Now Reading

Shelby Foote, The Civil War

Herman Melville, Moby-Dick, or the Whale

Michael Punke, The Revenant

Bill Bryson, Notes from a Small Island



The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators.  If you are looking for a open mind, I suggest you consult a neurosurgeon.

Katrina Blog Project

Christmas 2005

As you can see, my Christmas entry is on December 26. Needless to say, I was too busy yesterday, but it also bears saying that today is Christmas too. The traditional Christmas celebration is 12 days long, and does not end until January 6, the Feast of the Three Kings. In fact, Christmas was not the preeminent celebration of the Christmas season until about 150 years ago. Before the 20th century and the days of birth certification, many people did not even know the exact date of their births; but most people knew their baptismal date, because churches kept records of that.

For that reason, and for many others, New Year's Day was considered the most important day of the 12 days of Christmas. New Year's is the day most Christian churches celebrate the baptism or circumcision of Christ. Consider this fact: the Catholic Church reorganized the calendar times during the Dark and Middle Ages, the last time under Pope Gregory in 1582. The Church could have easily assigned January 1 the feast of Jesus' birthday, but it did not. It kept Christmas day were it was and made the first day of the calendar year the feast of Christ's baptism. This was probably intentional and suggests the relative importance of the two holidays at that time.

Christmas became The Day I think because of commercialism. For the last month I have been listening to Christmas music on the radio. I turn it on this morning and the music selection it might as well be from July. The Christmas songs are gone and Fleetwood Mac and Fifty Cent again reign supreme. Because Christmas day is the big gift-giving day, merchants have no reason to promote the holiday past December 25. December 26, things are right back to business as usual. People, who are heavily influenced by what they see on TV, simply mindlessly follow suit.

I like the old way. I think the Christmas season should be celebrated, if not all the way to January 6, at least through January 1. Christmas is not just about buying and giving presents, and we should carry the spirit of this delightful holiday through more than a 24 hour period. The great thing about the days after December 25 is that the good feelings have not died out yet but no one is rushing around looking for gifts and worrying about the social calendar. Other than what New Year's Eve party we should go to, our plans are pretty much set. So we can enjoy our holiday(s) free of the advertising bombardment, free of the rushing and worrying. We can eat our Christmas turkey for lunch with a cold beer and no ruckus to trouble us. God bless this day!

In Canada and Europe December 26 is known as Boxing Day. It also is sometimes called the feast of St. Stephen. (Remember the old Christmas carol, "Good King Wencelas looked out, on the feast of Stephen . . . ") Boxing Day takes many forms, but it is generally thought of as a day, after the excess of Christmas parties, that the rich give to the poor. The carol "Good King Wencelas" is about a Slavic king who was good to one of his poor subjects.

This is the spirit of the Christmas season. We need to bring it back. It seems so artificial to go back to work the day after Christmas as if nothing has happened. Holidays are not about feeling better for a day, or even "recharging our batteries." They are about feeling better for a day and then making that feeling stick. It may be a cliche to say that we should have the spirit of Christmas year round, but it is not a cliche to say that we need to be open to letting positive experiences reflect into our daily lives. Charity is not just for December, it is for July also, and we should be making every effort to ensure that the good feeling we have now carries on just that long.

Joyeux Noel et Bonne Annee!

My Christmas Op-Ed

Yesteday (December 22), the New Orleans Times-Picayune kindly ran an essay of mine on its Op-Ed page. It is about an experience I had with a patient in Chalmette, Louisiana and how it affected me through Katrina. You can read it here.


True Office Stories, Part 1

I once had a patient, Dan (not his real name), who lived with a woman and her two twin daughters. The daughters were terribly spoiled and gave Dan a miserable time. They wouldn't listen to him, they trashed his house, and refused to show him any respect. After about a year of living with the three of them, he got sick of the insolence, flew into a rage, and threw them out.

A few days later his girlfriend called him. "You need to tell your doctor when you see him that your Zoloft isn't working."

"My Zoloft is working fine," he said. "I threw all three of you out and I don't give a s**t."


Katrina #3: Help Out Storm Victims and Make Money, Too

So you want to help the folks who are suffering from Hurricane Katrina. What if you could do that and make money too? You might not think that is possible, but it is, and it is very easy to do.

The Gulf Coast will need a lot of money to rebuild. Not just public tax dollars, but also private investment. Much of this private investment money will come from banks. To help support this process of private investment, you, the private citizen, can lend money to the backs involved in the recovery effort. You do this by buying certificates of deposit in Gulf Coast banks.

CDs, or certificates of deposit, are bank accounts that you agree not to take money out of for a specific length of time. You can create CDs for 7 days, 1 month, 3 months, 6 months, 1 year, or even longer at most banks. When the time period expires, the bank adds the interest you have earned to your initial deposit, and then asks you if you want to renew your CD for another period of time. Say yes, and the bank puts the money in a renewed CD account. Say no, and it returns your initial investment, plus your interest.

CD interest rates are pretty good right now. Most 1 year certificates are going for about 4%, which means for every $1000 you leave with the bank you will get $40 back after a year.

Banks use CD deposits to make loans to clients. If lots of people buy CDs, the bank has more money to lend, and can charge lower interest rates. If not many people buy CDs, interest rates tend to rise and banks end up turning many borrowers away.

The goal, if you want to help storm victims, is to buy a CD from a bank that has lots of branches in storm ravaged areas. If you buy from a bank based outside of the Gulf Coast, most of your money will go elsewhere. For Mississippians, I would suggest Trustmark Bank. For Lousisiana and New Orleans, try Gulf Coast Bank and Whitney Bank.

This same technique could work for any disaster region. Just look for a local bank in the affected area, and buy a CD from them. You will be helping out, and it won't cost you any money to do it.


Pens, Pens, Everywhere

I am just starting up my medical practice here in McComb, and on slow days I get more drug reps than patients. For the uninitiated, a "drug rep" is an employee of a pharmaceutical company who visits my office with the purpose of convincing me to write more prescriptions of their product.

There are many thorny issues to explore in this subject, and I will touch on all of them over time. But today I want to tackle the subject of gifts.

Drug reps usually come bearing gifts. They give me something free, which theoretically makes me better disposed towards them and more likely to give them more of my time. Gifts come in many forms but professional ethics dictate a price limit. So they bring cheap stuff -- a few books, post-it notes, a clock or two, all with the name of their drug emblazoned on it. And they bring pens. Lots and lots of pens.

There are people who have the time to worry about such things who argue that accepting pens is a kind of bribery. That when I hold the pen in my hand and see the logo there that it kindles a fire in my soul to write prescriptions for that medication with the passion of a spurned lover. I like to think that the pens aren't worth that much and are not enough to sway me from prescribing the appropriate medication instead of the one on the pen.

I think ethics is very important in medicine. But there is no need for us to be so fastidious that we fuss over every tiny potential for error. I believe in robust ethics -- that is, an ethical outlook that can tolerate the little scrapes and bumps in the road that are normal to life. If my moral code is so weak that I would sacrifice quality patient care for a nice pen, then I have no business living in the world. Sure, the reps want me to write their product. And yes, the pens remind me of their product. But I cannot be so ethically feeble that a simple pen will cause me to disregard all my medical training, as well as my ability to make a rational decision.

If I am that weak, God forbid that someone should present me with a bribe of real value, say, a freshly smoked Christmas turkey, and then ask me to blow up a bridge, because I might do it. A pen is to a prescription as a turkey is to a bridge, or something like that.

Luckily, I am a bit less suggestible than that. I try to be always mindful of the influence of advertising. Accepting a pen is a way of playing ball with the drug reps. They talk to me, and give me useful information about their products. And they also bring free samples, which helps my patients. I think the benefits of the information and the free samples outweighs the drawbacks of accepting a trinket as a gift. And if you've ever gotten a free drug sample from your doctor, I'll bet you do too.