was because their Jewish quota had filled.

Are you starting to get the picture?  Yep, I strongly relate to this book.  I lived most of it and recognize many of the doctors, nurses and patients depicted by the author. Fortunately, or unfortunately depending on your point of view, I cannot relate to the portrayal of the interns, residents, doctors, and nurses (that staffed the House of God Hospital) fucking like bunnies. (Since my readership goes up if I mention sex, I thought I would use “fuck” and see how many readers I can bring onboard.)

The stresses of medical training are tremendous.  On June 30^, 1978, I was a student.  The next day, July 1, 1978, I was a doctor seeing hospitalized patients, working 36 hour shifts, living in the hospital when on call and, occasionally, torturing patients.  You do not want to be admitted to any hospital on July 1!

I guess I should explain what “torturing patients” means.  The only written complaint I ever got was from a middle-aged female admitted with pneumonia.  She was built like me (fat) and had horrible veins.  I missed on three attempts to start an IV, succeeding on the fourth.  The director of my program took great pleasure reading me the following: “I have nightmares in which Dr Segal is chasing me down the hall with an IV needle.”

My director and I did not see eye to eye on most things.  He had ‘book sense” but lacked clinical knowledge and people skills.  While I honed my diagnostic skills and learned how to relate and care for people, my director went to meetings and honed his political skills.  From the age of 13, I was convinced I would be a family physician.  Under Dr “S’s” tutelage, I grew to hate family practice.

Luckily, the director of the ER rescued me.  Dr. “A” was dying (literally).  On occasion, he taught with chemo running into a vein in his arm.  On graduating, I went to work in the ER at a local hospital.  ER medicine was exciting, even fun.  It also could be incredibly stressful.  One night, I was running the major illness, trauma side.  The paramedics dropped a 24-year- old female in our ER (in 1978, paramedics basically were a taxi service).  She was trying to die from a knife wound that penetrated her heart.  The cardiovascular surgeon was 30-45 minutes away, so my partner and I opened her chest and plugged the hole.  She lived!  Can you imagine how freaked out I was? Can you imagine how depressed I would have been if she had succeeded in dying?

According to “The House of God’s” author, I should have decompressed/celebrated by banging the “head” nurse.  Of course, I would never contemplate such a thing (Renee proofs this) as I was married.  But remember, “It is impossible to be depressed with an erection” (HOG)?  So, maybe the answer to the sharp rise in doctor suicide is hospital-based orgies. 

If your doctor appears stressed and overwhelmed, then, at the very least, you could ………  If you’re reading this, I got it past my editor!

Here’s a joke for today:

It ain’t always easy having erectile dysfunction

but it sure as hell ain’t hard

The sun is out, the sky is a beautiful blue and it’s supposed to be in the 60s today.  Mackenzie is upstairs playing with Renee and I can hear them laughing.  Unfortunately, I can’t join them as I can’t walk up the stairs this morning.  We’ve been here since May and I’ve only ventured upstairs a dozen times.  I’m glad the girls have a little alone time.  It’s good for them!

I’m working on my Blessings List and realize that there are many things that are not on the list that should be.  The missing items are things I’ve always taken for granted; and, now that they are gone, I feel their absence.  Today is one of the bad days.  Bad days are when having a Blessings List to fall back on is really important.

My morning dose of medicine has failed me. I’m having problems walking.  My feet shuffle when I walk and I’m having frequent periods when I literally freeze in place (can’t move).  Yesterday, I struggled to walk a block, froze so frequently I almost called Renee to come and get me, and eventually made it home.  One of the reasons I avoid steps is my tendency to “freeze.”  Being able to walk was never on my Blessings List.  It should have been!

Being able to wash myself, dress myself and clean up after myself should have been on my Blessings List!  When I was well, I never would have thought about it.  When I was well, taking a walk on a sunny day was a given.  As these skills leave me, I can’t stop thinking about them. My losses are accelerating despite my medications and my newfound attitude.

Parkinson’s may diminish me and may ultimately kill me; but, as long as I can breathe and be with family and friends, I will fight it.  I’m currently being assessed for DBS (deep brain stimulation).  In layman’s terms, a surgeon is going to drill into my skull and place electrodes in my brain.  In theory, by stimulating the parts of my brain that aren’t working, I’ll get better.  Over the next few months, I’ll be going through a battery of pre-op testing to optimize me for surgery.

In the meantime, I’ll concentrate on expanding my Blessings List, exercising when I can and enjoying my family and friends.  You should do the same.  What’s on your Blessings List? 

Here’s your joke for the day.

The doctor says, “Larry, everything looks great. How are you doing mentally and emotionally? Are you at peace with God?”

Larry replies, “God and I are tight. He knows I have poor eyesight, so He’s fixed it so when I get up in the middle of the night to go to the bathroom, poof! The light goes on. When I’m done, poof! The light goes off.”

“Wow, that’s incredible,” the doctor says.

A little later in the day, the doctor calls Larry’s wife.

“Bonnie,” he says, “Larry is doing fine! But I had to call you because I’m in awe of his relationship with God. Is it true that he gets up during the night, and poof, the light goes on in the bathroom, and when he’s done, poof, the light goes off?”

“Oh, no,” exclaims Bonnie. “He’s peeing in the refrigerator again!”