A Comment Worth Mentioning

aacommentDr. Culpepper writes in response to my recent post, “Thank You, Doctor.”

Dear Mr. Mulligan:

Medicine is a calling and I suspect that you would have served beautifully in this profession. A real physician does not have a job as a doctor, he or she becomes a doctor.

In the process of medical training, one takes on a new life… well, that’s the ideal. Much of the challenges of our healthcare quagmire result from medicine becoming instead a business.  It’s as if church and state combined into a disaster. So it is with healthcare becoming a business. No one begrudged a well paid physician, our community supports that concept. It is instead the focus on business: the margins, marketing, middlemen, and entrepreneurs (some of whom are doctors) that has poisoned this noble profession. Those physicians that are still true to the calling are swallowed up by the toxic agendas and often not seen except floating below the surface.

Please continue pointing to those brave souls. They need the attention and a lifeline.

Dear Dr. Culpepper:

it’s nearly impossible to practice a passionate profession be it medicine, applied sciences, mathematics, art, performing art, music or writing.. aacommentresponse While these passionate professions are often enjoyed by many, they fall far outside the gated community called business.

Your irresistible “calling” metaphor is the perfect rational as to why men and women pursue professions which require the volitional abdication of varying aspects of their human nature like sensibility, acceptance, support or reason. But it also provides a pathway to genuine propriety and inclusion in one of the most reverent and honored professions on a global scale. It is a profession which treats humanity not borders or anarchy or tyranny.

Physicians transcend the pettiness of our human condition to oversee the miracle of humanity. I myself have heard a calling; to ignore convention and weave together language inviting the curious to hear the harmony of words. To others blessed to hear their calling, I recommend you listen to its invitation; yet most discard it as folly. True Callings  never quiet; they continue to knock, disrupting whatever future you planned with doubt and obstacles.; then one day an example of the difference you could make persuades your abandonment of a false life to step off the canyon’s edge and begin your true life.

If it’s fear that stops you, consider your patient’s eyes filled with fear and the strength they see in yours; passionate eyes sparkling with compassion and the quiet strength of a truthful life.

Thank You, Doctor . . .

There was a time, oh, not so long ago that friends Michelle and Peter and Nick would remember that I sat in a chair in a public forum and wept because I never became a doctor.  Friends recommended nursing, but on my first day my instructor, wearing one of those origamitized hats mentioned the adjective caring in hundreds of examples.  By the end of the day I’d grown so weary of the word caring I returned my shiny new mules and knew I didn’t have the dedication to the lives of total strangers simply because your unyielding care and uncompromising affection for humanity seemed as close to grace as most of us will ever know.

I’ve been very lucky to have been able to continue my 20 year relationship with my primary care physician.  In 20 years we’ve both learned a lot about each other: he more so of course, especially with those physician distributed x-ray glasses (and we thought they were some manifestation of a cartoonist’s imagination) because how else could doctors have the degree of insight simply by engaging in an innocent conversation.

I’ve been thinking lately that all these men and women who voluntarily step up to education and raise their hands so strongly, so surely, and so hopefully that witnessing that depth and degree of service to strangers must be one of the most moving examples of humanity stepping into a life where their life is secondary.

Why they do this happily, proudly, compassionately in order to be in the presence when most of us aren’t gussied up for prom astonishes me and thanks God for loaning humanity a few hundred thousand angels to leave Heaven and come to earth (by way of unimaginable hours pouring over manual after manual after manual and I can’t even remember 3 things to buy at the grocer’s), then share their own type and degree and experience of the comfort they know to be true once we let go and become fine examples of colorful balloons rising higher and higher and out of sight but not out of mind.

To all those selfless and defenders of the weak or ill or mentally compromised or children or any other of the millions of disenfranchised a mere thank you will never repay your kindness. But maybe God’s set up a 401(k) for you in heaven.



When I Was A Boy, A Doctor’s Insight Was Law



When I was a child and was literally dragged to Dr. What’s-His-Face for an annual check-up (less a check-up and more a ritualistic cadence of tsk, tsk, tsk’s) as he poked and kneaded and cold-handedly fiddled with my . . . which backs away from coldness . . . and shy’s away from evaluation like a cub scout whose self-built car elicits jeers from his Scout Master (who also happens to be his dad).  The snap of gloves and odor of soap which resembled anti-freeze gave the doctor time to compose his subtle and sensitive conclusion:  “He’s too fat and getting fatter and his fat is hiding his . . . which, for sanitary reasons may require the removal of . . . which was when I buckled my Indian Beaded Belt and disappeared until hours past dusk when a neighbor found me shivering beneath the front porch.

That incident was a painful secret which I’ve carried on my back for fifty years and continues to cause retreat when doctor’s or lover’s reach out.  Such a sad burden to carry because of one unsympathetic phrase from a stranger who had no right being a pediatrician.  I often wondered how he treated his dogs.

My mother’s ignorance and prostrating to figures of authority always meant that any run-in with any adult possessing even a pinch more aacopauthority than her resulted in stern and week-long pain.  Just what exactly did these arrogant and sadistic adults possess that was never crossed?  They had been appointed to their position because of educated insight which was never, ever, EVER questioned..

Which, of course, perpetuated a multi-century tradition which has continued even to this day.  Most doctor offices have a small-framed notice somewhere above their “All services must be paid TODAY!”  reminder which reads something like,  “My profession hasn’t been questioned or challenged in three hundred years, so don’t try to be the first today!”  And in you go to be examined, quizzed, and questioned only to receive a prescription scribed in ancient Egyptian and an “order” for physical therapy.

aaangryguyDo I sound somewhat angry?  Of course I am!  Doctors get paid enormous salaries yet complain about the escalating costs of malpractice insurance.  Malpractice insurance exists because professionals are trusted and believed and paid.  And for this degree of faith we get an educated guess of what might be ailing us.

But this is what I’m REALLY angry about: Two doctor’s at Froedert Hospital assured me my brother Rich did not suffer a stroke based on a CT scan.  It was 48 hours later when I insisted they perform an MRI.  Voila’!  A clot in a vein feeding the occipital lobe (responsible for eyesight).  Because of unconscionable arrogance my brother is legally blind while these two doctors suffer NO consequence.  Upon discharge from Froedert, I was told that Rich was totally blind due to A) The Stroke and B) A severe seizure two days later.  I made decisions based upon the information told to me by staff in the Stroke Unit.  And guess what?  He isn’t blind!  Albeit his eyesight has been significantly compromised, but his field of vision is approximately 17″ in diameter!  And the staff at Froedert?

And the worst example of guesstimating occurred this past weekend when Rich suffered a severe heart attack.  The errors in order of aapuzzleddocappearance: A) Someone at the acute rehab facility removed his DNR bracelet, yet never informed the paramedics that he had a DNR order in effect; B) The paramedics, unaware of the DNR order, couldn’t inform the ER staff;  C) When Rich went into arrest they performed heroic measures to yank him back to life including five minutes of chest compressions resulting in several broken ribs and the insertion of a temporary pacemaker to maintain his heart rate (why didn’t anyone call me while they repeatedly beat Rich?  They called me after!)  D) An ICU doctor called me and informed me that the ER stepped beyond Rich’s wishes and now, NOW I’ve got to decide if and when we reverse their . . . their, what . . . their adrenaline infused jump to action?  And when YOU do decide he will . . . be gone.

For nine hours I held firm to Rich’s wish: DNR. And I would honor his wish just like I’ve always honored him. And I aastoplightwouldn’t allow my own emotion, hope, or desire to shake my resolve. I spent nine hours picking up strength like a child picks dandelions. And upon my arrival at his room in the ICU he was semi-conscious, breathing on his own, and occasionally howling in pain as he coughed with broken ribs. The equivalent of The Cuban Missile Crisis was over and Rich, contrary to what the ICU doctor emphatically informed me, was alive, on his own, without my intervention. And even though he’d crossed that line, he’d come back, I think, just so we could laugh at the old, standard jokes as though it was the first time we’d heard them!

And those doctors? The heroic and uninformed professional, and the cardiac-specialized professional made two BIG mistakes and continue to work without consequence for their egregious and painful errors. Alas, that three hundred year old tradition continues.


The Short Reach of 9-1-1

What does fifteen minutes mean to you?   To me, it’s a short walk with Jenni or the edgy, flinching time I endure, while sharp picks and mirrors and a fistful of rubberized fingers examine my mouth.

To a heart attack it’s pay dirt; to a stroke it’s a killing; to an overdose it’s long enough; it’s 25% of your critical hour.

It was the way he answered the phone and repeated “nauseous”  that prompted my intervention and a feeble attempt at reassurance, “I’ll call 9-1-1,” which began a 15-minute byzantine pursuit through a labyrinth of indifference, ignorance, misinformation, unyielding tenacity, irrationality, and finally the grossly delayed ringing of the fire department serving my brother‘s address.

In this age of instantaneous access to millions and millions of useless and the occasional entertaining tidbit of useless information, we assume that a federal infrastructure would be installed and activated and by dialing three simple digits you would be transferred to the emergency department serving your father’s address.

But there isn’t.  Instead you’re passed along with great indifference until, smartphone in hand, you’re barely capable of performing search after search of increasingly familiar street names and coverage maps and administrative offices which you call in desperation and quickly evaporating hope.

Fifteen minutes while your brother or sister or father or mother follow your misguided instructions based on years of same-city-9-1-1-calls.  Who would ever think that soliciting an emergency service would be impossible.  Impossible?  Really?  Impossible, while your brother or sister or mother or father sits alone in their home slowly dying.

Without question, the federal government should appropriate whatever amount of money it will cost to rebuild a one-city call center into a network of transferable calls to the exact city where emergency help is needed.  Please, spend less of our money on bombs which kill scores of innocent people in faraway countries and use it here at home for emergency call-centers purposefully designed to assure the caller that first responders are on route to your brother or sister or mother or father’s house to save their lives.



Just Ask and then Listen

aaapaperworkI’ve struggled for months with a question:  How do I accomplish, with zero tolerance for failure, the assessment, strategy, implementation, occupation, research, study, report and application, monitoring, compromise of personal values, extortion, catastrophic emergency, invasion of personal papers, rehab facility decision, $1,000 down payment, retaining attorneys to guide strategy for Title XIX approval (zero tolerance for failure), leading the unraveling of real estate, bankruptcy, discharge, fraud, malpractice quagmire and retention of law firm to defend our interests in our private property, without allowing sobbing emotions, hopelessness, and the fact that my older and only brother will never return home?

The first time he asked, “Am I ever going home?”  I did everything I could to keep my composure so I could ask him to hold the line as I bellowed through a weeping and deep, deep sorrow for my partner to pick up the line.  And then my sanguine veneer burst and the mourning and loss aaaweepingand sadness and exhaustion and anger were released like Pandora‘s evils of humanity.  It was then that I damned myself for my own humanity; it was this humanity that undermines brotherhoods and best friends, silently damning a single vein then discarding the blind, the weak, the imbalanced to . . . exist among other damaged examples until his emancipation appears upon his death.

“Where am I supposed to find the strength to yet again marshal a campaign to establish and confirm his welfare for the entirety of his now crippled life?  I screamed as a fresh bout of sorrowful nausea racked my formidable frame!

And then I heard it.  Faintly, breathlessly, as though it had traveled a great distance at extraordinary speed.  And then I heard it again clearer, distinct, simple.

“It’s your job,” it said, “Not your Life.  Administer his guardianship with authority and leadership.  Then one day after you’ve navigated his life through a dangerous channel you’ll surrender your charge and let him set his own course.”

The following day I began the intrusive deconstruction of his financial, legal, medical and administrative life with the same degree of organization, tenacity, and dominance as I’d done quite frequently and consistently successful my entire career.

That was my job.