Clay's Blog

Some Photos I Took During Our California Trip

2010-01-09T21:13:00.026-07:00

One day after Lori's surgery, we drove down Sunset Boulevard to the beach and hung out for an hour or two. I took a few photos I wanted to post here. These first ones are of a rusted out steel barrier intended to keep the sand from washing away sideways down the beach, I think. I thought it was interesting to see the water splash over and through it. In one of these you can see little fish swimming in the surf.All of these birds were clamoring for space on this rock outcropping.
These next two would make good desktop photos for your computer! I think it's interesting to take a repetetive/monotonous field and do foreground/midground/background things with focus and depth of field. I'd like to do more stuff like that; I need to get more familiar with my camera's settings and capabilities. The first shot here would look better with the background fuzzy, I think.
This one almost got me (and the camera) all wet!Some babe was too busy talking on her cell phone to notice me stalking her, so I snapped her photo when she wasn't looking. She apparently forgot her bikini that day, however.Somebody made a couch out of the stones lining the beach (which were actually just well-worn pieces of old concrete that had been dumped in there years ago; one might think that would be a really ugly thing on a beach, but I thought that after all those years of weathering they actually had a neat look to them with all their corners and rough edges worn off). This would be a cool place to sit and watch the sun set!
This aging hippy was so into his yoga zen that I could also snap his photo without him noticing. I kept watching to see if he would levitate, but he didn't. This time.
In this one, you can really see how tiny the guy was, about twice as tall as an average seagull, included in the photo for reference.At first glance, this just looks like a dead crustacean washed up on the beach, but upon closer inspection we see that...well, yeah, it's just a dead crustacean washed up on the beach. I thought the colors and the little crusty things on it were cool, okay? Lori, no commenting allowed. I've heard enough about it in real life already.Aha! On closer inspection we see these tiny little sand fleas popping in and out of the dead mollusk. Fascinating! (I'm easily entertained.) I took like 30 photos of these little guys and was tempted to post them all here, but I decided just to pick out the best one instead. They were surprisingly difficult to photograph, what with them hopping about and everything.Here's a photo stolen from the Internet of a more well-behaved one, which also looks a little older. The ones I saw were really tiny. I messed around with them for quite awhile and didn't have any problems, but, apparently, they bite.A beach-side house, probably worth a few bazillion dollars or something, before the bubble. Now it's on the market for $4.99, OBO (furnished). No thanks, I'll keep my normal-looking house in bubbleless (so far) Rexburg. Besides, this will probably be the first house to hit the drink when California falls into the sea, or when the next el nino pattern comes. (For those of you who don't speak espanol, el nino is Spanish for... "the nino!")
More sea birds. They were quite tame and I could get pretty close up. They acted genuinely annoyed when I got so close they actually had to stand up.
These pelicans made for interesting subjects, I thought. I love their little faux-hawks.
I'm going to submit this one to National Geographic, and tell them I had to swim out to a deserted island in Tahiti to take it, holding my camera above water the whole time.We also went to a place called the LaBrea Tar Pits, which is a place where tar comes bubbling out of the ground and has trapped all kinds of animals over the eons. Nerdy little scientists like this guy extract all the bones, clean off the tar, and make exhibits out of them. It was an interesting little museum, partly outdoors. Smelled like an asphalt plant in there.
More foreground/background stuff. Should have gotten the camera closer to the ground.
City Hall in Beverly Hills.
Cool looking tree in a park we visited. You can't see it in the photo, but there are hundreds of names, messages, and other sorts of graffiti carved into the bark. Old-fashioned facebook!
I'm not sure what kind of tree it is. Could it be a mangrove?

Treatise on Health Care Reform: Part 4 of 4 (My Health Care Bill)

2009-12-30T10:56:00.004-07:00

To both houses of congress, an open invitation: use this one instead. Please, read it first (if you do indeed know how to read). It won't take long, you can probably get it done before some lobbyist wants to take you to lunch today.

WHEREAS these United States of America were founded upon principles of liberty and freedom, and WHEREAS free market principles and capitalism have propelled this nation to its position as the only remaining superpower, and

WHEREAS this position of worldwide dominance is now threatened by excessive and ill-conceived government regulations in many sectors, including health care, which inhibit or restrict the actions of free markets in our nation, let it be

RESOLVED that the current "third party payer system" be abolished through the following actions:

1) Beginning today, it is unlawful for a provider of health care services to bill a "third party" for health care services. Payment should be collected from the person or person who received the services.
1a. Recipients of health care services are encouraged to carry health insurance. Benefits claims and reimbursement will be the sole responsibility of the recipient, not the health care provider.

2) Beginning today, it is unlawful for a provider of health care services to contract with a "third party" regarding the price of health care services.
2a. Recipients of health care services may contract with providers individually, or may do so as groups (such as groups of employees, communities, or neighborhoods). Insurers or other "third party payers" may not negotiate prices or conditions on behalf of health care recipients.
2b. Recipients of health care services may contract and negotiate individually or as groups with insurers regarding reimbursement amounts, premiums, and other terms of insurance.

3) Beginning today, the law requiring health care providers to provide emergency medical services to people, regardless of ability to pay (EMTALA law), is repealed. Individuals who choose to be uninsured do so at their own peril.
3a. Providers of health care services are encouraged to provide charity care to individuals who cannot afford it, but this decision is left to the discretion of the service provider.
3b. Local and state governments are encouraged to provide and administer funds for needed health care for the truly indigent, or for those in the income "gap" between Medicaid eligibility and insurable income. This will, in no way, be a responsibility within the jurisdiction of the federal government.

WHEREAS the current dual system of "individual" and "group" health insurance, each with separate rules, is patently inherently unfair, let it further be

RESOLVED that the laws governing these two separate types of insurance coverage be repealed, effective immediately, to be replaced with the following common sense initiatives:

1) There are no special protections for the underwriting of certain "groups." Premiums are individual.

2) With regard to "pre-existing" or current health conditions, underwriting for the purpose of premium assignment may be based upon health conditions which have been duly proven to be directly resultant from the choices or actions of individuals. Conversely, no pre-existing or current health condition may be considered in the underwriting process that has not been duly proven to result from the choices or actions of individuals. For example, a current or prior smoker may be assigned higher premiums since this choice is well proven to lead to worse health, but having Huntington disease (or having this genetic condition in the family) may not be considered in the underwriting process. Similarly, BMI may be considered, but age alone may not.
2a. Which conditions may be considered and which may not in the underwriting process will be determined by a panel of medical experts who are independent from and not to be governed or influenced by any branch of government. Their decisions will be subject to peer review, debate, and appeal, and will be reconsidered on a regular basis.

WHEREAS entitlement programs including Medicaid and, to a lesser extent, Medicare, are costing the American people more than they can afford, and

WHEREAS these programs do not do enough to encourage individual accountability for health and the use of health care resources, let it be

RESOLVED that the costs for these programs be reigned in through the following measures:

1) Medicaid recipients will be issued a series of vouchers at the beginning of each year. These vouchers will serve as currency for "copays" which will be required whenever health care services are sought.
1a. Visits to a primary care provider will "cost" 1 voucher, visits to specialists will cost 2 vouchers, visits to the emergency room will cost 4 vouchers. Recipients who have vouchers remaining at the end of each year will be allowed to redeem them (for cash, cell phone minutes, or Nascar tickets; that will be left up to the States to decide).
1b. Recipients who either run out of vouchers, or show up somewhere seeking care without one, may still be cared for, but will not be eligible for a refund.

2) Medicare recipients will not be eligible for benefits until age 70. Minimum age for eligibility will be adjusted based on changes in life expectancy, every 5 years.

There you have it. It's short enough that you can print a copy for everybody. Let's try something like this, then let these changes percolate through the system for about five years, and then institute further changes or regulations only as needed, allowing free market principles, capitalism, and free enterprise work their unique magic on "the system."

Since I began this series, it has become apparent that the liberals currently in power intend to pass some kind, any kind, of health care overhaul legislation. It has become glaringly obvious that they don't care so much about the actual content, or even whether it will "fix" the ailing, bloated industry. What these people want, and seemed intent to get, is control over a major American industry. Let's hope that, when all is said and done, common sense and some well-proven principles of American industry will win out over this insanity.

Treatise on Health Care Reform: Part 3 of 3

2009-12-24T08:37:00.001-07:00

My final thoughts on the health care debate are focused on one specific type of "cost." Most of the things you buy when you purchase health care items are not things at all, but are services. MRI scans, doctor visits, surgeries, and the like are things that you have done for you, not things that you take home. There are certain goods, however, that fall under the category "health care costs." These things fall under two basic categories, the first being equipment (known in the medical world as "durable medical equipment" or DME) such as wheelchairs, walkers, elbow braces, CPAP machines, etc. The second category is medication.

Because these items are "goods" rather than "services" it is easier to focus on them and compare them to similar items in other sectors; it is much easier to place intuitive value on an actual thing than on a service.

Take pills, for example. Never has a society paid so much for so little. To understand this, consider the cost of most generic medications these days, which can be purchased for $4 for a month's supply at WalMart. This price includes the wholesale cost, plus markup, plus a standard "filling fee" that goes to the pharmacy. Many people don't realize it, but the actual production cost of that same medication is probably less than $1. The manufacturer, and the pharmacy, are probably each taking a 100% or so markup, still a killing.

Now, consider the cost of your average, new, branded drug. Most of these now cost in the neighborhood of $100-120 for a month's supply. Some are less, some are much more. The actual production costs of these drugs isn't any higher, usually, than drugs that are available generically. The pharmacy typically makes the same on the sale whether the drug is generic or not. So, all that money in the margin is going straight to the manufacturer.

How can this possibly be justified? Drug reps will tell you that the answer is simple: R&D. It costs so much to bring these drugs to market that they need to charge that much to recoup. There is always the risk that, once the manufacturer has expended all those research dollars on a drug, it doesn't make it through the FDA approval process, so they need to charge that much to recoup the costs of the "duds" they test but can't bring to market because they flunk out somewhere in the testing and approval process.

Well, I see somewhat of how much money these corporations throw away on stupid, frivolous things, and so I don't fully buy that explanation. Plus, the system as it is does not encourage companies to develop drugs that I need, it encourages them to develop drugs that will make the most money. What kind of drug will make money? Let's see, a "golden goose" drug will be intended to treat (not cure) a lifelong, chronic illness. No wonder my sample closet is chock full of hypertension and diabetic drugs! No wonder we haven't had a significant new antibiotic in 15 years: those are too good at curing the conditions they treat!

As I have outlined previously, I believe strongly that allowing free market principles to take hold in health care would go a long way toward "fixing" the system. I'm not sure this axiom fully applies to pharmaceuticals; all the competition in the world isn't going to encourage companies to develop drugs that we need. These people went to college, and it doesn't take a rocket scientist to figure out which types of drugs, for which types of conditions, will sell.

So, if the government is so intent on socializing something, why not the pharmaceutical industry? It irks me that probably 90% of the biochemical research done to develop a drug is done in the academic realm, mostly funded by the NIH and other government organizations, from my tax dollars. A pharmaceutical company then takes that knowledge base, built on the backs of the taxpayers, tweaks a chemical a little bit, patents it, and laughs all the way to the bank. They, literally, get us coming and going.

Why not make it illegal to patent a chemical intended for human consumption (a drug)? Pharmaceutical companies could still battle it out to produce better drugs than each other, they just couldn't own exclusivity.

True, this would stop private-sector R&D in its tracks and remove most of their incentive to develop new drugs. That's okay, in my view, since the new drugs they're researching aren't necessarily the ones we need anyway. As a physician, I don't need one more hypertension drug, I need the ones that I already have to be affordable. I need to not spend half my day figuring out how my patients are going to afford the treatment they need.

Let a governmental organization decide where research dollars are directed, based on public health needs. Let them assume the costs associated with FDA approval, and then pass those costs on to the consumers. Drugs would start out generic! Insurance premiums would plummet.

While I am, by nature, loathe to voluntarily trust the government to run stuff if it doesn't need to, I really do wonder if this would be one area more suited to that. What private entity can decide where to best direct drug research? If there is one that can do it fairly and rationally, let them do it. I would not completely socialize pharmaceuticals; I would hope that pharmaceutical companies would still produce, market, and distribute drugs; they would simply do so in a much smaller market, in terms of dollars. Americans don't need, or want, to see drug commercials during the Super Bowl.

Keep watching for the fourth (and final) installment in this series; this will be my own "healthcare bill," the one I would put into law if I were King, guaranteed to be considerably less than 2,400 pages long.

Update: Lori Can Smile! And Taste! (A Little)

2009-12-10T21:48:00.010-07:00

It has been over 3 months since Lori's facial paralysis began, and just this week she began to get the first tiny bit of movement back in her face. Watch in the video how she can turn the right corner of her mouth up in a trace of a smile. It may seem like a small thing, but it's progress!

The video also shows her blinking with her new "palpebral spring." She has been SO much more comfortable since the procedure. Almost all of the swelling and redness are gone (it has been about 5 weeks since the surgery). If you watch closely, you can see that the right eye blinks just slightly slower (and opens slightly slower) than the left. It isn't so obvious that you notice it during casual conversation with her; you have to look to see it. She is thrilled with the results, and thinks that it was definitely worth it! We remain amazed at the simple brilliance of this procedure, and how much benefit a person can have from the restoration of the simple act of blinking the eyes!

She also noticed during breakfast today that she could taste her key lime yogurt and banana! This is also a new thing, and a sign that the nerve is regenerating. She is ecstatic about this, and doesn't even complain that she now gets the metallic "Lunesta taste" with her sleeping pill again.
Here are some photos of her tonight. She is looking beautiful as ever.
Lori continues to handle this medical adventure with grace and style. I admire her for the courage and fortitude with which she has faced this so far. Maybe we are starting to see the end of it for her, though, and that is exciting!

Treatise on Health Care Reform: Part 2 of 3

2009-11-19T19:53:00.000-07:00

I want to put forth here a philosophical discussion of healthcare funding in America. Before meaningful, long-lasting reform can be accomplished, Americans need to decide as a people whether the responsibility to pay for health care lies with the individual citizen, or should be shouldered by society as a whole.

There are definitely some things, in any society, that are simply better to be paid for collectively. For example, having each individual pay for and build the roads that he wants to travel upon simply would not work; there are obvious benefits to sharing the streets, and sharing the costs involved.

On the other hand, history has proven that when a society tries to have all things in common (as in the case of communism) dysfunction of all kinds tends to ensue. Although desirable in theory, the imagined equality under these types of systems rarely materializes in real life. A case in point is the former USSR and its communist system of government that eventually collapsed in on itself. Hitting closer to home, even covenant-bound Latter Day Saints couldn't pull this off effectively, on a relatively small scale when they attempted to live the united order.

We are a capitalist society (at least for the time being). Capitalism is, in part, governed by the principle of laissez-faire, which means, literally, "let it be," or "let it alone," (ironically enough, in French). With capitalism, it is generally accepted that, for the most part, people and markets should be free of government interference or control. Laissez-faire is by no means absolute, however; many industries are regulated by the government, to ensure quality or stability, or to prevent monopolization. Although there are some who think there should be absolutely no government regulation of commerce, etc, most reasonable people agree that some oversight is needed and helpful, particularly in certain sectors, like those that involve the basic safety, well-being, and yes, health, of the people. My dad, as a relevant example, worked for many years in a utilities sector, where the government has a certain involvement in ensuring that folks in rural areas have access to adequate, high quality telecommunications services on a more-or-less equal basis with those living in more urbanized regions.

These economic issues aside, there are other philosophical issues at stake with regards to health care funding. For example, while it is generally not considered unjust for grocery stores to deny people food because they can't pay for it, there is a sense that an injustice has occurred when a person in need of health care, particularly lifesaving health care, can't afford it and is, therefore, unable to obtain it. Of course, food is equally necessary for that person's existence, but is not necessarily considered something the person should be entitled to have when in dire need.

For a real-life but hypothetical example of this, consider a destitute person, about to starve, who walks into a grocery store and demands a meal; he likely would not get anything from the store's inventory without making payment (although a compassionate grocer might direct them to a food bank). On the other hand, the same person could walk in to any emergency room of any hospital in America at any time, and the law requires that the person be treated, regardless of ability to pay. Even I was irked the other day when I heard an uninsured patient's story about having been diagnosed with pre-cancer of the cervix, and then being told by her unapologetic gynecologist to raise enough money to pay for the surgery, and then come back. By the time she saved enough and returned, the cancer had advanced and spread, and was much more difficult and risky to treat.

Therein lies the dilemma for me. I am, in a way, of two minds. On one hand, I don't believe that providing every needed service is an appropriate undertaking for a democratic republic with a capitalistic economy. Nor, for that matter, do I trust our government enough to feel confident turning over health care to it. On the other hand, I don't quite feel right about denying health care to folks who can't afford to pay for it, particularly lifesaving care. If I had lived 150 or 200 years ago, I probably wouldn't have had a philosophical problem with it. But, in my heart of hearts, being who I am in the year 2009, I do.

This interesting shift in the collective thinking of Americans has been shaped over the years, without doubt, by the way health care has been paid for in America (see installment 1 in this series). In short, most of us have gotten used to somebody else paying the costs of our care; our employers pay for it while we work, and the government takes over when we retire. As a whole, we haven't needed to include health care costs in our personal budgets very much; once our basic needs for food, clothing, shelter, and the like have been met, we have been free to spend our surplus on things we wanted, like vacations, vehicles, cell phones, and other luxuries. We don't tend to "save up" for medical care, or include those costs in our planning. I see this every day in my practice when patients who "can't pay their bills" make me wait while they talk on their cell phones.

While there is definitely a certain percentage of Americans who simply could not afford insurance no matter what financial adjustments they made, I believe there is another group, probably a larger group, who choose not to purchase insurance. If asked, most in this group would, undoubtedly, say that they don't have it because they can't afford it. And, in their own minds, they honestly can't. A review of their budgets, however, would reveal that, with a shift in priorities, they could afford the premiums, although this would require that they sacrifice some things that they have come to view as essential "needs."

At certain points in my own life, I, by the way, have fallen into this group. I chose that approach during college, for example. At times, when my wife and I were first married, we went without insurance. We didn't try too hard to prevent pregnancy, knowing that if she became pregnant, she would qualify for Medicaid, and that the government would pick up the tab. Why did we do it this way? Well, we were all healthy, and not likely to incur major medical expenses. (All insurance is, after all, a gamble, and when one is young and healthy, the odds are a lot longer.) Plus, looking back, I think I knew in the back of my mind that if something catastrophic happened, there was an adequate safety net there. I didn't have to live in fear that I wouldn't be treated; I knew that, when push came to shove, I would be, regardless of my ability to pay. If I wanted to have health insurance, I would have needed to work more hours, and cut back on the credits I was taking in school. This would, of course, have resulted in a significant delay in my career track, probably by 2-3 years, at least.

Although I never spent much energy investigating the implications of "going bare," in the back of my mind I also knew that medical bills really couldn't ruin me financially, because I didn't own anything of value. I had a good sense that, in the end, if some unanticipated thing happened to me or my family, we would qualify for government aid because we had no significant assets that could be taken away to pay the bills. Was that the wrong approach for a responsible citizen to take? Perhaps. (Ask not what your country can do for you...) Was it a good decision, purely in terms of finances? Sure! In a health care system funded mostly by insurance dollars, is it going to work if very many people choose that approach? Not on your life!

So, at this crossroads in the history of American health care, one major decision we should be making is whether we believe, deep down, that health care funding is an individual or a public responsibility. It is a difficult question, and, unlike the issue discussed in the first article I wrote on this subject, I don't think this issue necessarily has to be answered in "either/or" fashion. Perhaps this one can have it both ways; I'll elaborate my own ideas on this further in the fourth installment.

Update; Plastic Surgery in Beverly Hills, Baby!

2009-11-06T19:36:00.016-07:00

Last week Lori accidentally tore out her tarsorrhaphy while getting dressed; her shirt caught on the stitch and pulled it right out. Needless to say, that didn't feel very good, and sort of made mincemeat of her eyelids. Here's what it looked like after it came out.Her ophthalmologist said at that point, since she really hadn't regained any significant function, it was time to have something more definitive done; we couldn't do any more temporary tarsorrhaphies. Lori had been worried about this eventuality, but she had been talking with one of her friends one day, whose dad had a permanent facial nerve palsy resulting from a brain tumor. His eye had been giving him fits just like Lori, and he had tried all kinds of things including an implantable gold weight, none of which had really solved the problem for him. Eventually, though, he had seen a doctor in California who had implanted a metal spring in the eyelid, and restored his ability to blink. This intrigued Lori, and she had done some research into the procedure, discovering that the physician, Dr. Levine, was still practicing in Beverly Hills, California, and had performed thousands of these procedures over the past forty years or so. At one point, he had even called her personally to explain the procedure and answer her questions; she had been pretty impressed with that. As she looked into it more, she also discovered that Dr. Levine is the world's foremost expert in eyelid springs. If you have to have it done, he is the guy you want to do it, apparently. He has done thousands of spring procedures, has been doing it for more than forty years, and has, literally, written the book on the subject (well, there isn't any book, but almost any medical literature you can find on it over the past forty years has his name on it).

So, when this happened, we quickly began making plans to go down there, knowing that the longer her eye remained opened, the more uncomfortable she would get. Here she is with him having her preoperative evaluation.He is a nice, short little Jewish man in his seventies who, although he has been living in California for decades, still has a trace of New Jersey accent that betrays his eastern upbringing. After I got to know him, I asked him if he had ever though about retiring, to which he shrugged and dismissively replied, "I enjoy what I do."

The idea of the eyelid spring is simple, really; because Lori's ability to shut the eye is impaired, but her ability to open it is not, she needs an artificial, downward or "closing force" to balance out the unopposed "opening force" left over from her damaged nerve. By implanting a bent and coiled piece of metal within the eyelid, attaching one end to the bone above and the other end to the top eyelid itself, the needed closing force is supplied. Here's a picture of the spring as it appears before fitting; it will be shortened considerably on each end and then, when its implanted, each end is coiled and placed within a dacron pouch so that there aren't any sharp edges. If done right, the opening force still works, so that she can overpower the force of the spring and open the eye, but when she "turns off" the opening force in the act of blinking, the spring takes over and gives her a nice, quick blink that looks pretty much like the other eye and closely resembles normal function of the eyelid. Implanting a gold weight within the eyelid is another option which accomplishes nearly the same thing, the major differences being that the gold weight is more noticeable, and tends not to work when the person is lying down, since the "closing force" in that case is really just the downward force of gravity pulling on the weight. If you're lying flat or even tilting your head back slightly (as many people tend to do while sleeping), the weight actually tends to open the eye even more, so a lot of people who have weights tend to have to tape their eyes at night. Since gravity is slower to move than the "snap" of a normal blink, the weighted lid tends to lag behind the other one and, if it is too slow, it won't shut all the way during the blink.

Anyway, as it turns out, Dr. Levine's office is located in Beverly Hills, so we ended up staying at a hotel right at the end of Rodeo Drive called The Tower Beverly Hills all week while Lori underwent her evaluation and spring fitting, had the surgery, and her postoperative care. Before her first appointment we had a few hours, so we walked around the town for a little while. If you look closely, you can see a beautiful movie star that happened to be standing under the sign.He was kind enough to agree to let me come in during the surgery, so I took a couple of pictures in the operating room. Here is Dr. Levine on the right, with his assistant, Norma, on the left.They actually woke her up at a couple points and had her sit up and open/close her eyes to make sure the eyes were more or less symmetric during blinking. Like all good plastic surgeons, he took some photos (for the tabloids, I guess).To look at her today, you couldn't tell because her eye is swollen completely shut, but I saw it during the surgery and it was looking really good.Dr. Levine also tightened up her lower lid, and lifted up her right cheek, which were both sagging a bit. This makes it easier for the lids to meet during a blink so that she will get a nice, smooth film of tears covering the cornea and protecting it from the harm that comes when it dries out. You don't realize it, but you blink your eyes about every 4 seconds while you're awake. If you don't think losing your ability to blink is a big deal, try keeping your eyes open without blinking and see how long you last. For the past 2 months, Lori has basically been involved in one big, long staring contest with her right eye; it is easy to see why that was making life difficult for her. We are excited for the swelling to go down so we can see how it all turned out.In the postoperative photo, Lori looks like she is grimacing a little on that side; during the surgery another surgeon named Dr. Joel Aranowitz used some really long sutures to lift up the sagging part of her right upper lip; the "lift" is a little exaggerated right now because of the swelling, but should make her face look and function more normally once the swelling subsides. We are, of course, hoping that this will be temporary, just for a few months. We remain optimistic that she will regain most, if not all, of the function in her face. But, everything we have heard has indicated it will be several months, or even up to a year. This will be, if nothing else, a very nice, temporizing measure. They can take the spring out again, later, and we certainly hope that is what will happen.

Lori's friends had this really pretty flower arrangement sent to her in our hotel.We have wonderful, supportive, loving friends and family who have supported and loved her during this difficult time. We don't have words to express the gratitude we feel for them.

Treatise on Health Care Reform: Part 1 of 3

2009-10-27T15:10:00.009-06:00

I can't help it. I need to sound off on "health care reform" since the whole argument is driving me crazy. It seems like you can't watch the news, pick up a newspaper, listen to the radio, or read anything on the Internet without hearing about how we need to reform the healthcare system.

Well, I have a few thoughts on the subject, so here's one physician's current view on the debate. Actually, it is more than a few thoughts; this will probably rival the stimulus package bill in length, so I plan to present it in four parts: 1) Controlling Costs & the Concept of Employer-Funded Health Insurance, 2) Rights vs. Expenses, 3) Pharmaceuticals and Equipment. The fourth (much shorter) installment will succinctly outline what direction I think reform should take for the best good of all concerned; I plan to call this last one my "Proposal For Health Care Reform 2009." Lest you think I am suffering from 'delusions of grandeur,' let me say up front that I don't think for one minute that my opinion counts one whit in this debate. Still, it makes me feel better to put it out there, so here goes:

Controlling Costs & the Concept of Employer-Funded Health Insurance
One one hand, some politicians today think we should let the government finance the system entirely, turning it into something akin to the public school system, available to all at no direct cost. Increased governmental control will reign in costs (somehow). On the other hand, some think that the insurance industry just needs to be deregulated and allowed to sell plans across state lines. Fostering increased competition between those who pay for health care will reign in costs (somehow). And, of course there is every conceivable variety of opinion in between.

What nobody seems to want to talk about in the whole debate, is why medical services cost so much in the first place. Why is it that the cost of evaluations, treatments, supplies and equipment are so quickly outstripping society's ability to pay for them?

During my short career as a physician, I've seen a remarkable transformation occur. We have always had people who lacked health insurance entirely and were burdened with heavy bills when they got sick, but when I started practice as a resident in 2001, most people with health insurance rarely thought about the costs of health care at all. They had low deductibles, low or no copayments, and their employers usually picked up the tab for the insurance premiums, entirely. There were few, if any, restrictions on which physicians they could choose or which treatments they could have.

Now, many employers have limited how much of the premium they will pay, passing the rest on to the employee in an effort to have some control over the cost of these benefits. Yearly deductibles are increasing, and copayments for drugs, a relatively new concept, have risen from around $3 to $60 or more monthly for many meds. Additionally, insurance companies are increasingly involved in the doctor-patient relationship; the question for many patients has changed from "which treament is best?" to "which treatment is covered?" And, more recently, I have noticed an increasing number of patients with average incomes who can't begin to afford their medications, even with their insurance paying its portion.

Why? This is what nobody seems to be asking right now. While they squabble back and forth about how we can possibly pay for the "skyrocketing costs of healthcare" things, nobody wonders how the heck we got here in the first place. Perhaps part of the solution lies in identifying and correcting the underlying cause of the cost increase.

Let's review a short course in American Healthcare History, from a funding perspective. Health insurance as we know it didn't exist until around 1930; prior to that people were on their own to pay, in cash or in kind, for medical services. Those who couldn't pay simply did without, unless they could find a charitable physician or hospital, or some other generous group to pay for medical services for them. Many of these "uninsured" patients died of potentially curable conditions, simply because they couldn't afford treatment; this was not considered unusual or cruel, or in any way unfair. It was, simply, a fact of life.

Early insurance "cooperatives" were set up by large employers as a way to provide low or no-cost medical services for their employees, usually for the treatment of on-the-job injuries or illnesses. These groups evolved over the years into large conglomerates we know today as Blue Cross, CIGNA, and the like. As other, smaller players entered this market, they began to stratify patients into various risk categories, using an underwriting process like that employed in the life insurance business; patients likely to cost the company more were charged higher premiums, or were denied insurance altogether.

The next major evolution in healthcare funding was the HMO; these organizations were different in that, rather than trying to control costs simply through risk stratification, they began to focus on the supply side of the cost equation. They negotiated with hospitals, physicians, and other suppliers of healthcare using this basic bargaining phrase: "we have a ready supply of insured patients for you, if you agree to the conditions of our contract." The original HMO concept was that cost management through time-tested business principles, combined with an emphasis on prevention, could produce lower premiums for patients and higher profits for insurers. To an extent, the HMO concept works as a business model, although much of the envisioned cost savings gets swallowed up by the vast 'middle management' required to administer such plans effectively. Initially, these groups only attempted to control how much they would pay for each service recommended by physicians, not which services could be offered; the doctor-patient relationship was considered independent and sacred.

More recently, though, as costs have continued to spiral upward and profits have become more and more difficult for insurers to realize, even this boundary has been crossed and, in many cases, obliterated. Many physicians in HMO arrangements feel like simple puppets of the organization; every decision they make with respect to their patients is influenced by the mandates of the insurance organization. The historical doctor-patient relationship as we know it has, for many, ceased to exist, supplanted by the doctor-patient-payer relationship.

Another important historical element is the introduction of Medicare in 1965. Patterned after Social Security, this fund basically takes money collected from working Americans in the form of a payroll tax to pay for health care costs for retired people. This fund was a godsend not only for many elderly people, but for the medical industry in general, which, along with the rest of the world, had undergone a technological explosion that had greatly expanded what medical science could offer patients. Now, able to offer lifesaving and life-prolonging treatments previously unavailable, and with a virtually unlimited federal fund from which to draw for payment, physicians and hospitals across the country became wealthy beyond their wildest imaginations. Life expectancy for the elderly increased accordingly, and this placed an additional demand on the fund. In time, Medicare learned and began to apply HMO principles like the rest of the insurance community, and introduced strict limits on covered services in an attempt to control spiraling costs. Today, Medicare is not appreciably different from any other insurer in most respects.

Around the same time Medicare was introduced, the government instated certain tax incentives for businesses supplying health coverage for their employees; special laws were introduced governing "group health insurance," which gave special protections to individuals covered by group plans. These special protections took away many of the risk stratification strategies insurance companies used to determine who they would and would not cover. For example, insurers were prohibited in many cases from denying coverage for preexisting conditions. These same protections were not afforded people who weren't covered under group policies, and the difficulty those with health problems have in obtaining "individual insurance" persists even today; this disparity is one thing that some politicians are targeting as part of the reform being considered this year.

With that historical context, consider the original question. Why does healthcare cost so much in America, particularly compared with what it used to? For sure, there is no single, all-inclusive answer to this question. I believe, though, that most of the reason has to do with the way insurance has removed costs out of the consumers' eyes. For too long, patients knew nothing of what their medical services were costing them. Not only were they not paying the bills, they weren't even paying the insurance premiums.

Without incentive or motivation for patients to shop around, the providers of medical services have for years had basically no free-market control over rising prices, and they have acted accordingly in the pricing of their services. Rather than set their prices based on competition and what the market would tolerate, providers simply set their prices "higher than the highest payer's allowed cost," leaving all cost control in the hands of payers alone, who don't actually consume the 'goods.' Of course, competition among payers for patients then drives costs up, instead of down, like competition among providers would do. Not experiencing the costs themselves, patients as a whole have gotten in the habit of demanding nothing but the best, latest, greatest, most convenient, and, of course, most expensive care; this behavior is a natural by-product of the system we created. Not surprisingly, this handcuffing of free market principles in the healthcare market has led to the price explosions we continue to see. We have, unwittingly, created a system that is a perfect recipe for price inflation.

Of course, the lucrative nature of this service sector as a whole has encouraged more and more research, innovation, and development of new technologies for diagnosis and treatment, each more expensive than the one before. Of course, once a new modality for treatment or diagnosis is available, it becomes part of the "standard of care," and insurers have to cover it; premiums, then, rise accordingly as the insurers' cost burden increases.

When you think about it, the surprising thing is not that this has happened. The surprise is that the problem has taken so long to reach critical mass, which I believe it has. I see it every day in my practice, where the 'standard of care' comes head to head with its associated costs, which more and more patients simply can't afford, even if they have insurance.

So, what to do, then? Well, I'll offer my opinion on that in part 4, straight up. But before we can meaningfully reform the health care system for the long term, I think we need to decide one thing as a country: should health care services be available to Americans as service market items, like catering, carpet shampooing, or window-washing? Or, should they be purchased by the public collectively, through taxation, and provided to the people as a "right," of citizenship like we have decided primary education should be? In my opinion, you can't have it both ways and also have a system that will work for the long term, and that is what Americans have come to expect.

Two important legacies have been created with Medicare and the employer-funded health insurance concept, which are important to recognize. The first of these legacies is government involvement in health care. As with any program supplied by federal funding, Medicare has federal strings attached; the introduction of Medicare and its sister program, Medicaid, introduced government regulation of medical services. Most insurers now piggyback their own regulations and reimbursement rules on to those of Medicare so that, in a very real sense, the government controls funding for the entire healthcare industry. In effect, the doctor-patient-payer relationship has now further evolved into the doctor-patient-payer-government relationship, even for those who aren't covered by "governement insurance." Too often, people and their various medical problems are treated as just another football in the great political game. The introduction of politics into the mix has further complicated the delivery of health care in America.

The second legacy is that patients across America have come to view access to health care services as a public "right," like access to education has become, rather than as an individual "expense," like food or housing. While not specifically granted either by the Constitution or by any existing act of a governing body, this alleged right has, nonetheless, become very real in the minds of many Americans. This dichotomy will be explored more fully in part 2; stay tuned.

Update: The MRI

2009-10-04T21:07:00.007-06:00

Lori is doing much better the past couple days; her facial paralysis hasn't improved but she is feeling much less tired and run down. Earlier in the week she was having a lot of ear pain, so she went to see Dr. McMaster our local ENT, who was quite worried about the degree of paralysis she has, and recommended that she have an MRI of the brain to rule out other causes, such as tumors, etc. The MRI was normal except for a significant amount of inflammation along the facial nerve as it courses through the temporal bone. Here is a picture of what Bell's looks like on MRI. Of course, this example is on the left, and Lori's is right-sided.

And here is an MRI picture of Lori's brain in side view.

Just kidding! On the serious side, Bell's is graded on a 0-6 scale, with 0 being normal and and 6 being complete paralysis. Lori's case is a 6, and Dr. McMaster feels like, because of the severity of her paralysis, she is probably looking at several months, rather than weeks, before function returns to her face. So, that is discouraging, but she is getting used to the idea and hunkering down for the long haul with this crummy illness.

Here are a couple more pictures I found on the Internet that show the neuroanatomy relevant to Bell's palsy.

Thanks to all who have called, expressed support, brought food, flowers, and generally loved us through this. Understandably, it has knocked Lori back on her heels, and having such great friends and family is a wonderful thing for us. We love and appreciate you all!

Update: The Temporary Tarsorrhaphy

2009-09-22T21:23:00.007-06:00

Lori woke up this morning with severe pain in her eye, definitely worse than it had been. She's pretty sure her eye patch came loose during the night, so her eye was probably open for some time. Luckily, I had most of the day off, so I got her in to see my ophthalmologist friend, Dr. Fullmer. He took a good look at her eye and could see that there were some very small ulcerations on the cornea, probably from excessive dryness, and that was what was causing the pain. We talked about options, and we eventually decided on a procedure called a "temporary tarsorrhaphy." Translated, that meant he would sew her eyelids together for a little while until the lid regains strength. Here she is after he instilled the local anesthetic. She looked like Hitch when he had the allergic reaction.Here it is tonight. The little white things are pieces of rubber used to bolster the stitch that holds the eyelid together, so that it doesn't cut through the skin like a cheese slicer. The eyelid isn't all the way sewn shut; it needs to be partially open to allow oxygen to get to the eye, and to provide a means to examine it and instill antibiotics. She is already a lot more comfortable. It will probably stay in for about 2 weeks.Thanks to all of you who have written encouraging comments, called, brought food, prayed, or otherwise shown such great support. She has literally been showered with friendship since this came on, and the outpouring of generosity and well wishes has been overwhelming and gratifying for her, and for me. I will continue to post updates on her progress.

Lori: Feeling a Little 'Down in the Mouth'

2009-09-19T20:10:00.013-06:00

Lori called me at work Thursday with an odd question: "What does it mean if, when I smile, only half of my face moves?" She had been struggling with a touch of the flu for a few days, and, knowing that, my heart sank. I have seen a few cases of Bell's palsy in my practice; it is not a fun condition at all and it is often preceded by a viral illness like the one she had.Sure enough, when I got home that night Lori described how she had felt a little weird in that side of her face all day, and then had developed actual weakness on the right side. She had also noticed that she was having a hard time tasting anything at all, and that she had a vague pain in and behind her right ear. By the next morning, she couldn't take a drink without half of it running out that side, and she couldn't shut her right eyelid all the way.

As it turns out, the eye symptoms are the worst part of the whole illness. The affected eye dries out quickly and has to be lubricated constantly. The irritation and burning are driving her to distraction, and the eyelid on that side is inflamed from all the various tapes and patches she has been trying to keep the darn thing shut. This seems to be the most comfortable method she has found so far; unfortunately, it isn't exactly inconspicuous!As long as she isn't trying to move her face, she looks pretty normal.
But, when she tries to smile, or talk, or eat, or drink, the right side of her face won't move. The left side gets pulled over to the left, since there isn't anything to oppose the contractions of the muscles on that side. When she blinks, her eye rolls back in her head, but the eyelid doesn't close, so that looks kind of creepy.Medically, Bell's palsy is interesting because it helps teach the neuroanatomy of the facial nerve. When the nerve signals are interrupted after they leave the brain, the entire side of the face is affected, including the forehead; if the nerve fibers are interrupted inside the brain (such as with a brain tumor or certain strokes, the forehead often works normally because the signals from the other side of the brain compensate for the loss of signal to that area. Here is an illustration of how that works.The second diagram here shows which types of nerve fibers run through the facial nerve. This explains why she can't taste things very well, and why she has to use lubricating drops in the eye even when she has it constantly patched and closed; the tear glands don't work well when denervated. Some people get dry mouth because the salivary glands are affected. She hasn't had that symptom, thank goodness. There is a muscle in the ear called the "stapedius." This muscle helps dampen loud noises, and it gets taken out of commission by the palsy. This explains why everything sounds loud to Lori right now.Bell's palsy is almost always temporary, but the time it takes for the damaged facial nerve to regain function is variable; it can return in 2 weeks, or it can take up to 6 months. My ENT friend says that, in most cases, even severe ones, most function has returned within 2 months. We're certainly hoping for a quick recovery, and our family had a special fast today for her. This is no fun for her and we feel bad! She is a trooper, though, and besides, if she cries it is only out of one eye anyway, so what would be the point of that? We all think she is beautiful no matter what!

Lake Powell Trip Over Memorial Day

2009-06-28T20:14:00.020-06:00

Nathan and I were invited to go to Lake Powell over Memorial Day Weekend with our neighbors, the Bauers. Their youngest son, Kole, is a lot younger than their other kids, and he needed a bud. I was invited to accompany him, and to fill the role of 'family sherpa,' which means I could earn my keep by carrying stuff and performing other menial tasks as my limited nautical skills permitted.

Most of the Bauer family had gone down earlier, but Nathan, Kole, Stacy, Julee and I were slow getting started, so we didn't leave Rexburg until around 5:00 Thursday. We took turns and drove most of the night, and made it as far as Kanab before we decided to stop for a few hours' rest. Friday morning dawned rainy, and we were stranded briefly while provisioning in Paige due to flash floods across the roads from a pretty impressive storm. All of the rain had lots of desert wildflowers blooming.The Bauers have this really nice houseboat and the really nice ski boat pictured here.We finally got to the lake, though, and the weather improved. We had a fun time playing in the water, wakeboarding, and just relaxing. Here's one of the guys, C.J., surfing.I walked up the hill one morning to take some pictures, and saw more than I wanted to. This guy obviously didn't see me up there, and I couldn't resist snapping his photo on the sly as he took a whizz off the back of his boat. I also couldn't resist posting it here. Think: "You might be a redneck if..." Of course, it's hard to say which is more "redneck," him for doing it, or me for taking his picture doing it.One day we took an interesting hike to see these old Indian ruins. This circular stack of rocks probably had a wooden roof on it at one time. There was a little fireplace in one end where you could still see the soot from their fires.Here, it appears the Indians had stacked rocks to make a small dam in the wash that runs through the area. (Or, maybe they just didn't have anything better to do than stack rocks up in a straight line.)We saw this very large lizard sunning itself on top of this outcropping. When we tried to approach, it took off running. We couldn't believe how fast that sucker could go. He ran down the hill, and just kept going. I would bet he ran a good quarter mile, and was still going when we lost sight of him!We also saw this desert hare; he had very little fear of humans. Sort of an ugly creature, really.Here's Nathan jumping the wake while wakeboarding. He's a natural!Dude! I got like three feet of air that time!Here's one of Stacy's daughters, Holly, captured in mid-wipe out. She really did get like three feet of air that time!I thought this was a cool photo Nathan took. Doesn't the water look cool coming up over the board? I've played with the colors a little bit to enhance it. Ignore the constipated look on my face (if you can).A gorgeous Lake Powell sunset!Thanks to Stacy and Julee for inviting us to come along! We had a wonderful time playing at Lake Powell and getting to know their awesome family better. We made some really good memories with them and we're already hoping for another trip with them soon. They are so much fun!Even if Julee won't let me take her picture.

Ashlynn's 10th Birthday

2009-05-17T18:34:00.015-06:00

Ash celebrated her tenth birthday on May 11. She didn't want a big party this year; her only request was that we take her and a friend to the local Thai restaurant so that they could "split a mango curry." Needless to say, she's always been the most adventurous of our children when it comes to cuisine.Interestingly, though, all of our kids will eat oriental food. Nathan won't touch a hamburger, but give him Mandarin chicken or stir-fried vegetables any day of the week...We didn't get any photos at Original Thai, but picture a "little hole in the wall" place with circa 1970s floor and wall coverings, fluorescent lights, and a single row of round tables with fold-down sides. The menu is a little limited, but they have some excellent dishes, including Ashlynn's favorite mango curry, Lori's favorite Masiman curry, a delightful lemongrass soup with mushrooms, and some kind of chicken-on-a-stick appetizer (I can't remember the name) that reminds you of the little things the penguins eat in Surf's Up. And, of course, they have the classic mangoes with sticky rice dessert that we all love; we didn't get it this time because we had cake and ice cream waiting at home, but my mouth waters just thinking about it.

Here's a couple pictures of Ash blowing out her candles. She almost smoked us out!Going along with the Asian theme of her birthday (I guess) she asked for coconut cake, which is something I really like but not something kids usually dig (more of an adult taste, wouldn't you think?) She obviously likes it, though. It is a white sheet cake infused with coconut milk and with whipped cream and shredded coconut on top. Yet another of the amazing recipes Lori has picked up over the years.

She got her ears pierced over the weekend in Salt Lake; we made her wait until she was ten but she wasn't about to wait one minute more, and certainly not until she was 55 like her Grandma Elma Lynne. Apparently she was trembling until they did it-both ears at once-but said later it was no big deal. These photos were on Lori's camera; I wasn't allowed to come along. This rite of passage is "girls only," I take it.Her friend, Alison, who also waited until she was ten, had it done a few weeks ago, so they're excited to share earrings. Ash got a bunch of new ones for her birthday.
The present she asked for was a "rip-stick." I'm not sure whose idea this little beauty was, but I am sure that whoever engineered it wanted to make sure of at least one thing: that no adults could ever ride one. Think about it, have you ever seen an adult swivel-hipping it down the street on one of these things? I'm pretty sure it is physically impossible for anyone over about 16 years of age; I don't understand how kids get the hang of it so quickly. It's like a double amputee trying to ride a unicycle with a bent wheel, or something like that. On the bright side, at least she isn't asking for a cell phone...yet.It is so hard to believe my little girl is growing up. She hasn't shed little-girlhood totally, but I am starting to see the signs and I can hardly believe it. She is such a beautiful, intelligent, spunky girl who is so full of energy and life. Everywhere we go people comment on her beautiful red hair and her gorgeous smile, which really can just melt you! Her constant giggles keep us all smiling, and we are thankful she is part of our family.

Looking For A Few Free Masons

2009-04-19T20:57:00.010-06:00

No, not the kind with the funny hats and all the temples; the kind of free masons I need are the ones who actually lay brick and mortar (for free).

I built this little shed in my backyard for the lawnmower and such, and the exterior needs to be completely bricked (Lori only let me build it if it "matched the house." I'm sure that's some kind of a girl thing, and that's all I'm going to say about it so that I don't end up living in there after she reads this).
Anyway, by the time I paid for the concrete pad, the shed, and the brick, I'm not finding myself really enthused about paying somebody to come and lay the brick; apparently nobody has filled our local masons in on the fact that there's a nice little recession going on right now, as their bids seem $$$HIGH$$$ to me.

Besides, it's Spring, which does mean, after all, that it is time to carry out my yearly tradition of getting some kind of foolish idea in my head for a project. So, I'm thinking about doing it myself. But, as I work through this little thought process of mine, I keep running into the same little problem: I have absolutely no idea how to do it. None. Zero, zip, nada.

In response to this post, I'm hoping all have all kinds of willing friends and relatives (Dad? Feel like a nice little trip up North in the near future? Please?) who actually have any small amount of knowledge who will be ready to drop everything and come help me for a couple days. Weeks? How long will this take, anyway?

In any case, the "do-it-yourself" flame is kindled now, and there's no turning back. I've had this little bug before, and the little voice in my head keeps trying to remind me that it often hasn't been pretty or ended well, but I am helpless. I've got to do it. Yes, it will end up costing me more in the long run. No, it will not be as fun as it seems right now. Yes, it will take a lot more time than I think. Life has taught me a few lessons, you know.

So, those of you who can't drop everything and actually come help, do you have any words of bricking wisdom you can pass along to me as I gear up for this little project? How about some ideas from your book of "Masonry For Dummies"? Remember, we're starting from ground zero here, so anything you might have to offer will surely be tremendously helpful.

I can tell you that so far I know that the mortar will be black (to match the @^#$%@ house), and that the mortar will also be "raked" (Yes, I do know what that means! Kind of, anyway.) My builder friend, Brett, says it also needs to have a "soldier course," but I see no reason to involve the military. It's just a shed, after all! ;-)

Oh, and if your words of wisdom fall in the category of "don't do this, you stupid man," don't bother. I'm getting plenty of that from within the ranks already, with exactly the opposite of the desired effect. Poor woman just won't ever learn that all she does is take a little passing notion and turn it into a do-or-die quest when she attaches a challenge like that to it.
I'll post some pictures of it once it's done. Unless it is just horrid and then I'll just blow it up with dynamite. But, of course, I would have to post pictures of that, too, wouldn't I? (Before I do that, I'll put up a post asking for your "Dynamite For Dummies" advice. I've never done that, either!) Wish me luck!

Eat Your Heart Out, White House!

2009-04-14T20:30:00.015-06:00

Jill & Kevan came up for Easter weekend and we took advantage of some rare good weather to have a huge Easter Egg hunt outside. If we only knew what an "Easter Egg Roll" is we really could have eclipsed the DC event!

Here are a few snapshots of the kids hunting for eggs.

Jill & Kevan, Jason and Andi are moving to Nashville, Tennessee. We're going to miss them when they're gone!

Ashlynn's Thespian Talents

2009-03-18T14:19:00.006-06:00

Ashlynn recently wrote a poem which was entered in the Rexburg Civic Club's Annual Art & Poetry Contest for Children. Much to her surprise (and to our delight), it won first prize! Here she is reading it in front of all the parents at the Rexburg Tabernacle.
Here is the winning poem:

Are We There Yet?

Are we there yet?

I just cannot wait!

To be where I've dreamed of

my excitement can't wait!

Are we there yet?

"NO!" yells mom

But soon we will be

to where I have dreamed of

my whole life long!

YAY!

Because she was the winner from her grade level, her poem has been entered in the General Federation of Women's Clubs' state competition, in Boise. It is rumored that, if her poem wins there, she will get to read it on the radio! Her poem was also published in the local paper; you can link to the article by clicking here.

Here are a few other examples of her recent work (perhaps it is the budding artist in her, or perhaps it's the twenty bucks they gave her when she won, but she has had quite the creative streak lately). I've put them here how she typed them, including the font colors.

Dishes

Dishes, Dishes, Dishes.

I hate dishes!

Washing dishes is horrendous,

horrible, and atrocious!

Some dishes have slimy beans

And some dishes have

Squished bananas!

YUCK!

I HATE DISHES!!!

AYLA

WHO'S THAT GIRL WITH CURLY, CURLY HAIR?

WHO'S THAT GIRL THAT'S EVERYWHERE?

WHO'S THAT GIRL THAT'S CRAZY, CRAZY, CRAZY?

IT'S AYLA BAYLA RUNNING EVERYWHERE!

Creations of God.

The sun, the moon, the snow, and rain, and

lots of other things,

Are all of God's creations,

that he made for you and me.

Any interested publishers can contact me or my agent directly to discuss the rights. :-)

The (New & Improved) Rexburg Medical Center

2009-03-14T08:50:00.008-06:00

My medical office has undergone a major renovation/expansion over the past year and a half or so, which was finally completed in November. The building was completely redesigned for efficiency, and to maximize our space usage.The first thing we did was convert our record-keeping system to electronic. We have been using a system called eClinicalWorks for 2 years now. It was an expensive changeover, but well worth it, I believe. It has created a lot of efficiencies for us in our day-to-day processes, and the usable space we gained by getting rid of our paper records more than pays its expenses.We added some new space, most of which has been leased to a group of Physical Therapists and to a local General Surgeon, Dr. Coray.

The PT group has a whole suite for kids downstairs, and they have this cool climbing wall with a mural of the Tetons painted on it. This would be the coolest part of the building, except...This is our new 350 gallon saltwater fish tank. Granted, it doesn't look like much yet, but it is a work in progress; soon it will be teeming with sea life of all kinds, including fish, of course, but it will also have corals, starfish, anemones, sea snails, and other kinds of aquatic wonders, sort of like this similar tank at our local hospital.

Anyway, having a saltwater tank in my place of employment has given me the "SCUBA bug" all over again. I'm going to need to spend some time underwater in the near future, somehow.

Now we have all our exam rooms in one place, in a sort of oval configuration, with the nurses' work station in the middle. Check in and check out are in a totally different place, and redesigned to provide more privacy for patients. The only place in the whole building that is in the same place is xray; we kept them in the same location because all of the lead-lined walls are really expensive to move. All in all, this has been a much more efficient way of doing things.We have also added a separate suite for "DermaChic," which is our skin care clinic that does laser hair removal, Botox injections, and that sort of thing. And, our latest addition is the "RMC Wellness Center," where we provide medically supervised weight loss and other preventic health care services. We have some additional space to rent, and a dermatologist has recently signed a lease for that space, so we'll be all full again.
I think the floor coverings, paint colors, and all the other trimmings are very well done and really add a new touch of class to the office. Most of our patients seem to think so too, although I did get one comment recently from a patient who really misses the "homey" atmosphere we had before. (Personally, I think if your doctor's office feels "homey" to you, you might want to try to spend less time there. Just a thought.) And, of course, we have always had the best staff anywhere, so that isn't any different at all!I am really appreciative to Dr. Zollinger and Mary for all of the blood, sweat, and tears they have invested in the new and improved Medical Center. They really stuck their necks out, and I hope it pays off for them; I think it will.

As for me, I am still really excited every time I go to work there, and think it is a great place to build a strong and stable medical practice for many years to come.

I Can't Believe Nathan Is 12!

2009-03-10T12:15:00.017-06:00

Twelve is one of those landmark birthdays that, when you reach it, signals the beginning of growing up, the prelude to teenage-hood, and a lot of other landmarks in the life of a child, particularly an LDS child, who graduates from Primary and starts going to Mutual. Nathan's twelfth was January 30.

Twelve is, apparently, about the age when kids begin to discover they are smarter than their parents, if Nathan's attitude lately is any indicator. Don't get me wrong, Nathan is a GREAT kid. I believe you simply could not ask for a better one. But, it is strangely comforting and disconcerting at the same time to watch him develop "a mind of his own." On the same subject, though, it is fun to watch him develop a more sophisticated, grown-up sense of humor, to have little "inside jokes" with him, and to laugh at a lot of the same movie lines (does that mean my own development is stuck, suspended at around age 12? Please, Jillyn, no comments.)

He is excited, because he is pretty sure he got "straight A's" this term; the trimester just ended and he hasn't got the report card yet. This would be quite an amazing accomplishment for him, he works very hard. I can't believe how much homework he has, particularly in math. I don't remember ever having that much, not even in high school!

Here he is in his new suit, ready to go to church and pass the sacrament. He is very conscientious about his priesthood duties.

He received his Tenderfoot, Second Class, and First Class rank advancements at a recent court of honor. Here he is attaching the pin on his mom's lapel.

Big Sky, Montana

2009-02-12T21:46:00.027-07:00

When our next door neighbor came over recently and asked if we wanted to use the last half of a timeshare week they had in Big Sky, Montana, we couldn't pass up the chance, so we took the kids out of school a couple days for a midwinter ski trip.To get to Big Sky, we drove north out of Rexburg on Highway 20 all the way to its end in West Yellowstone, Montana. From there, we turned north on to Highway 191, which skirts the Northwest edge of Yellowstone Park, and even goes inside the boundaries for part of the way through some very beautiful country.
Most of the way follows the Gallatin River, which I almost got to flyfish a couple years ago when Lori and I went to Big Sky for our anniversary in September. (As luck would have it, snow was coming down pretty hard the day we were supposed to go, so we bagged it and came home.) Here are a couple pictures of cute little Ayla... just being Ayla.Anyway, the condo where we stayed was right next to Big Sky Ski Resort. It had two bedrooms, plus a couch bed and a loft, so it was quite roomy. Lori's sister Cari and her husband Aaron happened to be visiting when we decided to take the trip, and although it strained our powers of persuasion, we got them to come along with us. We also happened to be watching a couple of other kids for our friends who were on a cruise, so we took them, too. That worked out well since they are Nathan and Ashlynn's ages, so they each got to take a friend along. All together, there were eleven of us, including our little baby niece, Kendall. Here's a picture of Ashlynn's friend Alli.We had been told that the resort at Big Sky is big, but even so we were surprised at the sheer size of the place. The resort itself has something like fourteen lifts, which cover an astounding amount of skiable terrain; one of the nicest things about Big Sky is its many extremely long, wide, well-groomed runs that are excellent for beginners. They aren't too steep, but they're steep enough to keep you moving without having to stop and climb. Here are Ash and Alli behind me on the chair lift. Most of the lifts there are high-speed quads, so they really get you up the hill quick. We didn't have to stand in a single line the whole time.I was amazed at my brother-in-law Aaron, who before this trip had never skied. He spent 10 or 15 minutes on the bunny hill, then got on the lift and went for it. He skied all day long, and even went on a couple of "blue" runs before the day was over. He had his share of wipe-outs, but he really caught on quickly, and had a lot of fun. He was so sore the next day, however, that he had no desire to return for another round. Here he is with his daughter on the tubing hill.Cari, on the other hand, wasn't such a quick study. She gave it a try and, much more typically for a beginner, struggled to catch on. We started with a simple skill known as "stepping on to the magic carpet," which took a little time to master.For some reason, riding that thing was worse than a bucking bronco for her; she kept falling off. One time, she fell down, landing face down on the tread. Since her body was only halfway on, the moving belt beneath threatened to rub her face right off, so she just flopped around like a little fish until she could get herself completely off into the snow. The whole thing was terrifying for her, and really embarrassing I'm sure, but for the rest of us this little episode provided excellent belly laughs for the rest of the day.
In her defense, she does have a mild case of cerebral palsy, and I think those ski boots really weren't getting along well with her shortened achilles tendons and off-kilter stance. She was a trooper to even try; I think she could do well with a little more time to learn. Even if she didn't do well, we would all get a kick out of watching her try!

Avree had a couple more sessions of ski school; she's really about ready to be done with that now. She's getting pretty good, and will soon be keeping up with the other kids. Ashlynn had a lot of fun with Alli, but she scares her dad because she likes to go through the trees, and I'm afraid she's going to wrap herself around one.
Nathan loves to snowboard, never having had any interest at all in skis. He looks pretty good out there, and is learning more tricks all the time. We make them all wear helmets.Here's a picture of Lori's new skis, affectionately known around our house as the "naked ladies" because the design on them includes a rather busty chinese woman who is, for some reason, fanning her exposed cleavage. (Here, they have been covered with snow to protect any innocent eyes.)Yeah, that Lori is getting pretty wild in her old age. Watch out, pretty soon she'll have a tattoo. She had to try on several pairs of boots before she found some that fit very well; even then she needed to have some special fitting done by a "Master Boot Fitter" so that they wouldn't make her retarded right foot go numb. (Where do you suppose a Master Boot Fitter goes to school? Does he have to be an Apprentice Boot Fitter first?)
Lori has skied quite a bit this year, and has really enjoyed having something to do outdoors during our endless winter. She feels like she has gotten a lot better at it, too; all I can say about that is strap a couple naked ladies on my feet, and I could glide pretty good, too!
The second night, we took all the kids up to the "family fun zone" to go tubing. It was a blast, and we all had fun, but one time Ayla and I went down a little too soon after Avree, and when we got to the bottom she hadn't quite got off the course yet and we ran right in to her. She went flying! I would have just bailed off the tube, but I didn't dare with Ayla on my lap. Avree was a little shaken up, but okay.Here I am shushing down the slopes.
We had a really great time in Big Sky, and made some great memories. Skiing has been a fun family activity this winter. We really appreciate our neighbors the Bauers for letting us use their condo. They're the greatest!

Nathan Playing Hoops/Ash Dancing

2009-02-02T21:26:00.000-07:00

Nathan is a pretty good basketball player, and he really enjoys playing on his team this year. Here are a few photos of him in action!

Basketball probably isn't the best sport for him to pursue, though. Neither Lori or I hit puberty until we were like 22 years old, so here in a year or so when all his buddies start to grow, he's highly likely to start feeling like a midget.

Ashlynn had a dance performance last night; her group performed during halftime at the local high school girls basketball game. She has really gotten good!

Isn't it amazing to watch your kids grow up and see all the cool things they can do?

More Cat Tracks?

2009-01-31T21:55:00.000-07:00

So, a few days after the fabled Rexburg cougar eluded the mighty hunters, I was home for lunch one day. As I casually munched on my sandwich, I happened to look out the back window to see a solitary line of tracks crossing the back yard. From a distance, they looked relatively fresh, and quite large.

Curiousity piqued, I put on my boots and went out to investigate; the pictures here show what I found.

I'm no expert tracker, but going back to my Cub Scout days, I remembered that cat tracks tend to be wider than dog tracks, and you don't see claw marks in cat tracks. Not having tracked many mountain lions, I would assume that their tracks would also be bigger than this, but I have to confess I don't really know.

There is a certain large dog in our neighborhood who, in the past, has never entered my yard without leaving a rather large pile of "sign" as his calling card, and there was none of that to be found here, and I haven't really seen him around this winter. (My empty CO2 cartridge is the only reason he wasn't sent home tie-dyed on several occasions last year, something that will be remedied come Spring!) Of course, there wasn't any cat-style scat either.

I stopped short of putting my nose to the ground to sniff for cat spray, as I had to go back to work in those same clothes, but after analysis, I think these are dog tracks. It was interesting, though, to see them next to the various housecat tracks like these that meander around the yard.

Whatever it was, it was definitely a much larger animal! Perhaps some of you cougar experts out there can give me an expert opinion?

We have, on occasion, had a moose in our backyard too (although not this year). I would like to see what kind of tracks he would leave.

Avree's Birthday Party

2009-01-28T20:29:00.003-07:00

Avree's birthday is on January 12, so this post is a little late in coming. She wanted to have a bowling party, so we loaded up a bunch of her friends and went to the Rex for a fun-filled evening of youthful chaos. (And the kids had a good time too!)

Two of the best things ever invented are "bumper-bowling" and "bowling by the hour." There are no bad rolls in bumper bowling; everyone's a champion! We didn't have to worry about getting all those kids through their round; after the hour was up, the lights went out and it was time for cake. How perfect is that?

Ayla has an unusual bowling style. After she pushes the ball down the lane, she likes to watch it hit the pins while laying face-down on the smooth hardwood.

And, of course, she needs some knuckles at the end. Yeah, baby!

Lori used her airbrushes and highlighting pens to slave for hours over this beautiful cake! (She also had a little help from Mr. Albertson.)

At the bowling alley, they also make really good ice homemade cream, right there on the spot, using liquid nitrogen. (He wears the chemical diagram on his shirt for credentials, in case you thought he was using something else. Freon, perhaps?) You can get any flavor you want, and it actually tastes really, really good! And you thought liquid nitrogen was only good for freezing off those big, ugly warts!

It is hard to believe my Avree is six years old already! She is an amazing little girl, and we all love her like crazy!

How to Make it Snow

2009-01-26T21:10:00.010-07:00

So, after our whiteout Christmas, we have had a January thaw with an associated 3-4 week "snow drought." This has concerned the kids, mainly because it's pretty unlikely the school will declare a "snow day" out of school without any snow.

They tried good old-fashioned prayer for a while, even disguising their appeals to a higher power as an altruistic plea "that we might have moisture for the farmers."

Well, that wasn't working, so of course they have had to get more creative in their approach. When you want something done right, do it yourself, right?

With this in mind, Avree, our six-year old, was having an in-depth discussion on the subject with her friend Lincoln the other day, who informed her that if you want to make it snow, all you have to do is sleep with your pajamas inside out. (I mean, geez, everybody knows that!) Here she is in her bed earlier tonight, trying for a repeat performance.

And, apparently, if you want to be extra sure, you also sleep with two (not one, not three, TWO) wooden spoons under your pillow, like this:

Avree gave it a try the other night, and sure enough, we awoke to a couple new inches in the morning. Not enough to cancel school, but it was a start. Well, tonight even Ashlynn has bought in. (Nathan, so far, isn't about to try it. He's playing the part of the cool, rational older brother who is way too cool for this sort of thing. I can tell he's watching it all with an interested eye, though. I mean, a day off school is a day off school, right?)

I'm planning to go skiing at Targhee tomorrow. I wonder if we have any more wooden spoons in the drawer!

UPDATE: (1/27/09) Sure enough, snow day today! We got a call from the school district this morning (at 6:00!) informing us school had been cancelled "due to extreme cold." It was -10 degrees at the airport this morning. It is also snowing, but only lightly.

I really should have turned my jammies inside out, since it was -20 at Targhee this morning, so I couldn't go skiing as planned, unless I wanted to come home a popsicle. Next week!

Skiing at Kelly Canyon

2009-01-11T21:21:00.038-07:00

Lori's sister Jill came to visit over New Year's, and we all went skiing at Kelly Canyon, a nice little ski resort that's only a half hour from our house. We all had a great time even though it was windy and the snow wasn't great.

Avree and Jason spent a couple hours in ski school, and afterward Avree was ready to go on the lift and down the bunny hill! I was proud of her, because she is quite timid by nature, and I was surprised at how well she did on the hill. She was pretty tired at the end of the day, and ready for a nice cup of hot cocoa!

Here she is with her instructor. She was really nice!

Here's a picture of Nathan starting a run on his snowboard. He is getting really good! He loves to play in the snow, and when he isn't snowboarding or sledding, he's out making tunnels and forts with his friends. Rexburg's climate doesn't get him down!

Ash keeps getting better, too. Here she is lying exhausted at the bottom of the hill after several fantastic runs. The kids don't have the "get out of school ski school" until middle school, so she hasn't even done that yet but she is already doing really well! I'll bet she'll want to switch to snowboarding before too much longer. That seems to be what all the kids like to do any more.

Here's Kevan acting like an x-games pro! Kevan is really good at all these kinds of sports. He is good at skateboarding, rollerblading, and loves to play ice hockey too. All he needs now is long curly orange hair!

It was Jill's first time, so she was just finding her "sea legs." It was her first outing, and she did just fine. She'll probably start doing backscratchers next time. That's Kevan in the background. I'm pretty sure his cell phone is in his hand in case he needs to call 911.

Lori looks really cute in her ski bunny clothes, don't you think? She really loves to ski and she signed up to be a parent chaperone for Nathan's ski school on Wednesdays this month. What that really means is that in exchange for riding on the bus and helping put everyone's boots on, she gets to ski free for half a day. That girl has always known a good deal when she saw one! (I did it last year with Nathan when he went on Tuesdays, which is my day out of the office.)

I didn't get any pictures of me, but I was proud of myself just for not wiping out and reducing my new camera to a million parts laid out all along the ski hill. I also somehow managed not to take any of Jason. It was his first time, too, and if genetics plays any role, he'll be thrashing the slopes before we know it!

Rexburg Cougar Hunt!

2009-01-08T14:31:00.021-07:00

There have been recent news stories about a cougar seen in and around town over the past few days. The most recent update had said Fish & Game had followed its tracks down to a river, and thought it had left the area.

Last night, however, just as we were finishing up seeing patients, David Day, one of our PAs got a call from his wife, who said that their 10-year old daughter and a friend had been sledding in Smith Park (which is sort of the main park in the middle of town, and not more than two blocks from my medical office). While sledding, they had run across some large cat tracks. Jokingly, they said it must be the "Rexburg cougar" they had heard about in the news and at school. After following the tracks for a while, they decided to go across the street to the friend's house to get a camera, so they could take some pictures of the tracks.

This they did, but upon their return and just as they were about to enter a stand in the trees, one of the girls stopped, saying she just had a really bad feeling, and didn't want to go back over there. The other girl teased her a little and they stood there a few minutes before finally deciding to go back to the friend's house. Just as they turned to go, one of the girls spotted movement in one of the trees, which drew her eyes to focus on the Rexburg cougar, right there in the tree!

At this point both girls skedaddled back across the street and indoors, excitedly relating their experience to the other girl's mother who, skeptical but curious, scanned the trees across the street with binoculars. At length she spotted what appeared to be a "yellow tail hanging down, and possibly the backside of a cougar." After a minute, the big cat moved, and lept into another tree close by.

At this point, the woman called the police, who said they would drive by the park, but that really this was a Fish & Game issue, and that she should call them (presumably because the lion had not yet broken any laws). So, she followed their advice, and got a recording telling her Fish & Game was closed for the evening.

Well, upon hearing the story and realizing this news was less than a half hour old, Dave, Dr. Watson, Mary Zollinger and I decided to check things out for ourselves. After a quick trip home to don coat and boots, we met back at ground zero, armed with our high-powered xenon flashlights Dr. Zollinger gave us for Christmas.

Somewhat timidly at first, and then more boldly, we began to explore the park, utilizing the time-honored search grid known as "random wandering." We nearly made ourselves dizzy, alternately shining our searchlights into the foliage above, and down on the snow beneath, all the while criss-crossing around the park aimlessly, shining our searchlights into every nook and cranny.

After a fruitless half-hour, I was nearly frozen, and starting to wonder about the credibility of our sources. Grandpa Darce always says, "Tracks make thin soup!" We couldn't have even started the broth with what we found. Finally, we gave up. I didn't get my coveted photo of a cougar in the wild, which I'm sure they would have put in the paper (or, possibly, National Geographic), but I did capture these two schmucks who were wandering around in the bitter cold looking for a mountain lion in the middle of town, that turned out to be just a wild goose.

So, did this story simply come from the active imaginations of two ten year old girls? Was there just a large tabby loitering in the park, sharpening its claws in the pine trees? Did the play of light and shadow, and the heat of the moment have their mother seeing things too? We'll never know, but consider this: the next day, Dave drove his daughter over to the park so she could point out exactly where the "sighting" occurred. Not only could she point out the very tree, but the exact branch the big cat was perched on. When Dave told her to stay there while he took a closer look, his normally level-headed and non-dramatic daughter began to tremble and almost to cry, saying, "No! Dad! You're not going out there!" She was still absolutely terrified, a whole day later!

Dreaming of a Whiteout Christmas

2008-12-26T07:52:00.015-07:00

Merry Christmas everyone, from the Princes. We were dreaming of a white Christmas this year, and got a whiteout!

It is hard to know exactly how much snow we got all night Christmas Eve and all day long Christmas day, since in some areas the ground is bare, and in others the drifts are over your head, but let's just say the neighborhood was completely snowed in. Here is Ayla looking out the back door, where the snow was packed in like concrete! (Look at the imprint of the door frame frozen in there!)

When the wind finally quit blowing, Christmas day was just about over and the hazy daylight was fading away into night. At that point, the whole neighborhood got busy digging ourselves out (the city crews seem to always get to us last). It was quite a scene!

I'm excited because I got a new camera for Christmas. It is a Nikon D40 digital SLR. I added the photo of Ashlynn above at its full original resolution; click on it and check out the fine detail it captures in her beautiful red hair, particularly right across her nose there. Cool! It is only 6 megapixels, but that's plenty for an amateur like me.

I also got a couple of photography lessons that came with the camera, so I'm excited to learn more about photography and take some better pictures. All the pictures on today's blog came from the new camera! I only took about 125 pictures yesterday (but at least they weren't all of the same thing, right Dad?)

Here's a picture of Ayla and her new Tinker Toys. She also got a great big new dinosaur named Spike, since she is such a fan of dinosaur toys. She won't go anywhere near Spike, though. He's too scary. Yes, that was another of Dad's wonderful Christmas present ideas. (I wonder what giant, roaring, burping, radio-controlled dinosaurs are going for on ebay.)

Here's Lori with her new road bike. She got really into biking last year, so I surprised her with this lean mean machine this year. The surprise lasted until about 11:00 Christmas Eve, when I was caught trying to sneak it into the house. Oh well. She also got a "trainer," which is a thing that attaches to your bike so you can ride it indoors during the winter.Nathan got this bass guitar and an amplifier to go with it. He would much rather play this than the piano, as the "cool factor" is much higher, of course. His uncle Kevan, star bass player for The Craving, has offered to give a few free lessons. I have this feeling Nathan is going to be getting headphones for his birthday next month, though. I played around with this photo a little last night and added some fun digital effects. (I spent like four hours on the shading for his upper lip.) We'll probably put it on all his band's t-shirts one day. One of his friends plays the bass, and another one got a new bass guitar, too. I hope we don't have to clean out a bay in the garage for them.

I'll post some more Christmas photos later (I have lots to choose from), but for now I've got to go to work.

Maestros Nathan and Ashlynn

2008-11-24T21:48:00.007-07:00

Recently Ashlynn participated in a piano contest in Idaho Falls. The top two performers from each division came back the next day to perform their numbers in front of lots of people and some very prestigious judges! Here she is playing The Magic Game by Bela Bartok.

Although Ashlynn wasn't awarded the first place prize this time, she did take second place and was given a gift certificate to the local music store, which she promptly used to purchase a light blue ukulele.

Here is a video of Nathan playing Agent 402 by Louise Garrow at the piano recital this weekend.

Both of these guys work really hard and are faithful with their practicing. It has been amazing to see how far they have come already, and we are very proud of them both.

Their teacher uses the so-called "Suzuki Method," which is an interesting approach to teaching pioneered by a Japanese man named Shin'ichi Suzuki, who lived from 1898-1998. He theorized that teaching music was kind of like teaching language, and that language is best learned by first learning to speak, then read, then write. He saw that most music teachers teach "speaking" music (playing the instrument) simultaneously with "reading" music (recognizing the notes, scales, key signatures, etc) and wondered if focusing on simple imitation at first (just like a little child learns to speak) would yield better results. It turns out that he was right, and he produced many "prodigy" musicians using this method (I believe he was a violin teacher, mainly).

Of course, many students taught in this way will never learn to read music, just as many people who can speak a language never learn to read it, and fewer still ever learn to write well in a language, since each of these things is a different learned skill. The Suzuki method doesn't ignore reading music as an important skill, it just emphasizes "speaking" it first.

I don't know whether it's that much more effective than other methods or not, but our kids' teacher asked us to read Suzuki's book called Nurtured by Love when our kids started lessons, and I thought it was interesting food for thought. Check it out sometime if you're interested.

eCW Conference in Orlando

2008-11-11T06:43:00.025-07:00

Lori & I travelled to Orlando, Florida November 2-6. I attended a work conference, and Lori got a little much-needed R&R. The conference was held in a large resort near Disney World called the Omni Resort, but we weren't able to stay there as all the rooms were sold out before we made our travel arrangements. Instead, we stayed at the Celebration Hotel, shown here on the right, with a lovely model posing in the foreground.

Celebration (the name of the town the hotel is in) is an interesting little place. Apparently, the land was all owned originally by Walt Disney, and was slated to be part of his grand resort complex there. The land wasn't needed, though, and was sold. I'm not sure if some of the buildings were already built, but it seems like they could have been; the downtown area has sort of a theme park feel.

The trip wasn't all business, though. One night we went out to eat at a place called Sleuth's Mystery Dinner Shows; during dinner these actors portray a comedic mystery, while diners try to figure out whodunnit, and how. It was fun, kind of like the board game Clue, only with real characters instead of little plastic pieces, and with prime rib instead of potato chips. Lori, of course, had the whole thing figured out. I was way off, so that's another way it is like the board game. She always wins at that dumb game!

Here is a picture of a nice couple from Indiana we met at the show. We sat at a table with them during dinner, and chatted with them afterward for an hour or so. His name is Nathaniel, but I can't remember hers (if you're out there, remind me!) She is a nurse at Riley Children's Hospital in Indianapolis, and he is a data analyzer for my great and abominable enemy, Medicare.

We also ate at a nice Thai restaurant (Thai food is our favorite, lately), and at a good but overpriced restaurant in our hotel called The Plantation Room. Call me weird, but it made me feel strange to be served exclusively by black people in a place with that name. Only in the South, I guess!

On Wednesday, the conferences were over at noon, so Lori and I drove over to the Epcot Center, mainly so that Lori could fulfill a lifelong dream of having her picture taken next to the great big ball. With that accomplished, we turned our attention to the many attractions at the only major family theme park where, apparently it is not only acceptable but expected for parents to get drunk in front of their children. We happened to be there during some sort of international beer and wine-tasting extravaganza, and I'm guessing that is why the place had more of a night club feel than usual. I hope so, anyway.

I would imagine that, in its day, Epcot was quite a spectacle. To me, though, it was certainly not worth the $80 each we had to drop for admission. I to think what our "bar tab" would have been had we been sampling the various beverages available. We did try out one Austrian treat from a vendor who promised that "funnel cakes are more addictive than heroin." It was good; not that good.

We were able to extract some thrills from a few of the rides; for me the biggest was riding in the dark next to a beautiful girl on the "future of space" ride, or whatever it's called. She even let me steal a kiss or two, just like we were both teenagers! Here we are on the giant screen TV at the end that puts your faces into a little animated movie.

Needless to say, I am not the biggest fan of theme parks, particularly the Disney variety, but on the bright side the weather was great, I got to spend a whole day with my sweetheart, and I didn't have to hear "It's a Small World" even one time.

All in all, the trip was very fun and a nice break from the daily grind. I learned all kinds of new things about our electronic medical record software that I will be able to take back to my colleagues and staff, so I am excited about that too.

If I Were President

2008-11-04T05:32:00.002-07:00

In conjunction with today's election, which in my humble opinion nothing more or less than a choice between Dumb and Dumber, I have decided to release my own presidential platform. It's probably too late for this year, but in case anyone wants to nominate me for 2012, here it is. (I have a feeling whoever is lucky enough to get the job this year isn't going to be so popular in four years. We have some tough times ahead, I'm afraid.)

In order of importance, my stands on the issues:

1. Healthcare. Do you know how I set my prices? Do I go through the process that everybody else does, and set my prices just a little bit lower than the guy down the street? No. I simply find out what all the payers (read: insurance companies) will pay for my various services, and I make sure to set my prices a little higher than that. That's what we all do in this business. Does that make you angry? When it does, you'll know the solution to the "healthcare crisis."

I would fix the healthcare system by making one simple but sweeping change. When you see the doctor, or have surgery, or get an MRI, (or fill your Zoloft prescription), you pay the bill, period. If you have health insurance, or government assistance, you are then free to seek reimbursement from your insurer, for whatever portion of your bill they will pay. This would, quite simply, direct the accountability of each involved party back where it belongs.

When I'm President, the "third-party-payment-system" will be a thing of the past. Of course this issue is more complex than that; there are many complex and valid arguments on each side. (I'll further clarify my plan through national media outlets once I get the nomination.)

2. The Economy. No government bailouts, ever. Risk is the price of admission for participating in the great gamble known as capitalism. If you lose your shorts on some sort of investment, including your home, that's sad. I feel bad. But, it is your problem. Suck it up, and go at it again, that much wiser. If this policy sends the country into the next Great Depression (which it won't), so be it. We gotta learn somehow.

Our commitment to capitalism and free enterprise is the only significant economic advantage we have over competing nations. Give it up, and we're another France in 50 years, or less.

Somewhere along the line, too many of us have come to see the government as some kind of a wet nurse. That will stop under my administration, so help me.

3. Foreign Policy. Any country that gets one cent of aid will comply with each diplomatic condition, fully and without question, or the aid is stopped, immediately. As for the rest of diplomacy, there will be a visual aid sitting on my desk in the oval office: picture a bronzed baseball bat and a carrot, crossed over each other in the shape of an 'X' with a large caption underneath in 25 languages that says, over and over again: "What'll it be, pal?" Behind it will be a large, full color photo of Clint Eastwood (before he became a liberal and got facial leprosy). This will be prominently displayed at all diplomatic events, and will have its own seat on Air Force One when I travel abroad.

America is the only remaining superpower for a reason. It's time we remembered that. We will maintain the world's strongest, most destructive, intimidating, overwhelming, fearful (and most compassionate and restrained) military. Spare no expense.

3. Iraq, the Middle East, ism. As far as Iraq is concerned, each of those cheeky Arab leaders will regularly, publicly express unconditional gratitude for their recent liberation and beg us to stay and help them become civilized, or we pull out everybody and everything, tomorrow, and let them tear each other limb from limb in the streets like the barbarians they are. No skin off our nose. The day after I take office, they will begin to pay back all the money we spent in the process. No checks, please. We'll take it in the form of crude oil, face value.

Under my administration, we will simply starve these dysfunctional cultures back to the Dark Ages where they belong. Much more difficult to organize and motivate Jihadists when there's no pot of gold at the end of the rainbow. See "Energy" below.

4. Immigration. The borders will be closed. Trespassers shot on sight, survivors deported. Come in legally, we'll help you find work if we can. Come in illegally, ton of bricks when you get caught. Commit a crime as an illegal, rot in the cellar of a jail until the rats pick their teeth with your bones. You've got no rights as an American if you are not one.

5. Energy. We will finally suck it up, quit spending tax dollars on stupid, inappropriate entitlement programs that don't work, and invest heavily, massively, in infrastructure. We will raise taxes across the board to do so, if necessary (the only reason, outside of any necessary war chest, that I would ever raise taxes).

I will begin immediately to build nuclear power plants, lots of them. The country's electrical grid will be modernized and upgraded. That we haven't already done so is an absolute indictment of the intelligence of present and past leaders. Yesterday's infrastructure won't fuel tomorrow's economy. I think that's going on my signs).

We will create extremely attractive incentives for invention and refinement of alternative sources of energy, particularly those in the transportation sector, and particularly those that are cleaner. The money for this will come partly from economic expenditures, partly from military, and partly from the Department of the Interior, since this issue is critically important for all three. We will ask environmentalist whackos to put their money where their mouth is and support this initiative, instead of simply standing in the way of progress as they do now.

I will impose massive tarriffs on all imported oil, and massiver ones on imported oil from unfriendly nations. There will be no "oil for food" or similar programs. We will make no apologies for our strategy: cut off the supply of money to ist states and the cultures and peoples who sponsor them.

There you have it, my Presidential Platform. Now go out there and vote!!

Happy Halloween

2008-10-31T08:24:00.005-06:00

Halloween is one of the favorite holidays at our house. Lori loves to get the kids in their costumes; we all love her homemade chili and breadsticks, a family tradition passed down from her Mom. Here we are with our very artistic Jack 'O Lanterns. My doctor's hands had some blisters after we made these ones!

Here is a picture os Ashlynn getting ready to be the Narrator in her school Halloween Play, entitled The Best Halloween Ever. She did a great job; she had the most parts of anyone!

Here's little Ayla. She loves dinosaurs lately, so she and her dinosaur buddies are totally engrossed in her dinosaur movie. I had a hard time getting her attention away from the tube to even take her picture!

Here's a nice picture of the sunrise as seen from our back porch this morning. One interesting aspect of living halfway to Alaska is that you get an exaggerated change in the length of day between summer and winter. Watching the sun come up at 8:00 am (7:00 after this weekend: don't forget to change your clocks!) and set at 5:30 in the afternoon is a sure sign that winter is coming to the frozen North! In midwinter, I hardly ever get to see the sun because I get to the hospital well before first light and leave my office after sunset.

The weather this week has been fantastic, though! Highs in the 60's, no wind; should be perfect for the trick or treaters tonight, so we'll be able to see the kids' costumes for a change. The weatherman says it won't last, however; we're supposed to pay the piper next week.

Lori and I don't mind, though. We're off to Orlando on Sunday for a work conference most of the week. Hello balmy Florida, here we come! We'll take some pictures to make you all jealous.

Richard H. Schmidt, MD

2008-10-25T22:15:00.003-06:00

I attended a continuing education lecture at my hospital early Friday morning. The topic was "Emergency Room Treatment of Serious Head Trauma;" the lecture was a "Grand Rounds" presentation broadcast live via Internet from Primary Children's in Salt Lake. I still work a few shifts in our local ER, so I try to go to these type of things when I can.

I arrived a few minutes late, so it took me a minute to realize why there was something familiar about the speaker. His name was Richard Schmidt, MD, and he is a Professor of Neurosurgery at the University of Utah where I went to medical school.

That's not how I knew of him, though. Dr. Schmidt is the guy who operated on my mom about nine years ago when she had a ruptured arterial aneurysm in her brain. Without question, he saved her life, so of course I have been a fan ever since. I have occasionally run across his name reading medical articles with his name as an author; I have even referred a patient to him since I've been in Rexburg, a young man that I diagnosed with a cerebral arterio-venous malformation a couple years ago.

His lecture was very interesting; I discovered he is not just a great surgeon but an eloquent orator too. I must admit, though, I was having just a little trouble concentrating, as running across him brought back all kinds of memories about that very scary time for us all those years ago. I still remember how apologetic and truly distressed he was when we learned that Mom had lost vision in one eye as a results of his surgical approach. You could tell he felt awful, like he expected better of himself. We feel the same way now as we did then; we're just glad to have her still with us. In fact I, for one, hardly ever remember that she has monocular vision now. Her eyes both look completely normal and she never complains.

At some point after that whole ordeal, I wrote an essay about it called "Subarachnoid Hemorrhage," which I dug up in my old computer files tonight and will post below. If you have a few more minutes and any more interest, keep reading...

"Subarachnoid Hemorrhage"

by Clay Prince, MS3

"Hello? Yeah, hi Dad."

"Oh man, what time is it? I rub my eyes, trying to focus on the clock across the room. 6:30 a.m. It’s early—even for him.

"Wake me? Nah, not me. I’m up."

Yeah, right. I’m right in the middle of my only vacation in months. Three days ago I took step one of the National Board Exams, the most grueling, ruthless test that a medical student has to take. I studied a solid month, fifty hours a week minimum, and now I have a week off before third year clerkships start. It’s Friday morning, the start of the weekend. Yeah, sure I’m up.

"Sorry to bother you so early. I know you’re off from school and everything."

"No problem, Dad, really." The sleepy, sluggish gears of my mind slowly begin to turn as I wonder about the reason behind this early morning call. Fishing. We are supposed to go fishing tonight. He is calling to cancel, calling early so I can make other plans.

"So, uh, how’s it going?" I say, already disappointed. Then, even before he answers, it hits me and jolts me wide awake. Something is wrong.

“Well, not too good, actually.” His voice is strangely quiet, his words slow with the effort of forced calmness.

“What is it, Dad?” In the instant before he speaks again, I frantically search my memory for another time when his voice sounded this way. I want some kind of context, some frame of reference to place myself within to cushion the blow instinct says is coming. There is none. This is something new. In twenty six years of knowing my father, I have not one experience, not one instance in memory to associate him with fear.

I suddenly notice that I am cold. The kitchen tiles feel cold on my feet as I stand in my underwear at the kitchen phone.

“This morning, she got up to make breakfast just like she always does...”

While I listen I somehow notice curiously that I am becoming intensely aware of my surroundings. I hear a bird outside, chirping tentatively, and the absolute silence of the rest of the house penetrates my consciousness.

“A few minutes later, as I was getting out of the shower, she came staggering back into the bedroom...”

Even in the soft light of the early dawn I can see every detail in the room. I feel alert, vigilant, and even as dread washes over me I fleetingly wonder if this feeling I am experiencing is “fight or flight,” a sudden, intense flood of stimulation from my nerves, telling my senses to be ready for anything.

“Now she has a terrible, terrible headache, and she can hardly stand up.”

Subarachnoid hemorrhage. It is the first thing that comes to my mind. Blood, under pressure, spilling into the closed space of the skull, into the brain. Blood, washing over the twisted contours of gyri and sulci like a great flood from a broken dike. Blood, full of caustic chemicals and polluting proteins, coloring the pure clearness of cerebrospinal fluid like crude oil spilling into a pristine lagoon. Blood, upsetting homeostasis, increasing pressure inside the head. Blood, causing pain—extreme pain.
“She’s never felt anything like this before. She says it’s the worst pain she’s ever had.”

‘Worst headache of my life.’ The description learned in those second-year medical school classes is there in an instant, surprising me even as it comes that my memory is so acute: Patients with subarachnoid hemorrhage complain of extreme pain. Words like ‘explode’ and ‘burst’ may be used. The headache is often called by the patient “the worst headache of my life.”

“Since you’re the medical person in the family, well, I guess you were the first person I thought to call. I was just wondering...” There is a pause while he searches for words. “Can you give me some advice here?”

Now, added to the shock of this unfolding event is an incredulousness I feel that my father, the man to whom I have taken every unsolvable problem and been given a solution, the man who I still think knows everything worth knowing, is now asking me what to do. It might be that my father and my lifelong admiration for him are part of why I chose to go to medical school. I mean, who knows? It could be that my feelings while growing up that I could never be as good as him, as smart as him, as utterly competent as him, are what steered me to a profession completely unlike anything he has done. Certainly his high expectations of me and constant reminders that “You can be whatever you want to be if you’ll work for it, son” are what gave me the confidence to try for it and the drive to succeed. Now, for what may be the very first time, my father, my childhood idol, is seeking my advice. Somehow, superimposed on my sense that something terrible is unfolding, I suddenly feel grown up, important—an equal.

“Well, Dad, this could be any one of a hundred things, and most of them aren’t that big of a deal. But I am thinking of one thing in particular it could be, and if it is that, it is very serious.” I realize as I speak that the words are correct, textbook. I try to sound confident, precise, but I can’t help feeling like he sees right through me. I have studied medicine for two solid years, memorized a zillion things, doubled my vocabulary. I just took and passed a standardized national medical exam. I am halfway to being a doctor, and in a terrible instant I realize how pathetically little I know about medicine.

“What do you think I should do?” He tries to ask it casually, as if asking my opinion on whether the fish are biting, but he cannot hide the urgency in his voice, and I realize that my answer right now is very important.

“Well, I think she needs to be seen. She should be seen right away.”

“Where should I take her?” Let’s see. Think. Salt Lake City with its major hospitals is 45 minutes from his house. Park City, Utah, itself a small town, is the closest place with 24-hour medical care. “Probably Park City, Dad. I would take her there just so she can be seen faster. I think they have an Instacare or something.”

“I don’t know where it is.”

“I don’t, either. You’re going to have to look in the phone book.” It is as if I am gaining confidence, becoming more sure as he becomes less. “Call them first, Dad. Let them know you’re coming.”

“Think it will be in the yellow pages?”

“I’m sure it is, Dad. Call them right away.”

“Okay, I’ll do that. Thanks.”

“No problem, Dad. Let me know what happens.” I hang up, drained, and once again I notice the cold. I try to contemplate what has just taken place but instead my mind goes blank. There is too much to process it all just now. I step to the sink and pour a glass of water from the tap and drink, trying to swallow the lump in my throat. All of the calmness, the surety I had maintained while on the phone has evaporated, and all of a sudden I feel naked. I am underdressed for what has happened and I want some clothes or at least a robe with which to cover up.

Feeling helpless, I go to my bookshelf like an alcoholic to the friendly bottle. Pulling out my newly purchased copy of Harrison’s Principles of Internal Medicine, I quickly thumb through the index and open to the page where I find the printed words soothing. I said the right thing. It was all correct. For the first of what is to be many times over the next several days I feel a strange and powerful mixture of emotions, confusing in its intensity. No one close to me has ever been seriously ill. For the first time in my life I have become the 'loved one,' the 'concerned family member.' We have never had a real crisis in our family. We have no experience with family emergencies, and I find this new experience terrifying. Strangely, though, I simultaneously feel electrified and proud somehow, glad with the satisfaction of knowing that after all the constant memorizing, after the seemingly endless process of mental binge and purge of the past two years, I do know something after all.

Medical students are taught to dread ‘the pimp,’ a barrage of questions asked to the student by an attending physician on the hospital wards about a particular patient or condition. These questions are supposed to aid the student in the process of learning, but they are often seen as an attempt to humiliate, or at least to humble, the student, by showing him that he doesn’t really know as much as he thought. The attending physicians take great pleasure in asking these so-called ‘pimp’ questions, and, in turn, the students take great pleasure when, on the rare occasion that they know the answer, they are able to give it correctly. I feel like I just had my first ever pimping, my initiation to clinical medicine, and my father was the attending! How gratifying that I knew it, that I was right—off the top of my head I was right. And how horrible, how terrifying, how unimaginable, that I might actually be right.

A few minutes later he calls back, no longer trying to hide his worry. He can’t get her into the car. She can’t walk. She doesn’t want to go—still in her pajamas, after all, with no make-up. She thinks if she moves she will throw up, or pass out.

“Call 911, Dad.”

“Really? You think so?” He says it as though he is glad someone else was thinking it, too. Neither of us has ever dialed it before, never even considered it. We have never had reason to.

“Hang up and dial 911. I will meet you in Park City.”

I drive surprisingly slowly. By the time I reach the small Instacare I have nearly convinced myself that everything will be fine. She is in the middle of a pretty rough menopause with all of its weird symptoms. She is healthy. She doesn’t smoke. This sort of thing just doesn’t happen in our family. Probably just a migraine headache. My assurance evaporates, though, with my first glimpse of her as I enter the room. She is white, ashen, and the lines of her face are drawn out in an involuntary grimace that makes her look as if ready to panic. She looks fragile, delicate, and very, very ill. I realize that I have never seen her in pajamas past 6:30 am, and then briefly wonder why such a thing would strike me at this moment.

“Hi, Mom.”

“Hi, Clay.” Good, she recognizes me, at least.

“Not feeling very well, huh?” I realize I sound pathetic. I have no idea what to say. I move close, and pat her hand. She seems not to notice, and this disturbs me.

My father and I exchange glances. All of the fear I detected over the phone is visible in his eyes. At that moment, without consultation with the doctor, without tests, without imaging studies, I know without doubt that something is terribly, terribly wrong with my mother. I see the same realization in his eyes, the same confirmation taking place inside him.

“Where’s the doctor?” I ask.

“I don’t know. He came and looked at her. I haven’t seen him for ten minutes or so.”

“What did he do?”

“Nothing. He is trying to decide whether to send us down to Salt Lake.”

“Well, what is he doing?” I look around the large room. There are several other beds, mostly empty. One other patient is resting comfortably nearby.

“I don’t know. Do you think we should go and find him?”

A man enters the room and walks toward us. He looks young, not much older than me. He is short, casually dressed. No white coat. Earring.

“Is that him?”

“Yeah. That’s him.”

We shake hands. He introduces himself, and tries to make small talk.

“Well, what’s the plan, doctor? What’s going on?”

He proceeds to repeat the story my dad told me on the phone, and says he isn’t sure what it is. “It could be a lot of things, and we just need to rule out a few serious things.”

“What about subarachnoid hemorrhage?”

“That’s a possibility. I don’t think it is the most likely thing.”

“Why not?” I do not want to ask these questions. I told myself early on I would never be the cocky, impudent medical student who thinks he knows it all. He is, after all, the doctor. He is the attending physician here. Still, the questions pour out of me, and as they cross my lips they sound like accusations.

“Well, for one thing, she never lost consciousness. People usually lose consciousness briefly at the onset.” I wonder if he had been reading that in Harrison’s just before he came into the room.

“Well, what are her vitals?” This question surprises even me, and even as I ask it I realize I will have no idea what the answer means. The physician is silent, looking at me. Then, he looks at the ambulance workers standing silently nearby, as if to ask for help. His earring gleams in the fluorescent light. When he turns back to me I can see shame, or maybe just irritation, in his countenance. He knows that he should know that one, and he knows that I know he should. I am acutely aware that my mistrust of him now shows plainly on my face.

“Her pressure is 110/50 or so. We are having a hard time getting a diastolic reading,” says one of the emergency medical technicians. “Her pulse is 50.” These guys, volunteers, live in the small community with my parents. One of them drove the ambulance once when I was injured at work and had to ride to the hospital for stitches. They know Mom, and they are worried too. One of them is slowly wringing his hands. “She has been stable and alert the whole time.”

“We are just getting ready to send her to Salt Lake for a CT scan,” the doctor says. “It is the only way to know for sure.”

“Well, let’s get going, then. What are we waiting for?” I can’t believe my own voice.

“I just called the hospital. They will be waiting for you. I think we are ready now.”

I am relieved. I want out of there. I want her back in the ambulance. I want her in Salt Lake City. I leave my car there and ride with Dad, telling myself he needs me to be with him, but knowing it is me that needs to be close to him right now.

Once we arrive, things begin to happen quickly. The ER physician who greets us does not waste any time. “The CT scan is positive, we can see blood in her brain. It is quite an extensive hemorrhage. This is a very serious condition. She needs immediate surgery. We are transferring her to the University of Utah Hospital, where their neurosurgeons are better prepared to handle this problem.”

His abruptness and efficiency are unnerving to my father, who looks dumbfounded, confused. My sister, who arrived moments before with hands shaking, begins to cry, panicked. I find his style reassuring, however. Finally, somebody knows what to do, and knows to do it quickly. Interestingly, I am not surprised much by the confirmation of her condition by the CT scan. I had made up my mind in Park City, so this was not news to me.

At the University Hospital, I feel better. These are familiar surroundings. This is where I have spent the majority of my life for the last two years, attending classes, studying for exams. This is my territory. Nothing too bad could happen as long as we are here. After all, this is the place where I have hung all my hopes and dreams for the future.

Mom has been admitted to Neuro Critical Care, the NCC, a small ward with ten beds or so with locked doors and strict rules. This is the ICU for head injuries. This is where they bring all the broken necks. This is where they bring all the motorcycle wrecks in the middle of the night, all those poor patients with swollen, purple heads, the ones bleeding from their ears. Although I have not yet been inside, I know that this is not a fun place. People do not leave here the same as they came in, if they leave at all, that much I know about the NCC. And now, my mother is in there.

As we wait outside, I remember learning Neurology during my second year of medical school. I remember being fascinated and intrigued at the complexity of the architecture and electrical activity of the brain, being intimidated by the immenseness of the human command center. I remember thinking that there is something about neurology that is different from the rest of medicine. Most physicians heal the patient, at least some of the time. They give a little medicine, cut a little here, sew a little there, and watch the patient be restored to health. The body has a tremendous ability to heal itself, given the right environment.

The work brain doctors do is different. They perform miracles, they save lives. Their surgery is perhaps the most intricate of all the doctors, their knowledge is vast. They are the electrical engineers of medicine, for they know how it is all wired. If doctors are intelligent people, neurologists and neurosurgeons are geniuses. Their work takes them past life and death to the very core of our existence. But, in the end, all they can do is shore up the problem, sandbag it. Brain injury is permanent, unforgiving. It can often be delayed, even stopped, but never reversed.

Not long after we arrive, these troubling thoughts are interrupted as a tall, young man with dark hair and tired-looking eyes introduces himself as the resident who will be working on Mom’s case. He is wearing light blue scrubs with the pants way too short, and despite this and the fact that he seems very young, he carries an air of confidence. “So, as you know, her condition is very serious. In fact, she could very well die as a result of this problem. I only say that so you will know how absolutely essential it is for us to treat her right away.”

“What are her chances, doctor?” Now, my questions sound sincere. I cannot place my finger on it, but there is something about my first impression of this doctor, this resident, that makes me trust him.

“Without surgery to repair the bleeding vessel, there is about a 30% chance that she will die within 3 months. This may be even higher for her, since she has had quite an extensive bleed. Without surgery, almost all of these will hemorrhage again within a year, and a second hemorrhage usually results in death.” I get the feeling that he is trying to convince us about the surgery. I want to tell him not to worry, that we are going to let them do it, that we want them to do it. Yes, do it! Fix it! Give us our mom back! I bite my tongue. “However, if the defect is operable, her chances of survival are excellent.

“So, how do you know if it is operable?” Again, I am surprised at how sincere I sound and feel—such a contrast from just hours before.

“We will be doing some tests, including an MRA, which is a special kind of MRI scan that allows us to look at the vessels inside her head. Based on her CT, we suspect that she has a small ‘balloon’ defect, called a berry aneurysm, in a vessel called the anterior communicating artery. If so, there is a good chance that we can repair it. The surgeon, Dr. Schmidt, has fixed a lot of these, in fact, he is really a world-renowned specialist in this particular problem. Many of these aneurysms are in that location.”

I feel tremendously better. His explanation feels like an organ systems lecture, something I am familiar with, in which medical problems and their solutions are cut and dried. In those lectures, so carefully prepared with facts and statistics, there is always the attitude that, yes, people get sick, but hey, we fix them. Just like that. Lickety split, no problem. I like that. It feels good. This feeling is something that I trust. All of this makes sense to me. They know what they are doing, and I feel my confidence growing. Everything will be alright.

“So, if you will excuse me, I need to get back. We are just finishing up our admission process, and then we can let you come in and see her. Just to warn you, she has been given some medication and is not very alert, so she may not respond to you right now.” He turns to go, and then turns back. “Oh, and one more thing. We will be doing thorough evaluations on her every 10 minutes or so. If her neurological status starts to deteriorate, we may have to take her to surgery emergently, so you will want to stay close by, okay?”

“Yes, of course,” says Dad. “We will be right here.” He forces a half smile. “And, thanks.”

“Don’t worry.” The resident returns the smile, his concern for us evident in his eyes. “Let us do the worrying now. That’s our job.”

By now we are together as a family, those of us in town anyway. My older brother had no idea how serious this was until arriving at the hospital just now. He is dumbfounded, stricken with this news, and he still has not seen Mom. My only sister, the other woman in the family, still sheds tears silently, trying to comprehend, attempting to deny. I look at the time, noticing that it is afternoon already, and then at my father, who bears a look of helplessness. Seeing his expression, I wonder what my own looks like. We all look silently at each other, each wanting to say something, but not knowing what.

It seems like forever before they let us see her, and then we are allowed into the NCC, two at a time. Seeing her offers little comfort, for she is unresponsive, sleeping deeply, and she gained a variety of tubes and wires since we last saw her. The only sounds in the room are from the monitors and IV pumps. After a short visit, we are escorted to the waiting room, and told to make ourselves as comfortable as possible—it will be awhile, they say.

So far, this day has flown by like lightning, each new event happening too quickly for assimilation of the last. Now, however, time seems to nearly stand still as we wait for answers. As time passes my mind begins to wander. I find myself repeatedly fantasizing that someone comes out to tell us that it was all a mistake, that there is really nothing wrong, she is fine. We can go home now. Various scenarios play themselves out through my thoughts as my mind searches for a way out of this, for a way that it can all just go away. Then, although I try to push them out, I have thoughts about never seeing her again. What was the last thing I said to her? What if she survives, but can’t recognize any of us? What would Dad do without her?

“I was just thinking.” It is my older brother. “I can’t think of the last time I talked to her. I mean, what if...”

“Yeah,” I answer. “I know. But you can’t think that way.” I don’t know why I am saying this to him, when he could have taken those words straight from my own thoughts. “She knows we love her.”

“This is just so...out of the blue. You know what I mean, things like this just don’t happen to Mom. I just can’t make myself believe this is all real.”

“Yeah.” He is right. It doesn’t seem real. I wonder to myself if it will ever seem real, if it will ever sink in.

Finally, after hours pass, the resident finds us again. The MRA is done. The aneurysm is in the anterior communicating artery, just as they thought. It is operable. Best of all, they now know that there is only one aneurysm. Once they get this fixed, he says, she will have less chance of having a hemorrhage than the average person. He seems very happy to deliver this news, perhaps even surprised that he does not have something worse to tell us.

“We are just finishing up our preparations, and we hope to take her to surgery within the hour. We are very optimistic that the surgery will be successful.” It is 5:00, nearly 12 hours since this all began. For the first time today I allow myself to feel relief, and I can tell that the others are allowing themselves the same luxury. We are all still very aware that she is not out of the woods, but with this news, with this plan, it is as if a tangible cloud has been lifted.

Later, as she is wheeled silently across the hall to the operating room, my dad places a soft kiss on her cheek and squeezes her hand. A single tear rolls down his cheek and falls. It lingers for a moment as a droplet on her covers before soaking in and disappearing. Seeing this gesture, I am reminded of a daily ritual I witnessed each morning as a child. Mom, in her house coat and slippers, would meet my father at the top of the stairs leading to the front door of our house. There, they would kiss goodbye before he left for work. Often they would kiss more than once, and then, as he descended the stairs, she would ask him if he was planning on coming home for lunch that day. No matter how hectic the morning or what was going on, they did this every workday at 6:55 a.m. It was such a regularity at our house that I grew up thinking everyone’s parents did it.

Now, remembering this, I suddenly want to cry, and for brief moment I am sure that the tears will flow unchecked. They do not, however, and the surge of emotion leaves as quickly as it came, replaced by a strange, hollow feeling not unlike when I used to get homesick during Boy Scout camps. As I watch her disappear through the automatic double doors into the operating room, I wish I had been able to cry, not just for the emotional release it would have provided, but also for the comfort of knowing I am normal, for the reassurance of knowing I am capable of feeling. I wonder if my background as a medical student, my learned objectivity, has hardened me, taken away capacity for normal emotions, and this thought frightens me.

There is a small waiting room just outside Neuro Critical Care, probably ten feet by fifteen, with a few uncomfortable chairs and a television propped up too high to look at. A round plastic clock hangs crooked on the wall, its cord dangling out from behind to an outlet in the wall. The family gathers there now, wondering what to do next. The surgery will take six hours or longer, according to the resident, and it seems like an eternity to wait. If we were at all involved in what was happening before, it is completely out of our hands now. It occurs to me that the operating room is one of the only places in this hospital that I have never been before. I am halfway to being a doctor, and have never in my life seen the inside of a surgery suite, have no idea what goes on behind those doors.

As I sit in that tiny room, my mind is drawn back to many long nights during the past year that I wandered the halls of the hospital, trying to stay awake while studying my notes and review sheets for an exam the next morning. Some of those times I was there all night, cramming desperately in a futile attempt to remember more than I was capable. I passed by this very waiting room several times at all hours during those nights, and, looking up from whatever paper was in my hands, from time to time had caught fleeting glimpses of loved ones waiting, wringing hands as they took their vigils there. I barely noticed them, so intent was I in memorizing the various cytochrome interactions, or whatever other medical details that seemed so important to know.

Thinking of this, I remember that once, thinking no one was there, I stepped inside and turned on the light, wanting to sit for awhile and rest from my pacing. As I flipped the switch, the bright fluorescent lights illuminated the form of a shabbily dressed man with bent glasses, wrapped in a thin hospital blanket, sleeping on the hard floor. He winced at the brightness, but did not awaken, and I remember mumbling a lame apology as I flipped back the switch and continued walking. I had not given that incident a thought since then. Now, sitting there, I wonder which of his loved ones was in there, and why. I wonder if they made it.

Finally, becoming weary of the tiny room and the crooked hands of the clock, someone suggests that we go down to the hospital cafeteria and get something to eat. No sense, after all, in waiting here the whole time. The cafeteria is nearly empty and we take seats near some west-facing windows where the late afternoon sun feels warm and reassuring on the tabletops. From here there is a good view of the valley below, where things are beginning to settle down after the rush hour. The food is greasy and bland, typical, but I am glad to have it. It feels good to eat, not only because this is the first food I have had all day, but also because it gives us all something to do but think about the overwhelming events of this day. Even after we have all finished, no one seems to want to leave, preferring to remain here than return to the closed quarters of the waiting room. After awhile, we are even making small talk, catching up with the siblings that we haven’t seen in awhile.

“Your attention please, your attention please.” The soothing female voice, familiar to me, comes from the hospital intercom. “Will the Prince family please return to Neuro Critical Care.”

I am instantly weak, shaking. It is too soon. All eyes focus on my father, who has paled. Without a word, we stand up, in unison, still staring at each other in disbelief. Then, quickly, we obey the voice. Never before have I felt close to hysteria, but now, striding back down the corridors, back toward the waiting room, I feel as close to crazy, as out of control of my own emotions, as I have ever been. Everything seems surreal, detached, in slow motion, although I remain acutely aware of each step, knowing that before I get there I must brace myself for what has happened. Frantically, I search for some alternative, some other reason they could want us there, but there is none. There is, simply, only one reason they would call us back so soon.

Arriving outside the waiting room, we are met by the resident, who immediately ushers us in to the waiting room, which has been cleared of other occupants, and shuts the door. He moves quickly, as if strangely eager to deliver the awful news.

“I am sorry about paging you like that. We knew it would alarm you, but we needed you back here and didn’t know how else to do it.” The situation does not add up, and I am confused. Then, realization, relief. She isn’t dead! “We have finished the final preparations for surgery, and we are ready to go. Dr. Schmidt, the surgeon, would like to speak with you for a few moments before he proceeds.”

A moment later, he enters the room. He is a skinny man with grey hair, very white skin, and a noticeably erect posture. He is wearing blue surgical scrubs with a cap and blue rubber clogs. His mask is pushed down and he wears it around his neck. There is a certain air with him, a mood, and this is what I notice first, before he even speaks. In a soft, calm voice he apologizes again for alarming us, and explains the surgery in more detail. Everyone has questions for him; he answers each of them patiently, expertly. I get the feeling he has heard them all many times before, yet he considers them each very carefully, thoughtfully. I have great confidence in this man, this surgeon, and wonder why, since this is the first I have ever seen him.

“Now, as you know, brain surgery is serious business. You should know that there is a significant chance that she will not make it through the surgery. The recent reports say there is about a twenty percent chance of or serious complications.” He looks at each of us, making sure we understand. Then, he smiles reassuringly and adds, “But, my own personal success rate is much, much higher than that.” He says it proudly, but he is not bragging. I feel as though he cares about each of us, the waiting loved ones, and wants to give us as much hope as he can. “We will try to have someone let you know how it is going, but don’t expect any news during the operation. With this type of surgery, no news is good news. It could take six or eight hours at least, and don’t worry if it goes longer. I’m not running any races in there. "He pauses to smile thinly, reassuringly.

"Well, then, if there’s nothing else, I would like to get started.”

As he leaves I feel eager. I am ready to get on with it, ready for him to go in there and get it over with, to go in there and fix it. I feel hopeful now, and it feels good to have this confidence. More waiting. The sun finally sets and disappears, bringing an unfriendly darkness and making the hospital seem cold. I try to read a magazine, try to make conversation, but inevitably end up watching the second hand go around and around on the eyed clock. Slowly, the hours go by. Visitors come, relatives, friends who have heard the news. There is nothing to tell them. We won’t know until after the surgery.

Finally, Dr. Schmidt opens the waiting room door. It is very late, and he looks tired but is smiling. As he moves in close to us I notice that there are specks of a white, chalky material clinging to the lenses of his glasses and stuck to the front of his cap, along with a few tiny droplets of blood, and I find this curious as he declares the surgery a success, and announces that he is very, very pleased with the results.

“Of course, she is not out of the woods yet,” he says, “but we were able to find the aneurysm and put a clip tightly on it. She is out of danger for the time being.” He tells us that they are just closing the incision now, and then we can see her. Then, unbelievably, he heads back for the operating room where yet another patient awaits surgery, this time the emergency repair of a man brought in a few hours ago—motorcycle crash. “I will see you in the morning,” he says.

“It is morning,” replies my father, looking at his watch. “Don’t you ever get to sleep?” “Sometimes,” he says, smiling. “Not with all this fun going on, though.”

When she comes to and talks to us, we all cry, even me. They only let us in two at a time, so we take turns going in. It is such a relief to hear her voice, to see her wake up. She doesn’t understand what all the fuss is about. She thinks she is in Hawaii, where she was with Dad a week before. She can’t see out of her left eye. But, she is alive. She recognizes us—she is intact. She has tubes and wires and a room full of monitors and medicines, but she is back.

Weeks later, it is 4:55 am. I walk alone from the parking lot toward the hospital, clad in white coat and stethoscope. I am in the middle of my internal medicine clerkship, and have patients to see and examine before rounds. There is a definite chill in the air, warning that autumn is near. A light fog covers the ground and shimmers in the glow of the still-lit street lamps as the cold dew begins to lift. There is no one else around and all is quiet but my footsteps as I trudge past the medical library toward the back door. Breathing deeply, I savor the quiet and the fresh smell of morning—I love this time of day. As I approach, a smallish, middle-aged man with tired-looking shoulders and erect posture comes out of the hospital and down the back steps, a large stack of manilla folders under one arm.

“Hello, Dr. Schmidt,” I say quietly, almost timidly as he passes by. He seems startled, as if he had been lost in thought and did not know anyone was there. “Good morning.”

He slows down and looks down at me curiously, seeking recognition. It is obvious he doesn’t find it. I don’t expect him to. I do not stop, but smile to myself as I open the door and stride past the cafeteria, under the fluorescent canopy, determined to learn all I can today about how to take good care of my sick patients on the wards.

Little Brokeback Mountain?

2008-10-21T22:30:00.001-06:00

One day during the trip, we became attracted to some kind of commotion going on outside. New Harmony is normally a nice quiet place, so, naturally, we went out to investigate.

In the yard, we discovered a couple dozen photographers with cameras of every possible description taking pictures of all the horses, cows, barns and such on the Prince property. They were also taking pictures of a couple guys all dressed up like cowboys, riding their horses around and posing in various situations.

Of course, we quickly arrived at the natural conclusion that this must be the Paramount film crew, "on location" for a sequel to a certain emmy-nominated cowboy movie with controversial themes. But, on closer inspection we noted that the two "main characters" out there on the horses were none other than good old Uncle Brent and his big brother, my dad Vern! So much for that theory.

Or, do you guys have something you need to tell us?

For a more truthful blog on this unusual (but highly interesting) event, click here. Or, for a really funny related YouTube video, click here.

Yippee Ti-Yo!

2008-10-21T21:33:00.001-06:00

Growing up in Kamas, Dad kept a couple horses in the pasture in back of our house for several years. They were there mostly to provide chores for me to do, as we rarely rode them. I'm pretty sure the horses lasted for about two hours after I left. Their names were "Golden Plates" and "Chico," and I think we had one other one at some point, but I never liked him anyway.

Well, Grandpa has picked up the habit again since retiring to New Harmony. I guess he figures Uncle Brent needs some more chores, or something.

Anyway, the kids really enjoyed riding the horses during our visit. Little Ayla was constantly begging to "go outside and ride the horsey." In typical, fearless fashion, she even said, "I want to ride that big one, by myself!" Not with Mom around! No way!

Dad's horse (the bigger one) is called Duke, and Mom's is named Lola. Mom had a different one when they first got horses. I've already forgotten its name, but they bought it from a guy off the side of the road whose other sales offerings included a bridge in San Francisco, some oceanfront property near Phoenix, and six magic beans. Anyway, to make a long story short, she got a good deal, but the noble animal died tragically of "causes incident to age" not too long after the purchase. Lola is a much better ride for Grandma anyway, we think. She's already survived her first fall off from her, and it's a lot less distance to the ground!

There are a lot of pretty rides to go on in the mountains around Harmony. Uncle Brent offered to take me one day, but I declined as this trip was all about family time (which we never seem to have enough of here in Rexburg), but I'm hoping he'll take a raincheck so we can do it some other time. Next time, I'll even bring my boots! I've included a picture of them, so you can be impressed that I own some. Dad says they're not really cowboy boots, more like "work boots." We're all entitled to our opinions.

One day I had Nathan, Ashlynn, Avree, and Natalie's Kaylee on them, and I decided to lead them off the road and take a shortcut up part of Little Mountain. I thought they would think that was neat, and it really wasn't all that steep or treacherous, but it scared them all pretty bad; they were sure the horses were going to trip and fall. Avree still hasn't forgiven me.

The kids also had a fun time riding all around the roads and trails on Grandpa's four-wheelers. Nathan and Ashlynn are already starting to get the "driving bug," so of course they couldn't get enough of that!

The Old Man And The Sea

2008-10-18T00:02:00.000-06:00

Dad has been back in Harmony long enough now to have rekindled old friendships, reestablished old ties, and, more importantly, to have sniffed out a couple of nice fishing holes in the neighborhood.

We took the kids fishing at a couple different ponds whose owners have been well-schmoozed (good job Dad), and had a great time catching some very nice, fat rainbows and tiger trout, and some scrappy smallmouths and bluegill. Nathan tried out flyfishing for the first time, and did well; he is definitely going to need a little help with the "10 & 2 flick of the wrist" concept. He had something more like the "8 & 5 water slap" going on. It looked more like he was pitching a baseball than casting a line! He still managed to catch a few fish, somehow. Some friends brought by A River Runs Through It tonight, so maybe we'll continue his training by watching that together.

Purists might have chortled just a little if they had seen the three of us all piled on a paddleboat, fishing tube jigs from ice-fishing poles in somebody's private puddle. (You might be a redneck if...) Let 'em laugh, though. We had a ton of fun together, and those fish were tasty breaded and deep-fried for lunch the next day. Anyway, the cattails were high enough around that pond that I'm pretty sure nobody saw us anyway!

As usual, Grandpa Vern outfished us all. His trophy was 23 inches, 5 1/2 pounds. (Hence the title of this post.)

New Harmony Trip Over Potato Harvest

2008-10-17T22:56:00.000-06:00

This year during the annual harvest holiday (just one of the many reasons we love Idaho) we decided to go to New Harmony to spend time with Grandma & Grandpa Prince. They promised there would be lots of fun things to do so we just decided to spend the whole week there with them. They didn't disappoint! My first few posts will be a rundown of all the things we did while we were there.

First, though: We left Saturday morning and stopped in Salt Lake to see family there and to drop off Lori and the girls. Then Nathan and I went on to Provo to see the BYU/New Mexico football game. The game itself was...let's just be kind and say anticlimactic (read: yawn), but Nathan thought it was pretty cool to actually be there in the stadium; we got there pretty early so we went down next to the field to watch the players warm up. It is amazing to see how BIG those guys are when you're looking up close! I believe it when these guys say they don't use steroids. It was their mothers that used them, while they were pregnant!

As for me, well, the experience brought back some childhood memories of when Dad had season tickets for a couple of years. He had two seats, and he would give each of us kids a turn to go with him to see a game. In those days, guys like Glen Kozlowski and Robbie Bosco were my heroes. Now they're old; Kozlowski even has a son on the team right now!

I ought to clarify here that I'm not really a true blue BYU fan. After all, I'm an alum of both Utah State and the University of Utah. But, what's a guy supposed to do? You have to be pretty thick-skinned to be a Utah State football fan, and all my years at the U did was harden my hatred for the guys in red, despite the fact that the basketball team went to the Final Four one year while I was there. (Some might think my being there had nothing to do with that, but consider that they haven't been back since I left. Draw your own conclusions.)

Plus, along with my memories of going to the games, I also have the memory of many Saturdays at home, watching the games on TV and hoping BYU would win, mainly so Dad wouldn't be in a bad mood all day. Perhaps it can be traced to these early, formative experiences (and the resulting deep emotional scars), but I do seem to always find myself hoping BYU will win (at football anyway).

The photo shown here (stolen from the Internet, not taken myself) is of Austin Collie, the wide receiver du jour for BYU this year. I've added it mainly just to test out adding photos. I plan to add some more relevant ones later on.