Notes on life, philosophy, and medicine

You carried me through  My small newborn body wrapped in your arms You must have smiled knowing  I was flesh of your flesh  Creation  Creator You may not have known always what it meant to be my ba But in your quiet ways  You carried me A home I always had because of you A safe place  Full of anguished love  Because of its depth  You left this earth but never without considering  How you would leave us cared for  You shed tears unseen  You wore the wrinkles of stress on your forehead And always it was for us  Your precious children Your little babies  How grateful am I to have been yours. Father,  Because of you, I could shine. How I wish I could relive those moments when you first held me When you first saw me and knew I was yours  May your days right now be as sweet as my memories  May you carry on that smile and heavy lightness that gave me wings Wishing you well daddy and hope your journey in life after is treating you well. 

How does one keep the best primary care note, we can copy and paste and transfer historical information from one to the next. We can update problem lists with care plans. We can addend the previous care note to reflect upcoming plans to not miss all the possible things we can miss.  My desire is to create a note that reflects the complexity of our patients, the stories that are interwoven and the dynamic changes that move in and out of their health story.  I wish to do that and to do it well. May our patients know that we know them so that our health care is not just limited to one problem.  May we as the stewards of health/family medicine doctors in partnership with our patients create thriving and fulfilling lives that bring together a community. 

Starting to feel the fish bowl effect of isolation. I like it. It's fascinating. I do have a room with a lovely view of calm rippling water moving gently with the wind, glowing lines of reflections undulating, a line of tall evergreens, and shades of gray/blue skies. The sound of water hitting water playing softly from my fishtank. The mild yellow hue of a lamp on my desk. Smiling faces of some of my most valued humans staring back at me from their frames.  If in the end I will settle in one room, I would have more photos. I would want to see it all and remember all the wonderful times. I would wish for all the above. Perhaps not in isolation but one does not know but most certainly in the presence of angels. I had never really put much thought into this, I wonder if that would be such a useful exercise. To manifest and visualize so that you can appoint that day.  Well I would probably get rid of a lot more junk, there is trash strewn about, a few dishes to be put away, and bag ful

I once said that I wanted to experience what my patients experience, that in knowing, I could have a deeper appreciation, deeper understanding of the disease process and therefore 1) I could diagnose it and give people clarity and 2) hopefully have the read enough, learned enough that I could present the cure or treatment plan toward healing.  So, over the last few days, I've been home experiencing some of the symptoms of Covid-19, I suspect the omnicron variant as it spread relatively quickly through the home I was staying in, regardless of the mindset I took in staying and visiting with family I suspected having it, I am here now.  I started with a slight cough but mostly noticed deep aching pain in my back/left thigh, wondered if I could just be feeling run down from the trip. I can't recall if I had headache yet, if anything it was mild and intermittent, similar feeling the next morning but headache was more noticeable, and now I felt certain that the ache was not just from

My 8 year-old son bought this sweater for me with the help of one of his grandmas and this is where my story will always end.  I was thinking I would post a photo of me in my mask + N95 looking absolutely ragged because I've been sick. I caught Covid. Hindsight is always 20/20. Knowing what I know would I make the same choices?  I have no idea, help me walk through this. Talk therapy.  I recently looked at the death count in the United States, we have definitely had more deaths in 2020 than we did the year before but if this macro trend website is correct  U.S. Death Rate 1950-2022 | MacroTrends We had been having a decline in death rates until about 2007-2008 (the housing market crash?) and it has been uptrending since taking us back to around 1975 levels. I've heard several years ago that the generation I was living through was the first generation to have die younger than our parents. What does that say about our country and where we are going? That said, we have much to mou

My son started posting videos on youtube just a week ago; he's really enjoying it and so I'm supporting his efforts but I asked him today if he has shared any of his videos with his friends,  he said "no, I am scared."  I know the impact of pursuing "likes" and "subscribers" so we talk about it incessantly, I tell him his value is not derived from on screen likes or the number of dislikes; I know he hears me.  But he challenged me to whoever can get to the first 10,000 subscribers so we are constantly checking; I have all of 1 subscriber and 4 videos, he has 30 videos.  Pretty cool and pretty fun but beholden to that comment is a glimpse of the deep dark world the internet has allowed us so many of us to hide, to be "seen" but not really, to see only what we want others to see, and to be seen by people we cannot have meaningful relationships with.  So as we start out this year, I hope we rise to the challenges of our day, pull back the co

This nation and its people have been undergoing major pressures. For me here, in this little part of the world, I have to admit it has felt pretty lonely at times, but I've eaten my fair share of holiday desserts and I'm ready to dust myself off and put on my working gloves.  My hope is in Christ and through him I know it is for us to find common ground.  Can we all not agree that how and why George Floyd died was wrong?  Can we all not agree that moments like that in our present history is a symptom of things that are still broken in our country?  Can we generally agree that many of us, myself most certainly included, don't actually have a good grasp of history and perhaps are even so distracted by the noise that we are not even aware of our own part in history?  Can we agree that it's really nice to feel and be safe doing things like going to school, church, or shopping? And that when we don't, that there's a problem there?  Here though are a few things that I

"Her Private Life" - Korean Drama on Netflix  "What Alice Forgot" - Novel by Liane Moriarty  And this poem that plays in pieces in my head about becoming a woman but always the ages before you -  Our life is made up of yesterdays, stretches of memories that can't necessarily be replayed minute by minute or relived. Within these sometimes distant memories are the makings of who we are today, perhaps not defined by but certainly defining moments, whether they were marked by laughter or tear stained and broken, they are yours and it's collection is yours alone. A masterpiece that can only be claimed by one person. Unique.  That story doesn't dictate our future and it cannot dictate our next step in life. It is not a blank slate but we can control the next brush stroke. Like a large mural on museum walls, see it for all it is and still call it beautiful. May we find inspiration to keep painting. May we share it with the ones who love us most and have them sa

 Well almost, but not entirely...   I was clearly not the only one captured by this book. I heard of it, saw that it made some headlines as a major motion picture but had no idea what I was getting into when I clicked download from my local public library. I figured it was some fictional adventure, but instead met with brutal honesty, historical facts, a picture of America's truest economy through the last century plus.  I'm about a third of the way through this book after taking my own little adventure in an RV unbeknownst to me that there is an entire community making their own way all the while I'm working a well paid job, living out what could be casted as an American dream yet I feel like I'm missing a key ingredient - of love and people - having wandered somewhat to achieve this career and so at a lost on how to set out roots, how to find my tribe and keep it going while 100s if not 1000s of miles away from presumably my closest family and friends.  Strewn about b

One of my big takeaways from this trip we took was how much the material world has stripped us of our connection to earth and in essence, to one another. I came away from exploring this small massive part of the world - The Colorado Plateau - with such wonder and realization that we need to spend time outside, that I WANTED to spend time outside all the time. Sure I talk about 30-60 minutes of physical activity, I tell kids and adolescents, spend time outside, but I had no idea it is so much more than making sure all our kids don't need glasses from too much screen time, it's about being and connecting with nature, it's about the cleansing air of trees and the dirt under your feet. It is about climbing mountain peaks and having your eyes wander around bends along the Colorado River and seeing beauty beyond measure.  We are sharing this little journey with you, hopefully to make it easier for you to have your own. Here's our first day of the trip.  https://youtu.be/TqgW9

 Day 8  Where I most want to be  hearing the sound of a chicken crow as daylight breaks  walking around the Coral Sands RV site  in the presence of a few shanties  I was immediately displaced back to those mornings in Vietnam  with only less humidity and before the heat of the day  as I was drawn to such a time and place I wondered  is that where I most want to be  traveling with unrestrained awe  limits set by no one  If I cannot go back  how do I go forward and reach out of my past  to make a part of my present?  The 3/4 glow of the moon lies directly overhead  the mesa tops of bluff, utah in front  the sweet chill of early summer breeze whooshes through the trees and  in between by uncombed hair the anachronistic computer in which I use to type  hoping my words will guide me  because I'm searching for something  perhaps just the present - enjoyment of the sun rising to my left shining against the towering rocks that appear erected but is more likely eroded  no, not quite, my anx

No answers. No judgement. Just silence, whispering breeze, chirping birds, floating moon and sunrises. Here. 

Just waking up, the buzzing sound of the river behind us, the dawn before us, and the still of the night still among us. This is my favorite time. Alone. Peacefully taking in the newness of a day, breathing my first conscious breath that can only be done in present. Then just as quickly, swept away by the worries of later. May we all spend a little more time in the now. Till later.  

Day 4 - we are here at Somerset, Co in our third ever RV park on the same trip. I am wondering what brings me out here and why we still have 6 nights and 7 days left. A part of me wishes for time to fly by so that I can back in the comfort of my own home, another very real part of me recognizes that moments like this, with my now 7 year old, will be a distant memory but one I hope he can cherish and remember; I hope I can remember it.  We have had far too many smores and have added at least 1000 miles to the treads of this Cruise America rental. James is now fondly acquainted with his aunts Jennifer and Nancy but perhaps for him, more critically, time is being spent in the company of a gentle Doberman named Billet. While for me, other than a dwindling fitness level from too much time spent mostly in the seated driver position, I want to set an intention for this trip, I want to reflect on the questions I first posed to myself as I planned on making this excursion happen - was I trying

what do they represent, these sad ugly tears? the unforgiving history, the beautiful life, the loving future that is unlikely to be? Wow truly wishing for a world without such pain, where goodbyes that feel like forever, where our own mortality is not so in your face and you have to LIVE - but how?  ...

Living 37 years, it's only in hindsight that I am able to reflect on the choices I've made... and watching my 7 year old grow up, seeing the pain that I can put him through... how to be adult about THINGS when you are still figuring out what it looks like to be an adult, to make wise decisions and to not REACT.  I tell him all I can about what I know about love and goodness hoping and praying that he can do what I say and not what I do...  I pray for a tomorrow when I can do better.  All I can try to do is leave the world a better place than when I came into it for him and his friends.  So I'm rambling, what am I really wanting to say? I'm hurting all the time about the choices I've made, I've played out my past 100 times over and lived and relived it - yet seeing no different outcome - because here I am, and nothing can change that, but what's next? what can be changed? what choices do I make next that alter the course of my path and those around me? In all

We want to change the world, when the world we need to change is right here in front of us. As a nation, I feel that I can safely say we have had our issues and that we have tried to have these dynamic conversations about our core values and deepest held beliefs on the national stage but its been frustrating. Right/Left, somewhere in between... What felt easy was losing sight of each others' humanity  as if somehow we can just talk however we wanted about our principles and values and ignoring the personhood in front of us.  My hope is that we boil down our frustrations and we redirect our energy to where it counts the most, amongst our friends, families, neighbors and local community. Right here, right next to us, there is much work to do be done.  May we take the gains and lessons from this years' conversation and do what counts for the people that live right around us.  Because it is right there that I think we will see and feel change for the better. 

I’m a little bummed I didn’t do a proper reintroduction- but I have discovered a few things that may generally be true for people - of course you don’t know until you do your own whole 30 experiment so try it!  Here’s some of my random discoveries - peanuts interrupt my sleep - twice I added it back and both times I woke up at 2 or 3 and had trouble going back to sleep. I don’t think I’ll try it again; not sure why I would- I like my mixed nut butter from Trader Joe’s or almond butter from Costco. Corn makes my joints sore. Flour/gluten rich foods gives me a headache. Dairy, particularly cheese, I knew before whole 30, but after the onset of my runny nose was instant. Bizarre!  Sugar? I’m not sure but one of these food groups makes me tired and does not help me get up for some morning exercise. That’s it for tonight. But coming soon, I’m really excited to delve into what we are planning/doing with our medical practice. For now I’d like to share a few photos I’ve taken lately of some of

I have never done any sort of "diet" before, and though I don't count Whole 30 as a diet, I am certainin some ways it is...but I love it and if you're interested and want to find out more check out  Whole30 Downloads - The Whole30® Program . This is where I print out the basic information for my patients for free! A few things that helped me:  1) it's easier to do along with at least one other friend. Along with Melissa's text messaging service which I did pay for (not sure it's totally worth it for me but it did keep me on track and helped with the day count), I texted with two other friends doing the program with me.  2) announce your intentions with your family and let them be there to encourage and celebrate each day with you, "what day are you on?" "...how great you have completed another day". I much prefer this than holding you accountable which might sound like this "you can't eat..." or "why are you eating...

One of my patients came to me recently, she just a got a new job and said she's learning things in her job she wished she had learned in school. While I don't think school will teach us everything we need to know, it has certainly done us a major disservice. Yes, a major part surely is a significant lack of funding but I tell you we can usually do things with little funding if we are creative and are actually given the space to do it.  So my major gripe today, I never really learned to cook from my mom; and I am not blaming her because surely I can learn now. It's just why did schools take away home economics classes and shop classes? We tossed it aside for what? If we don't have the basics? Were we all going to become engineers or whatever else that we didn't need to learn the basics of home economics and all this time as the family as we knew it has changed and altered some for the better and others for the worse.  I hope we are on our way to recovery but if nothi