Renewing Vows

I love you. Today is a very special day.
Long ago you were just a dream and a prayer.
I promise to give you the best of myself and to ask of you no more than you can give. 
I promise to accept you the way you are.
I promise to encourage and inspire you, to laugh with you,
and to comfort you in times of sorrow and struggle.
I promise to love you in good times and in bad,
when life seems easy and when it seems hard, 
when our love is simple, and when it is an effort. 
  I will be your friend and life partner no matter what life brings to us. 
Today I pledge my commitment to you.

Jerry & Veronica

Bodega Bay, California

2 - 22 - 2008

2012 - Random Thoughts #1

Life has changed quite a bit since we got a dog.  It's like having a baby without the possibility of sending it off to boarding school once it turns five years old.  My DH and I went through a period of yelling at each other over random things during the first week mostly because we were sleep-deprived from the every hour potty trips to get the dog housebroken.  Dixie's done very well, though, so in the long run it was worth it.

But, seriously, life revolves around Dixie and her schedule.  We wake up early to take her out, then it's breakfast time.  We play for 30 minutes then it's potty time.  More play or a long walk and then it's nap time.  After our her nap, it's usually about lunch time.  Another 30 minutes and it's potty time again.  Then more playing, more walking, more napping.  Then comes dinner time.  The next 30 minutes passes, potty time, play time, snack time, then finally bedtime, with one more potty run just in case.  And, we wake up and do it all over again.

And, when I say "we" I mean my DH.  Why, because I am usually working most days of the week.  You see, I like to travel, and that means consolidating my 16 shifts into usually 20 days out of the month because I want the other 7 - 10 off for different adventures.  This month, I had to fit in a spontaneous trip back to So. Cal with a course on public speaking and our yearly anniversary trip.  And, I only had 29 days in this month's schedule to do it in.  So I am working, A LOT...!

Which means I am not available to help with important things around the house... like unpacking all the boxes we had to move from our rental or planting the trees we bought a week ago... So, my house looks like a scene out of "Hoarders" and the trees are lying on their sides in the back yard pond.  Also, I keep thinking of things I need, but I don't know what box they are in or if it's easier to just go out and buy a new one at this point...

Work is the usual combination of a few real emergencies mixed in with the plethora of non-emergencies and a peppering of crazies to make the shift just that much more interesting.  Like the guy whose chief complaint was "eating all the time."  If you want to know what makes medical care so expensive and where your hard-earned tax dollars are going, it's to support people like this.  He wanted me to give him medications to make him stop eating so that "he wouldn't get fat" because if he did then he was "going to fly to Switzerland to see the 'doctor' who performs assisted suicide on non-terminal people."  He asked me for amphetamines and anti-seizure medications to help him with his "problem."

If I can't keep a straight face during your initial exam, I don't think I can help you...

I also can't help:
 - any symptom that has been present for longer than 48 hours, that has been extensively worked up by another doctor, and for which the cure is, in your opinion, more pain medications
 - children whose parents insist on smoking (oh, I only do it outside with a smoking jacket) when their child has a cold/asthma/repeated ear infections;  I actually had one mother break down in tears at her daughter's bedside when I admitted her child with asthma, she dramatically threw her pack of cigarettes in the trash and apologized to her daughter for making her sick... funny thing is I saw her the next morning in the smoking hut where she was taking a break from visiting her daughter
 - bad teeth:  I am not a dentist, I don't pull teeth, again stop smoking...

Fuel the Machine

While I have been known to indulge in the occasional bacon-blue cheeseburger from time to time, for the most part I have been following a mostly raw diet.  When I get a chance to cook at home, I use natural ingredients and shy away from processed foods.  So when I consult my overweight patients about healthy eating, I know what it takes to do it.

My philosophy from my days training in cardiac surgery is "Nothing in a bag, nothing in a box, nothing in a can."  Nothing in a bag means fast food.  I know you can get a full meal from Micky D's for about $5, and the same meal would cost you more to buy and take more time to make, but the health benefits should take precidence.  Nothing in a box means TV dinners and pre-processed "add water and heat" type foods.  They have little nutritional value and are usually salt or sugar loaded as preservatives.  Nothing in a can means sodas and canned foods.  Sodas, again, have no nutritional value, and have high concentrations of sugar and salt.  Remember the 50 pound two year old I talked about in a prior post...?  Canned foods also have high sugar and or salt contents to help with preservation.

So when Mrs. POTUS talks about programs to limit what you can and can't buy at school or limiting personal freedoms under the guise of "if you can't take care of yourself, let the government take care of you," let me let you reflect on the EBT buyer who had a grocery cart loaded with Top Ramen, packaged juice boxes and sodas.  I maybe saw one object of nutritional value - a gallon of milk - which most likely was to be poured over the box of sugar bombs also sitting in her cart.  Maybe that school diet will be the healthiest thing those children eat all day.

If you need any further proof of going raw or going natural, watch this video...

Ghost of Dorm Rooms Past

I was visiting my mother this past week, and I started digging through some old boxes in the closet of a room that used to be mine while growing up. I had reconnected with a childhood friend on Facebook, and I knew I still had the letters we exchanged during our high school years. Yes, I am a closet hoarder.

Anyway, amoungst the other things I found in one of the boxes was a scrapbook photo album that I had created when I started college back in 1985. Wow. It's incredible to think that it's been almost 27 years since I was this bright-eyed freshman who was out to conquer the world, and who had yet to suffer any disappointments more severe than not getting my first choice in class schedules. The things I would love to tell this old me.

Combing through all the cards and letters (remember when we used to have to actually write something down and send it via mail?) I read through stories of friends lost, loves lost, crushes crushed... you get the idea. I read letters signed "friends forever" and can't remember the person behind the name. Where did I meet them that we "had such a great time with you, and can't wait until you visit again." What happened to that girl who used to send me birthday and Christmas cards addressed to "my sister" because we were such good friends? I lost touch with her when she dropped out of college and then wouldn't return any calls or respond to any letters. Last I heard she was studying archeology, or something like that... wonder where she is now...

And, who are all these people in these pictures, and what happened to them? Some are in multiple pictures. Some we're hugging on, some we look like we're just putting up with. This one was studying medicine. This one was a drama major. This one broke my heart, several times. I carefully put back all the letters and photo album into their boxes.

I didn't have enough time on this trip to carefully read through the pile and decide what to keep and what to throw away. A few pictures I did photograph, like the one above, for future Facebook blackmail.  Go back and do it all again...?  Maybe, but could someone please tell the old me how to work my gaydar earlier rather than later because it will save a lot of angst and frustration in the years to come.

Setting Priorities

I sometimes think that all of our healthcare problems could be solved if people could just get their priorities straight.  I talk to patients every day who won't buy their high blood pressure medications because they "don't have any money until their CMSP kicks in" but yet they have the money to buy meth.  They can't get in to see their primary care doctor for a follow-up because they only have enough gas this week to get them to the E.D. and back, yet they insist on driving the most expensive 4x4 truck that gets 7 miles to the gallon.


I've had patients with dental abscesses buy their pain medications but not the antibiotics because "that's all I could afford;"  probably along with the pack of cigarettes they just had to have as well.  I've had to dispense Tylenol and Ibuprofen to children because their parents don't have "time to run to the store" but seem to have time to text on their cell phones while making appointments for their manicures, and asking if we can "watch the kid for a second while I run out for a smoke."


I had a child (18 month old) brought in who was three times the weight they should be because "grandma gives them a liter bottle of Pepsi" every day when she babysits.  When I suggested that Grandma not buy any, the parent responded "but ___ will cry if he doesn't get his Pepsi."  And, I've heard the same said about Happy Meals, ice creams, Starbucks, etc.  Which explains all the "Baby Hueys I've been increasingly seeing in the E.D.


Until patients start taking some responsibility for their health, we're going to continue to see medical expenses rise.  And, we're going to continue to be the nation spending the most on healthcare and not seeing a return on our investment as patients become even more obese, diabetic, hypertensive or continue with their narcotic, alcohol, or tobacco addictions which lead to their own special set of problems.  As a friend of mine likes to point out, "You call it annoying;  I call it job security."

Life in Dixie's Land

I got my puppy!!  Dixie is so cute, and so very smart.  It's scary how smart she is.  We got her yesterday, and already she knows Sit, Come, and is learning the concept of Fetch.  We had one oops... but, hey, housebreaking doesn't happen overnight.  Although, she did let me know twice during the night from her kennel that she needed to go out.

Her adventures are going to be detailed in her own blog lifeindixieland.blogspot.com where you can watch this amazing little creature grow up and develop into what I am sure will be a great dog!

spring is like...

One of my favorite poets is e.e. cummings, and I was thinking about his poem "spring is like a perhaps hand" the other day when we visited the OK Corral in Tombstone, Arizona.  As many of you know, I love to travel, and while in Tucson for a conference this last weekend, we did something fun for my husband which was to indulge his Wild West fancies.            Have you ever been to a tourist location before it "opens" for business?  That's what reminded me of this poem.  We got to Tombstone relatively early... around 9:30.  Since most of the stores didn't open until 10, and since it was the weekend, the town was still in the process of "waking up" when we got there.   We went into one of the small cafes for a quick breakfast, and while we were in there several of the store owners and tourist operators were stopping in for their own breakfast.  Everyone in town dresses in the style of the late 1800's, so it was fun to see the high boots and spurs on the men, and the long skirts and prairie tops of the women.  We walked out onto the main street just a little after 10, and you could see the town slowly coming to life. 

As we came in and out of stores, you started to see more people on the streets and soon the town was humming along.  More cowboys showed up.  Fights broke out on the streets.  A lot of tourists came in costume.  It's always an amazing thing for me to watch.  It reminds me of early morning walks in Boston when the city slowly comes to life.  We spent several hours in Tombstone, mostly to find my husband the perfect cowboy hat and to watch a live performance show at the Wyatt Earp Theatre (very reasonable, and good actors btw - better than the OK Corral show).

We drank ice cold sarsaparilla (very creamy smooth) sold by one of the local vendors who recommended we go to the town of Bisbee which is located about 20 miles south of Tombstone.  Since it was about time for lunch, we decided to go.  Bisbee is a copper mining town that has now turned into an artist/antiques touristy venue.  There are lots of small shops and restaurants to explore, not to mention the array of houses built onto the hillside.  All in all, a very fun "off the beaten path" road trip.

by e. e. cummings

Spring is like a perhaps hand
(which comes carefully
out of Nowhere) arranging
a window, into which people look (while
people stare
arranging and changing placing
carefully there a strange
thing and a known thing here) and

changing everything carefully

spring is like a perhaps
Hand in a window
(carefully to
and fro moving New and
Old things, while
people stare carefully
moving a perhaps
fraction of flower here placing
an inch of air there) and

without breaking anything.