Doctor Outspoken (A poem about doctors and free speech)

Doctor Outspoken

Dedicated to all the docs who pay for their opinions with harassment and sometimes with firing.

Oh doctor dear, we need you here!
We need you day and night!
We need your skills
At treating ills
So sick folks are alright.

Oh doctor wise, we need your eyes!
We need your healing touch!
We need your knowledge
From med school and college,
Your training all matters so much!

But doctor loud, doctor proud
we need not hear your thoughts.
You tend to complain
And you’re always a pain,
Remember that you have been bought!

Doctor mad and doctor sad,
Please silence your dissident views.
You’re here for the money
And trust me there honey,
We’ll find other doctors like you.

Oh doctor broken, doctor outspoken
We know that you have a full cup.
But don’t speak your mind
Just smile and be kind.
And oh, one more thing…just shut up.

Oh doctor mister, doctor miss,
Do keep in mind who is in charge!
You heal patients’ woes
But you’re really the foes
Of the suits and the clip-boards at large.

Doctor tired, you could be fired,
For sharing the things that you see.
You just have been ravaged
By business-folks savage;
Who think speech should never be free.

Doctor wise who tells no lies,
Thank you for fighting the fight!
If we all surrender
Then none will remember
When speaking for truth was still right.

Sleeping Around in Odd Places

I used to practice locums medicine; which for the lay-person means traveling to different jobs, sometimes several states at a time.   During that time I stayed in a lot of hotels.  But, occasionally, I had more unique accomodations.  Obviously, if you travel enough you’ll sleep in an airport here and there. No big deal.  I actually like sleeping in airports occasionally.  When you’re stuck, you’re stuck.  Weather or mechanical issues, it’s fun to watch everyone freak out.  I’ve put my carry-on under my head and passed out cold in the waiting area.  Probably snored like a freight-train.

I have also been put up in apartments owned by the hospital. Not necessarily bad, although one of them felt as if it really weren’t in the safest part of town.  I wouldn’t leave my things there, and I insisted on a hotel.  Such is the power of locums.  I had a nice room the next night.

Once I had to spend my first night in a sleeping room, after hours, in the back of a local mental health clinic.  That was a little creepy. Again, I said, ‘no mas.’  I had no interest in being accidentally committed.

I’ve also slept over in hospital call-rooms, even on days off. That can be good or bad, but generally the beds are wretched.  Which always makes me wonder why patients are so anxious to get into them.  I guess any bed beats an ER gurney.

In one small, critical acces facility, I worked 24 or 36 hour shifts and stayed in a converted patient room.  I felt a little like a very old man, raising and lowering the head of the bed, and listening in the hallway to hear nurses walking up and down, taking care of the elderly who were there for rehab.  I ate off of hospital trays, sometimes reclining on my hospital bed.  I may have gotten a little too ‘into character.’

Today, however, was unique. I’m not doing locums per se, but I’m working a full-time gig out of town; three or four on, seven off. The hospital has an apartment that it keeps for us to use.  However, after I worked overnight last night, I was given a key and an address and sent off to find my sleeping hole.    However, at 6:00 am, the lights were dim, the signs were poor and I had almost no idea where to go.  In the dark, I was driving down abandoned streets, looking at windows and doorways, skulking up stairs in a retirement center, trying to figure out just where to go.  Confident I would eventually be arrested, Tased or shot, I went back to the hospital and a few phone calls later I was told where to go.  Indeed, my apartment was on the premises of a retirement community/nursing home. At 6:30 I was admitted to said nursing home where the lights were bright, the news on, and on old man propelled himself in his wheelchair, whilst holding coffee and looking at me suspiciously. It had that feel of a place where the day is about to start, but the changing days mean nothing.

I had a momentary terror, that I had it all wrong.  Was I really leaving my shift, my 53-year-old self sleeping off the busy night?  Was I still in my vigor?  My children still unmarried and my wife a couple hours away, looking forward to my return?

Or was one of the kids going to come to me and say, ‘Papa remember, you retired.  This is your home now!  We’ll visit you later, now go back to bed.’  Shudder.  Anyway…

A kind nurse took me to my apartment, and out of the off timelessness of the nursing home proper.  I slept a while, and left to go home.  However, due to some schedule issues decided to stay in town.

Rather than return to the apartment, which would be in use by the next doc and would consign me to the couch, I got a hotel room.  ‘Ah, rapture!  Cool sheets, dark shades, television before the bed!’

But as I checked in, I was cautioned, ‘we’ll be testing the alarms, don’t worry!’  I didn’t.  And then, for about two hours the fire-alarm intermittently sounded, all but deafening me.  My ears still ring from the thing.

Finally it stopped, and I slept off some of the night shift and its exhausting chaos.  And I was not shot, stabbed, Tased, arrested, committed or restrained due to dementia.

It was, therefore, another pretty good day.

Mid-sized ER Madness; Thoughts?

I know, I know, I spend way too much time ranting about work in the emergency department.  But after some recent shifts, my box of rants is full once more.  And what I want to point out is the enormous struggle of the mid-sized emergency departments in America today.

I know this is a problem; I work in them, and I know and talk with people who work in them.  It’s getting harder all the time.  So what is that ‘mid-sized’ ED?  For purposes of my discussion, I’d say (depending on coverage) somewhere from 16,000 to 40,000 visits per year.  Now that’s not scientific, that’s just for the sake of discussion, and based on personal experience.

I’d love to hear commentary from readers, because I’m trying to figure it all out.  But let me start with a story.  When I was fresh out of residency, I worked at dear old Oconee Memorial Hospital in Seneca, SC.  Our volume as I recall was around 23-25K per year.  We had pretty good coverage at first, with three 12 hour physician shifts a day.  Patients were sick but we moved them through.  And when I worked nights, I remember that it wasn’t unusual for me to lie down about 3 am and sleep till 7 am.

Fast forward.  Even at my current job where I see 19K per year, there’s barely a night when patients don’t come in all night long.  So is volume spread out more?  Maybe.  Are patients sicker?  Possibly.  I think some of this may be that patients have no primary care, and so they don’t even have an option to ‘wait till morning.’  In addition, a large number of patient (in all ED’s) are jobless.  So in their defense, 3 am is as good as 3 pm when you don’t have to go to a job in the morning.  (I’m not disparaging; but I do think this is true.  Think about your teenagers who sit up all night in the summer if they don’t have jobs!)

I also wonder if our patients are sicker.  I mean, medicine is pretty amazing nowadays, and people who would certainly have died when I was in medical school now repeatedly survive significant heart failure, MI, stroke, pulmonary embolism, respiratory failure, various infections and all sorts of problems.  And when they do, they have to come back to the ED frequently.

For those with docs in the community, I’m sure the offices are crazy busy all the time. Even those docs have patients they just can’t squeeze into appointments. They use the ED.  And maybe, just maybe, our patients are much more ‘medicalized’ than before.  So much of what the emergency departments see is really psycho-social.  Anxiety, depression, suicidality, substance abuse.  The numbers of these conditions seem to be exploding, and they can seldom afford primary care, much less mental health care.  The all-night ED is the place they go.

And there is a subset of patients who use the emergency department for entertainment or convenience; rides, snacks, a way to avoid arrest.  ‘Officer, I…have…chest pain!’  These also take time and space.

So what happens is all of this descends on departments with limited resources and staff.  And all day, and all night, one physician or two, maybe a PA or NP, struggle to sift through five or six chest pains alongside two stroke alerts, a suicidal overdose, two septic senior citizens, a dialysis patient who missed two appointments and has a potassium of 10 and a femur fracture.  Add to that the family of five with head colds.   Sure, this is what we do.  We are emergency physicians and nurses and mid-levels.  But into this mix, in the mid-sized department, recall that there is:  no cardiologist, no neurologist, no psychiatrist or counselor, sometimes no available ICU beds, possibly no pediatrician and definitely no dialysis in the hospital.

The day is spent sorting, stabilizing, making phone calls, transferring and waiting for ambulance or helicopter to become available.  All the while?  Sifting through very cumbersome and inefficient computer documentation systems designed for billing not flow.  And being scrutinized for through-put, time stamps, protocols, national standards, Medicare rules, re-admissions and all that mess.

I really don’t want to sound like a complainer. What I’m concerned about is 1) the safety of the patients and 2) the physical and emotional health of the caregivers.  At the end of the day, we’re all exhausted.  And so much is going on that we can barely find the obvious stuff, much less the subtle things that can also kill.

It sometimes seems as if departments are intentionally understaffed to save money.  I understand that it’s expensive to have doctors, nurses, etc.  But administrators get mad at folks ‘standing around,’ without realizing that in the chaos and suffering of the ED, sometimes it’s really important to ‘stand around.’  To breathe, to think, to rest, to gather oneself, to look up a condition or problem, to debrief.  To eat.  To pee.

I think that the world of medicine has decended on the emergency department.  I know that we handle it valiently.  But I don’t think it’s safe; and it’s nowhere as unsafe as in the relatively under-staffed and under-equipped mid-sized community hospitals of the world.

I’m proud of what we do.  But some days, most days, I wonder how we do it.

Any thoughts?

Edwin

Electronic Devices Shouldn’t be Used as Comforters (for Frightened Children)

The Dangers of Summer

This was my most recent column in the Daily Yonder.  Unfortunately, the Yonder website is down or I’d give you a hot link.

It’s Spring now and all across the land things are bursting with life. Flowers are in bloom, yards are bright with new grass and the sun is high in the sky. My car was, for a while, covered in a thick, green coat of pollen. Carpenter bees are still turning my log-house into Swiss Cheese. It’s pretty out, the sky is blue and the days are warm. Blah, blah, blah. I for one don’t really like this time of year. And it’s mainly because warm weather brings me patients with all kinds of injuries; some of them pretty nasty.

In rural America, there are dangers that seldom occur to people in more populous, metropolitan areas. Ironically, though, rural folks often assume that life in the city is more dangerous. And indeed, murder rates are higher.

However, according to the CDC, deaths from unintentional injuries are 50% higher in rural than urban areas; https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html. These differences in death are due to several causes; rural citizens are further from necessary health care and are closer to large lakes and rivers, use dangerous equipment and firearms. Doubtless there are many factors involved in the difference.

Of course, some of the perils of rural life are just the result of living in close proximity to nature and all her deadly charms. In Spring and Summer, we encounter creatures that bite and sting. Just last year, while mowing our lawn, we must have run over yellow-jacket nests at least half a dozen times. By the end of the summer I just let the grass grow. ‘You win!’ I screamed to the little jerks, hiding in their holes. Whether it’s scorpions, hornets, wasps, centipedes, spiders or some other tiny monster, we simply encounter such creatures more in the warm months. And their various stings and bites, while rarely fatal, can cause dangerous allergic reactions. And make your spouse want to leave the area and move to a condo.

Fortunately, deaths from allergic reactions of all sorts are rare, and around 99 deaths per year in the US. https://www.aaaai.org/global/latest-research-summaries/Current-JACI-Research/death-anaphylaxis. Still, If you or your loved-ones are afflicted with such allergies, please talk to your physician about what to keep on hand; hopefully epinephrine injectors will get cheaper. And there are some other brands besides the ‘Epi-Pen’ that should be less costly. They just hurt a lot (the Black Widow) or make ugly wounds (the Brown Recluse).

Poisonous reptiles (Copperhead, Rattlesnake, Cottonmouth and Coral snakes) are also a feature of rural life in many areas. Those who ‘ooh and aww’ in city zoo reptile houses rarely have the singular delight of encountering these wonders in their own yards or whilst walking through the woods. But these creatures, while important to the eco-system, can deliver nasty wounds and in rare cases can be lethal. They’re certainly dangerous to your finances given the cost of anti-venin to treat the bites. So be aware as you go about working and playing in places where snakes are also enjoying the summer sun, or cool evenings.

Remember also that at least in the US, many snake bites occur because people are 1) intoxicated and 2) trying to mess with the snakes. And yes, ladies, this is a peculiar affliction of men that starts with ‘hey, betcha’ I can catch him!’ Actually, I have it on good authority that snakes don’t even like the taste of drunk people and would like to be left alone, thank you very much.

Now, other dangers of rural life have to do with the necessity of power-tools. In my own life, the chain-saw, weed-trimmer and lawn-mower are absolutely essential to keeping nature from simply over-running our house. But as the dear reader knows, these are things to be treated with great respect. Please use appropriate protective gear, like safety glasses, gloves, appropriate clothes and heavy shoes. Of course, those who work on highways or farms use much bigger types of tools and heavy equipment and have to be ever watchful. This is probably more true in Spring and Summer because that’s when farms are busy, roads need to be fixed, bridges repaired, pipes laid, power-lines connected, houses constructed and all the rest. God bless all those folks who make our lives better by doing hard, dangerous work on the hottest of days.

And of course, warm weather brings assorted recreational dangers. Hiking and camping are delights, but someone always manages to fall off of a waterfall or cliff-edge, break an ankle, sustain a laceration or encounter said biting and stinging creatures.
Bicyclists and motorcyclists look forward to warm months so that they can enjoy the open, dry road. But helmets really are important as is appropriate protective clothing, reflective material and good education. I’ve seen patients who left their tanned skin on 50 yards of asphalt. Nobody enjoys that.

Lakes and rivers are warm, and filled with persons who typically want to be dragged at high speed behind a power-boat while skiing, clinging to a large inflatable item for dear life, or kneeling on a wake-board. Likewise, fishermen head to their favorite spots (either in tournaments or alone for peace and quiet) and other aquatic persons kayak, canoe and raft the rivers that draw so many to rural America for vacations. All of which is fantastic! But remember to learn to swim, always wear life-jackets and follow local laws when doing all of the above.

Obviously there’s always the danger of heat exhaustion, heat stroke, dehydration and sunburn. We all have to remember to be careful to stay hydrated and remember that beer and caffeinated sodas don’t help. Also be reasonable about sun exposure and wear sunscreen to hep protect against skin cancers.

And if the gentle reader wishes to avoid painful foreign bodies and sutures, here’s another bit of advice. Wear shoes all; all the time. Simple and to the point.

Spring and Summer are glorious in rural America. But the dangers are many; I’ve only skimmed the surface here. Please remember to be safe, think before doing, follow the laws, don’t drink and boat, drive, ride, ski, pick up snakes, work with power-tools or do just about anything else. If you’re going to drink, find a chair and sit in it. That bit of advice would keep many an ER quiet all night long. Also remember that everything I said you shouldn’t do when drinking is something you shouldn’t do while taking narcotic pain medications.

I hope everyone has a great summer, free of emergencies. And that you can still be around when that first breath of cool air dips down from Canada and a proper season comes back once more.

Just please, please, be careful out there, OK?

(If you’re interested, here’s another link to a nice discussion of the unique injuries common in rural America. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448517/)

Welcome new physicians! Watch where you step…

Today is the day that new resident physicians begin their training all across the United States.  Today, our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (OK, not really a specialty, just a side-line) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school.  Anxiety-filled and debt-ridden, they will embark on four to seven (or even more) years of training to make them knowledgeable, technically proficient physicians.

I will occasionally wax poetic and philosophical for their benefit.  But not today.  Today there are practical matters.  Today I want to give them a few pointers, to ease their transition into the maelstrom of post-graduate medical training.

1)  Any flat surface that holds still, is free of gross body fluids and not used as a walk-way or cook-top will serve for a quick nap.  Practice sleeping in odd positions:  sitting upright, reclining at various angles, lying sideways or with your head cradled in your hands.

2)  In my day (always wanted to say that!) we filled our fresh, white lab-coat pockets with review books, algorithms, reference manuals, scissors and calculators.  And candy bars.  You, doubtless, have a smart-phone of some incarnation, which contains all that we had, as well as the Web.  Which means, where we had to play video games in the lounge and find answers in giant, antiquated things called attending physicians and books, you can look up fun facts on hyponatremia and instantly play Angry Birds, whether you’re on rounds, in the cafeteria or hiding in the call-room, pretending you didn’t hear ‘code blue.’

3)  Eventually, you may decide the lab-coat isn’t worth it.  Don’t be surprised.  Your kids will eventually wear it for Halloween.

4)  If you keep the lab coat, what with the extra space in your pockets, carry extra candy bars.  Or protein bars, or whatever it is you crazy kids snack on these days.

5)  Watch where you step.  Trauma patients and cardiac arrests are exciting!    But there’s almost always some body fluid on the floor when the shouting is over.  Try not to get too covered in blood early in your call night.  It’s sticky and gross.

6)  You know so much.  You don’t know anything.  Keep those two ideas in constant tension.  Odds are, your command of modern evidence-based medical research is extremely impressive.  Eighteen years after residency, I can still leave you in the dust when it comes to making decisions and knowing who is sick and who isn’t.

7)  See above.  Learn, as quickly as you can, who is sick and who isn’t.  Hopefully medical school helped; but don’t count on it.  If you know this simple thing, you will know when to go for help, when to panic (or not) and what to tell your upper level residents and attending physicians on rounds.  And you will become that greatest of commodities:  useful.

8)  Look professional, develop your own style.  Be comfortable.  My friend Sherri used to wear pearls on call, with her green scrubs.  They always made her appear elegant, no matter how much pediatric vomit had been hurled her direction.

9)  Patients can be frightening.  But remember what they told you at camp, about bears, raccoons and snakes.   ‘Don’t worry, they’re just as afraid of you.’  This is kind of true.  Except patients really aren’t afraid to ask for pain medicine or call attorneys, whereas you are afraid to do anything since you can’t believe you know anything yet.

10)  You may be more frightened of physicians than patients.  But remember, the people assigned to train you are smart, capable and experienced.  And they put their tentacles in their pants just like everyone else.  Ask them questions, listen and watch.  And remember what I said above:  be useful.  My surgery resident was fond of saying, ‘Help me, don’t hurt me!’

11)  You will soon have a thing called a paycheck.  It will have a stub that shows how much the government is taking from you.  Do not be surprised.  This happens to everyone.  It’s just that you owe a lot more money than most people.   Cheer up!  Everyone expects you to be rich someday, so they can complain about the fact that your rich.  (Whether you will be or not remains to be seen.)  Remember that no matter how little or much you make, never tell a contractor or car-dealer you’re a physician.  Tell them you work in customer satisfaction, or something nebulous like that.

12)  Crazy people, even really crazy people, are sometimes terribly ill.  Pay attention.

13)  Ill people, really ill people, are sometimes very crazy.  Pay attention.

14)  Medicine is inexact.  I promise you will make mistakes. Don’t live in fear, and don’t let error define you.  No one in medicine, or law, is capable of perfection.  Except for being perfectly insufferable, of course.

15)  If you poke things that look like they are filled with blood or pus, they will explode into your face; if you tend to hold your mouth open when you focus, well you know what will happen.

16)  Scalpels really are sharp.  Pneumonia and HIV and TB and Hepatitis really are communicable.  Psychotic patients really will try to choke you.  Medicine is dangerous.  Be careful out there!

17)  Human beings are really frail, vulnerable and hurting.  Be gentle and kind whenever possible.

18)  Have fun!  Don’t think of it as residency, think of it as a chance to spend most of your waking and many of your sleeping hours in a huge, cold-building where people are dying!

19)  Everyone is proud of you.

20)  Pay attention to what the nurses say.  They aren’t always right.  But for quite a while, they’ll be right more than you are.

21)  Only three to seven years to go!  Hang in there.  Remember, it’s no different from Boot Camp.  It just lasts much, much longer.

The Canine Pain Verification Team

We’re all familiar with the dogs used by the blind, and more recently with dogs used to comfort those with PTSD. There are even dogs that identify low blood sugar in diabetics!

What I want is a ‘pain scale dog.’  Physicians who treat pain in the emergency department and elsewhere are often confused and frustrated by the pain scale, by its inherent subjectivity and by the abuse to which it is subject.

That’s why I want the Pain Verification Dog.  Let me illustrate.

21 year-old-patient presents to emergency department ambulatory.  He is healthy appearing but grimaces, saying ‘I pulled it at work.’

Me:  ‘What’s your pain scale, sir, if zero is no pain and ten is the worst pain in the world?’

‘It’s a twelve!  No kidding, maybe a 15!’

Me:  ‘Nurse, call the Canine Pain Verification Team!’ Dog enters room.  ‘I repeat sir, what’s your pain scale?’

‘Now it’s a 20!  I have to have some, what is it, it starts with a D and it’s all that ever helps!’

Me:  ‘Sir, that’s Axon. He’s highly trained and very sensitive to pain scales and he feels that you may be overestimating!’

‘Dude!  Get that dog off me!  I’m serious!  OK, OK!  It’s, it’s a ten!’

Me:  ‘Sir, I appreciate your situation; but Neuron disagrees.  What do you think?  Is it really a ten?’

‘I’m serious, I’m scared of dogs!  My back hurts and this is making it spasm!  OK, OK, it’s, it’s maybe a three, OK?  A three!  Can I get a Tylenol or something!’

Me:  ‘Sir, the pain scale dog team leader, Decem, says “good boy!”  Here’s a list of exercises and an Aleve.’

Now those are useful service dogs!

 

Emergency Medicine: a Model for Unity

This is my April EM News column.  I hope you enjoy it!

http://journals.lww.com/em-news/Fulltext/2017/04000/Life_in_Emergistan__A_Model_for_Unity_and.12.aspx

How do you define yourself? How do you describe yourself? In the past, I have tried to avoid immediately categorizing myself by my profession. I always agreed with The Little Prince:

“Grown-ups love figures…When you tell them you’ve made a new friend they never ask you any questions about essential matters. They never say to you ‘What does his voice sound like? What games does he love best? Does he collect butterflies?’ Instead they demand ‘How old is he? How much does he weigh? How much money does his father make?’ Only from these figures do they think they have learned anything about him.”
-Antoine de Saint-Exupery, The Little Prince.
Taken from https://www.goodreads.com/work/quotes/2180358-le-petit-prince

And yet, we do this constantly. Physicians especially love to divide ourselves into groups. Each group has its own characteristics. Most of those reading this (but not all) are EM docs (ER docs if you’re older), also known sometimes as ‘pit docs.’ There are internists, or fleas. Surgeons, or cutters. Anesthesiologists, or gas passers. Pediatricians, or pediatrons. Radiologists, or shadow doctors. Orthopedists, or carpenters. (I kid!) This is a natural division as our specialties are our big, nerdy fraternities and sororities. They are the places we learn to make our living, establish habits of thought and behavior, create world-views and life-long friendships.
Unfortunately, it goes much further than specialty. We are divided between rural and urban, and there are significant problems in that chasm, as physicians in urban teaching centers sometimes have little knowledge of the stark limitations of the rural setting when we call for help or transfers. ‘You don’t have a surgeon? You don’t have an ICU?’ Likewise, rural physicians often forget that even ‘the big house,’ eventually reaches capacity and can’t take transfers; and the presence of the large center (or a helicopter) is no excuse for sloppy care on the outside.
We are also demarcated by into ‘community vs academic.’ In my medical wanderings over the past few years, I have found that this is a point of contention with many community physicians. Research, treatment pathways, algorithms, check-lists and new imperatives seem to constantly emanate from academic centers and flow to the community hospital and its citizens. Community physicians, many of whom have lived through countless swings of the medical pendulum and associated policy changes, are often reasonably skeptical of the latest study, the latest rule about pain medications or sepsis protocols. They feel cut-off from what they perceive is a connection between academics and policy-makers, and they feel particularly excluded if, later in life, they have an interest in entering academia, which seems like a closed club.
Physicians are also increasingly divided by gender and sexuality, as we see various physician advocacy groups pop-up. That’s fine, I suppose, so long as it doesn’t split us further apart but serves as a source of encouragement and connection for the members of those groups. (It becomes toxic when it is used as an exclusionary tool. I was told once that my opinion in a debate was less relevant because I was a ‘straight white male.’)
However, our divisions seem to be at their worst when it comes to politics. And it’s a pity, really, because we have such potential to be models for the rest of the world. I have seen physicians argue politics in person and online. I have been part of some of those debates, and it can be very, very ugly. I have recently withdrawn from most political dialog because it wastes time, causes anger and accomplishes nothing.
But I will give this ‘opinion’ and stand by it. I’ve worked with physicians who were Christian like me, Muslim, Hindu and atheist. I have worked beside ardent progressives and hard-core conservatives who make me look like a socialist (and that’s tough to do). I have worked with physicians who were gay and straight, rural and urban, academic and purely clinical. I’ve laughed and cried with them, eaten with them, encouraged and been encouraged by them. And I’d do it all over again. Because when it comes to our job, our real job of treating the sick, easing suffering and saving the dying, all of our differences evaporate into vapor.
So identify yourself by whatever category you wish. But never forget that we can serve as a model for unity, a model for the greatness of all free people, when we do our jobs well, and do them together for the good of others.
Now, what’s your favorite food? What’s your hobby? Tell me about your wife, husband and children. Because those categories interest me more than all the rest.

Pandora’s Pill Bottle. (A poem about the narcotic epidemic)

Pandora’s Pill Bottle

‘Patients who suffer from painful conditions
Should always be treated by caring physicians,
Who never forget to give good medications
For problems from fractures to awful menstruation.’

‘The fifth vital sign is your bright guiding light
The pain scale will lead you to do what is right,
So doctor remember to show some compassion
Since giving narcotics is now quite the fashion!’

Thus we were told for a decade or two
As patients stopped breathing and turned rather blue.
But hospitals loved their new high survey scores
And doctors were turned into pill-writing whores.

Yet things are now changing across the whole nation.
There’s blame all around and new drug regulations.
‘What were you thinking? What were you doing?’
‘How could this happen? Someone will start suing!’

In ER’s and clinics and every location
We docs shake our heads with increasing frustration.
We did what they told us despite all our fears
And Pandora’s Pill Bottle spilled out for years.

The pain scale betrayed us and caused too much trouble
The fifth vital sign is a big popping bubble.
The statistics we’re reading have left us quite nauseous.
So we’re trying new things to save lives and be cautious.

Dear doctors it’s you that must make these decisions!
Push back against administrative derision!
And when those ‘above us’ make policy errors
Stand in for the truth to prevent further terrors.