Sunday, December 27, 2020

Pandemic Fatigue Threaten Recovery

One of the most challenging symptoms that physicians and patients grapple with is fatigue.  It is exceedingly common and elusive.   In general, medical studies do not identify a cause and the symptom remains unexplained.  And, failure to identify an explanation only compounds the frustration.

I have been frustrated recently over a new iteration of fatigue, a malady that has crept onto the national scene over the past few months.  This illness, spawned by the COVID-19 plague, is called Pandemic Fatigue (PF) and it is spreading aggressively.

As of yet there is no vaccine to prevent it or any proven therapeutic agent to combat it.  Scientists thus far do not even understand how one contracts the illness.  Judging by the rampant community spread, one would suspect that it is highly contagious, but no infectious agent has been identified.

The disease seems to follow several weeks of adhering to public health guidelines to mitigate the spread of coronavirus.   At some point, either insidiously or abruptly, the individual rejects these protective measures and seeks liberation.   Keep in mind that nothing in the pandemic justifies any relaxation if mitigation efforts.  Conversely, as most states in the nation are reporting rising number of COVID-19 cases, experts have counseled a tightening of restrictions to attenuate what appears to be the raging of a 3rd wave of infections.  Paradoxically, Pandemic Fatigue is rising just as the virus is roaring back.

There is no Virus Fatigue

Pandemic Fatigue is a welcome development from the virus’s point of view.  As folks let their guards down, it makes it much easier for the virus to infect more of us.  So, you could argue that PF is actually showing kindness to a virus that has been the victim of so many vitriolic attacks.  Should we celebrate this viral empathy?

If you have had thoughts or heard statements such as those that appear below, then you are at risk of PF and should seek professional guidance very soon.  How soon?  How ‘bout Warp Speed soon!

“I can’t do this one more day!”

“I’m planning a huge family reunion.  We all need this desperately.”

“This is so depressing.  I’ve already missed out on 2 vacations.  I am not missing this wedding!”

“I am much more worried over my family’s mental health than the virus.  We need to go to a real theater to see a real movie to keep our sanity.”

“I’m zoomed out.  I need a hug.”

“Fauci?  What does he know?”


Are you a PF sufferer?   Remember, acknowledgment is the first step toward recovery.



Sunday, December 20, 2020

Whistleblower Holiday Cheer 2020!


‘Twas the night before Christmas

And Trump was still lyin’,

Hark!  What’s that sound?

Is Pelosi blow dryin’.!


The nation is split

Divided we stand

As Trump tells his millions

He’s still in command.


The election was rigged!

The votes must be stopped!

Except for the states,

Where Trump was on top.


While the world welcomed Biden,

One leader was rootin’,

For Trump to prevail,

Vladimir Putin!


And with Trump in the ditch,

And becoming quite moody,

He turned to that savior,

We know as Rudy.


And as Trump trashed the system.

The Dems are all sissies!

The brave GOP

Threw Trump lots of kissies. 

For a profile in courage

I have the sense

That the man for the ages,

Is Vice President Pence.


The virus roars on

There’s no place for hidin’

We’re turning to you

Vice President Biden.

Joy and Peace!





Sunday, December 13, 2020

Do All Patients Want Good Medical News?

It is a pleasure to give patients favorable medical news.  It’s an even greater pleasure to receive it.  Technology has replaced so much of our wholesome and human interactions.  Book stores are disappearing.  Handwritten thank you notes?  Nearly extinct.  The corner hardware store where the owner knows your family?  Today, we have Big Box warehouses where, if you hire a private investigator, you might be able to find a hiding salesman. 

Need a salesman?  Hire Sherlock!

The joy and relief that a patient and family feel when the physician says that all will be well has no technological equivalent.   We have all had anxiety about our own health or the well-being of those we care about.   When the physician enters the room to deliver news, there is fear and tension knowing that lives may change after just a few sentences are uttered.

Fortunately, the vast majority of the news I deliver is just what patients and families want to hear.
  • The biopsy result was benign.
  • The CAT scan was normal.
  • You won’t need surgery after all.
Paradoxically, I have discovered over the years that many patients are downright disappointed when they receive good medical news.  Gastroenterologists like me evaluate thousands of patients with chronic digestive symptoms, such as pain, nausea and bloating.  Although these symptoms are 100% real, diagnostic testing often shows no abnormalities.   I cannot count how many instances in my career that patients are upset to learn that the test results were normal.  Now, of course, these patients don’t want to learn that they have a serious medical condition.  But, they do want an answer and are frustrated that no clear explanation is apparent.  We physicians understand their frustration, but we are relieved that these patients are not facing a dire medical threat.

Here’s my profound summary comment.  Good medical news is a gift, even if it leaves some medical issues unexplained. 

Sunday, December 6, 2020

Test Your Knowledge of COVID-19

Many of us have sought distractions from the rising fears and frustrations of the pandemic. Why do you think it’s nearly impossible to buy a jigsaw puzzle now?  They are all on back order as the supply cannot meet the demand.  Board games are also more popular than ever.  Even I've competed in a few rounds of Boggle.  And binge-watching various television series has become a welcome oasis from the surrounding chaos.

Jigsaw Puzzles - Endangered Species

As a medical professional and an ordinary person, I am well aware of the health and economic horrors that the virus has wrought.  Yes, the upcoming vaccines represent a monumental scientific triumph, but there will be many dark months before they are widely available.

In this posting, permit me to offer readers a lighter look at COVID-19 to provide a few minutes of deserved distraction.

Here’s a COVID-19 quiz to test how current and accurate your knowledge is.


True or False

Anthony Fauci, MD is obsessed with masks.  He really needs to lighten up.

Deborah Birx’s scarves are soaked in bleach to repel coronavirus which is how she has escaped infection..

Donald Trump, a true statesman, attacked the pandemic without any political considerations.

Scientists predict a decline in viral infections in northern U.S. states in the next 2 months as the snowbird virus hates the cold.

Just like the ‘flu shot’, it is possible that the upcoming vaccines can actually cause COVID-19.


Choose the BEST answer.

Which of the following is the most effective method for avoiding coronavirus infection?

Using Lysol as a food additive.

Avoiding Chinese food.

Wearing a mask that fits snugly over your mouth and nostrils.

Joining an aerobics class since the vigorous kinetic activity will shake off any virus that lands on you.

Leaving the bar by 10:00 sharp which is an hour before the virus awakens.


 Our best hope for defeating this virus is:

President Trump reversing the election and continuing his leadership for another 4 years.

Having bleach brownies with a Clorox chaser every evening. 

Prohibiting masks which many people say might be making the pandemic worse.

President-elect Joe Biden.

Having friends and family from near and far come together during the upcoming holidays. The virus will respect our resolve and then fade away.

I hope that you performed well on this academic challenge.  Want some extra credit?  Wear a mask and keep a proper distance between you and others and I’m prepared to raise your score by a full letter grade. 




Sunday, November 29, 2020

Thanksgiving Day 2020 - COVID-19 vs Us

This is not really a fair fight.  In one corner of the ring sits the novel coronavirus.  It's invisible and can attack without warning.  Moreover, when it lands a punch, the victim may not even feel its impact for several days.  It can fell even a highly trained athletic competitor.  And it has proven expertise in psychological warfare.  It's opponents - us - are scared that we might become tomorrow's victims.  The virus clearly understands and exploits the power of fear.   And with deepening pandemic fatigue, the virus gains a strategic advantage as we tire of practicing recommended public health mitigation efforts.  

And in the opposite corner sits us, with a mask dangling loosely below our nostrils.  We thought that heading into the mall or to a friend's party would relax us before the competition.   After all, how much risk could there to be to have a quick drink at a coworker's house?   Or flying to another city to join with family at a Thanksgiving reunion?   "Didn't Dr. Fauci imply that airports were virus-free zones?" we recalled.  And all passengers on the plane, even the guy who kept coughing, were wearing masks, except when they were snacking every 15 minutes or so. 

The fight is only half over and I'm not sure we'll be able to endure 12 rounds.  Either we'll be knocked out cold or the referee will call a TKO.  

This is us with 6 rounds to go.

Perhaps, we should pursue a new strategy?

Sunday, November 22, 2020

The 2020 Election was Rigged!

How often have we heard or read after a courtroom verdict, ‘we are going to appeal’, issued by confident lawyers who claim that their crusade for justice will yet be realized.  Indeed, I think many of us misunderstand the appeals process.  You cannot successfully aim to appeal a verdict simply because you reject the outcome.  There is no automatic judicial do over.   The losing party must offer convincing arguments to an appeals court that there were errors in the trial that rendered the proceedings unfair.  In other words, the error(s) must be material and not simply a harmless error.  Obviously, any trial or human endeavor will include mistakes that have no bearing on the ultimate outcome.

For example, if a physician like me mistakenly records a patient’s height to be a half inch shorter than the true height, then the error is not consequential and won't affect the patient's care.

'I lost? I demand an appeal!'

One of the many regrettable developments in the current post-election chaos has been the widening of the expectation that an unwanted result must be wrong and should be challenged.  This is a departure from our heretofore general acceptance that findings and rulings by authorized bodies were correct or at least should be respected.  If this new practice is maintained or extended, it will threaten so many established norms that we have previously become accustomed to.  Consider some typical scenarios.

  • A student (and his parents) claim that his lackluster SAT score is wrong and demand a hand count.
  • A sports teams loses the final playoff game.  The manager suggests that the referees were biased and possibly corrupt.
  • A high school wunderkind loses in the final round of the National Spelling Bee.  His high school principal cries ‘fowl’ claiming that the winning contestant received a much easier word to spell.
  • A contestant in a juried photography contest loses in the first round.   He rejects the decision and hires experts who give attestations that the photograph has true artistic merit.
  • A presidential candidate loses but refuses to accept the results.  He responds by attacking the process, demanding recounts and pursuing a scattershot of legal attacks.

 Of course, outcomes may be unfair or wrong and we are entitled to pursue a cure when there is a reasonable basis underlying our claim.  But I maintain that the greater good, as well as our individual interests, are served better when as a general principle we accept the findings of our institutions.  And, if we wish to challenge a ruling or a result, then we are obligated to explain in advance why we feel that the process was tainted.  We should not have a right to an investigation hoping to find evidence of impropriety that does not currently exist in a quest to achieve a new outcome. 

Naturally, this is a nuanced issue and there are exceptions to everything.  But do we want to live in a society where every outcome is summarily rejected and assumed to be wrong?

When a loser graciously accepts a result, we all win.

Sunday, November 15, 2020

How Honest Are You?

What is your threshold for speaking up?  Most of us claim to hover at an upper orbit of personal integrity.  But for many if not most of us, the boundary can be wavy.  We see and hear every day how political leaders use different sets of weights and measures depending upon political considerations.  Let me make this plain for readers with the following brief example.

“When your guy does it, it’s corrupt and dishonest!”

“When my guy does it, it’s completely ethical!”

Test your own integrity as you peruse the following list.

"Hmmm, what do I tell mom?"

Is it a lie to tell your mom that her meat loaf was great when it conjured up visions of Ken-L Ration?

If you catch your kid plagiarizing a term paper, do you contact the teacher?

If a friend divulges that he is working under the table to avoid paying taxes, do you notify the IRS?

If a coworker asks you to punch the time clock for him to hide a late start, do you simply refuse or also notify the manager?

Have you visited a small private business to find out the exact product that will meet your needs and budget and then head out to a big box store where the product will be cheaper?

If a patient asks a physician to modify a diagnosis so that a medical test will be covered by insurance, does the doctor refuse? 

And if political leaders observe their president and his minions wallowing in an amoral abyss, do they jump up to denounce him or jump in with him?

Sunday, November 8, 2020

Election 2020 - Time to Change the Rules?

Four years ago, the country was shocked at the outcome of the 2016 World Series of Politics when the darkest of dark horses triumphed over the establishment.  In that contest, the New York Elites came up short against the New York Six Packs.  The final score of the decisive game was Six Packs 7 and the Elites 6 – a clear victory.

The Elites and their supporters were incensed and bitter.

“This is not fair!” they proclaimed.  “We got more hits than they did,” explained their team captain.

“Who cares?” replied Captain Six Pack.   “The rules only count the runs, not the number of hits.”

Over the next 4 years, every time Elitists referred to the prior lost contest, they always added, “We got more hits than they did.”  In fact, many of them began murmuring that the unfair rules should be changed such that the number of hits should now determine the winner.  Fairness, they grumbled, demanded a rules change.

Let the Games Begin Anew!

It's four years later and we are all spellbound as the 2020 World Series of Politics is drawing to a close. The New York Six Packs – the defending champions – seem to have met their match against the Scranton Scrappers.  The Scrappers have the upper hand.  It’s the top of the 9th inning and they are leading by 4 runs to 1 in the final game.  The Six Packs are at bat.  There are 2 outs and the batter is facing a count of 0 and 2.

It looks grim for the Six Packers.  While no winner can be called yet, as the game is not over, hope of the Six Packs prevailing is vanishing.   Indeed, in the Scrapper’s locker room, the champagne celebration has already been set up. 

At this moment, the Six Packs call a time out. The team owner then issues a statement that the Six Packs have won and are champions once again.  He explains that all 4 of the Scrapper’s runs were achieved by cheating, and he has the evidence to prove it.  The umpires seem unmoved and even some of the Six Pack’s players seem confused.

Yes, I have concocted this fairy tale from my own imagination.  It’s so silly I would be amazed if any reader has made it this far.  Could you imagine if such a scenario actually occurred in real life?

Sunday, November 1, 2020

Election Day 2020 - First Step Toward Healing?

Two days from now is Election Day, which heretofore had been a demonstration of the majesty of American democracy.  Her Majesty has been dethroned.   Millions are wailing for a change in presidential leadership and millions of others demand that the current administration be granted another term.

We are an angry people who seem willing to fight over everything and anything.  No issue is too trivial to demand someone’s cancellation.  Has the current administration caused these seemingly irreparable angry divisions or simply revealed them?  What is the pathway back to civil life?

Those who support Vice President Joe Biden do so in part because they believe that his decency and empathy can serve as a national healing elixir.  I pray that this is the case, but I have deep doubts in his capacity to turn a lumbering ocean liner around with only a set of oars.  The healing, if it is ever to occur, will have to come from within.  And we have to want to be healed.  If an angry person wishes or needs to remain so, then no change will be possible. 


Consider these realities that will confront the next president.

  • An angry nation with deepening divisions.
  • Seething partisanship in the government and in society at large.
  • A pandemic that is oozing over the nation like hot molten lava.
  • Economic collapse with more pain to come as the virus roars back.
  • A stock market that may be poised to tank.
  • Racial injustice and unrest.
  • Cancel culture.
  • Erosion in the integrity of many of our nation’s foundational institutions.
  • Loss of trust in everything.
  • Cybercrime, an untraceable scourge which causes damage, chaos and rising fear.
  • Fractured foreign alliances.
  • Aggressive actors on the international stage.
  • Natural disasters.
If we elect a change in leadership, all of these quagmires and those yet to come will be his.  In time, he will own them.  The intractable challenges will surround him and us.  One set of oars won't move the ship.  Many of us will have to row along side him  Which direction will you be rowing?


Sunday, October 25, 2020

Will a Coronavirus Vaccine Heal the Nation?

Presently, your humble scrivener is situated in Atlanta, Georgia, the destination of a long road trip from Cleveland, Ohio.  Tucked safely inside our car, we were insulated from the novel coronavirus as well as the storm surge of seething of the nation.  As of yet, there is no vaccine or truly effective therapeutic agent available for either of these afflictions.  My sense is that the virus will be sooner and more easily vanquished than will be the malignant divisions that are threatening our society.  

Am I being serious here?  Do I actually argue that a scourge from an invisible warrior that has wounded millions will be more easily defeated than our vile and vindictive politics?  Is reaching across the aisle or across the street or across the table such in insurmountable task?

Here’s why the virus, as wily and destructive as it is, will at some point be the first to be defeated. Our politics, in contrast, will be more like arthritis and diabetes, long term and progressive diseases that have evaded cures. 

Consider these distinctions.

  • We literally have decoded the DNA of the novel coronavirus.  We know the actual guts of the enemy.  The wiring of our political antagonism and strife, however, is an amorphous cloud that defies concrete understanding.  It has no tangible structure.
  • When we scream against the virus, it remains silent and permits us to vent.  When we yell at our neighbor, he yells back as we yell past each other.
  • As our experts combat the virus, they follow sound scientific principles and rely upon the successes and failures with prior pandemics and health crises.  There is playbook to follow.   Our fraught political divide is largely fueled on emotion, alternative facts and anger.  It is a zero-sum game.  There is no off-the-shelf playbook for this.  How do you dismantle an emotion?
  • Folks who are sick or scared that they may become the next coronavirus victim want to be healed and to stay well.  Self-preservation is a powerful motivator.  They want to pursue a pathway that will bypass pain and promote healing. A political force, in contrast, that spends its time and resources demonizing its enemies, doesn’t aim to avoid conflict but to foment it.  It stokes the fire.

As our road trip proceeded through Kentucky, Tennessee and rural Georgia, the political signage reflected the red character of these regions.  We ended up in a progressive Atlanta neighborhood where many houses display Black Lives Matter and various whimsical anti-Trump signs. 

I am confident that safe and effective vaccines against the novel coronavirus will emerge. Ultimately, they will be gamechangers.  But the Culture War epidemic will rage on.  Clearly, we have no natural immunity to protect us and the disease is beyond the realm of science.  Progress, should it develop, will have to happen one good person at a time.    

Sunday, October 18, 2020

Portland Protesters Topple Statues of Lincoln and Roosevelt.

To note that our nation is seething with anger – although deeply disturbing – is certainly not Breaking News, except on CNN where Breaking News flashes even when they are breaking for a commercial.  It is not that the nation is angry over a handful of controversial issues; we are angry over every issue.  Indeed, part of my dismay and fascination is how even a trivial event or utterance can provoke rage.  A few decades ago, if a person provoked or insulted someone, an argument might ensue.  Today the same provocation can have a fatal outcome. 

Let me offer a very bold pronouncement.  I do so under my own name and stand ready to accept a searing rebuke.  Ready? 

Humans are not perfect.

Yet, when we judge current political leaders, historical figures, athletes, law enforcement personnel, writers, musicians, educators and the rest of us, any flaw discovered may generate outrage.  The paradigm is not to consider any surrounding circumstances or the context of the time that might distract us from our search and destroy missions.   Ready! Fire! Aim!

Here’s an interesting twist that the search & destroy folks routinely employ.  A flaw found in one of their allies is overlooked while the same flaw in an adversary is magnified to gigantic proportions.  There is a very fancy term for this – hypocrisy.

This past week, protesters in Portland, Oregon toppled statues of Abraham Lincoln and Theodore Roosevelt over charges of racism and unjust actions against Native Americans.  I am not a historian who can judge these men, but I do know that our nation was considerably less enlightened and tolerant during their times than we are today.  Slavery during Lincoln’s presidency – while immoral and abhorrent – was lawful.  And Roosevelt served during the Jim Crow era.  They were both great men and great leaders who deserve to be honored.  I completely accept and encourage that their flaws and immoral thoughts and actions be scrutinized and studied. Give the context and judge accordingly.  But we should not allow our current sensibilities and anger to view their flaws through a modern lens as we diminish their accomplishments to justify current outrage.  We must reject this revisionism.   Isn't this how we would hope the next generation will judge us?

Should we dynamite Mount Rushmore?  In addition to taking out Roosevelt and Lincoln, we could also cleanse the landscape of two additional flawed figures, Thomas Jefferson and George Washington.

Should we blow it up and use the granite to make some woke statues?

With a demand for 100% purity, which has a very elastic definition, what statue will be left standing?

Many of the famed suffragettes whom we celebrate were racists.  Margaret Sanger, a pioneer and champion of women’s rights, had a permissive view on eugenics.  Many of our colleges and universities practiced racism and anti-Semitism.  Several universities had direct ties to slavery.  Yes, they are making amends in recent years, but why did it take them a century or so to come clean? 

We are imperfect people in a flawed nation in a defective world.  Blotting out, redacting and destroying recklessly won’t improve us.  Conversely, it will widen the gaping divide.  Surely, decent and tolerant people can forge alternative pathways to address raw disputes.

Who will be left standing after the statue police clear our parks and public squares? Would Gandhi, Mother Theresa or even the Almighty make the cut?

Sunday, October 11, 2020

Dr. Sean Conley - White House Physician - a National Mentor

 In one’s profession and in life, we strive to improve our performance.  There are so many pathways available to progress on this journey.  One of the best ways is to emulate others.  Athletes, artists, musicians, writers, parents, tradesmen, educators, clergy, law enforcement personnel and even physicians can better their performance by imitating others.  And while it might seem axiomatic that our best role model is one who is more proficient than we, this is not necessarily the case .  The team captain can learn much from a rookie.  The Jewish Talmud expresses the truth more eloquently. 

                                               Who is wise? One who learns from every man.

Over my career, I have tried to improve my practice of medicine from watching other physicians and nurses in action.  As an example, I have heard medical professionals having difficult conversations with patients which taught me how to do this better.

So, when President Trump’s doctor recently led several news conferences to discuss the president’s COVID-19 status, flanked by the an expansive medical team, of course I was rapt.  At his level of the profession, I knew he would have much to offer me, an unknown community gastroenterologist.  After studying his speech pattern, facial expressions, clarity, humility and truthfulness, I was anxious to emulate this national medical mentor to take my own professional performance into a higher orbit.

Based on what I learned from Dr. Sean Conley, here’s an example of how I hope to communicate with patients and their families henceforth.

Doctor Whistleblower:    I’m here to update you on your evaluation for abdominal pain.

Patient:  I’m so glad you’re here, doctor.  What’s causing this stomach pain?

Doctor Whistleblower:  Well, one thing for sure; it’s not athlete’s foot.  We’ve ruled that out.

Patient:  Whaddya mean athlete’s foot?  We’re talking about my stomach.

Doctor Whistleblower:  Exactly my point. 

Patient:  Did the CAT scan show anything?

Doctor Whistleblower:  Only the usual expected findings.

Patient:  What findings?

Doctor Whistleblower:  Like I said, the usual.

Patient:  Did I have appendicitis or something else?

Doctor Whistleblower:  I really can’t say.

Family:  What’s going on here?

Doctor Whistleblower:  Please don’t interrupt the patient and me or I’ll have to contact security.

Patient: Can you please tell me what’s wrong with me?

Doctor Whistleblower: I wish I could, but I can’t violate patient confidentiality.  You know that HIPAA stuff?

Patient:  But, I’m the patient!

Doctor Whistleblower:  Exactly my point!  You’re finally catching on.  My hands are tied here

Patient:  Can I be discharged home please?

Doctor Whistleblower:  Sure, but it will be against medical advice.  So, if things head south at home, it’s on you.  I'm so glad though that you're feeling better and are ready to go home.  

With all that I've learned, I hope that I can serve as a mentor for younger doctors and pay it forward.  





Sunday, October 4, 2020

Trump has COVID-19: Our Year of Disaster Marches Onward

The year 2020 has been an annus horribilis and it's not over yet.  Seemingly out of nowhere a virus, heretofore unknown, has seeped over the globe like hot molten lava leaving a wake of destruction and despair.  The fatalities here in the U.S. have been staggering and the death count continues to rise.  Millions here have been infected and have suffered greatly with severe illness, hospitalizations and intensive care unit treatment.  Those who have so far escaped infection are anxious that their fate might change at any moment.  All of us have been affected.

And, we have had a catastrophic economic melt down from which we may never fully recover.  Furloughs, layoffs, bankruptcies and permanent closures have affected nearly every sector of our economy.  The airline industry – the nation’s circulatory system – now has a very weak pulse, as one of countless industry examples.  Job losses have crippled much of the nation which has caused consequences to real people and families far beyond their economic losses.

As we struggled through the pandemic, the nation witnessed and participated in protests throughout the nation decrying racial injustice and demanding change.  While we tried to focus on this movement, we were distracted by those who engaged in looting, vandalism and other criminal actions.  One section of Seattle, Washington aimed to create an autonomous zone free of law enforcement.  Police became vilified by many which widened existing and raw fissures.

Reminiscent of Newton’s Third Law of Motion, where an action generates an opposite reaction, the violence that occurred in many of our cities led to a Law and Order counter-movement, which only served to further infame and divide us from each other.  It was as if the entire nation was talking past each other.

Sir Isaac Newton Offers Guidance

Then, we mourned, however briefly, the passing of Justice Ruth Bader Ginsburg, as a replacement was offered just days later who is slated to be confirmed by the Senate in record time.  Democrats howled and threatened to retaliate if they recapture the Senate in the upcoming election.  Do we really need a judicial cage fight on top of everything else?

We were not reassured that there would be peaceful transfer of power or that the election results would be accepted.  Might this supposition contribute to the national angst?

And, then the nation watched the first ‘debate’ between the 2 presidential candidates which took place just 20 minutes from my home.  The performance largely served to further demoralize us about the nation’s current mood and psyche.  We are not well, and we agree on nothing. 

And the nation and the world felt a collective frisson when we learned that President Trump has COVID-19 and was hospitalized.    

And, we haven’t even had the election yet.

Certainly, in my lifetime, I have never seen so much pain, anger, despair and anxiety packed into such a short period of time.   Where’s the way out?  Returning to Newton for guidance, his First Law of Motion states that an object in motion will not change unless some external force acts upon it.  Will you be part of that external force?



Sunday, September 27, 2020

Ruth Bader Ginsburg Lights the Fuse

Before Justice Ruth Bader Ginsburg’s death certificate was signed, Judicial Warfare commenced.

Both sides, of course, were prepared for this moment.  Justice Ginsburg, seemingly indefatigable, was well into her ninth decade and had numerous collisions with cancer.  It’s cruel, but entirely expected, that the nation was not given a proper opportunity to honor her legacy and accomplishments which should command admiration from all Americans.  One need not agree with her judicial philosophy or her opinions to admire the breadth of her accomplishments, her work ethic, her intellect, her vision and her humanity.  Indeed, her storied friendship with the late Justice Antonin Scalia shows a nation overflowing with anger what is possible.

The efforts to recall her legacy were soon subsumed in partisan warfare.  The Democrats accused the GOP of monumental hypocrisy as they juxtapose their statements in 2016 when Judge Merrick Garland was nominated to their current proclamations that confirmation must now go forward.  The GOP, brushed this flip flop aside with some slight of hand claiming justification to proceed now since the Senate and the president are of the same political party.  I can barely grasp their point even after engaging in rhetorical contortions followed by linguistic acrobatics. 

Senators McConnell and Schumer Sharing Love

So, what’s next?  The GOP are poised to achieve confirmation prior to the presidential election.  Perhaps, this effort should be called Operation Warp Speed, instead of the COVID-19 vaccine development.   The Democrats can’t stop it but they won't soon forget this power grab!  If they capture the Senate, particularly with the rise of the political left wing, they will be pressured to consider adding justice seats or curtailing the justices’ lifetime appointments with shorter terms.  They will demand measures to ‘balance’ the court.  (Read:  install justices who will likely make rulings that Democrats want.)   Democrats are also understandably fueled by the shameless stiff-arming of Judge Merrick Garland 4 years ago.  If Biden wins, Judge Garland's Supreme Court opportunity may be rejuvenated.

And, then what happens when in the future the GOP recaptures the Senate?  For a hint, consider the words payback, retaliation and revenge.

But, let’s remember that the judicial fuse was first lit by Democratic Senator and Streetfighter Harry Reid who abolished the filibuster for confirming judges at all levels of the judiciary below the Supremes. 

Look, each side blames the other and crafts their own supportive narrative.  Here’s what I think.  If the Democrats retake the Senate, they should restore the filibuster for all judges at every level of the judiciary.  Our best chance to lower the hyperpartisan temperature, to foster collegiality and to achieve more balanced courts is to restore the status quo ante when both parties had to cooperate.  With the filibuster, neither side will be able to install extreme candidates as 60 votes will be needed for confirmation.  Indeed, the filibuster is a deep senate tradition that gives the minority party influence.  If the Democrats take over the senate, they might eliminate the filibuster entirely - a true nuclear legislative option - that would create more enmity between the parties, if this is even possible.

What is the probability that the Democrats would pursue my high road strategy if they take over the Senate?  Probably as likely as Senator Mitch McConnell inviting Senator Chuck Schumer to his porch on a lazy Sunday afternoon to shoot the breeze as they sip Kentucky bourbon. 

No, the Democrats will be out for blood.  And so the cycle will be perpetuated.  And who will be the real losers here?


Sunday, September 20, 2020

Stopping Coronavirus on College Campuses

Perhaps, October 31st will be an inflection point in the pandemic since more folks will be wearing masks on Halloween.

I assume that the annual ritual of trick or treating will be suspended this year, as have so many of our performances, celebrations, concerts and athletic event spectating.   It has been my observation in Ohio that more folks are masking up, although there are exceptions everywhere.  Our governor has directed concern for some rising case numbers toward college youth, who astonishingly haven’t followed the rules.  Just because one is a college student doesn’t guarantee that his decisions will be graced with wisdom.  And, if there is to be any chance that college kids who are drawn toward campus parties like iron filings are attracted to a strong magnet, there will need to be sure and certain enforcement.  What if a college made students aware that violating public health rules would result in expulsion with no refund of monies spent?   Yes, I know this sounds draconian, and it may not always be clear when an actual violation has occurred, but if we expect students to resist all of their impulses, then proper incentives and accountability need to be in place.

News Flash!  College Kids are not Saints!

Let’s recognize that not everyone does the right thing for the right reasons.   As an example, let me offer three reasons why people do not shoplift.

  1. It is wrong to steal property.
  2. It is wrong to commit an illegal act.
  3. Fear of getting caught and facing the consequences.

Once again, if we were all saintly, then laws against theft wouldn’t be necessary.

We have all seen these past months how many folks reject mask wearing and maintaining adequate physical distancing rejecting the advice of health experts and government officials.  I suggest that more rigorous and certain enforcement would have increased compliance.   Remember, we are discussing an issue that has life and death consequences.  A person who prances about maskless and mingles freely with others can cause a death or serious illness of someone downstream who he does not know.  Since the stakes are high, our tolerance for non-compliance should be low. 

How would you bring folks into line who threaten all of us?



Sunday, September 13, 2020

Dealing with Angry People - Better to Do Right than Be Right

 The nation’s racial upheaval, particularly vis a vis law enforcement, has shown us the value of the skill of de-escalation.   A situation arises and several outcomes are possible, although some are clearly preferred.  The specific technique and approach utilized may determine the end result.  A range of options are often available.  What can make these situations so difficult to unravel afterwards is that an option that may lead to escalation may be deemed to be acceptable, according to the training protocol.  In other words, even the approach taken was acceptable, there may have been a better way.

Obviously, we all endorse training and practices that has the highest probability of bringing calm to a potential combustible situation.   I expect law enforcement – the professionals – to pursue de-escalation as their default mode.  But, the citizenry can and should do its part to de-escalate.   If all parties share the desire for a calm denouement, then it is much more likely that this will be the result.

I realize that my views here may sound naïve and idealistic, particularly as the nation is a cauldron of anger and dispute, but we all have to try.

Even a face mask can light a fuse.

It seems to be that de-escalation has never been more important than it is now.  Who would have imagined that one would need de-escalatory expertise when confronting an individual in a store who is not wearing a mask?  We’ve all had the experience of inadvertently annoying another driver on the road who proceeds to either tailgate within a foot or two of our rear bumper or to display a well-known digital gesture of displeasure? 

Even in my own profession, I am facing a patient and their family who bring anger and frustration into the exam room.  While I may not be responsible for their state of mind, I am responsible in how I deal with it.  Do I want to win the argument or win the peace?

The reason why de-escalation is so critical is because we are suffering from an epidemic of anger.  Our current fractious and divided nation is in part the result of malignant escalation by our leaders, elective officials, interest groups and individuals.  What would life be like here if all of us served as fire extinguishers instead of arsonists?


Sunday, September 6, 2020

Labor Day 2020

Labor Day is a time to pause, reflect and to thank all those who keep this nation vibrant. You are the guts of the country.

Labor has battled many adversaries over the decades.  It has sparred with management.  It has railed against 'right to work' legislation.  It has struggled to compete against low wage workers in foreign countries.

But this year it has been sucker-punched by the most formidable adversary that has ever entered the arena. And Labor is still reeling.  And, so are the rest of us.

An enemy like no other

It will be a slow grind, but it will lumber forward.  Yes, we will reach the other side.  How will we get there?  Of course, we will need our medical and scientific community to put the virus in its place.  And everyone will have a role to play.  But, the grit, sweat and determination of Labor will be a major force leading us out of the abyss.

Sunday, August 30, 2020

Why I Don't Tell Alcoholics to Quit Drinking.


I have seen many alcoholics during my gastroenterology career.  It is likely in the majority of cases that I was not aware of their abuse history.  Patients often deny or minimize their alcohol history when queried. 

“Do you use alcohol regularly?”

“Only socially.”

At this point the physician and the patient engage in a linguistic tete-a-tete on the precise meaning of ‘socially’.

Patients are more forthright about their habits when they have a medical condition that has a clear an obvious connection to alcohol, such as jaundice or liver injury.  And, if family members are present, they often serve as fact checkers and truth tellers.

What is my approach to these patients?   Do I wave my arms and preach like an evangelist that they should throw their bottles away?   Do I tell them that they must quit or face medical damnation?  Do I threaten to sever them from my practice if they persist with their addiction?   I have adopted a rather different approach.  I do not advise alcoholic patients to quit their drinking.  Yes, I know that this may sound like an abdication of my responsibility to protect my patients’ health, but I do not see it that way. So before you report me to the state medical board, here me out.

I certainly do not endorse or otherwise support injurious addictions.  I wish that everyone could unshackle themselves from their suffocating tentacles.  And I conduct my personal life in a rather abstemious manner with regard to spirits and hard drink.  But, I do not directly implore patients to cease and desist as I believe that they must make this decision themselves as the very first step in their hoped for recovery.  In my experience, all successful recoveries start from within, not from without.  

I lay out the hard medical facts to these patients with clarity and candor.  I discuss the natural history of the disease and the dreadful and irreversible complications that they are at risk to suffer.  I review their available medical data emphasizing that their lab reports and imaging studies may not accurately reflect the depth of injury present in their liver and other organs.  For example, a patient with cirrhosis of the liver may paradoxically have completely normal liver blood tests.