CABIN FEVER

“I know you think you understand what you thought I said but I’m not sure you realize that what you heard is not what I meant”


― Alan Greenspan

I want you to take a few minutes to digest what Mr. Greenspan is saying.  The last few months have been especially stressful.  While sheltering in place had its positives (spending more quality time with family), it also had significant negatives (driving your family crazy).

Too much of a good thing is not necessarily good and the intense togetherness sheltering at home enforced has stressed relationships.  Don’t get me wrong, Renee and I have loved being together 24 hours a day seven days a week.  If you don’t believe me, ask Renee.  We communicate really well.  I know what I heard and she knows what she meant and sometimes, the two are the same.  Sometimes, it’s actually laughable!

How are you and your loved ones doing?  I bet you are having laughable moments. Communication is the foundation on which relationships are built and as we get older, the ability to communicate often diminishes.  Hearing often falters as we get older.

Renee and I have hearing aids.  Currently, mine are on my dresser.  My dresser can hear Renee just fine!  Unfortunately, I can’t.  Of course, I don’t think she is wearing hers as the neighbors can hear the TV.

Senility, in its various stages, plays a major role in miscommunication as well.  Thank God we aren’t dealing with that.  Now, what was I saying?  Oh yes, I was talking about the fact that what I say is not necessarily what you hear or even what I meant.

There are myriad other reasons to miscommunicate with your loved ones.  The next time you get upset by something your spouse says, check to be sure that what you heard is what he said and what he said is what he meant.

When it comes to communicating with your children, God help you.  Trying to fathom what’s going through your kids’ minds is literally mind boggling.

Here’s your song for the day.  Here’s a joke:

“What would you like?” says the barman.
“What would I like?” says Bob. “A bigger house, more money and a more attractive wife.”
“No,” says the barman, patiently. “I meant what do you want?”
“To win the lottery, for my mother-in-law to die and for my child to be born healthy!”
“What’s it to be?” says the barman, less patiently.
“A boy or a girl, I don’t care.”
“You misunderstand me,” says the barman, impatiently, “I only asked what you want to drink.”
“Oh,” says Bob, “I see. Why didn’t you say so? What have you got?”
“Nothing at all,” says the barman. “I’m perfectly healthy.”

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MEDICAL MALPRACTICE

We’ve all seen them.  They start off with a question.  Has your loved one suffered from bed sores, broken bones, laceration or death?  If so, call 800-screwanmd and we’ll sue for millions!  The commercials clearly imply that any injury that occurs while you are in a nursing home must be from malpractice.  According to the latest commercial, if you die in a nursing home, the law firm of Screw’em LTD will get you at least a million.  The commercial is quick to point out that the attorneys work on your behalf is free if they don’t collect!

Why is your loved one in a nursing home?  They certainly aren’t there because they are young and healthy!  People go to nursing homes when they need extra care because they are old, infirmed, confused, at high risk of falls, etc.  Yet, according to the attorney’s commercial, anything that happens while your loved one is in a nursing home must be from neglect.

So, I’m retired.  Why should I care?  Why should you care?  Reason number one is that part of every medical bill you pay is the price of malpractice and liability insurance.  How much of your bill is related to lawsuits?  It’s hard to say.  Calculating the cost of malpractice insurance per patient treated is an easy equation.  The complicating factor is discerning how much of the care you receive is “cover your ass” (CYA) medical care.

There are times when your patient is clearly litigious and CYA cost are obvious.  I’m sure there are subconscious decisions related to fear of lawsuits that drive up the cost of care.  Now that I’m a patient, I really don’t want to pay the price for CYA care.  You shouldn’t have to either.

I’ve been sued twice in my 34 years.  The first time was by the parents of a patient I never saw.  To this day, I’m not sure how my name got attached to the suit but it took 4 years and around $50,000 to get a judge to look at the case and dismiss it.  That case taught me that practicing CYA medicine is useless as anyone can be sued at any time for any reason.

My second suit was for failure to diagnose and treat an appendicitis in a timely manner.  On the day she presented to my office, my note clearly stated that she needed hospitalization and should go to the ER immediately as I suspected that he had an acute appendicitis.  My note the following day showed that she did not go to the hospital, so I called her and strongly advised that she go to the ER.  I called her 5 more times over the next 5 days and she finally went to the hospital.  Her attorneys (she had 4 or 5 as they kept firing her) claimed that she didn’t understand how serious her condition was and that I should have been more emphatic!  I guess telling her she was going to die was not emphatic enough.

That case took 5 years and close to $100,000 dollars to defend.  It was finally thrown out.  The scary part was when my attorney told me that had the case been in Cook County, I might have lost.  Apparently, in Cook County, jurors look at insurance companies as winning lottery tickets.  This case taught me to be more emphatic.  Subsequently, when a patient refused to heed my warnings, I would tell them and write in the chart that they were going to “Fucking die!”  Interestingly, there is a difference in simply dying and fucking dying because everyone would respond the same way, “If you feel that strongly, I’ll go to the ER.”

It won’t be long before the legal ads will start suggesting that, if your loved one died in a hospital from COVID, it must be the hospital/doctors’ fault!  Lawyers across the US will go on fishing expeditions, testing the waters and limits of the law as they sue the heroes that worked so hard to save so many.  When you see those ads, get angry!  Call those law firms and make sure they understand how angry you are.

We, the patients of America, have been silent too long and we’ve paid for that silence in inflated medical bills and defensive medical care.  The time for tort reform is now!

Here’s today’s music (click on underlined words).  We could all use a little help from our friends.  Here’s your joke of the day:

An attorney was working late one night in his office when, suddenly, Satan appeared before him. The Devil made him an offer. “I will make it so you win every case that you try for the rest of your life. Your clients will worship you, your colleagues will be in awe, and you will make enormous amounts of money. But, in return, you must give me your soul, your wife’s soul, the souls of your children, your parents, grandparents, and those of all the your friends.” The lawyer thought about it for a moment, then asked, “But what’s the catch?”

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CAMP SEGAL

Well, Camp Segal officially closed its Illinois campus this week.  Camp Segal was established in the early 90s.  First came the swimming pool, then the basketball court.  In time the volleyball court, bags setup and ring toss was established.  Camp Segal was incredible.

Renee and I wanted the kids under our direct scrutiny, so we made our home the gathering place for our kids’ friends.  Eventually I added pinball machines, other arcade games and a pool table in the basement.  Several years we actually hired a camp counselor.

Those were marvelous years.  Renee and I got the opportunity to play significant roles in dozens of kids’ lives.  I’m happy to say they have all done well in life.  Of course, there were hard times.  Party crashers were always a problem.  As the kids aged, parties ran in to the early morning hours.  It wasn’t uncommon for me to open my bathroom window (overlooks the pool) and yell, “Kill the music, shut off the lights and go to bed.”  All in all, I wouldn’t change a thing.

Now Camp Segal is up for sale and I’m shocked that none of the kids who grew up in the backyard are considering buying it.  I really want it to go to a family who will enjoy its many activities.  Especially, with Covid, it’s a bargain.  Your own piece of heaven.  It even has a separate entrance to the basement bathroom so that swimmers do not have to walk through the house.  I certainly will miss it!

Over the years, my friends and guests would ask, “Don’t you want peace and quiet when you come home from works.”  My answer was always the same.  “Laughing kids are full of life and I want to surround myself with life.”

Fill your lives with the laughter of children but be careful to maintain safe social distance.  If you know anybody looking for a safe summer resort to go to, tell them Camp Segal is for sale.

Here’s your music for today.  I always listened to it while floating in the pool.  Here’s today’s joke:  During a bank robbery, the burglar’s mask is dislodged and he’s afraid people can identify him.  He asks a lady, “Did you see my face?”  She answered, “Yes” so he immediately shot her in the head.  Next, he asked a man, “Did you see my face?”  The man answered, “

No, but my wife did!”” – “Yes, sir,” says the customer and g

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ANCHORING

Oops, I think I packed my sense of humor in one of the carboard boxes.  I was on a roll, awakening with music in my head and remembering the good old days.  Six more days and Renee and I will be on the road.

Talk about humorous situations, Renee and I are a stitch in the car.  First of all, neither of us can hear. Second, our sense of direction is not great.  Thank God for GPS.  Third, I’m hot, she’s cold.  Fourth, I need to find a bathroom every 100 miles.  You have to be in the car with us to appreciate how funny it gets.  Getting old sucks and turns a 12 hour trip into a 16 hour trip; 12 driving and 4 finding bathrooms.  Maybe I’ll buy some Depends.

Thursday, I had lunch with three of my patient /friends. I was at the birth of their now 30 something son.  Donna likes to tell the story about her son’s pacifier.  Johnny was in the office for a routine exam and it was time to get rid of the pacifier, so I asked her to give it to me and to make all the other pacifiers disappear.  Johnny handled it well until he got to the lobby where upon he dropped to the floor and started screaming.  He needed his pacifier.  Apparently, I opened the exam room door and tossed him his pacifier.  There’s an old adage, “Man plans, and God laughs.”  My plan for Johnny was obviously laughable.

One of the most important attributes of a good physician is the ability to recognize when to change plans.  “Anchoring” in medicine refers to latching onto a diagnosis or treatment so firmly that you ignore other possibilities or outcomes.  “Fluidity” refers to the ability to change your position or plans on the fly. “Anchoring” is dangerous as it blinds you to the truth.  Had I anchored to my plan to get Johnny off the pacifier, I would have been successful.  Johnny would have given it up at the expense of the patients in the lobby, his parents and Johnny.  By stepping back accepting that he was not ready and giving him back his pacifier, everybody won.  That his mother remembers this incident 30 years later illustrates how important it is to be fluid in your treatment of people.

The concepts of “anchoring” and fluidity are valuable at all stages of life and apply to everyone, not just doctors.  In my youth, people told jokes.  In my old age, people spew their opinions about politics and Corona.  It appears that everyone has anchored themselves to a particular political opinion and are willing to fight for it.  Listening to people arguing over political rhetoric is almost humorous and, at the same time, very sad.

Today, my job is to search through the boxes in my house and find where I packed my sense of humor.  I suggest that you actively look for and find your sense of humor.  Laughter is the medicine we need to survive Covid-19 and the isolation it has forced upon us.  Laughter is what we need to survive the highly polarized political world we live in.  Learning to be fluid as opposed to anchored will help as well.

Here’s your music for the day.  Here’s a joke.  


Pierre, a French fighter pilot, takes his girlfriend, Marie, out for a pleasant little picnic by the river Seine. It is a beautiful day and love is in the air, so Marie leans over to Pierre and says: “Pierre, kiss me”.

So our hero grabs a bottle of red wine and splashes it on Marie’s lips.

“What are you doing, Pierre?” shrieks Marie.

“Well, my name is Pierre, the French fighter pilot, and when I have red meat I like to have red wine!”

His answer is good enough for Marie and things begin to heat up. So she says: “Pierre,
kiss me lower.”

Our hero rips off her blouse, grabs a bottle of white wine and starts pouring it all over her bosom.

“Pierre, what are you doing” she says.

“My name is Pierre, the French fighter pilot, and when I have white meat I like to have white wine!”

They resume their passionate interlude and things really steam up. Marie leans over once more and softly whispers into Pierre’s ear…”Pierre, kiss me lower.”

Pierre tears off her underwear, grabs a bottle of Cognac and sprinkles it all over her private region. He then grabs a match and lights it on fire.

Patting the flames out furiously, Marie screams, “PIERRE, WHAT ARE YOU DOING!!!?”

“My name is Pierre, the French fighter pilot, and when I go down, I go down in flames!”

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THANK YOU

When I started in medicine, I was an emergency room doc at Northwest Community Hospital.  Bruises, lacerations, breaks, strokes, heart attacks, etc. were run of the mill.  The paramedic system was in its infancy.  Ambulances scooped up patients and dumped them in the ER.

In time, the ambulance became a mobile ICU and the patient was treated from the minute the paramedics arrived.  I can’t tell you how relieved I felt every time Lake Zurich’s crew walked in my front door.  As an ER doc, nothing rattled me.  However, every emergency seemed to rattle the family physician and internist.  I would come home and say to Renee, “You wouldn’t believe how rattled Dr So and So was when his patient coded from chest trauma from the car accident.”

Then I left the ER and became a family doc.  The first 10 years were easy.  I was still an ER/Family Doc.   With time, my ER skills diminished, and I found myself in the same place as the docs I had denigrated as a young man.  I would attend to a patient having a heart attack in my office while we waited for the paramedics.  My heart would be racing and I would joke that if they didn’t get here soon, I was going to have an MI.  You see, while I was CPR certified and capable of resuscitating a patient in the office, I really did not want to do CPR or breath for a patient.

My heart and mind would instantly calm down when LZ’s finest came through the door.  The point of this article is that I want you to trust the paramedics and call 911 if you are in trouble.  If you think it’s an emergency, it is!  Once they are on the scene, let them do their job!  They will take you to the appropriate hospital.  They will stabilize you and report their findings to the ER.  

Simply put, paramedics are awesome and LZ’s are the best.  Thanks, guys, for all the years you prevented me from having a heart attack and all the times you saved my patients.  I miss you guys and gals!

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PEE AND POOP

Many of you will remember Jack.  Jack worked with me during the busiest years of my practice.  Jack and I worked hard and played even harder.  We fed on each other’s humor.  When we got started, it was hard to stop or rein us in.  Hell, a pharm rep once complained to Renee (practice administrator) that our off colored humor needed to be stopped.

Reps who wanted to sell me their products used to bring in lunch for the staff.  They pitched their goods while Jack and I ate (which amounted to 10 minutes a day).  One day a rep brings in a Heart Bar (supposed to be heart health).  I opened the package and immediately thought that the bar looked like shit (literally).  I started rolling the bar in my hands and Jack followed my lead.  The end product looked like a poo emoji.  When placed on the floor, you would swear a dog had left you a gift.  It was one very healthy pile of shit.

We had so much fun leaving piles of shit for select patients and students to find.  Naturally, while apologizing and cleaning up the mess, we would smell it, “Gee, this stuff smells good,” and then taste it, “Gee, it tastes really good, would you like some?”  I’m sure you get the gist.  Unfortunately, Heart Bars disappeared, and we found the fart machine.

As mentioned above, I loved teaching.  Students of medicine would spend a few months working with me. I would ease them in to various roles within the office including teaching them to do lab work.  We kept bottles of Mountain Dew in our desk for just such an occasion.  Jack or I would label a urine specimen container with a fake patient name.  We would fill it ½ way with flat Mountain Dew and put it in the specimen window, then we would send the student to get it.  I loved the look on their face when the dip test showed 4 plus sugar in the urine.  We would then discuss the diagnosis and treatment of diabetes. At some point, I would tell the student that, in the olden days, the doc might taste the urine to discern if it had sugar in it.

You got it! I would take a big gulp and offer it to the student.  Jack, seeing the grossed-out student would take the specimen cup, finish it and walk off.  Juvenile? Yep, certainly was, but fun! 

The day to day practice of medicine is one filled with stressful decisions, difficult problems, happiness and loss.  There is always an emergency.  Occasionally you have to contend with the dead and dying.  The beautiful thing about Family Medicine is that the joys of birth and caring for the children balanced the loss associated with death.  The childish behavior listed above helped us decompress, get ready and go to the next person in need.  I miss Jack, he brought my child out to play.

Tomorrow, I’ll talk about our inner child and the importance of nurturing it.

Today’s music.

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STORIES PART 2

One of the most anxiety producing exams a woman can have is a pelvic exam.  Over the many years I’ve practiced, I’ve discovered that each patient’s pelvic can be optimized if you take the time to take a careful history prior to handing the patient a gown.

Nurses new to our staff were always confused by my insistence that the patient remain dressed until I interviewed the patient.  In particular, I wanted to know if my patient knew how a pelvic exam was done, what a speculum looked like, did they ever have trouble with a pelvic exam in the past and if they had any personal preferences for how the exam should be done.

One of my favorite patients (yes, doctors have favorites) told me that she hated pelvic exams but that if I told off colored jokes during the vaginal exam, it would help her relax.  I always made sure I had new material for her exam and we laughed our way through a difficult situation.

There was the woman who brought her husband into the exam room and explained that every time her husband gave her an orgasm, she got a bad headache.  As I took a history, it was obvious that both patient and spouse were uptight and anxious about discussing their problem but needed an answer and a cure as they were sexually very active.  I turned to her husband, hands together in a prayer position, did a head bow and said how proud I was that he had mastered the art of giving orgasms.  They cracked up, laughing their way through the rest of the visit. Ultimately, we solved the problem.  Saturday, close to 30 years later, my patient reminded me of that visit and thank me for my unorthodox use of humor.

The most fun I ever had in the office was when I brought a fart machine.  No matter what your age, farts are funny. My fart machine was triggered by a remote.  Jack and I taped it to the bottom of a chair in the check-out area.  One day I had my staff seat a pharmaceutical rep and his boss in the check-out area.  The boss was an A-hole so we sat him in the fart chair.  I waited until an older lady was checking out and then I pushed the button.  A loud, long, wet sounding fart emanated from beneath the manager.  The old lady gave him a disgusted look.  His employee gave him a disgusted look.  My staff maintained their composure, so I lit him up again.  

This time, the old lady looked at him and said, “That’s disgusting!”  The young rep stood up and walked away.  The staff cracked up as did the old lady who couldn’t stop laughing when I told her what I had done.  The old lady became a loyal patient and every time I saw her she asked if I had the fart machine hooked up.  The rep became a good friend and the A-hole manager never came back.

Here’s your daily music.  Enjoy.  Tomorrow we’ll review the humorous side of poop and pee.

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STORIES

Saturday’s caravan of patients and friends was amazing.  Each of the 55 cars pulled into the driveway, one by one, and stopped to chat with Renee and me.  Each had a story to tell, some funny, some happy and some sad.  In 34 years you accumulate many, many stories.

One patient remembered the pregnancy scare she had at 18 years of age.  She was more afraid of her parents finding out about it then she was about being pregnant.  She thanked me profusely for charging her for Strep test rather than a pregnancy test. There are those who would call switching codes illegal, inappropriate and unprofessional.  I called it a holistic approach to my patient’s care, mind, body and soul. It obviously worked out well.  

It’s taking care of the little things, going that extra step and addressing the patients concerns that make the difference in bonding the patient to their physician, creating a strong doctor-patient relationship.  One of the most common things a teenager would say to me is, “My parents are going to kill me.”  They were always floored by my response: Rather than belittling their apprehension and fear, I took it literally. 

“Shit, I had no idea your parents were murderers. How many people have they killed?  Should I be afraid to be in the same room with them?  I’ve always suspected that your mother could turn on me in a split second!  Should I call the police?”

Almost always my humorous approach would defuse the situation and allow us to find a solution and involve the parents.  Humor belongs in the exam room which is the one place you rarely find it.  Humor, when used appropriately, helps defuse tense situations, dissipate anxiety and facilitate understanding.  Sometimes it backfires.

When my patient was really, miserably sick and was in the exam room with their spouse, I used to turn to the spouse and say, “I told you to give him all of the poison at once, otherwise he would suffer miserably.”  Generally, I’d get a laugh out of my patient and the spouse and, at least for a few minutes, my patient would feel better. On one unforgettable day, I looked at the wife and started into my spiel when I realized that the look on her face was a” how do you know” look.  Her husband caught it too and he got better when the poison was removed from his diet.  Needless to say, the husband loves me, the wife does not!

Over the next few weeks, I hope to make you laugh a little and smile a lot by recounting some of the ways I incorporated humor into my practice of medicine.  The stories are real and the patients involved in the stories have given permission to use them.

Here’s today’s music.  At LZFTC we tried to give you what you wanted but, if we couldn’t, we worked hard to give you what you needed.

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THANKS FOR THE MEMORIES

Yesterday was incredible. It started off incredibly bad.  My motor skills were shot. My back and other joints screamed at me.  My mind kept repeating “PACK, PACK …”  I had a momentary lift in my spirits when I looked out the window and saw the glimmering water of my pool.  That joy immediately went away when my scale started in on me.

“Hey fatso!  You’ve got pictures to take today.  Do you have a tent that will fit you?”  Lately, I hate pictures!  Literally, I don’t recognize the guy who is standing where I’m supposed to be.  However, there is no time to wallow in it (LOL) as we have a showing at 1:15.

Showing done, we return home and prep for pictures.  The photographer and his wife are delightful.  He takes pictures in front of the house and by the pool. By now I’m thinking it’s enough, but he wants more pics out front.  Click, click, click (sounds usually associated with my medical practice) and we are done.  It’s time to sit down.

Thanks for the memories!  I’ll never forget the honking, the fire truck and the long precession of cars packed with love and memories!  It was as if the sun had come out and all of my pain and immobility had been washed away.  I wanted to ignore Covid-19 and hug and kiss each and every one of you!

Thanks for the memories!  You made me laugh, you made me cry.  You actually brought me some of the most cherished items available today, toilet paper and masks.  I’ll think about you when I use them.  Please stay in touch.  My cell phone will stay the same and I’ll always be glad to hear your voice.  Oh yes, one more item: consider yourself hugged.

So, thank you Lisa, Spring and the crew! I woke up this morning feeling good and singing, “Thanks for the memories.” Yesterdays memory will ranked right up there with my wedding, the birth of my children, finding Lake Zurich and you guys!

Here’s Frank’s version for your pleasure and my version for what its worth:

Thanks for the memory
Of things I can’t forget
Journeys on a jet
Our wond’rous weeks in beautiful LZ
With Renee and the crew
How lucky I am to have been with ya’ll

And thanks for the memory
Of summers by the pool
Halloween dressed as ghouls
We had such a time in old LZ

Of Maki and me
That we didn’t even stop to pee


Now since retirement I wake up
Alone on a gray morning-after
I long for the sound of your laughter
And times together

The good and the bad
Oh what parties we had


So, thanks for the memory

Renee and I are blessed

To share so many memories with you

Not bad for a short fat Jew

Who bids ya”ll adieu

It’s off to Indian Trail

To start anew

Close to family and friends

Old and new

Thanks again, for the memories!

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STUFF

If you found the genie in a bottle and the genie offered to provide you with any tool you could imagine, what would you ask for?  I’d ask for a retrospectascope.

The genie would give me one of those strange looks and ask, “What the hell is a retrospectascope?”  My retrospectascope would allow you to look back at any point in time and either put you on the right path to success or, in my case, stop me from making a fool of myself.

My mother moved from Norfolk to our house in Long Grove in 2009.  At that time, I told her to sell most of her belongings and only pack the essentials as we had a full house and everything she could want.  I was furious when the movers showed up with the entire contents of her house.  I still have a substantial amount of her stuff and she died in 2014.

Flash forward to today.  As I’m packing to move to our new, much smaller house in North Carolina, I realized that Renee and I have packed way too much.  We started packing weeks ago and promised to take only the bare minimum.  We failed!

It’s hard to let go of stuff!  I’ve got stuff of my mom’s and my dad’s.  I’ve got stuff from my childhood, my college years, Mexico and my Illinois life.  I’ve thrown stuff out only to pull it out of the garbage later.  How do you give away or throw out your stuff?

One thing is for sure.  I owe my mom an apology.  She couldn’t let her stuff go.  Looking back through a retrospectascope armed with the knowledge I now have would have stopped me from being an ass.No one understands stuff better than George Carlin.  If you’ve never heard his “Stuff” here’s a 5 minute version

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