Wednesday, January 22, 2014

The Power of the Prosecutor

     The Florida medical license renewal process is not a simple matter.  Besides filling out a standard demographic form there is a series of questions containing legal language requiring translation into layman's English, thirty Florida Statutes and Administrative Codes* that must be navigated, and a multitude of continuing education requirements the applicant has to prove he or she has met, including specific classes on domestic violence, HIV and prevention of medical errors.  Links to two different agencies, CE Broker and the American Academy of Family Practice, are supposed to make it easier to collate one's study and class credits accumulated over the past six years, but they don't itemize the precise categories of credit required by the Board of Medicine.  After four phone calls and hours of gathering education data, I was allowed to pay $379 to renew my license.
     The fourth phone call was to my lawyer.  Given that it's a crime to fill out the license application wrong, an act which could be interpreted as misrepresenting one's position, I had to make sure that certain questions meant what I thought they meant.  Have I entered "a plea of guilty or nolo contendere to, regardless of adjudication, a felony under chapter 409, chapter 817, or chapter 893, or a similar felony offense committed in another jurisdiction"?  If so, "any such conviction or plea shall exclude the applicant or candidate from licensure, examination, certification, or registration," unless it's been more than 15 years since the probation period for the plea has ended, for a first or second degree felony, and ten years for a third degree--except under section 893.13(6)(a).  What did all this mean?  And was it applicable to me?
     My lawyer returned my call promptly and told me none of this applied to me, at least not yet, since I haven't been charged or convicted with anything, nor have I plead "no contest" (nolo contendere="I do not wish to contest," meaning I don't accede guilt or innocence, which is viewed, in the eyes of the Medical Board, as about as damning as a guilty plea).  I finished my application and paid the fee, but not without calculating how much power the federal prosecutor has to ruin everything I have worked for in my chosen profession.   
      Having made it through medical school and residency training, having practiced without triggering malpractice lawsuits for twenty-one years,** having studied for and passed the Family Practice Board Certification exam (required every seven years) in November for the fourth time, having earned 138.25 hours of continuing education credits in 2013 (similarly for all preceding years), having jumped through all the hoops to maintain a clean medical license, DEA privileges and Board certification, having attended workshops and conferences to keep abreast of medical advances, having devoted at least 30 minutes a day to reading current medical journals, I could lose it all with one swoop of his sharpened statutory scythe, if the prosecutor should decide, out of boredom, or irritation with me and my blog, or a necessity, begotten by pressure from his superiors, to make something happen in a case that has been in limbo for forty-three months.
     There you have it, the power of the government--the power of one prosecutor--to destroy a person's world, a profession built up over decades--and to wave a victory baton afterwards, followed by hurrah's from a propagandized public--glad that greedy doctors and other villains have been brought down--and maybe even to get promoted to newer and more purposeful positions of power.

*Here's an example of one of the codes:  
     456.0635 Health care fraud; disqualification for license, certificate, or registration.
(1) Health care fraud in the practice of a health care profession is prohibited.
(2) Each board within the jurisdiction of the department, or the department if there is no board, shall refuse to admit a candidate to any examination and refuse to issue a license, certificate, or registration to any applicant if the candidate or applicant or any principal, officer, agent, managing employee, or affiliated person of the applicant:
(a) Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under chapter 409, chapter 817, or chapter 893, or a similar felony offense committed in another state or jurisdiction, unless the candidate or applicant has successfully completed a drug court program for that felony and provides proof that the plea has been withdrawn or the charges have been dismissed. Any such conviction or plea shall exclude the applicant or candidate from licensure, examination, certification, or registration unless the sentence and any subsequent period of probation for such conviction or plea ended:
1. For felonies of the first or second degree, more than 15 years before the date of application.
2. For felonies of the third degree, more than 10 years before the date of application, except for felonies of the third degree under s. 893.13(6)(a).
3. For felonies of the third degree under s. 893.13(6)(a), more than 5 years before the date of application;

(b) Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the sentence and any subsequent period of probation for such conviction or plea ended more than 15 years before the date of the application;

(c) Has been terminated for cause from the Florida Medicaid program pursuant to s. 409.913, unless the candidate or applicant has been in good standing with the Florida Medicaid program for the most recent 5 years;

(d) Has been terminated for cause, pursuant to the appeals procedures established by the state, from any other state Medicaid program, unless the candidate or applicant has been in good standing with a state Medicaid program for the most recent 5 years and the termination occurred at least 20 years before the date of the application; or

(e) Is currently listed on the United States Department of Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities.

This subsection does not apply to candidates or applicants for initial licensure or certification who were enrolled in an educational or training program on or before July 1, 2009, which was recognized by a board or, if there is no board, recognized by the department, and who applied for licensure after July 1, 2012.
(3) The department shall refuse to renew a license, certificate, or registration of any applicant if the applicant or any principal, officer, agent, managing employee, or affiliated person of the applicant:
(a) Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under chapter 409, chapter 817, or chapter 893, or a similar felony offense committed in another state or jurisdiction, unless the applicant is currently enrolled in a drug court program that allows the withdrawal of the plea for that felony upon successful completion of that program. Any such conviction or plea excludes the applicant from licensure renewal unless the sentence and any subsequent period of probation for such conviction or plea ended:
1. For felonies of the first or second degree, more than 15 years before the date of application.
2. For felonies of the third degree, more than 10 years before the date of application, except for felonies of the third degree under s. 893.13(6)(a).

**The average family doctor is sued every seven years.

Monday, January 20, 2014

Is Exercise Really So Great?

     Now that the holidays are over, if you're one of those resolution-makers who's vowed to start exercising again, don't be surprised if you get sick.
     Gym memberships are at their peak in January, paralleling a rise in respiratory illnesses.  Despite new insurance deductibles, which ought to be a deterrent to doctor visits, January remains one of the sickest months of the year.  No one has ever properly correlated illness with freezing temperatures, so Grandma's admonishment, "Bundle up, or you'll catch your death of cold," isn't validated by research.  December's visiting relatives and the viruses they distribute account for a percentage of sore throats, bronchitis and colds in January, but not all.  I wonder if vigorous exercise could be a cause of illness, rather than the preventive it's touted to be.
     When you exert yourself at the gym, especially doing muscle work, your body perceives it as injury and gets to work repairing torn muscle filaments.  The reparative process recruits an army of satellite cells, the oldest known stem cells, with large nuclei and very few intracellular organelles, located adjacent to muscle cells, capable of differentiating into and fusing with muscle cells.  Satellite cells receive marching orders via chemicals secreted by your body in response to exercise.
     Exercise triggers release of many inflammatory substances--cytokines and growth factors--as well as an increase in the sub-contents of muscle cells, like mRNA, ribosomes, Golgi apparatus and mitochondria.  In short, when muscles are damaged, inflammation results.  Inflammatory chemicals rush to the site of injury, as they ought to, but they get there via blood and lymphatics, which are your body's public transport systems making local stops along the way to drop off their chemical passengers everywhere, including nasal and bronchial membranes, the gastrointestinal tract, and the meninges, which enfold the brain and spinal cord like Saran wrap.
     Sometimes exercise hurts in places you didn't stress at all, causing headaches, distant joint pain, neck stiffness, gouty arthritis, and stomach upset.  Overexertion has been linked to more frequent respiratory illnesses, perhaps because it stimulates the body to manufacture and deposit inflammatory chemicals all over, especially in highly sensitive membranes like the respiratory and gastrointestinal tracts, increasing susceptibility to ubiquitous viruses.
     Inflammation is the scapegoat in medicine these days for cancer, coronary disease, aging, dementia, and almost any problem you can name.  The cytokines and growth factors which were designed to repair tissues sometimes do their job too well, creating nodes of panic in anatomical locations that become the setting for worse problems.  Inflammatory cells that help pave over damage to the endothelial lining of coronary arteries can leave scars on top of which cholesterol and protein debris get fixated, strangling the flow of blood and causing heart attacks.  A similar process may take place in joints, tendons and organs, triggering arthritis, tendonitis and organ inflammation.  Inflammation in one body part may ignite inflammation in other parts.
     Arthritis patients often say, "The pain started in my knee, but it traveled to my back and neck."  The idea of arthritis "traveling' used to seem unscientific to me, so I'd nod quizzically when I heard this.  But so many patients described their pains in the same way that I began to understand:  inflammatory cells from one body part can travel to distant sites and ignite inflammation in other parts.
     Here's the sequence.  1) vigorous exercise causes muscle fiber damage;  2) cytokines and other inflammatory factors are produced in response to this damage;  3) these inflammatory factors hitch a ride via blood or lymphatic circulation to the rest of the body;  4) susceptible body structures, like the joints, coronary arteries, lungs, or oropharynx receive messages from these inflammatory factors and go on red alert, producing more chemicals of alarm, more cytokines;  5) the body parts affected by distant inflammation may have something to do with a person's genetic make-up or previous medical conditions--if you're prone to neck pain, headaches, asthma or a bum knee, those areas will be the first to pick up inflammatory signals and start hurting.
     Like all doctors, I had many patients from a previous generation that never exercised.  Many people in their seventies and eighties grew up with the idea that the only ones who used their muscles were manual laborers, therefore they weren't going to join that group.  In many countries today, the leisure class really is at leisure, leaving exercise to those lower-class workers who have to make a living with their muscles.   Among the many older folks who never exercised, I saw few people who truly suffered ill-health, as long as they lived lives of moderation and weren't completely sedentary.  If we were to interview the centenarians of this country, I doubt if many of them would be found to have exercised in a formal way--lifting weights, running marathons--for any part of their lives.  There is even some evidence that regular bouts of vigorous exercise taxes the heart, making cardiac rhythm problems more likely.
     It's an unpopular idea in medicine nowadays, but my recommendation is that people get whatever physical exercise is needed to support their lives, and no more:  carry groceries, mow the lawn, wash the car, pull weeds, take walks, hang out clothes, plant flowers, clean the gutters, sweep the driveway-- and forget about joining a gym, training for triathlons, biking across America, and impressing people with your biceps.  

Saturday, January 18, 2014

Lessons from Dounton Abbey

     TV shows with stories about other people's problems and heroic resolutions offer a voyeuristic escape from the inexorableness of our own lives, even if the settings and costumes of those other lives are no more familiar than a Tolkien fantasy.  The main thing is, the characters suffer, and the acting is so good that their suffering feels familiar and can make us cry.  At least, I cried.
      Last weekend I watched all the episodes of Dounton Abbey back-to-back in two and a half days--that's 28 shows, 1,602 minutes.  I stayed up way past midnight, engrossed, like120 million other viewers, by this fanciful rendering of one British upper-class family's set of personal lives in the early 1900's, and their shadowy underbelly, the butlers, maids and kitchen laborers whose fussy industriousness and unquestioning devotion stabilize the pillars of this extravagant world.  It's hard not to tally up the hundreds, maybe thousands, of working-class people who buck up the highborn Granthem family's superiority complex, from the farmers who grow and deliver those daily wheelbarrowsful of fresh flowers--to freshen up countless parlors and ladies' dressing tables--to the crew who iron the morning newspapers, whip up fish souffles and fruit-filled meringues for lunch, and help the lords and ladies don their underclothes..  The show parallels "Upstairs, Downstairs," and garners most of its appeal from the mirroring that takes place between the two echelons of characters:  the ego-based ones upstairs, who are visible, beautiful, poetically in their suffering, and attentive to their images, and the frenetic ones below, who work, make messes, smoke, steal, moon, plot, and scheme in a windowless maze of scullery, wine cellar, hiding places, corridors and dark record-keeping rooms that are as mysterious and convoluted as a dreamscape.
     At the outset I knew which character I couldn't stand:  Cousin Isabelle, also known as Mrs. Crawley.  There is probably a character or two who grates on every viewer's nerves.  But this isn't a good-guy, bad-guy story, with a clear set of villains..  Except for two overtly mean-spirited figures, Tom and O'Brien, who prowl around downstairs with devilish deliberation, and who plot against newcomers (accruing a smidgeon of self-awareness, along the way) the show is cast with characters you might love or hate, depending on your complexes-- and this is where there are lessons to be learned.
     What are your complexes?  How much do you want to know about the estimated eighty percent of your personality that's wriggling behind the image you see in the mirror every morning?  Who is it back there who's responsible for botching things up, getting confused, drunk, or angry, falling in love, choreographing accidents, forgetting appointments, losing keys, overeating, slipping into reveries about how different life could be, and hating certain people?  However you censor or rationalize your thoughts and behavior, they're always pointing to that eighty percent you'd rather not acknowledge.  But cutting yourself off from it is like disavowing eighty percent of a sizable inheritance.  Why live on less than you have to?
      Some of the ways to get access to the parts of you you don't know are:  1) analyze your dreams;  2) pay attention to your slips of the tongue, forgetfulness and jokes;  3) watch how your world unfolds around you, especially when it's not going well;  4) listen to your criticisms of others, especially the ones you don't really know;  5) study the person you married;  6) identify the people you can't stand.
     Let's do a little exercise with that last one:  Who do you really dislike--in politics or Hollywood, at work, in your personal life, on TV, at the auto mechanic shop or grocery store, anywhere?  Describe the person, listing the things you don't like, including the ones you presuppose.  The people you dislike are the ones who have the most to teach you.  In Jungian parlance, they're your shadow.
     Mrs. Isabelle Crawley is a do-gooder whose excessive concern for others, especially the downtrodden, masks both her self-scorn and an unacknowledged wish to be loved and looked after.  The care she showers on others is what she might wish for herself, but because it's a wish that remains unconscious she sees neediness only in those around her, not in herself.  The sick, the wounded, the dying, and the castaways of society are the people who most resonate for her, because they personify her inner woundedness.
     I would describe Mrs. Crawley as stiff, moralistic, oppressive, and out of touch with her body and the deepest longings of her heart.  She is especially cut off from herself when a doctor-friend makes an oblique avowal of love, because she can't possibly see herself as lovable.  She's a workhorse, constantly  ministering to the debilitated, the lame, and the fallen--those who, in allowing her to care for them, give her access to tiny bits of herself.  But she doesn't have the self-awareness to open these bits up, or to be cared for, too.  She is too rigid to seek affection or pleasure, and if they tap at her windowpane she rushes out the front door to perform more good deeds, dodging self-recrimination.  She never laughs, or revels in the world.  She's the ultimate Puritan:  denying herself, giving to others, rigid, righteous, virtuous, chaste and no fun.
     There is something about Mrs. Crawley that reminds me of myself, but not a self I'd own.  That's why I need to pay attention to her.  If I can see her flaws as a finger pointing to my shadow--a do-gooder hiding behind virtuosity as a way of avoiding a secret wish for more of the world, for love, laughter, revelry, gaiety, and saturnalia--I might be able to dismantle some of the scruples that limit my experience of life and cause unhappiness.  As long as Mrs. Crawley remains other, I'll never get to know that other me, the one Mrs. Crawley makes look so bad, the one she represents.  But is she so bad?  I was shocked to overhear another Dounton fan say how much she admired Mrs. Crawley:  clearly the do-gooder character wasn't her shadow.  Instead, this fan hated Lord Grantham--which reveals something else altogether.  Accepting that Mrs. Crawley's mirrors my own rigidity would allow me to see how such a stance limits my life (whereas the same trait might be desirable for another person, especially someone without self-discipline), from which I might then allow for a different attitude going forward.  Mrs. Crawley could have accepted the doctor's marriage proposal, and had a very different life, if she had wished to change.  Without change, there is stasis and death.
     The first step in getting to know one's unconscious self is to look at the shadow, which is right behind us all the time, and mirrored by the people who irk us, or whom we abhor.  Television shows like Dounton Abbey can bring one's shadow into relief by giving voice to characters who personify our rejected self, the shadow.  If you enumerate the qualities you don't like about a character in any show, you can then assume that those qualities belong to you, and are waiting for you to acknowledge and integrate them, because doing so will open up your life a little.

Friday, January 17, 2014

Stuffed Cabbage

     This is a Pennsylvania Dutch staple, also known as "pigs in a blanket," but without ground meat.  Many filling substitutions and additions work well.  December, January and February are the best months to buy cabbage in Florida.  Use canned tomato sauce if you're pressed for time.  Good as leftovers, for lunch.

     2 cabbages, cored, with whole leaves separated

     Plunge cabbage leaves into a pot of boiling water and cook 1-3 minute, until flexible enough to fold.  Remove gently to collander and allow to cool.

     4 cups rice, cooked
     2/3 c olive oil
     2 large onions, diced
     8 stalks celery, diced
     8 carrots, peeled and diced
     6 cloves garlic, minced
     1 cup chopped pecans
     1/2 cup nutritional yeast
     2 Tbsp dried basil
     1 Tbsp dried sage
     2 tsp pepper
     2 tsp salt
     4 Tbsp soy sauce or Liquid Aminos

     To cook rice, rinse three times, then cover with 6 1/2 cups water. add 1 tsp salt, bring to boil, cover, and cook over very low heat for 45 min.
     Heat olive oil in large skillet and saute onions, celery, carrots, and garlic until soft.  Add nutritional yeast basil, sage, pepper, and salt, mixing thoroughly.  Sprinkle in pecans and add rice and soy sauce, stirring to mix.

Tomato Sauce:
     1/4 cup olive oil
     1 large onion, minced
     2 cloves garlic, minced
     10 tomatoes, diced, or 2 large cans stewed or diced tomatoes
     1 Tbsp dried oregano
     2 Tbsp dried basil
     2 can tomato paste
`    1 Tbsp salt

     Saute onion and garlic in olive oil until translucent.  Add tomatoes, spices and tomato paste.  Cook over low heat for 30 min or more, until flavors meld.

     To compose:  Gently fill each cabbage leaf with spoonfuls of filling, roll into cylinders, and place in oiled casserole or baking dish with the folded side down.  Line the stuffed cabbage roles side by side and cover with tomato sauce.  This makes two casseroles full of stuffed cabbage.  Cover with lid or tin foil and bake in 350 degree oven for 45 minutes.  Serve with fruit salad, carrot-raisin salad, or Waldorf salad, to add crunch and sweetness to the meal. 



Thursday, January 16, 2014

Million-Dollar Lawyer No. 3

     With shiny shoes, shiny blue tie, and head held high, Million-Dollar Lawyer No. 3 charged down the heart-pine hallway like a steed on a runway and caught my hand in his big, bold grasp just as I turned to see what was the commotion was.
     "What an incredible office," I commented, pointing out some fancy woodwork.  But he was way ahead of me.
     "Come on down and meet my associates," he bellowed.
     One more lawyer's conference room, one more handcrafted table as big as a mortuary's workbench. In fact, I was told, the swivel chairs were left over from a murder trial.
     "We've done some homework on your case," the first associate said.
     "A massive case," the steed-lawyer interjected.
     "It's going to be a lot of work," the junior chimed in.
     "How can it be massive?" I asked.  "I'm a single doctor."
     (What would they call a case involving a multi-hospital corporation?  Super-massive?)
     "Oh, there's a lot of paper in your case.  At least 2,000 lawyer-hours."
     "Hasn't anyone done discovery in this case yet?" Junior asked.
     "Who are your lawyers, that they can be sitting on your case this long?" added the steed.
     "Haven't they done anything?"
     "Stop!" I said.  "Stop with the prior-lawyer bashing. That's what blue-collar workers do, not professionals."
     "How long has it been?" Junior sneered.  "Three years?"
     "All we're saying," the steed went on, using a softer tone, which must have cost him effort, "is that someone should have been doing something in this case before now."
     He rested his eyes on me, full of sympathy, to let me know that if that someone had been him, the case would be all wrapped up by now.
     "Right," I answered.  "And what is it you plan to do?"
     "We'll get documents."
     "We'll make calls."
     "We'll move this thing along."
     All three spoke at once.
     "It won't be cheap," said the steed, rolling his shoulders forward.
     (Isn't rolling-shoulders on the list of warning signs in How to Spot a Liar?)
     ("A lie has no power whatsoever by its mere utterance;  its power emerges when someone else agrees to believe the lie"--Pamela Meyer.)
     "I didn't think it was going to be cheap," I said.
     "It's going to cost you a million dollars," he clarified.
     "We've got to review every single one of those charts," the associate said.
     "Eleven thousand records?" I asked.
     "Lots of man-hours," the steed said. "I mean, lawyer-hours."
     "And the only guarantee," I ventured, "is that I pay you a million dollars."
     "We can't guarantee success, if that's what you mean," the associate said.
     "But I'm a truly brilliant trial lawyer," said the steed.
     "Isn't that what other people are supposed to say about you?"
     "But it's true!" he answered.
     "Yes, it's true!" said his associates.  "He is brilliant!"
     I looked out the window.
     It was a nice, cool day, and I wanted some air.
     "Thanks a lot for your time," I said, standing up.
     The head honcho lawyer opened his arms to me, for a hug.
     For everyone's information, I don't do hugs for million-dollar lawyers.

Monday, January 13, 2014

Cure for Autism?

     Deep Brain Stimulation (DBS) has been an FDA-approved treatment for Parkinson's disease for twelve years, and for essential tremor for sixteen.  In both conditions electrodes are implanted into the motor cortex of the brain, resulting in improvement in motor function.
     A non-FDA-approved use of DBS is for severe depression (DBS-Psychcentral).  A few intriguing pilot studies have shown that some people--six out of seven according to one report--have been cured of intractable depression with this treatment.
     DBS, known in neurosurgery circles as "stereotaxic surgery" involves "placement of unilateral or bilateral electrodes in target brain regions connected to a permanently implanted neurostimulator which electrically stimulates that brain region" (DBS--German study).  No one knows how it works.  The electrodes are not unlike pacemaker wires:  instead of being lodged in heart muscle they're implanted in the brain and connected to a rechargeable battery that rests above the clavicle.
     In Parkinson's disease the electrodes are placed in the basal ganglia, a region known to release dopamine, a neurotransmitter deficient in this condition.  More than 30,000 patients have been safely treated with DBS.
     Between 2003 and 2005, five studies reported that DBS resulted in improvements in Tourettes syndrome.   In 2005 one patient was cured of depression when DBS was applied to an anatomical region of the brain called Brodman area 25, a place that is metabolically overactive in people who are extremely sad.  The authors of the German study cited above believe that using DBS on a brain region called the nucleus accumbens will relieve depression because it acts as a gateway for information going to and from the emotional centers of the brain.
     Like stem-cell research, the possibilities for GBS seem as boundless as the places in the brain it might succeed in manipulating:  appetite centers for obesity, new motor regions for people with partial strokes, speech centers in autism, areas for memory, sleep, vision, anxiety, impotence, cardiac rhythm, smoking, drug addiction, music appreciation, you  name it.
     Because DBS has been used with success in obsessive-compulsive disorder, and because autism is an obsessive-compulsive syndrome with a wide range of expression, a few years ago I began to wonder whether it might be effective for autism--especially for my son, Carmine, whose autism is so severe that he cannot initiate any activity, except breathing, without nonstop verbal or tactile prompts from caregivers.  Over the past few years a team of behaviorists and I have made modest progress in reducing Carmine's prompt-dependency, using upgraded, nonviolent Pavlovian techniques, but he continues to live a life so completely dependent on us that without someone alongside him every minute of the day he would remain in one position, immobile, all day.  He can't respond to the internal prompts we take for granted, the physical stimuli that impel us to move our limbs, eat, drink, use the bathroom, or shift position.  He can't voice preferences--he can't speak at all.  Assistive communication devices and iPad apps have been, mostly, a waste of effort.
     I did an internet search and found a case study in Frontiers in Human Neuroscience from January 2013 describing a favorable response to DBA in a 13-year-old autistic boy (DBA for autism ScienceNews) (DBA autism Frontiers in Neuroscience).  This may be the first time DBA has been used in autism, and it was justified by the boy's extreme self-injurious behavior.  Electrodes were placed in areas comprising the amygdala, a region of the brain that regulates emotion.  Not only were the boy's behaviors reduced but his parents reported that after DBS surgery he used two words for the first time, began to try new foods, and continued to improve for months.
     Autism affects one in every110 children (one in 80 boys), and most parents of severely autistic individuals, desperate for help, have tried dozens--if not hundreds--of treatments.  While we parents don't think in terms of cures once our children are adults, even small improvements in communication and social functioning can make dramatic differences in an autistic person's quality of life.  DBS is a minimally invasive surgical procedure and is completely reversible, so it's likely to be safe, as the DBS-treated Parkinson's population has proven.  If there is any current treatment that shows promise for curing some of the symptoms that make autism so difficult to bear, it's probably DBS.  I will continue to follow news about this innovative possibility, and may even look for a research center where Carmine might evaluated as a candidate for DBS.             

Sunday, January 12, 2014

Mark Your Calendar: My Trial Dates

     The government has set a date for a trial in my case.
     A trial, without an explanation for the SWAT raid on my clinic?  A trial, without enumeration of charges that have any connection to reality?  A trial, without a crime?
     The court has announced that each side may conduct "no more than thirty depositions" which may take "no more than seven hours each."  My lawyer says we have to move quickly, because there is a lot to do before then.
     I keep asking, "What have I done?"  but there are no answers.  I am straining to hear, but like one afflicted with deafness, who has not yet accepted the affliction, I can't hear a thing.
     Are there answers?  Or is it n more than noise, the clang of plastic and metal at a garbage dump.  It's our government doing this, and I'm supposed to be respectful, the way the lawyers are.  They talk to one another about my case, across an arid expanse of injustice, like real professionals, with interrogatories and depositions, motions and hearings, services of process, amended hearings, continuances and other couture of judicial "proceedings," the dressing-up that adds verisimilitude to a scarecrow.
     A nurse who worked in my clinic, a seasoned man with experience that included years in emergency room trauma centers and prisons, who claimed to have "seen it all," once told me the story of the worst accident victim he had ever treated.  It involved a steamroller.
     Those of us who work in the medical field talk intensely with one another, when we have time, as a way of unburdening the suffering we carry in our chests.  This particular conversation took place seven or eight years ago, during a rare pause in our clinic schedule, because we stood in the break room drinking coffee and picking at a box of cookies, waiting for the next rush of patients, and telling stories.
     We must have been feeling that constriction in the chest that comes from holding too much grief inside, grief that can be unstopped, a little, by opening the valve of real human interaction, because we were relating the most heartrending medical cases in our careers.
     The nurse's story was of a deaf man who had been standing directly in the path of a steamroller.  The driver of the steamroller was "on a roll," saw the man, and honked his horn with great energy.  But the man's back was to him, and he didn't move.
     "The guy must have been mentally impaired," he said, "because the steamroller operator said he honked and yelled the whole way, and couldn't stop.
     Not hearing what was coming toward him, the man didn't know to move.  Not able to translate the rumbling in the ground as potential danger, he stayed where he was, looking the way people do in a trance.
     Steamrollers are tremendous, bulky machines that can't be made to change direction at the last minute, so the poor man was killed.
     "He was flattened like a pancake," the nurse said, shaking his head, "and that's how they brought him into the emergency room." 
     "How can such a thing be possible?" I asked.  I was wondering how a grown man's physique, filled with pulsating organs and warm blood, and with a spongy brain sparking neurons like fireworks, and with bones like the branches of a sycamore tree, could be flattened.
     "You know those cartoons where a guy is run over and looks two-dimensional?" the nurse asked..
     "Yes," I said.  "Like on 'Road Runner,' where an innocent bystander comes along afterward, and holds him up like a sheet of cardboard."
     "That's what it was like," the nurse said.  "There was nothing we could do."
     The nurse had never been able to put the horror of the memory out of his mind, and now it's stuck in mine.  I have felt very sorry for that man, whom neither of us ever knew. 
       Like a steamroller, the government has started moving toward me, it's accelerating, and it cannot stop.  I should move, but I don't know what direction it's coming from;  the clamor seems to come from all directions.  There may be innumerable steamrollers--the government has great stores of heavy equipment--headed in my direction.
     The date of my running-over, the dates for my "trial," that is, though no criminal charges have been made, let alone proven--is September, 8, 2015 to September 23, 2015..   Put it on your calendar, if you care want to watch.