Perspective

The life of a family practitioner can become precarious at times. Each patient encounter is entering into a new realm. Even long term patients with mundane problems can present in chaos. Whenever I relaxed my guard, whether due to fatigue or the numbness that sets in while doing paperwork, or wrestling with the electronic medical record, I was quickly reminded that biology is the boss.

Generalists tend to have an arena where they are most adept. This may be due to a special interest or due to their patient population or it may be due to the particular training they received during internship and residency. Doctors are not created equal. There is latitude in structuring your education. This is what makes medical training unique and exciting.

In my case, I had been a Chiropractor for ten years before I managed (somehow!) to get into medical school. The Human Genome Project had begun in 1990 and my application essay (1992) was about using the genetic code to treat disease. But my true interests lie in the treatment of spinal disease. I tailored my electives towards that end.

I managed to put myself in many an orthopedic and neurological surgical suite. I spent time with anesthesiologist in pain clinics and with physiatrist in rehabilitation. Countless hours were spent in complicated surgical procedures and in the follow up. It is a separate realm from the nine to five world most of us live in. I admit I loved it and due to my obsession, Charlotte spent many a night and weekend alone.

The time comes when a student must declare a specialty. Then in my mid forties, it was time to consider my limitations. If I choose the surgical route, I would be in my fifties by the time the training was complete and I reckoned I would be divorced.

Throughout the training, I had kept in close contact with the medical college’s family practice department. I helped in the lab, spent other elective time in the clinic, and made some friends with the staff physicians; after all, I was closer to their ages than to my fellow classmates. At the last moment, I decided to pursue family medicine burning a few bridges in the surgical world.

I do not regret the decision. I knew my limits and the choice allowed me to participate in multiple pastimes I had ignored for a decade. Time is the tradeoff for living. It is finite, and it is, to steal Lenny Bernstein’s lecture title, “The Unanswered Question”. Since time is a priceless commodity, how to use it is a serious decision.

The thought that time and our lives are on hold due to the virus is a misnomer. March and April were scary, and May was even worse. I kept thinking how could I escape. Then June arrived and the warming weather expanded the universe to include the backyard. Now July is here and the walls are closing in once again. Half of the country decided to go back to normal. They let us down.

The earlier daily death counts and pleas for adherence created a feeling of panic. It brought back memories of Walter Cronkite’s nightly head count of Americans vs. Vietnamese killed. It was a weird calculus to make, to somehow justify the unjustifiable with a ratio.

Infectious diseases are on their surface not that complicated: to keep disease free, stay away from the offending agent. Thus the basic facts to wear a mask, wash hands, and simply limit exposure to possible disease carrying organisms, in this case humans.

In practice, doing this is horribly complicated and heartbreaking. Parents have to isolate from their children, grandparents from their grand kids, workers from their jobs, and since the virus is an unknown entity (other than it is murderous), there are no easy answers. Schedules set in stone will fail.

I wonder what our (my) parents would do if they found themselves in a similar situation. Of course, they had 30 minutes of news with dinner, not the 24/7 coverage we are bombarded with. I knew there was trouble brewing when the normally staid weather service, NOAA, began naming any storm that came over the horizon.

Several years ago while driving home from a banal activity that I would sell my soul for now, Charlotte and I stopped at Trader Joe’s for a packet of haricot vert and a few bottles of cheap French wine. It was late Sunday afternoon and the store was overrun. Many of the shelves were empty.

We were baffled and asked the chatty checkout worker what was up. Had we missed a conflagration imposed on us by a foreign nation we had wronged. Alas no, but there was a named winter storm on the way . . . oh? It is not that I am immune to the severity of storms but in decades of living in Chicago, which includes three hellish winters as a USPS letter carrier, rarely does it take more then a day or two to deal with the aftermath.

An atomic bomb builds on itself; one neutron hits an atom that sends a few more neutrons to hit a couple of more atoms and on and on. It gets out of control, which is what is wanted in a bomb but not in a weather forecast. I am an information junky but there is too much. It prevents the rational thought that comes from introspection. There is no time to process, just time to react.

There were many times in medicine where I had to react. Whenever I board a plane, I get nervous. In fact, the last time we flew to Japan I recertified in CPR. I am not sure the little card they gave me after I successfully passed the course made me feel better, but I was better prepared.

So, from my perspective the world, at least the socially connected world, needs to take a step back, turn down the volume, and take a breather. Let me see, can I think of another cliché . . . chill out might be a good one. It does not have to be for long, just long enough for rational thought to prevail.

July 2020

The photograph was taken by my nephew Matt. It is on the southside of Chicago early in the lockdown.

Stalked

It is summer. I am in the backyard. There is a virus out there stalking me, so, as they say, I am making the best out of a sow’s ear. The local fauna has decided to use the large blue spruce, which occupies the southeast corner of the yard as a nursery.

Robins, sparrows, and now cardinals made nests, and as far as I can tell, have successfully raised the next generation. Though, I should hold off on proclaiming the cardinals a success.

At the very top of the spruce, tucked in about a foot from the outside edge is a barely visible mud nest. It took a while to locate the small mud inclusion within the shadows of the branches. Even for us city dwellers the attention that this active pair of cardinals paid to that spot portended something was a foot.

Charlotte and I took to a watch schedule similar to one when piloting Carrie Rose. She had her binoculars and I had mine. And mine are the beauteous Leica’s I scrimped and save for, and then bought in the late 1980’s.

Though other binoculars are more powerful, these have clarity of vision. The image is sharp. The colors are vivid. The ergonomics are, well, ergonomic. For years they have lived on the boat, that is when I am on it, as they travel with me. So, it was with the Leica binoculars that I saw the first hint of the muddy brown nest.

Fledgling birds grow up fast. In the few days since spotting the nest, tiny heads with beaks open skyward appeared through the tangle of pine needles each time the parents came to the nest. Then an E, three octaves about middle C was sounded whenever the parents flew away.

As I watch the various birds flutter from yard to yard, I am reminded of a fact that I hear repeated on public television’s science programs: birds are the remnants of the dinosaurs that were left after the asteroid crashed into Mexico. Now, dinosaurs were big beast. So, when I see how the birds constantly fly around the backyards, I wonder if dinosaurs were as hyperactive.

Of course, I know not to lump all dinosaurs into the same category. A brontosaurus was probably not as active as a T-Rex and a T-Rex was probably not as active as a velociraptor. But I admit ignorance and since it is the middle of summer and over ninety degrees, I do not feel like doing research. I am on summer break after all!

I cannot get the images out of my mind. It make sitting in the backyard more adventurous. I anxiously wait for a massive feathered creature to bound over the neighbor’s fence, and stop just long enough for me to take a picture for Instagram.

For it is my secret wish that before I pass from this earth, I will have one picture go “viral”. It will be my 15 minutes of fame, and as long as there is power for the Internet’s servers my digital footprint will exist, waiting to be retrieved by the latest search engine’s algorithm.

Is this too much to ask for while sitting in the backyard, in the summer being stalked . . . is it!

July 2020