False Reports

     Today I had to call the Department of Children and Families to file a report on a child-patient who seemed in imminent danger.
     Before being connected with the Child Abuse Hotline representative, I listened to a series of automated messages.  Here's one:

         Any person who knowingly and willingly makes a false
         report will be convicted of a third-degree felony, and may
         be subjected to imprisonment and fines up to $10,000.

     Why aren't there fines or penalties imposed on individuals who "knowingly and willingly" make false statements about doctors, or involve law enforcement in investigations based on misleading information?
     Right now, there are only benefits for people who make frivolous allegations against doctors (and other businesses)--benefits such as whistleblower bonuses, rather than false reporting fines.  This serves as an incentive for individuals hoping to make a cheap dime (there's nothing material to lose) by putting doctors in the line of fire.
    The government penalizes people for calling in false reports about child abuse (even though there are no incentives for legitimate reports), but it gives incentives to people for filing reports (it takes a single phone call) against businesses and doctors--many of whom feel demoralized and end up plea-bargaining, guilty or not, after which a portion of the settlement money goes to whistleblowers--and there's never a court case to determine whether the report had ever been justified in the first place.
     Never mind that such allegations, followed by gestapo-type hold-ups after which government agents are not required to show cause, ruin people, destroy businesses, and erode the very backbone of this country, which owes most of whatever solvency it can claim to the integrity and entrepreneurial success of small businesses, like mine.


    

Brokenheartedness

     Sometimes it's more painful to leave someone than for them to leave you.  Most of us have experienced both, and know what I mean.
     That's how I feel about leaving medicine.  I'm forcing the change, so I'm the one responsible for the knotty feelings.  It takes twice the resolve.
     I know it's the right thing to do, but I'll miss a lot of little things about the relationship.  Like the routine--which is comfortingly the same every day--of zigzagging from one exam room to another, and the quirkiness of the staff, how one nurse spaces out for fifteen seconds when I ask for a referral form or prescription pad, or another says, "Yes, Ma'am" without fail,  and how no one will say hello or good-bye to me, per my request, so that my brainwork about patients can mature into diagnoses in the quiet vestibules of my mind.
     It feels like love, the way everything works--patients, staff, the system.
     There's the flag, light and bell mechanism I designed--a seamless method for summoning an assistant into a room without hullaballoo.  There are the exam rooms themselves, like exquisite kitchens, everything within reach, with excellent lighting, finely calibrated tools, spotless surfaces.  I spend so much time in these rooms that they have become a second home.  They reflect my personality, which is practical:  bulletin boards with medical news in everyday language, polished floors, natural light from lots of windows, comfortable armchairs, and bright-hued paintings by local artists.
     And, of course, there are my patients, a concatenation of personalities and bodies--people carrying terrific loads from the past, and tendering tiny questions that hold back rivers of suggestion, like dams.  It's my job to control the flow without affecting the truth, whenever it emerges--which is often at inopportune times, like when I stand up, holding the patient's chart, and start to say good-bye.
     "One more thing..." the patient interrupts, or "Before you go..." or "Could I just ask you...?" with that ellipsis, a few pregnant dots of time during which the patient gauges my true feeling about him or her from my instantaneous reaction to this last-minute entreaty.
     I know there are doctors who say, "Sorry!  Time's up!  Make another appointment!"  At least, that's what I'm told.  But when I am stopped with my hand on the doorknob, I realize the patient is about to give information that will fill in the blanks in my assessment, like clues for completing a tough crossword puzzle.
     I will now confess that sometimes there is a preamble of lightweight banter with patients that threatens to take up the entire appointment and, hedging my bets, I stand up and make a pretense of leaving as a way to coax out concerns that are coalescing like anxious little bubbles near the surface of our interaction.  Pretending to exit may catalyze the pot like salt, churning it to a boil, both of us ready for realspeak.  But just as often the patient sinks back into a weighty silence--distant, rejected, hurt, overtaken by doubt, as involuted as a black hole.
    "What's bothering you?  What?  What?"--I want to say, but this approach doesn't work.  Therefore, I re-assume my post on the blue vinyl doctor-stool and look at the floor, waiting for something as uncertain as a wild animal to come out of hiding.  I hold the space.
     I'll miss that space, in which many things can happen as the patient and I sit alone together in one of those clean exam rooms.  It's like a blank canvas, or a spiritual retreat, or an afternoon in the woods.  It's the experience of being human--the wish to relate, and a certain cautiousness about relating.  It's not easy to pull back the curtain of vulnerability.  I will miss the gift of being trusted.
     In these last weeks of my practice I'd like not to be sentimental.  But it's difficult, when you know something is dying, not to be noticing all the details, archiving them.
     Once, when I was twenty, a boyfriend and I decided to break up.  Really, it was my decision, and I had stowed all my things in a Jartran truck to haul clear across the country in the snow next morning.  That final night I registered every minute--the sounds of our breath, the chill air on my elbow when it poked out of the covers, the glow-spot of a streetlight on the slatted closet door, my cat purring, the garbage trucks clamoring into town before dawn, and the thumping in my chest.
     My brokenheartedness about leaving medicine is not a sign that something is wrong.  Like other pains, it's "the breaking of the shell that encloses your understanding."  These lines from Gibran's poem--which has hung on my clinic wall these twenty years--now come to mind:

     Even as the stone of the fruit must break, that its
     heart may stand in the sun, so must you know pain...

     It is the bitter potion by which the
     physician within you heals your sick self

    Therefore trust the physician and drink
    his remedy in silence and tranquility...
      

A Class Action Lawsuit against the Government?

     Today John Stacks, owner of Mountain Pure Water in Arkansas, gave me a call.
     His company produced the youtube video, "Rampant INjustice," a reenactment and discussion of  federal raids on two companies, Mountain Pure Water and Gibson Guitar (log onto:  http://www.youtube.com/watch?v=bFALonjLay0).
     Mr. Stacks is working with attorney Tim Dudley (Appellate Supreme Court...), to organize a class action lawsuit against the federal government.  Since posting the "Rampant INjustice" video he has received dozens of calls from other business owners who believe their constitutional rights were violated by federal agents during raids.  He asked me to join the class action lawsuit.  Our goal would be to force the government to be accountable for its raids, forfeitures, and mistreatment of individuals in this country.
     "Ninety percent of federal agents are good, upright people," Stacks said.  "It's the other ten percent who are on a power trip."
     "The government has been invested with too much power," I said.  "Because of HIPAA and the Patriot Act,  many of our rights can be overridden by government agents desperate to prove their worth, take back money for the national debt, and meet hefty FBI agency payrolls."
     "We need to work together to protect our civil liberties," he said. "This is a way to do that."
     Congressman Tim Griffin of Arkansas is also behind our cause, and said he'll raise the problem of overzealous raids and forfeitures against Americans with other leaders in Congress.  Ruining local businesses affects our representatives' constituencies.
     Yesterday I spoke with Ted Yoho, who is a large animal veterinarian and has been working in Central Florida for over 30 years.  He replaces Cliff Stearns (incumbent for 24 years), having just been elected by Floridians to the U.S. House of Representatives, and will begin his first term in January. 
    He watched the youtube video listed above and told me he couldn't believe the government is using these large-scale paramilitary tactics against individuals and small businesses--people who don't pose an imminent threat to agents, and who would likely respond to a subpoena without delay.
    "Their methods are wrong," Yoho said. 
     One piece of information from the web gives me pause:  Ted Yoho may have instigated the federal government to investigate Planned Parenthood, as a way of promoting his extreme Christian values and appealing to right-wingers who don't mind mixing church and state, as a way of boosting his campaign base.  If Ted can use the feds to damage a legitimate nonprofit, is he likely to be an advocate for me against the federal government?
    I hope we can persuade Ted Yoho and Tim Griffin to join forces in Congress, and challenge existing legislation that gives government officials authority to attack and harm innocent citizens and businesses with impunity. Such methods were intended for terrorist attacks and the extremities of wartime.  All I want is transparency:  the government should tell me why it raided my clinic, what charges it thinks it has, and when my patients' charts and office funds will be returned.  And it shouldn't take ten years to do it.c
     It's been 18 months since the government's raid, on my clinic, and 30 months since federal prosecutors began an "investigation" on me.  It's 16 months since the clinic and my personal bank accounts were forfeited.  Not enough time, apparently--because not a peep has been heard from the government about why, wherefore, what...? 
     Why was I raided?  What's going on?  Who's in charge hear?  What statutes support their action?  What about my rights?
     My lawyer, Gilbert Schaffnit, sent me an update.  Here's what he emailed--("Corey" is the government prosecutor in charge of my case):
     "No news from Corey [Smith]--which I believe is a good thing, as they usually try to make their 'numbers' by the end of the year."
     Oh, yes--I almost forgot. The government registers me as a "number," not a person, not a taxpayer, not a business owner who has been stimulating the economy.
     If you believe congressional representatives should be aware of the facts surrounding the raid on my clinic, as well as other rampant violations of citizens' rights, please call:

      Ted Yoho, elected Congressman for the 3rd District, Florida, (352) 665-8223

You are one of his constituents, and can tell him to investigate this matter.  The U.S. government needs to justify its actions against individuals like me, and businesses like mine, and Gibson Guitar, Midamor meatpacking, Mountain Pure Water, and many others.
     If you do call, I thank you heartily for exercising your rights!
     If you decide to do nothing, and sleep through the transformation of our government into a dictatorial force, remember:  you could be next.
    
      

Is Apple Cider Vinegar Good for You?

     My brother started drinking apple cider vinegar every morning.  He'd heard it was a good tonic--good for everything, and natural--unlike the medicines his doctor prescribed.
     Two months ago he started taking two ounces mixed in water, gulped down quickly--followed by a handful of Tums to quell the burning.  He quit taking his prescription medicines at the same time.
     The members of my family don't hide the fact that they hate doctors.  At times, their vitriole has no limits, and it doesn't seem to matter that I'm a doctor.  They gripe to me that doctors don't know anything, order too many tests, don't explain things, "force" medicines on people, and want to make a quick buck off them.
     "But I'm a doctor," I remind them.
     "Well, if the shoe fits, put it on!" is the reply.
     Until they want my advice, which is several times a month.
     "Should I be drinking apple cider vinegar?" my brother asked me last week.
     "I thought you hated doctors!" I gibed.
     "Yeah, well, I do," he insisted.  "But this is different."
     "Why are you drinking it?"  I asked.
     "Well, I figured it was good for me," he said.  "So...is it?"
     "That depends on what you're trying to accomplish."
     "Whaddya mean?"
     "I mean, are you hoping it will make you live longer?"
     "That would be good," he said.
     "Or do you think it will give you energy?"
     "That would be good, too."
     "Or do you think it will lower your blood pressure?"
     "Well, will it?" he demanded.
     "Or, do you have head lice?"
     "No, nothing like that!"
     "Well, are you trying to bring your cholesterol down?"
     "Yeah, maybe," he admitted.  The guessing game was over.
     "So, you think that I, a detestable doctor, can tell you that?"
     "Just gimme a straight answer, will you?" he said.
     Of all the supplement questions patients ask, the one about apple cider vinegar is the most tenacious.  Other fads have their day and disappear:  noni juice, pomegranate pulp, kiwis, red yeast rice, panax ginseng, cinnamon, ginger, odorless garlic, the Atkins and paleo diets, protein powders, creatine, turmeric, spirulina, green tea, and one or another miracle cure for obesity, fatigue, or sexual function.
     Sometimes patients think I'll fall into the same propaganda trap they're in, and promote their pyramid-scheme product to me, hoping I'll help make them rich.
     "It really, really works!" they insist, without being able to give specifics.
     That's the effect of glowing testimonials--absent scientific backing--on the colorful pamphlets in the mail.
     "Go ahead and keep taking it," I say. "It's probably not doing harm."  Most of these panaceas have no active ingredients.
     If I raise the subject a few months later, their enthusiasm has fizzled out.  The products cost too much.
     Apple cider vinegar is good for cleaning your coffee pot, so it sort of makes sense that it might dissolve the calcified plaque in your arteries, too.  The problem is that you can't infuse your arteries with vinegar as though it were Drano--and when you drink it, it doesn't get past the duodenum without nullifying biochemical alterations.
     Whatever its flaws, the beauty of western medicine is that it uses the scientific method to separate truth from falsehood when it comes to miracle cures.  Without the scientific method, people rely on emotional cues to decide whether something is good for them or not.
     Given the slick, psychological marketing employed by industry today, it's a good thing we have the scientific method.  It may be big and bunglesome, like an elephant stamping out termites on a football field, but it's the best we have right now.
     There are no reliable scientific studies showing that apple cider vinegar lives up to any folk medicine claims.  It doesn't grow hair, or lower blood pressure, or lead to weight loss, or correct cholesterol, or kill lice.  It hasn't been proven to increase life expectancy, either--but it might give you a case of heartburn.
     Although the stomach's parietal cells secrete up to two quarts of hydrochloric acid a day, and the mucosa of the GI tract can resist the burn of this production, adding vinegar in one fell swoop throws the stomach out of kilter, and may cause acid indigestion.  Taking an antacid may counteract the pain, leading to belching and a sense of relief, but what kind of relief is it, when you caused the problem in the first place?
     Not counting water, the main ingredient in apple cider vinegar is acetic acid.  It also contains micronutrients, a carryover from the apples that were used to ferment the product in the first place.  These include potassium, sodium, amino acids, and traces of vitamins.  Certain blood pressure medicines like lisinopril can accentuate the effect of apple cider vinegar to cause dangerously high levels of potassium.
     Vinegar may "alkalinize" the system like citric acid, which is prescribed to prevent gout, kidney stones and gallstones.
     I prescribe citric acid pills (as Urocit-K) to patients who are prone to these conditions--but not without a litany of dietary instructions (no meat, mushrooms, alcohol, coffee, tea or processed foods; more fruits and vegetables), which are much more important than pills.  Real foods (like citrus) are a better source of citric acid than pills.
     Apple cider vinegar makes good salad dressing, combined with sour cream, herbs, salt, and oil, and in salads that include avocado, apples, pears or oranges.  Why take vinegar in any other way?
     Salads have long been served before a main course to enhance digestion.  Vinegar perks up the taste buds for more savory dishes, and may contribute to a sense of fullness by the meal's end.  The micronutrients in vinegar probably have health benefits that can't be measured by science--the human body has developed in parallel with its food sources over millions of years.  Fermented and vinegary products, when used the way our ancestors used them, must be good for us.
     "Why don't you skip the morning tonic," I suggested to my brother, "and make salad dressing or pickles with your vinegar?"
     "Would that be better for my health?"
     "Probably.  There's no science to support the idea of drinking it like medicine."
     "Great!" he said.  "I can quit drinking it.  I'm sick of taking that stuff every morning--it makes my coffee taste bad."
     "I'm glad the doctor could be of some help," I said.  

Other Federal Raids: I'm Not Alone

     I'm not the only person whose business has been raided by the government, without cause.
     The United States government has unprecedented power.
     Its agents use gestapo tactics, denying Article 1, Section 9 of the Constitution--the Writ of Habeas Corpus (no one can be detained!)--and ignoring the Miranda rights of employees during these raids.  In my own case, the government locked employees for up to seven hours in my clinic at gunpoint, and would not allow them to leave until they had submitted to "interviews." They barred the clinic doors, told patients to find another doctor, treated us like abominable criminals, and boxed up all the patient charts, personnel records, billing records, and copies of everything in our fifteen computers.  A few weeks later they took all the $400,000 of working capital from my bank accounts, without warning or an explanation.  They have ruined my reputation.
     There are no consequences for bad behavior on the part of the government.
     In the youtube video below, two other business describe the government's "emperor-like" actions.  Mountain Pure Water Supply and Gibson Guitar reenact the events of government raids at their businesses--eerily similar to the raid on my clinic, which took place on June 16, 2011.
     According to the youtube documentary, many other business-owners whose workplaces have been raided reported, privately, that something similar happened to them, but they declined videotaping for fear of government reprisals.
     What can we, as American citizens, do?
     Watch this video, if you want to know something about America.  It's also a link on my blog sidebar.  Send it to other people.  Share my blog.

http://youtu.be/bFALonjLay0



  

Do You Eat Your Children?

     In the beginning, Gaia, the beautiful Earth, fell in love with Uranus, the overarching Sky.  They had twelve children, the Titans, who were the first gods, the begetters of all things living.
     There were six Titan brothers, who married their six Titaness sisters.
     After that, Gaia had more children:  the three Cyclopes, as well as three more offspring born with fifty heads and a hundred arms.  Uranus thought they were ugly, and hated them, so he threw them under the earth into Tartarus, to get rid of them.
     Gaia couldn't stand to see her children banished, and begged the Titans to challenge their father, her husband.  It was Cronus, the youngest, who was strong and brave enough to seize the throne from Uranus.
     Cronus became the new lord and, like many in power, he feared that one day one of his sons would overthrow him, as he overthrew his father.  Therefore, every time his Titaness wife, Rhea, gave birth, he took the little god and swallowed it.  His offspring were inside him, then, and could not pose a threat to his sovereignty.
     Rhea resented losing her first five children in this way, and asked Gaia to help save her sixth, Zeus.  As soon as he was born, the women hid the infant on the faraway island of Crete, where his cries couldn't be heard.  They tricked Cronus by giving him a stone wrapped in baby clothes to swallow.
     Zeus grew strong, and accumulated allies so that he could conquer his child-devouring father, Cronus.  Zeus petitioned his wife, Metis, to give Cronus an herb that made him so sick he threw up the stone as well as all five pf the children in his belly.  Then, they all rose up against him along with Zeus, and usurped Cronus's power.  In this way, Zeus became the lord of the universe.
     The story may be an ancient Greek myth, but it has survived because of its allegorical truth.
     There are two kinds of parents:  the ones who eat their children, and the ones who don't.
     Over the years I have been impressed by patients whose children were terrifically devoted to them.  How does one raise children who love their parents so much, I wondered?  Here they were, children growing up in America, with all kinds of freedom and a world running over with potential adventures-- but they never left their home town.  Now full-fledged adults, they called their parents one, two, even ten times a day, and were available at a moment's notice to care for them.  Their own children became similarly devoted, it seemed, and the love and concern was passed down from one generation to the next, with nary an exception.
     My own sons, on the other hand, were anxious to leave the nest.  They snatched their drivers' licenses on their sixteenth birthdays as though that was the first ticket for passage into real life.  They suggested ways to get out of the house:  taking risks with their friends, visiting relatives far away, spending entire semesters of high school away from home. They seemed unconcerned for my well-being, as they ventured out into the world, and though I made it clear that I loved hearing from them and catching up on their news, this didn't inspire them to call more often, or rush home for holidays or special events, or worry about my health and happiness.  At least, they weren't concerned in the way I've observed some adult children taking an almost painful interest in their parents' everyday lives.
     It's not that my children don't care about me, for sure, but that I haven't "eaten" them.  I haven't lived in fear that one day they would leave me all alone, or surpass me in some threatening way, or vanquish me, or seize control of my authority.
     What authority?  I am a child of the sixties, an era that encouraged us to think of all people as flower children, including our own babies.  Leave them alone, and they'll grow into themselves, their true, creative selves, like the flowers of the field in Ecclesiastes--that was the prescriptive.  My philosophy, borrowed from my generation, was to stay out of the way of my children's personal unfolding.
     Of course, this isn't entirely possible.  Humans are imitative creatures--they look for role models to mime, and ideas to try on.  They play house, and school, and war, pretending to be their elders.  And they need parameters, when they're young.  But it was against the rules, in a way, for civil rights- and women's lib-era parents like me to tell our children who they were and what they ought to become, and it was even a little irritating if our children didn't rebel, become creative, or take the path, diverging in the yellow wood, not traveled by.
     This has turned out to be a difficult path, because the freedom this generation of similarly-raised children have been afforded is far-fllung and, paradoxically, burdensome.  There are too many options, and no firm, guiding principles bequeathed by tradition and religion, or imposed by the dire straits  of subsistence.   The children of flower children don't boomerang home every time they encounter problems, and they're out there all by themselves, scared, overwhelmed, unmoored.  Will they find courage, as Cronus did?  Will they be able to remake the universe, like Zeus?
     My style of child-rearing was the epitome of not-eating-your-children.
     Eating your children means taking them inside yourself, envisioning them as aspects of who you are--it's an unconscious process.  You don't know you're doing it.  You don't intend to clone them. You would deny getting in the way of their aggrandizement, if someone mentioned it.
     Eating your children means being shocked and unnerved when they tell you they're homosexual, or want to couch-surf for a few years, or aren't getting a job or going to college or doing what you think they should do.  It's feeling offended when they get themselves into trouble, take drugs, get pregnant, or start smoking.  "I taught them better than that," you think. "Where did I go wrong?"  It's using guilt or the vague symptomatology of illness in yourself, without even knowing it, to manage your children's behavior by getting inside their heads.  Eating your children is keeping such close tabs on them that nothing can go wrong.  They live inside you, they fail to sprout in directions that veer from the sturdy, strong stem of your being.  They replicate your life, which might, finally, be boring.
     There are definite advantages to eating your children.  They stay close to home, and are available when you're sick or need someone to fix the plumbing or tote you to the grocery store.  You can be proud of them, because when you look at them it's like seeing a handsomer version of yourself.  They fret over you, when you hurt, and they know where you're going and what you're doing every day.
     It might feel like love, to have people who are so concerned with your life--and maybe that is love.  Or maybe it's a subtle form of oppression, which even keeps you from being who you really are, you're so preoccupied with them.
     Whether you eat your children or not, it's important to know that you have a method, like it or not.  Are you Uranus, making your children part of you from Day One, swallowing them like so much nutrition, and preventing them from overthrowing you...or are you Rhea, fighting for your children's freedom, and yearning to discover what new thing might emerge from your unobtrusive tending of them, and from your own individuation?

Italian Red Pepper Salad

     I threw some charcoal and fiery matches on the grill, and when the flames died down placed eight whole red peppers neatly in rows atop the grates.  Four times I turned them, lowering the grill cover, until there were black streaks all around and the peppers were soft.  Then, placing them in a paper bag, I waited for the heat to dissipate.  The skins slid off like leotards, and the cores came loose, like shoes.  I sliced the peppers longways and set them jewel-like on a white platter.  This dish is a stunning celebration of color.

     8 whole red peppers, charred, cored, peeled and sliced*
     1/4 cup olive oil
     2 cans anchovies in oil
     8 large garlic cloves, minced
     finely minced parsley or basil
     lemon zest from one lemon
     (Kalamata or black oil-cured olives)
     (capers)

     Place the peppers in an attractive pattern on the serving dish.
     Divide the anchovies among the peppers.
     Heat the olive oil and minced garlic in a skillet over low heat until the garlic is soft and the oil aromatic.  Do not brown the garlic.  Pour the garlic and oil over the peppers.
     Sprinkle the lemon zest and parsley or garlic lightly over all.
     Garnish the platter with olives and capers, if desired.

     *If you use the heart-shaped cherry peppers for this recipe, you will have true pimientos.