50/50

Continuing from yesterday, I want to share my own personal theory of chance.  Many times, when a patient gets a diagnosis of cancer the first thing they will want to know is how long do they have left.  The oncologist will discuss survival rates in terms of months or years and will ultimately give them a percentage alive at x years.  The next thing that happens is they see me.

“Doc, I’ve met with the oncologist and surfed the internet, and things are dismal.  They say I’m not likely to be alive this time next year.  What should I do?”

Me – “Personally, I don’t believe in looking at odds. Realistically, the odds of me being alive this afternoon are 50/50.  Either I will be alive, or I won’t.  They’re the same for you.  Either the chemo and radiation treatment will work, or they won’t.  Life is a roller coaster ride, once you’re on it, you have to take it to the end.”

“Doc, what if the treatments make me worse?  They say that 20% of patients won’t tolerate the meds.”

Me – “Again, either you will tolerate the treatment, or you won’t.  We’ll have to cross that bridge if we get there. They say that living in the past causes depression and that trying to live in the future, causes anxiety.  They are right!  The hardest thing you have to do is work at not creating future scenarios in your head.  They serve no purpose and cause immense anxiety.  In this case, anxiety is your enemy.  You’re on this coaster for better or for worse.  I’ll take the ride with you and hold your hand till the end.  Hopefully, the highs won’t be too high, and the lows won’t be too low.”

My 50/50 theory assumes that everything is a binary choice; either it will or won’t be.  No matter how well you plan, once you start the journey of life the only firm rules are that the course your coaster takes is uncertain. It would be great if you could enjoy the ride, taking each high and low point as they come, without becoming too anxious about what lies around the next corner.  Unfortunately, anxiety over what’s around the next corner often steals your ability to savor life and rarely does anything positive for you.

In the case of my patient with liver injury, I often wonder if rather than saying that there were 7 cases in the world literature, I had said that the odds were 50/50 (either the patient would be number 8 or not), what the patient would have done.  Oops, there I go living in the past.

At this moment in time, the world is anxious.  Journalists pontificate on what Covid is going to do.  They have models predicting who shall live and who shall die.  They act like they know where the ride is taking us.  They don’t!  They have been wrong all along, simply adjusting their future predictions and forgetting their past ones.  Scientists are just as baffled.  Of course, the internet knows everything and everything you can imagine is published as facts on the internet.  It’s been consistently wrong as well.

I keep hearing an old jingle in my head.  It goes:

Buckle up for safety, buckle up.  Buckle up for safety, always buckle.  Show the world you care by the mask you wear, buckle up for safety always buckle, buckle up.

My advice is to buckle up!  Put your mask on, sit as far away from others on this roller coaster called life, and get ready for a long ride. As the coaster goes upwards preparing for a plunge don’t be too nervous. Following a plunge, things normally level out for a while before the next rise and fall, and the next, and the next…..

Here’s your music and a joke.

Psychiatrist to his nurse: “Please just say we’re very busy.  
Don’t keep saying “It’s a madhouse in here!”

Dog Rules for Stress – If you can’t eat it or play with it, then pee on it and walk away.

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INFORMED CONSENT

It’s really strange.  We spend more than half our lives planning and saving for retirement, then we retire and, in my case, wish we could go back to work.  I’ve seen this phenomenon before and mentally, was prepared for it. My plan was to never retire. I told my patients I was going to die in the office.

Someone said, “Man plans, God laughs.” God must be laughing!  Two nights ago, I got a real treat. No, not that!  What I got was a chance to see my patients in my old office for an entire night, in my dreams!  I was back in my element and happy.  Aside from being the first full night of sleep I’ve had in many years, it was a great trip down memory lane. 

One of the patients I saw took me back in time to the earliest days of my practice and one of my best lessons in practicing the art of medicine.  The lesson is particularly important as it pertains to what is happening in our country today. It has to do with the concept of informed consent.

Everything I did as a physician carried risk.  Every test I ran had the risk of being falsely negative or falsely positive.  Every time I drew blood, I ran the risk of injuring a nerve.  Every medication I prescribed came with risk of side effects.  When the risk was large, no matter how rare, it was my job to give my patient a thorough “informed consent.” 

In this particular case, my patient wanted a medication for a cosmetic problem.  The medication was thought to be somewhat effective for the patient’s condition but there were seven known cases of liver failure in the world literature.  If you asked me, one case was too many, but my patient insisted that seven cases in all the world literature were odds she was willing to take.

Well, I gave textbook perfect, informed consent.  I even had the spouse read the warnings and quizzed my patient and my patient’s spouse about their expectations and their understanding of the risk of taking it. My patient also consented to a monthly liver test just to be safe.  My patient became patient number eight.  My patient’s liver not only failed, it self-destructed.  Two liver transplants later and things stabilized.

The lawsuit came shortly afterwards.  I had done such a good job of giving informed consent and documenting it, that the suit was dismissed.  I actually wish my patient and their family had won. They needed the money and their lives were certainly ruined.  What I now know is true “informed consent” is a great idea. It’s also a fallacy!  My patient could not possibly have envisioned the shock and awe caused by the total destruction of their liver.  The patient and their spouse could not fathom being number 8 in the world.

Flash forward to today:  Those people who are taking hydroxychloroquine prophylactically cannot possibly imagine what life is going to be like after their heart is injured.  Parents who send their kids to school or Pom Pom practice cannot possibly understand what having a child dying alone in the ICU is going to do to their family.  Generation X and Millennials who ignore social distancing cannot possibly believe that a viral infection in the year 2020 will give them organ failure in the year 2030.

Consider document to be your informed consent!  I know you will scoff at it, discounting it as simple paranoia. I know that some of you will play the odds and continue life as usual.  Just remember that you’re betting with your life.

Here’s your music for the day.

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VACCINES

I’ve always had a love hate relationship with vaccines.  Those of you who are my age will remember standing in line and being given a sugar cube saturated with the polio vaccine.  I loved that experience.  Then there was the line I hated!  Yep, we stood in line a second time and had another polio vaccine.  Only this time the nurse used an air gun to inject the vaccine in our arm.  I hated that one.

While vaccines protect you from many viral infections, on rare occasions they can cause significant problems.  In the early years of my practice, the Pertussis vaccine caused high fevers and scared parents.  That vaccine is no longer used, and its replacement rarely causes problems of significance.  In fact, I have not seen a significant vaccine reaction in 30 years.

Even though I’ve not seen vaccine related problems, I’m still cautious with new vaccines.  Those of you who came to my office for a flu shot always signed an informed consent form prior to receiving your shot.  The flu shot is reformulated yearly.  While I have given the same tetanus vaccine for 30 years and know exactly what it is going to do, the flu vaccine is new every year and therefore does not have a track record.

When new vaccines arrived, I always waited 6 – 12 months before administering them.  I wanted to see how the general population did on the particular vaccine.  Sometimes a vaccine looks good in the research stages but when given to millions doesn’t look so hot.  When we are lucky enough to have a Covid-19 vaccine, I won’t wait! I’ll be the first in line.  Sure, I’ll be a little apprehensive, but I’ll trust the researchers and get vaccinated.  If there are side effects, I’ll deal with them.

While I’m no longer afraid of needles, a sugar cube sure would be a sweeter option.  I’ll also recommend that my readers get vaccinated as well.  Remember my favorite blessing?   May you be so blessed as to never know the disease you prevented.  

Until we have a vaccine, wear a mask, wash your hands, keep your distance from others and try not to go crazy.  Exercise as much as possible.  Rather than doing bench presses, I’m doing 20 repetitions of refrigerator door openings and closings 4 times a day. It’s a very rewarding exercise!  I’m also doing sprints at least 4 times a day.  Unfortunately, Renee is faster than I am, and I rarely catch her (I get a bonus cardiac workout when I catch her)!

Here’s today’s music and a joke.

“The doctor said he would have me on my feet in two weeks.”
“And did he?”
“Yes, I had to sell the car to pay the bill.”

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DON’T ASSUME

I really shouldn’t be surprised.  Renee and I have been married long enough to know what each other are thinking but it still surprises me when what she says is the thought that just ran through my mind.  In this case, the thought has to do with our Illinois home.

It looks like our home has finally sold.  It’s been a great house having hosted many summers of fun by the pool, our house raised three kids to adulthood.  In the early years of my practice, I had an exam room in the basement and did reverse house calls on weekends and holidays.  In a reverse house call, I stayed home, and the patient came to me.  Yes, I made house calls!

During my first year in practice, a family of 5 went to a civil war reenactment.  They lost. They came home from the battle with food poisoning and were too sick to make it to my office so I went to them.  They lived in a new neighborhood I was unfamiliar with and I got lost.  This was during the pre-cell phone era, so I stopped at a random house and explained that I was a doc making a house call and I was lost.  I stopped at 2 more houses before I found my patients.  The word spread through the community; Dr. Segal makes house calls.  

That house call was a major success.  As it turned out, one of the family of 5 had an acute appendicitis that would have been missed over the phone.  Correctly diagnosing that child taught me the importance of seeing my patients even if it meant making a house call.  The second lesson was that making house calls was a practice builder.  The third lesson was that making a house call on weekends and holidays cost me precious family time.  The obvious solution was for me to stay home with my family and for the patient to find me.

I know telemedicine has grown due to Covid-19 but, without being able to put my hands on my patient’s belly, I never would have made the diagnosis of appendicitis in a timely manner.  After all, they all had abdominal pain, nausea, vomiting and diarrhea.

Now, back to my main message.  Renee said, “I hope the new owners really enjoy our house.  It’s a great house with a great history,” at the same time I thought it!  I’m sure those of you who have been married a while have experienced this phenomenon.  Forty years of practice has also taught me that this phenomenon causes a lot of marital problems.  Yep, after a while, you start to assume that you know what your spouse is thinking and act accordingly.  The problem is that some of the time your assumption is wrong!  Today’s lesson is that you should always verify that what you assume your spouse is thinking is true.

Remember, assume makes an ass out of you and me.  Assuming that the child discussed above had the same thing as his parents and siblings might have cost him his life.  Assuming you know what your spouse is thinking may cost your happiness!  Check it out!

Here is your music and a few quotes.

Unknown author:

“SOME PEOPLE NEED A HIGH FIVE

IN THE FACE

WITH A CHAIR”

George Bernard Shaw

“The biggest problem with communication is the illusion that it has taken place.”

Unknown author:

“I’m not really a control freak. But can I show how it should be done.”

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LIVES MATTER

I’ve been chewing on this topic for weeks now and every time I get close to writing an article, I spit it out and move on.  Frankly, I’m a little apprehensive, fearing that I’ll be branded as a bigot.  The reality is that, as a doctor for 40 years, every life that came into my office or hospital mattered!  Every life was as important as the next regardless of race, religion, political affiliation, etc.  Every life was treated with dignity.

One particular patient tested my oath and resolve to give care wherever care was needed and taught me a valuable lesson.  The gentleman I am referring to had a large swastika on his shoulder.  I had known him since birth but had not seen him in years. I’ve never been one to mince words, so I asked him if he knew I was Jewish and how offensive his swastika was to me.

He did the worse thing he could have.  He started crying.  When he regained his composure, he apologized.  He explained that he was in the federal penitentiary for 5 years and the swastika “saved” his life. He explained that, to survive incarceration, he needed to a join a group and being pale, white, and blond, he joined the skin heads.  In his case, the swastika was the equivalent of the Greek letters that marked me as a member of Sigma Alpha Mu only, in his case, it warned inmates that his “brotherhood” would protect him.

Lives matter.  All lives matter!  They say you can’t tell a book by the cover.  My patient is the living proof.  One of the reasons he came in that day was to get a referral to a dermatologist in order to remove the swastika.  The other was to get a referral to a psychologist.  Prison had left other marks on him that couldn’t easily be removed.

I’ve gotten off track.  I don’t understand.  All lives should matter! Black Lives Matter seems to be a very exclusive fraternity.  It seems that BLM pertains to white on black issues only.  It doesn’t appear to matter when it has to do with black on black issues.  It doesn’t seem to matter when businesses are burned down and looted.  Why?  

The outrageous numbers of deaths every weekend in Chicago certainly doesn’t seem to matter as much as the sensationalized deaths that are broadcast over and over again on national TV.  Why aren’t there riots every weekend in the Chicago neighborhoods where people have been dying for years?  Where is the outrage?  Sure, the grieving families cry out for justice, but the massive outpouring of the BLM community appears to be absent.

It’s time to declare that ALL LIVES MATTER ALL THE TIME.  IF THE MASSIVE OUTPOURING OF OUTRAGE SHOWED UP ON INNER CITY CHICAGO STREETS THAT WE’VE SEEN IN OUR LARGER CITIES FOR THE LAST MONTH, WOULDN’T THE NUMBER OF DEATHS FROM GUNS DIMINISH?  I THINK SO.

What do you think?

Here’s your music.  There is no joke today.

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BREAKING NEWS

I can’t figure out why I listen to the news. In most instances, it’s really not news, it’s commentary.  Depending on which channel you watch, you can get whichever opinions supports your own beliefs.  You can get the opinions you are looking for 24 hours a day!  Every hour a banner crosses your screen proclaiming, “BREAKING NEWS” followed by the journalist of the hour recounting what the previous hour’s journalist reported.

To tell you the truth, the only thing that changes daily is the number of deaths in the US.  The rest of the news appears to be static.  The daily death count from shootings is fairly static. Social unrest persists as people use perceived discrimination as a reason to act out and destroy other individuals’ property and rights.  Police continue to get raked over the coals as mistakes get front page attention.  

I’m afraid that the “truth” is lost in all the media hype.  Truth is an interesting thing.  It used to be that you were innocent until proven guilty. Now you are tried in the news and proclaimed guilty no matter what the facts really are.  Unfortunately, rather than a prosecuting attorney investigating the charges and presenting the case to a judge and jury, the current day prosecutor is a lynch mob, toting signs, threatening riots and demanding justice.  It seems that “JUSTICE” is defined as giving the mob what they want regardless of what’s right.  It also seems that the mob is winning!

Last night, a journalist interviewed the mayor of a large city that had banned the use of tear gas.  When asked what the police were to use in the case of a riot, the mayor’s response was vague and meaningless.  As usual in the political world, the mayor side stepped the issue and started discussing the benefits of defunding the police and using that money to increase social programs in distressed neighborhoods.

Oh God, I just realized that I’m acting like a journalist, offering opinion without truly knowing all the facts!  Let me stop here and tell you the truth.  The truth is, I don’t know what the truth is!  “BREAKING NEWS!”  I’m sick and tired of the talking heads presenting their opinions as fact.  I’m sick and tired of watching modern day lynch mobs on TV demanding their “justice” before all the facts.  I am extremely disappointed in our government for bugling to mob action.  I’m also scared!

In my opinion, there are too many similarities to Nazi Germany.  As statues are defiled and removed and history is re-written, I am left wondering when the book burning will begin, and intellectuals will be rounded up and shot. 

Now that I’ve gotten that off my chest, I feel much better.  Time to turn the TV off and go outside.

Here’s your song and joke.

A little British boy raises his hand to ask his teacher a question.

“Miss, My mother says freedom is the most beautiful thing in the world. What does freedom mean?”

The teacher, seeing the importance of this question for the sweet, innocent child, thinks quickly about how best to respond.

She smiles sweetly and says, “Why don’t you come up and tell the class what you think freedom is, dear”

The little boy comes up to the front of the class and the teacher hands him a big thick dictionary of English.

“Go on, dear, find us the definition of freedom.”

The boy arrives at the section for F and finds the definition.

“Freedom means doing whatever you want whenever you feel like it with total disregard for others no matter the consequences it has for the people around you or the destruction it causes. Freedom is the broken record answer you give to end every reasonable argument where someone tries to get you to do something you don’t feel like doing.”

The teacher is shocked. The class looks up stunned and confused and the little boy bows his head in disappointment, tears filling his eyes.

About to console the little boy, the teacher notices the cover of the dictionary and beams a bright smile.

“Don’t worry, class!” she rejoices.

“That one is American English.”

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SOMETHING GOOD?

One of my readers suggested that I write an article about the good things that have come out of Covid-19.  She went on to give me an example talking about how nice it was to have her husband working at home since May. Obviously, I should tell you how nice it has been being quarantined with Renee since March.  She edits my articles and I’ll pick up a few brownie points by schmoosing up to her.

Realistically, I’m probably driving her crazy.  Can you think of anything good that has come out of Covid-19?  If you can, please leave a comment below.  I’ve gained 30 pounds since this started.  If I had been emaciated at the onset, that would have been good.  However, I was already overweight and now I’m thinking about becoming a Sumo wrestler.

I’ve saved a bunch of money.  Since we no longer go anywhere, we stay home in the evening and count our newfound wealth.  NOT!  Out of sheer boredom, we surf Amazon and buy all kinds of crap we really don’t need. The high point of our day is checking the front stoop for Amazon packages.  Today, my pickled celery came.  Pickled celery from NY is seriously good! 

I have not been this excited in months!

At first, donning a mask and playing doctor with nurse Renee was fun.  After a while she tired of me pestering her, so she decided that, in nurse Renee’s exam room, a temperature would be done rectally.  Oops, game over! 

Nurse Renee says the only positive she sees coming from the Covid-19 experience is an increase in family time.  Unfortunately, my literature suggests that the increased family time is associated with increased child and spousal abuse.  

I’ve always said that, if you can make something good come from something bad, the bad wasn’t all that bad.  For the life of me, I can’t find anything good coming from tearing apart the social threads of society.  I almost forgot, COVID has killed 140,000 people to date.

The only good I have witnessed is the calls and cards I’ve received from my former patients who worry about my depression.  Many have recounted how they are handling their depression.  I want to assure all of you that I really am doing fine.  I puke up the foul stuff that accumulates in my mind every day when I write this blog.  Writing is cathartic, just as your reaching out to care for me is good for you.

Together, we’ll get through this!  Here’s your song for the day and a joke.

Three golfing partners died in a car wreck and went to heaven. 
Upon arrival they discover the most beautiful golf course they have ever seen. 

St. Peter tells them that they are all welcome to play the course, but he cautions them that there is only one rule: 
Don’t hit the ducks. 
The men all have blank expressions, and finally one of them asks “The ducks?” 
“Yes”, St. Peter replies, “There are millions of ducks walking around the course and if one gets hit, he squawks then the one next to him squawks and soon they’re all squawkin to beat the band, and it really breaks the tranquility. If you hit the ducks, you’ll be punished, otherwise everything is yours to enjoy.” 
After entering the course, the men noted that there was indeed a gaggle of ducks everywhere. Within fifteen minutes, one of the guys hit one of them. The duck squawked, the one next to it squawked and soon there was a deafening roar of duck quacks. 
St. Peter walked up with an extremely homely woman in tow and asked “Who hit the duck?” 
The one who had done it admitted “I did.” 
Immediately, St. Peter pulled out a pair of handcuffs and cuffed the man’s right hand to the homely woman’s left hand. “I told you not to hit the ducks,” he said. 
“Now you’ll be handcuffed together for eternity. 
The other two men were very cautious not to hit any ducks, but a couple of weeks later, one of them accidentally did. The quacks were as deafening as before and within minutes St. Peter walked up with an even uglier woman than before. St. Peter determined which one had hit the duck by the fear in his face, and cuffed the man’s right hand to the homely woman’s left hand. 
“I told you not to hit the ducks”, he said. “Now you’ll be handcuffed together for eternity.” 
The third man was extremely careful. Some days he wouldn’t even move for fear of even nudging a duck. After three months of this he still hadn’t hit a duck. St. Peter walked up to the man at the end of the three months and had with him a knock-out gorgeous woman, the most beautiful woman the man had ever seen. St. Peter smiled to the man and then, without a word, handcuffed him to the beautiful woman and walked off. 
The man, knowing that he would be handcuffed to this woman for eternity, let out a sigh and said “What have I done to deserve this?” 
The woman responded “I don’t know about you, but I hit a duck.”

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I’M MAD

I’m mad!  I’m just not sure who to be mad at!  Several of my patients with chronic pain have complained that no one wants to fill their prescriptions for scheduled medications.  Scheduled medications (mostly narcotics) are more tightly controlled by the feds than non-scheduled medications.

Over the years, I accumulated about a dozen patients with chronic pain.  They all had good reasons for their pain and the majority were on low doses of their medications.  A dozen patients is a small number and I kept it small by aggressively treating pain syndromes with physical therapy, injection therapy, and specialty care using surgery when appropriate.

Towards the end of my career, I was telling patients who needed narcotics that the government believed that anyone prescribing narcotics was a drug pusher and anyone taking a narcotic was a criminal.  Yes, my profession went from openly stating that pain was a vital sign that needed to be aggressively treated to treating pain aggressively could end your career. 

Why?  There are, in fact, bad docs who sell pain pills in huge amounts in their pain clinics. There also exists greedy pharmaceutical companies that misrepresent their products and pay bad docs to overprescribe their medications.  Because of the sins of the few, many suffer.

“Chronic pain patients” are a real pain to treat.  They have to be seen on a regular basis. They aren’t happy about having to be seen regularly and they let you know it.  Their medications require extra paperwork and are monitored by big brother.  They tend to be broke emotionally, physically and financially as many have trouble working due to both the pain syndrome and its effect on their ability to work.  They suffer and sometimes take it out on those trying to help them.

On the other hand, treating “patients with chronic pain” can be emotionally very rewarding.  Goals can be set and reached in most cases. The effects of your treatments are easily assessed in how functional and happy your patient is once treated.  By controlling your patient’s pain, you also improve his family’s life; and, in some instances, you are able to get your patient back to work.    

Unfortunately, the sad truth is many of my colleagues are afraid to prescribe narcotics and push chronic pain patients out of their practices.  Please note that, in the paragraphs above, I refer to “chronic pain patients” and “patients with chronic pain.” There is a difference!  And that’s why I’m angry.  There shouldn’t be!!

Patients with chronic pain need care and get care from caring physicians!  If the physician sees them as chronic pain patients, they don’t get care, they get the boot!  That’s just plain WRONG!

So, who am I mad at?  Certainly, I’m pissed at the feds.  PATIENTS WITH CHRONIC PAIN AND THEIR PHYSICIANS SHOULD NOT HAVE TO FEAR THE GOVERNMANT!  NOR SHOULD THEY HAVE TO JUMP THROUGH MULTIPLE HOOPS TO GET THEIR MEDICATIONS.

I’m also mad at my colleagues. I understand their fears, but they can’t let fear stop them from caring for patients in need.  One of their fears is that a few bad apples may slip through their defenses and get their hands on meds they shouldn’t have.  That’s the risk a physician must take in order to serve the greater good: caring for those who are truly in pain. (I’ve seen some great actors in my day and been fooled more than once. That’s a story for another day.) 

I’m mad at myself.  Right now, some of my former patients are suffering in pain and can’t find a physician who will care for them.  I should be there for them and I’m not!  Unfortunately, there is nothing I can do to help other than write an article that will never get into the hands of the docs it’s meant to influence. (And, for sure, never change the governments stance on pain meds either.)

Feel free to share this with your doc.  If he actually reads it, you are probably in the right place.

Here’s your music for today ad a joke.

One morning at a doctor’s clinic a patient arrives complaining of serious back pain.The doctor examines him and asks him:

“Tell me what happened to your back…?”

The patient replies: “Sir, I work for a local night club. This morning I went to my apartment early and heard some noise in my bed room.

On entering I knew someone had been with my wife and the balcony door was open.

I rushed out of the balcony door and did not find anyone.

As I looked down from the balcony I saw a man running out and he was dressing himself.

I was very angry. I grabbed the fridge and threw it at him.

It was very heavy…

That is how I strained my back.!”



Later that day, a second patient arrives as if he has been in a car wreck.

The doctor said: “My previous patient looked bad..

But you look terrible..

What the hell happened to you ?”



He replied: “You know I have been unemployed for a while now.

Today was the first day at my new job…

I forgot to set my alarm and I was late…

I was running out of the building, getting dressed at the same time.

And you won’t believe it but I was hit by a fridge.

I don’t know how and where from this fridge fell on me…!!!”



Before closing hours, the third patient comes. He looks like he was punished in hell.



The doctor is shocked.

He asks: “What the hell happened to you..??”



The patient replies:

“Well, It started like this, I was in a fridge……….

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IT’S HOW MUCH THAT MATTERS

I heard a doc say, “It’s not just if you get infected, it’s how you get infected” that matters.  The larger the exposure/dose, the worse the disease.  If he is right and the size of the viral load you are infected with is directly related to the degree of illness you develop, then not wearing a mass is lunacy.

As I previously stated, masks primarily block larger particles in your breath from reaching others.  The secondary effect is to prevent or lessen the load of droplets being actively propelled into your airway by the person in front of you.  Yeah, every time you’re with unmasked or poorly masked individuals, you are breathing all of their air.

When I was bar hopping in my 20’s, inhaling a cute girl’s air was sweet, now it’s poison.  Wear masks in public, if not for others, then for yourself.  I know it’s your right to not wear a mask.  I know you believe what the internet says: masks don’t work or make you worse.  Even if there was only a small chance of controlling this virus by universal masking, it would be worth doing.  

My colleagues and I wore masks our entire careers. I treated infectious diseases while I donned masks, used sterile technique and hand washing for close to 40 years without getting seriously infected.  CERTAINLY, I HAVE NEVER SEEN ANY COLLEAGUE INJURED BY WEARING A MASK.

My readers want to know what they can do about those people who refuse wearing masks.  There is only one thing to do: turn and walk away. Actually, you could pray that you walked away fast enough and that the person who was exercising his/her right not to wear a mask never knows the pain of being wrong. MY FAVORITE PRAY IS “MAY YOU BE SO BLESSED AS TO NEVER KNOW WHAT DISEASE YO U PREVENTED.”

Here’s your music for this am and a joke.

They said that a mask and gloves were enough to go to the supermarket.

They lied, everyone else has clothes on.

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STRESS

One of my former patients posted the following:

I have a lot of

Excitement 

In my life.

I used to call it STRESS

But I feel much better

Now that I call it

EXCITEMENT.

Sometimes, the difference between a winner and a loser is how they manage stress.  While we all experience stress, a person with good coping techniques/stress management skills can turn stress into excitement (or a host of other sentiments/feelings).

How do you handle stress?  Have you had any stress management courses?  Been in counseling?  Read about stress management techniques?  If not, why not?

Most of us have never had a formal education in stress management.  When you realize that all humans experience stress, it’s remarkable that so little education in stress management is made available to us through the educational system.

As a doc, it was not uncommon for me to find myself in highly stressful, life and death situations.  The 60-year-old male having a heart attack in my office was always a stressful event.  When I read the above statement, I realized that I channeled that stress into excitement as I ran my code procedures and waited for the paramedics. 

How is it possible that I went all the way through undergraduate, graduate and post graduate training without a single stress management course?  Maybe it’s because admitting that you are stressed is taboo, unmanly.  I do know that I innately possessed good stress management skills.

When I was an ER doc back in the dark ages, the most stressful thing I had to do was put in a chest tube.  In those days, putting in a chest tube was somewhat barbaric.  While I had no problem opening the chest of a 24 year old patient with a knife wound in her heart, I had an unexplainable fear of putting in a chest tube.  My stress management technique was to go to the men’s room anytime a patient needing a chest tube came into my ER. It worked until, one day, Dr. J pounded on the bathroom door.

Dr. J – “Segal, gets your ass out of the bathroom and put in this chest tube.”

ME – “I’M TAKING A DUMP.  PUT IN THE CHEST TUBE YOURSELF.”

Dr. J – “She’s going to die if you don’t get your ass out here.”

Me – “Fuck, What’s wrong with you?  Go put in the tube.  I’ll join you when I’m finished.”

Dr. J – “You’re finished now!  Time to man up and get past your fear.’

Dr. J was a great teacher and he worked side by side with me until I conquered my fear.  Stress management can be taught in a classroom, at work or at home.  There are hundreds of books and programs on stress management.  Is it time for you to get an education? The answer is YES!

There is not much I can guarantee in life but I can guarantee that, if you take a course in stress management, you will be glad you did.

Here’s your music and joke.

1. Picture yourself lying on your belly on a warm rock that hangs out over a crystal-clear stream. 
2. You can feel both your hands dangling in the cool running water. 
3. Birds are sweetly singing in the cool mountain air. 
4. No one knows your secret place. 
5. You are in total seclusion from that hectic place called “The World”. 
6. The soothing sound of a gentle waterfall fills the air with a cascade of serenity. 
7. The water is so crystal clear that you can easily make
out the face of the person you are holding underwater.
See? It really does work. You’re smiling already!

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