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So many lawyers, so little time...

"The prospect of hanging focuses the mind wonderfully"--Samuel Johnson

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Location: Louisville, KY, United States

Gastroenterologist, cyclist, cellist, Christian, husband, father, grandfather.

Monday, November 14, 2005

What I know about America's greatness I learned from immigrants

Like many places, my city plays host to many different groups of immigrants: primarily Ukrainian, Bosnian, and Hispanic. I appreciate the last group because I'm trying to learn Spanish, and nothing helps to build the vocabulary better than walking through the local Home Depot.There's a smattering of other nationalities here from Eastern Europe, primarily Romanians. Romanians don't get no respect; our local drug stores provide free translation services for Poles, Vietnamese, and Filipinos, but not for Romanians. I think that's unfair. Any nation that has lost virtually every war they've ever fought in, yet thrives as an independent state (another country that comes to mind is Finland) deserves some respect, for resilience if nothing else.

An immigrant once told me, "No one knows exactly what the American Dream is, but what all Americans share is that we all believe that there is such a thing." Just as few defend the faith with the vigor and clarity of enthused converts, new Americans often see our country with the respect that we jaded old-timers lose after just a few generations.

I was proud of the unity that our country initially displayed after 9-11. In many ways I hope never to see the most touching scenes ever again: walking by a visitor's lounge at the hospital and seeing a dyed-in-the-wool "redneck", with his long hair braided into a pony-tail, openly weeping as the camera panned over the rubble of the twin towers. I didn't ask him if he were a registered Republican or a registered Democrat. That kind of thing didn't seem very important at the time.

One of the most passionate and outraged Americans I encountered was a Ukrainian who had recently just received her American citizenship and works as our hospital's librarian.

"How can zey do zees to my country!?!" she exclaimed in her heavily accented English. She'd been in this country for ten years, and she was every bit as American as my family that can trace it's descendants to the 1700's. Maybe even more so, given that members of my family couldn't tell you what the three branches of American government are to save their souls.

Back then one of my patients was an 95 year old woman from Poland. She showed up for appointment wearing a beautiful embroidered tiny American flag on the label of her jacket (like most folks her age, she would never have gone to the doctors wearing jeans and a sweater). She had had classic irritable bowel syndrome for sixty years, and nothing I prescribed ever affected her symptoms one way or another. She could remember the exact day her symptoms began.

"My father owned an apartment building in Poland. I remember one night the Nazis came and dragged off all the Jews. I remember the sound of their heavy boots coming up the stairs like it was yesterday. I've been nervous ever since. Then after the war one night the Communists came to my father's apartment building. This time they were looking for my father because he was a land owner. We left very quickly. I've had bad diarrhea ever since."

I've traveled to Romania three times and came away with two things. I'm told I have an excellent Romanian accent, probably because I naturally speak in a monotone and I can roll my "R's". I also have an enduring hatred of totalitarianism, regardless of ideological stripe. Nicolae Ceausescu was a "liberal" of sorts who routinely thumbed his nose at the "conservative" Kremlin hard-liners. He was also a vicious lunatic who damaged the Romanian psyche so deeply that it will take a generation or two for his ugly scar to heal.

Because I at least try to speak a little Romanian, I get to see what few Romanians live in my area. One of my patients is an older woman who was educated as, of all things, a lawyer.

"My education was a total waste of time under the Communists," she said. "The judges didn't care about the law. Most of them didn't even know it. You couldn't bribe them because they were rich compared to the rest of us, who had nothing. All the opposing lawyers could do is to convince the judge which one of them was the biggest Communist. I didn't care for the Communists, so I never won any cases."

I never knew what she thought about our Supreme Court and the conduct of the Senate Judicial Committee. I don't know what she thinks about our political climate in which our first question to any statement of "fact" is not "Is it true?" but "What is the party affiliation of the claimant?" Next time I see her I'll have to ask.

From what I can tell (perhaps there is some irony in this statement), the only just war we have fought since WWII was the Serbian campaign, in which we dislodged a murderous tyrant who, although he was a constant menace to his neighbors, posed no security threat whatsoever to our country. During the campaign our home shower door broke and needed replacement.

Two Bosnians came over to replace our shower door. One was a Muslim, the other an Orthodox. This struck me as a bit curious, given the enmity between the two groups that we were all seeing on CNN.

"Of course we would probably be trying to kill each other if we were back in Bosnia," the Muslim said, "but this is America, and here we all can voice our own views without any threats".

I think that moment was the proudest I've ever been of my American citizenship.

Sunday, November 13, 2005

Crisis of the uninsured

The enormous number of Americans without health insurance constitutes a moral and economic crisis. Perhaps we could extend coverage to these folks if only doctors, hospitals, health insurance companies, pharmaceutical companies, medical supply companies, and malpractice lawyers all decide that for the Public Good we'll do with less money.

As I ponder that last sentence, I think of which groups willingly and cheerfully work for less money than what they could be earning in the "free market". Those in the ministry (including the occasional secular do-gooder) and those teachers who shun the public school system and work for peanuts in private schools are about the only people who are willing to make that sacrifice.

For everyone else, to expect us to surrender income obligingly is to indulge in Utopianism/Totalitarianism. I say this not from any ideological perspective, but from simple observation. If you are thinking, "Well, I'd take a big pay hit for the good of mankind!", I would conclude that you are in the ministry, or teach in a private school, or are unemployed, or are less than honest with yourself.

The rest of us take pay cuts either when we're forced to, or when we make trade-offs for lifestyle considerations. We're just not wired to surrender our earning potential "for the Public Good".

The boiler-plate media portrayal of the uninsured is that of a 50 year old middle class male who gets laid off by his profit-seeking company, loses his health benefits, has a heart attack over the stress of it all, and incurs hundreds of thousands of dollars of medical bills which he cannot hope to ever pay. I'm sure this really does happen from time to time.

I'm on ER call this week so I kept track of all the uninsured folks I was asked to see. I've never met a "boiler-plate uninsured" and I thought this would be a good opportunity to look for one.

Here is my list of the uninsured:

  • middle aged male with alcoholic pancreatitis. He actually was laid off and lost his benefits for his erratic behavior which I suspect was due to his alcoholism. He was a very nice fellow who thought that his three sisters were unfairly ragging on him for his drinking.
  • middle aged male with alcoholic pancreatitis, in and out of the chemical dependency center. Not really interested in stopping because it was his ex-wife who drove him to drink.
  • young gangsta with alcoholic pancreatitis. He is a good-looking charismatic gentleman who could amount to being a lot more than a gangsta under the right circumstances.
  • middle aged male with GI bleeding. He owns his own business but chooses to save money by not covering himself. He's not worried about his bills because he was rear-ended by someone two years ago and he's going to sue the driver and all the physicians who saw him six months afterwards. "You don't have a thing to worry about, Doc". Thank goodness.
  • young male with belly pain due to anxiety, and probably from karmic retribution for being such a sociopath. He also owns his own business.
  • middle aged male with bad esophagitis. I'm not sure why he doesn't carry any insurance, but his responsible next of kin was his mom. That always raises a red flag for me when the patient is a middle aged male. Could it be that no one other than his mother wants to put up with the guy?
This is a random unscientific survey, of course, but I would conclude from this list that if we were to eradicate alcoholism and figure out a way to integrate sociopaths into our society better, that just maybe the problem of the uninsured would get a whole lot better very quickly.

Thursday, November 03, 2005

A first

Yesterday was planned out well. I'd go in early in the morning (never my first choice on a Wednesday, my "day off"), do a quick colonoscopy for a friend, go to the office and do "admin work", go home at noon and be available for the heating people to give my furnace an overhaul, then spend the rest of the afternoon on a local bike trail.

I would never complain about anybody being late for anything, so I simply note that the furnace person didn't show up until around 3, and took for ever doing whatever it is that those folks do. By the time he was done, it was clear that there would not be time enough to hit the trail.

I begged my son to give me some remedial wheelie instruction in our backyard. No sooner did we start to ride around than we were joined by six kids ranging from 8 to 12 years old, all on their cute little BMX bikes. I sensed a Lord of The Flies moment.

"Little dudes and future malchicks", I announced, "Let us form a bicycle gang and ride around the neighborhood. We shall threaten to beat people up unless they give us money or Gummi Bears or whatever floats your little boats."

"Cool!" they said.

"And I shall be your leader."

Next thing I was on my back, looking up at six hostile little kids. "How much is worth to you, Pops, for us not to leave tread marks on your face?"

After settling my account I had the further indignity of watching these kids fly off the backyard ramp we had constructed, even as I was unable to lift my front tire more than one inch off the ground.

Of course these kids have been riding for years and I've only been riding for four months, I reasoned. Maybe I should just do real basic stuff like they might do and see what happens. I started bouncing up and down on my bike in as exaggerated a motion as I could muster.

And then it happened. My entire bike left the ground and both wheels were at least a foot off the ground. Well, at least six inches. I had definitely completely left the ground. I had performed my very first bunny hop.

One of the little kids saw it. "Cool!" he said. "How did you do that?"

"Give me my Gummi Bears back and I might just show you," I said. The rest of the evening was spend in a state of pure bliss.

I just wish my knees didn't hurt so badly today.