Thursday, July 31, 2014

Short entry

This month I had been planning to share, because I've found it hard to find online anymore, my copy of the 1993 Caring People magazine's interview with the real Dr. Patch Adams. I have a paper copy, sent to me by Patch himself along with the first letter response to the first letter I ever sent him. (This fact alone--that he responds personally to all correspondence--is, to me, inspiring.)

I will try to share it next month. In Patch's own words, "Be physically fit. If you're not, your community will have to take care of you. In order to be a passionate worker, if you have a big project, you'd better stay physically fit. It's going to take a long time! (Unless your project is…dinner.) Make fitness part of the ethic of your effort. Rest when you need it. Otherwise spend your time wisely." Right now I need rest…tomorrow I go back to work with a 4-day stretch of hospitalist.

But I will share more of Patch's words next month. If ever I have felt the need for them, it is now! Washington is experiencing the largest wildfire in its history, at 250,000+ acres. The prediction of a continued increase in fires in the coming years, fueled by anthropogenic global warming, is disheartening. Omak right now is hot and smoky and I could use some inspiration. First, rest!


Monday, June 30, 2014

For LL, on the birth of our second child

one day soon
when life is simpler
I will wake up (rested) with the sunrise
put the water on to boil
take a little walk up the side canyon
pick a scattered handful of wildflowers:
larkspur, arrowleaf balsamroot, serviceberry.
return home and pour the water and bring you coffee in bed:
cream, no sugar.
we will have a leisurely breakfast of scrambled eggs with kale and mushrooms.
maybe you will read a chapter in that book club book you’re tolerating,
do a pilates workout video,
walk to the main street market for some fresh basil.
it's the one herb that has eluded your agronomical efforts.
I will stay home and do all the things a blogger is supposed to do:
write some emails, read some news, read other people’s blogs,
make intelligent and witty comments,
write something of my own.
with appropriate links attached.
maybe, later, you will read it.

that day is a long way away.

until then
knowing you may never read this
I can only try with my actions
—small, inadequate things, maybe a trip to the drug store for more balms—
to say thank you
thank you
thank you thank you thank you
for the interminable seconds
that stretched into minutes
that became hours:
how many we cannot know,
for your eyes were closed,
and mine were fixed on yours:
the hours of labor built on months of hope and years of love,
that you worked
and worked
and worked and worked and worked
to bring into this world the most unspeakable,
the most holy,
the most whole of miracles.

Wednesday, May 28, 2014


Continuing on the aquatic theme established last month…ok, sure, I'm trying to swim…sometimes, though, it can be nice to stay dry for a little while! This craft, constructed by our 2-yr-old (with a little help from Dad) has all the elements of appropriate 2-yr-old play: rope (requisite for ANY boat), power tools (the drill to put holes in the coconut and popsicle sticks), fire (candle wax for sealant), burning plastic (rope unravel prevention), heavy metal objects applied at the end of a lever arm (hammer to crack open the coconut). And of course, water!

Wednesday, April 30, 2014

Sharks and Waterfalls

At my high school graduation I received a card whose cover ran, “Once, you were a tiny drop of water. Then you became a stream, getting bigger and bigger, and now you are a mighty river, running towards the ocean…” I opened the card and read, “…where all the sharks live.” As fun as it is, of course, the analogy makes as much sense as a gust of wind fearing the birds. For this month’s blog I’m not even going to try to link my two themes, and instead give you two short entries. Waterfalls. Sharks.


In Pilgrim at Tinker Creek, Annie Dillard writes eloquently of standing on a bridge over the rushing river below. Looking upstream, she writes, is to look at the future. This is the water that has not yet reached you. Perhaps it carries a fallen branch, a floating leaf, a salmon hatchling. It is always new and different. To look downstream is to look at the water that has already passed. The past.

This works beautifully if you are standing on the bridge or riverbank. But for seven summers I guided whitewater river trips, and these rivers have indelibly etched in my brain that the future lies downstream. With the exception of eddies--and, once, an epic poison-ivy bank scramble pulling a swamped baggage raft back up to catch the eddy at Saddle Creek--there’s no going back. Even when we pull over, to camp for the night or to scout the next rapid, the river’s pull draws my attention to what will come next: the water’s flow becomes my own.

To facing upstream is to risk blindly drifting into Wild Sheep or Granite, class IV rapids.

In retrospect, I have been navigating the last 3 months not as a spectator on a bridge looking upwards to the future, nor as a river guide looking downwards to the future, but as a soaked rat on a piece of flotsam, gazing back at the rapids and—oops!—waterfalls I’ve just come through.

In February we moved houses. Rather than take time off, both LL and I worked more than usual in the last three months. We both took on additional extracurricular activities beyond our paid work. But the current did not slow down for us just because we decided to be crazy. There were still bills to be paid, food to be purchased, meals to be prepared, diapers to be changed. I'm thankful to say that we were mostly able to make our two-year-old our top priority, and I don't think he is much the worse for the wear. But eventually such stress will tear apart even the sturdiest raft. We have at least identified the need to seek calmer waters and back-eddies, to rebuild before we go over any even bigger falls.


A shark need to keep moving in order to breathe. This oft-repeated statement actually turns out to be true, as best as we can tell, for most sharks, most of the time. Those qualifiers might give one pause, yet all science has such qualifiers, whether we articulate them or not. The act of observing changes what is observed. Or, at the least, it is impossible to prove that it does not.

I digress. Sharks, movement, oxygen. I suffer from intermittent sesamoiditis, which sounds like some unbecoming disease contracted south of the border (doubly so), but is actually an inflammation (-itis) of a pair of tiny bones located directly under the ball of the foot. The simple equation is that more pressure causes more inflammation, so one would expect that being on one's feet, on a hard surface, for long hours, would cause inflammation and pain. This is exactly what happened during my residency training. For five non-consecutive months over the three years, I wheeled about the hospital on a "Roll-About"--picture a kid's scooter with the platform padded and raised to knee height--because it was too painful to stand.

The converse, however, is not consistently true: rest has not always healed my foot pain. Similar to the pain of plantar fasciitis (-itis of the plantar fascia running from the heel to the mid-foot), stretching the muscles and tendons that pull on my sesamoids has proved crucial in relief. Stretching requires movement. And whether or not piezoelectricity, the growth-stimulating charge that causes bones to become stronger with weight-bearing, plays a role, I have found that I do much better with daily exercise. It would seem that I need to move to be healthy.


Perhaps as a shark I can better navigate the waters ahead. If life is a constant reframing of perspective, then maybe I was not nearly so avant-garde as I'd pictured myself with my river-guide-rather-than-brigde-dweller viewpoint. Perhaps, then, I need to stop trying to stay dry and start learning to swim.

Friday, March 28, 2014

The Hobbit : a picture review

I believe that if you click (or double-click?) on the image you'll be able to see it in more detail.

Friday, February 28, 2014


"I love deadlines.
I love the whooshing sound they make
as they fly by."

-Douglas Adams

(if I had to choose only one desert island book,
it would be So Long and Thanks for all the Fish;
if I could bring along four more,
it would be the trilogy [comprising five books] of
The HitchHiker's Guide to the Galaxy)

Friday, January 31, 2014


For the last month I've been hoping to finish a pictorial review of Peter Jackson's 2nd Hobbit installment. It got started over Christmas break, but instead of finishing it, I've chosen to do other things with my time…

I serve on our state's board of directors for family physicians, and one of the things on my mind a lot in this role has been food and nutrition. (See "Leonardo and GMO", 9/29/13). Since last fall I've started reading "Food and Western Disease", by Staffan Lindeberg, and am interested in reading "Nutrition and Physical Degeneration" by Weston Price. Both recommend a return to a more natural and whole-foods diet, rich in vegetables but also, depending on location, incorporating a moderate amount of meat such as wild fish and game. By moderate amount I really just mean more than the zero amount argued for by T. Colin Campbell in "The China Study", which I read a few years ago. All three of these books are, as best I can tell, well-researched. All three, regardless of amount of animal protein they recommend, conclude that our modern diet of highly processed grains and feedlot-raised meat is unhealthy.

There are two major points I am struggling with right now, in considering this conclusion. (It is a conclusion with which I agree, and which more popular recent books such as "Grain Brain", "Wheat Belly", and Campbell's new work "Whole" also come to.)

The first is that none of this work is being taught to either new medical students or current physicians. In medical school I had one-half of one day on nutrition. On my drive over to Seattle from Omak for this quarter’s board meeting, I listened to five straight hours of CME (continuing medical education) covering a wide range of topics—not one of them nutrition. Nutrition is relegated to “alternative” medicine, while drugs and surgeries, which really should be the last “alternative” when lifestyle changes fail to achieve health, are the definitive focus.

My second struggle is with the disparity between the nutritional recommendations that I am or should be giving my patients, and what they can afford. Calorie for calorie, nutrition-dense food comes in at 10 times the cost of junk food: $36.32 per 2000 calories of healthy foods vs $3.52 per 2000 calories of junk food according to a 2007 University of Washington study.

When one considers that the U.S. has the highest income gap among the 30 most-developed nations, these data on foods costs help explain why we have the worst health statistics to match—and why, in addition to having overall worse health (e.g., the richest cohort in an unequal-income country like the U.S. is less healthy than the richest cohort in a more-equal country like Sweden or Japan), countries with a greater income gap also suffer from a greater health gap between rich and poor. If you’re rich, you can buy walnuts and kale and pomegranates and wild Alaskan salmon. And if you choose not to and only eat Big Macs, you can still buy yourself the statins and insulin injections and coronary artery stents.

In moments of such consideration, I have to step back and remind myself to not take myself too seriously. Yes, I will do what I can in the quest to right such wrongs, and do my best. But I am only one little hobbit, and the orcs are many and fierce. Look for a more light-hearted post next month. ☺