Cap'n Andy's advise for the lovelorn lawyer

Not long ago I encountered one of the most miserable-looking patients I had seen in my office in a long time. Overweight, out of shape, hypertensive, his face frozen in a scowl, this poor gentleman recited a litany of complaints ranging from stomach pain to lack of energy to sexual dysfunction. As he was getting ready for his physical examination I stole a glance at a large stack of papers he had brought with him, just in case I was running way behind schedule: "Party X alleges that Party Y knew or should have known that their actions, being negligent and wantonly irresponsible, caused damage and irreparable harm and yada yada yada..."

I might have known. A lawyer. Too bad.

One of the Big Lies in our culture is that we value freedom of expression and the right to express our opinions often and loudly. What we really value is the license to spout off whatever vulgar, ill-conceived and offensive nonsense we want. The Real Truth is that anyone who speaks the Real Truth takes a risk of getting sued, screwed, or crucified.

I speak the Truth in my office at most once every two or three years. I'm not proud of this, but it's true.

I recall one such time: "Bill, you claim to be a born-again Christian but you sleep around with every available woman in your congregation, catch hepatitis B, come to me to get patched up just so you can go and do it again. I'm writing on the prescription for you to take a vow of abstinence until you get married. No intercourse, no diddling around, no nothing. Put it in your wallet where you used to store your condoms."

Lest anyone think I was being brave, self- righteous, or (gasp!) judgmental ("Honey, pull the blinds and hide the children! I'm scared! A judgmentalist!"), I should add this:

• He was smaller than me. I knew I could whoop him if I had to.
• He wasn't a gun owner.
• He wasn't a lawyer.
• I was struggling with my own Mid-Life Crisis issues, so I was speaking as one pilgrim to another.

There are a lot of other times I would have liked to have told the Real Truth. "I'm sorry to hear that you're getting divorced, but over the last ten years you've been self-centered, self-indulgent, and image-consumed. You've put all of this over your family and it's taken a huge toll on your health."

"Just because you're gay doesn't mean you have to put any eager appendage into any willing orifice. Mother Nature isn't kind to the promiscuous, gender preference and condom usage be damned. If you don't stop, you're going to pick up something worse than hepatitis (I actually said something to this effect once, and the guy's two buddies almost fell off their chairs laughing. I'm glad I was a source of joy to them)".

"Ma'am, it's impossible to gain 30 pounds in six months if you're only eating 1200 calories a day, and no, you don't have a thyroid problem because I've already checked it. Truth be told, you have one bad case of Chronic Twinkie Poisoning."

Just this once I decided to tell the Real Truth to my lawyer patient: "You know, you make your living by siphoning money from your clients in return for no other benefit than to protect them from your own kind trying to do the same. What are you going to say when you're on your deathbed and recalling what you've accomplished with your life? 'Gee, I wonder if this is considered a billable hour?' You fool! Life doesn't owe you a Lexus and a summer house on the beach. Give them up. Tell you partners to buzz off. Open a bagel shop. You'll feel like a new man."

The Real Truth is that I said this: "Take these pills and you'll feel better. Oh, by the way, it looks like you're pushing it pretty hard. Try to take more time off and get some exercise."

No kidding!

I'm heading out of town for a day or two. Check out this very funny site to meet my soulmates.

Medical Grand Rounds XXXV

Grand Rounds have returned at Iatremia: The Chaplin.News. Should I be offended that they didn't publish any of my haikus?

Positive feedback

"What? You've never done serious biking before and now you're trying mountain biking? Are you nuts? You're going to kill yourself!"

Now they tell me.

More medical research

This time last year I was training for the Marine Corps Marathon. Disturbed by the rise of my resting pulse from the mid-50's to the low 70's, and inspired by the writing of John Bingham, I took up the sport and had managed to run a couple of half-marathons, enjoying it immensely.

My research demonstrated an important kinesiological principle: every two miles run beyond ten miles requires a doubling of the effort (and misery) of running it. If running ten miles requires, say, 100 exertion units, then running twelve miles requires 200 units, fourteen miles requires 400 units, and so on.

By the time I reached sixteen miles I developed such a bad case of plantar faschiitis that I'm still not able to run any significant distance without paying for it in blood later in the day. The uncreative doctor that I am, I simply stopped exercising. Let's be honest; when you've had the joy of experiencing a road race of about 6,000 people (I was stationed strategically in the back so I could take in the entire spectacle), sweating it out on an elliptical machine becomes unbearable tedium.

Losing that endorphin surge only plunged me into deeper fits of melancholy. If I didn't resume exercise, I knew that no amount of Zoloft would pry me out of bed in the morning. My resting pulse, which had gotten down to 48 on very mellow days, crept up to the high 60's.

That's when I bought a mountain bike. The decision was not a carefully reasoned one in which I balanced the risk of mountain biking vs. that of road biking, or any some such. I didn't want to wear those sissy black spandex biking shorts. In my neighborhood, the rubes hunt those folks down for sport. It wasn't for me.

For those of you that contemplate taking up a dangerous sport in their 50's, I'd be happy to give you some pointers. I bought an entry level mountain bike at a real bike shop manned by buff salesmen with calves the size of my thighs. It wasn't terribly expensive, and had all the basic stuff: front end hydraulic suspension, cool knobby tires, 24 gears, genuine Shimano everything.

I failed to calculate (because I had no idea) the cost of the accessories, which have exceeded the cost of the stupid bike. Here is my running total so far:

Cost of a black helmet with red flames down the sides: $49.

Cost of fingerless riding gloves: $15.

Bicycle rack: $105.

Sissy black spandex biking shorts with an outer nylon shell so they look like ordinary shorts: $69.

Drab looking riding jersey (so I don't look too foolish): $45.

Under-the-seat storage bag: $15.

Self-sealing bike tube in case I have a flat: $5.

Tube of Pedro's lubricant: $5.

Nifty swift army-type tool with 18 different gizmos, none of which I know how to use:$39.

Tire irons: $5.

Bottle carrier: $3.

Bottle: $2.

Portable light-weight bike pump:$19.

Really cool-looking Smith sunglasses with interchangeable wrap-around lenses (to my daughters and their friends: do not dare tell Mom how much they cost or I'm a dead man): um, $109.

Camelback hydration system: $29 (on sale!).

LED's for night riding: $25.

Chain-degreasing tool: $29.

Cost of careening wildly down a narrow path so steep that no one in their right mind would even walk down it, then running into a mud flat so deep that for a moment I thought that I wouldn't be seen again until archaeologists in some future epoch encountered my fossilized remains, all while my son was busting a gut laughing: priceless.

Things they taught me in medical school

It's been fun to visit the blogs of medical students and residents. Its good to see that all the old battles are still being fought, such as the student's desire to learn vs. his need for sleep and family interaction, or the student's humanitarian instincts vs. the cynicism that medical training seems to breed. It also give me cause to reflect on my own academic heritage. Like it or not, our instructors exert a profound impact that remains with us during our careers.

I don't always remember complex interactions and metabolic pathways, but I usually remember pithy aphorisms. Here are a few that I remember:

Only half of what we teach you is true. It is up to you to figure out which half it is.
I don't think this was true, actually. Most of what they taught us concerning the science of medicine was true, although big chunks of it are now obsolete. I missed most of my pharmacology lectures because I was not about to sit in class for eight hours straight. The time was much better spent down at the glider park (I no longer had my motorcycle and needed some reason to needlessly risk my life). I'm glad I didn't expend a tremendous amount of energy learning about nitrogen mustard or reserpine. We never use that stuff anymore.

Of course, the love of knowledge and the discipline of study is what we needed, but it definitely wasn't being taught in our pharmacology classes. I hope the medical schools are doing a better job with it these days.

If the patient has pain anywhere below the 'belly button' and if s/he has an an appendix, then always at least think about appendicitis.
This has been a nifty little rule as of late. Gastroenterologists are basically internists with endoscopic skills, so we don't usually see much appendicitis; they usually go straight to the surgeons. If the patient has a weird presentation, such as pain on the wrong side of the abdomen, or a protracted course, they often get misdiagnosed and sent to me, the lowly GI guy. "They still have an appendix; why, I bet they have appendicitis!" I've been right about that several times this year already. Its a great 'grandstanding' diagnosis to make, and the outcome is always good. It makes me want to learn how to go in and whack those suckers out myself sometimes.

Medicine is a jealous mistress.
This of course isn't true in this day and age, with the growing numbers of women in medicine. Maybe medicine is a dysfunctional viragoe who treats its practitioners like sex slaves chained down in the basement. Maybe not. But it certainly isn't a jealous mistress anymore. The allure just isn't there.

The problem with being on call every other night is that you miss half the action.
The medical school I attended truly believed this, and changed it only when applications for residency began to fall because people were just not willing to be abused when they could go to a perfectly good program that had every third or even (gasp!) every fourth night call. It was also wrong. It reduced the practice of medicine to the learning of techniques and the acquisition of facts so that we, the doctors, can fix them, the patients. It ignored our own human limitations, our need for family interactions, our need to participate in communities of faith. In short, it called us to sacrifice a big chunk of our humanity upon the altar of medicine.

Don't wear the clothes in which you dissect your cadaver to the student union if you want to hit on the babes.
I bet this one is still true.

A little research

I've taken a week or so off to conduct research on the tensile strength of senescent fibrous and fibroelastic tissue. In my effort to bond with my son and get his lazy backside out from in front of the TV, I bought a mountain bike. I have no mountain biking experience at all, so it seemed like a logical thing to do. Pedalling around the neighborhood, my son hopped up an 8 inch curb and made it look easy. My new bike has front end suspension and cool-looking knobby tires, so I assumed it would hop over the curb pretty much on its own. This was a mistake. I went slamming into the curb full-speed, doing a humiliating face-plant on the concrete.

My fibrous and fibroelastic tissue was not in the slightest bit amused. It was a few days before I could walk straight, and I still haven't figured out how to do a bunnyhop on the bike.

So I did the only thing that made sense in this situation. I sued my son. That'll teach the little turkey.

The Great American Novel

The demand for my authorship of a book has been overwhelming.

It takes very little to overwhelm my fragile psyche these days, so I should add: I've received one suggestion to author a book, by a very kind reader whom I suspect wants me to quit wasting broadband.

It would be a stretch, to be sure. My method, such as it is, is to craft a finely worded opening paragraph, beat it into the ground for a few more paragraphs, and when I lose interest in the topic, bring the post to an abrupt halt, hoping that readers will misinterpret my short attention span for irony. This is probably not an effective method for writing a full length novel.

I'm also hampered by having nothing much to say once I've finished whining about those nasty lawyers, and even that gets old after awhile.

My favorite paragraph was the one about the zen of Yogi Berra. What a great idea for a book, I said to myself; I bet no one else has ever thought of that one.

I assembled my reading list for this project:

• Zen and the Art of Motorcycle Maintenance.
• The Compleat Idiot's Guide to Zen and Other Weird Mystical Stuff.
• The Tao of Pooh. I almost dropped this from the list after I read about the author's sequel, The Te of Piglet which was universally condemned as a "mean-spirited neoLuddite polemic against everything Western".
• Any three books written by Thomas Merton during the last ten years of his life.
• The Tao Te Ching, of course.
• And finally, When You Come To a Fork in The Road, Take It by the Great One himself, Yogi Berra.

Impulsively, as I was ordering all this stuff on amazon.com, I entered "Yogi Berra Zen" in the search function and was bitterly disappointed to see that the book has already been written. I ordered it anyway. If the book is shabby I'll write my own version of it, and put in some medical lingo to give it a distinctive style.

Otherwise I'll write Zen and the Art of Colonoscopy. That I know almost nothing about zen won't be a problem. In our culture, if you say something kindly and compassionately that doesn't make a bit of sense, that's close enough. The subject of colonoscopy contains enough scatological allusions to keep me going for weeks.

I'm losing interest fast. May the cecum of your soul seek it's sole grounding in the grinding of the succus entericus.

Just one more!

The heart only beats
To pump blood to the colon
Been working too hard

Bad for your health

Turnover at the "Butt Hut" was a little slow today. That's not a problem for me, but it did give me a few moments to compose some of the worst haikus I have ever read. If you have a strong aversion to pitiful poetry, I suggest you click on the "Next Blog" button in the upper right hand corner of your screen.

You've been warned.


Let the light shine forth
Oops, the prep is bad today
Have to reschedule


The colon lining
Looks like its scrubbed with steel wool
Steroids on the way


The angry patient
Seeks disease. When none is found
Wants her money back


His gas is so bad
Pet dog gets up and leaves room
Sorry, just can't help


The fecal stream flows
Scopes go against the current
As the lawyers wait