Why I Quit

     I quit being a doctor because the government raided my clinic.  The effect on my local reputation was such that I couldn't hire physicians and mid-level providers to help me take care of patients in the medical facility I had established, in the way I had envisioned.
     Colasante Clinic was housed in a 4,000 square-foot space with a lease I kept down to $4,000 per month--but it was scheduled to increase.  I opened in February 2010 and furnished it with a wide range of medical equipment, fully intending to employ thirty to fifty employees working two or three shifts, so patients would have access to medical services at their primary care physician's office every day of the year, twenty-four hours a day.  I had sixteen years of clinic management experience when I opened this office.
     The clinic was overflowing with patients right from the start, so I hired three mid-levels and another physician to help me take proper care of them.  We expanded the hours of operation soon after opening, to fourteen hours a day, seven days a week.  I was looking for several more physicians, so that I'd have time to manage the business of the clinic, rather than seeing patients all day.  I needed to do teaching inservices for employees, establish protocols for handling patient and employee problems, review insurance contracts, keep abreast of medical research, and make additions to clinic services to give people in this new neighborhood exactly what they needed.  There were Spanish-speaking patients, for instance, so we needed translator services.  Many people had a history of abuse and trauma, and would have appreciated counseling on-site. 
     We were focused on preventive care, mostly, but had an urgent care component.  My thinking was that if we could get patients to come in for their urgent needs--stitches, fractures, infections, pain, headaches--we could persuade them to return for preventive care, or even have some of it done on the spot.  So, if a patient came in with bronchitis but was due for a Pap test, we'd suggest doing it on the spot.  If a teenager sprained his ankle, we would take the opportunity to address subjects like safe sex, drug use, alcohol, seat belts, peer pressure, gun safety, immunizations, and depression.  A 52-year-old patient with gastroenteritis would be treated for her symptoms, but might also get a referral for a mammogram and colonoscopy, as well as a chest x-ray for the nagging cough we heard, and smoking cessation counseling, and a flu shot.  An 80-year-old with trouble sleeping might be in need of outside help with meals and housecleaning, a bone density test, a cane, or treatment for depression.
     The mission of the clinic was to take care of the whole person, whatever that required.  Every employee was focused on preventing disease, or catching problems in their early stages so that patients wouldn't end up in an ambulance one day, surprised by pancreatitis, an infected gallbladder, or lung cancer.  And, in fact, we found lots of medical conditions that warranted treatment, thereby preventing catastrophes, or at least keeping patients from having heart attacks in the middle of the night, or having to spend ten times more for a medical problem that had been allowed to fester, because no one found it.
     This turned out to be a very popular model for a medical practice.  Patients appreciated what we did and how much we cared about them, and they referred their neighbors, friends and families.  We were very busy, late into the night.  If a woman wanted a gynecologic exam at 10 pm, that was fine with me.  If a college student was up at 2 am and had urinary symptoms, our clinic would have been the place to go.  Local residents began to figure this out, and expressed their gratitude by coming back.  They believed in preventive medicine, but hadn't known doctors who practiced it.  This kind of care takes time, persuasion, and sensitive counseling--but it pays off for society, in the long run, and costs less than emergency care at the last minute.
     I enjoyed teaching new physicians and mid-level providers how to read bone density and x-ray films, when to order ultrasounds and how to address the findings, how to do stress tests and echocardiograms, which patients would benefit from corticosteroid or Synvisc injections, how to apply splints and casts, when to do trigger point and carpal tunnel injections, how to read allergy skin tests and gram stains, and when to recommend the Hako-Med pain machine instead of prescribing narcotics.
     I liked thinking about what new services we might be able to provide under the same roof:  psychological counseling, acupuncture, nasopharyngoscopy, sleep studies, play therapy, group visits for diabetes and hypertension, massage treatments, Weight Watchers meetings, cooking lessons, herb and vitamin classes, jogging groups, and a colonoscopy suite were some of the services we were considering.
     Being raided by the government, whether there might be cause or not, casts a professional person's reputation into ignominy.  Even though most Americans doubt the government's actions (a recent poll has shown that 75% of Americans "don't trust the government'), that didn't mean doctors and nurse-practitioners wanted to join a clinic that was under investigation by federal agents.  After all, I could be indicted at any moment.  Then what would happen to the clinic, and their jobs?
     My clinic was too big for me to run alone.  I couldn't see patients all day, and manage the inevitable problems that arise in any business--and do both things well.  I might have scaled down the operation, which I did do, but then the large space I was leasing seemed unnecessary.   I could have moved to a smaller location, and continued to practice in a more limited way, but that wasn't my mission.  The only way to have a full-service medical facility is to employ many specialized people.  After the raid, I lost key employees in billing, ultrasound, x-ray, and nursing.  Only the bravest souls stuck with me, knowing there was nothing the federal agents would be able to find, to justify an indictment.  I ran a clean, upright operation, and the employees knew it.  But a government with money and guns is scary.  It scared people away from me and the jobs I offered.
     Thomas Jefferson is famous for having said, "When the government is afraid of the people, we have liberty;  but when the people are afraid of the government, we have tyranny."
     People are afraid of the government these days, and they hate being afraid, but they don't know what to do about it.  I guess I should be afraid of the government, too.  But I'm too sad and disgusted to feel fear.
     I quit medicine two weeks ago, for good.  I have regrets, but they aren't about the decision to close my clinic.  My regrets are broader than that, and have to do with the tendency people have to act automatically, without thinking, and out of fear, to preserve themselves, personally.
     Not everyone--not by a long shot.  But it's going to take a lot more people willing to stand up to an unjust system before our government is forced to work for us, as it was intended by the framers of the Constitution, not against us.  It's probably going to take a lot more people getting raided, and arrested, and robbed, and attacked, in the name of the government, for us to gather enough force to do something about it.  

My 300th Post: A Synopsis

     What happened on June 16, 2010 depends on one's point of view.
     I have reported my perceptions, because this is my blog.  I've cast myself as the victim.  But it hasn't been quite fair to represent the several dozen FBI agents who raided my clinic as intrusive perpetrators, or the federal prosecutors in charge of collecting money for the Department of Justice as monsters hell-bent on advancing their careers.  They are people like me, more or less, doing their jobs, following orders.  They got up that morning and carried out their duties, following a script written by someone else.
     Who is that script writer?  I make allusions to "the government," as though it's a stand-in for George Bernard Shaw--but is "the government" someone?  Can the agents of the government be held personally responsible, when orders handed down from on high go haywire?
     I don't blame the FBI agents, or the prosecutors, for their misguided actions against me, or even for my decision to close my clinic.  I do, however, think it's in the best interests of any society for each member to take the trouble to have thoughts, and entertain doubts, about the work they do every day.  Unfortunately, FBI agents and prosecutors are like soldiers:  they don't think, they can't doubt themselves without sacrificing efficacy on the battlefield.  The problem is, this isn't a battlefield.
     Inasmuch as we act out our characters--meaning, we are both actors in a play as well as individuals who identify with certain noble character-traits, from which our sense of identity and the desire to do good arise--we are true to ourselves and can't be blamed for making bad calls, like the one the FBI made.  But what happens when those bad calls have dire consequences for others?
     Thirty or forty FBI agents woke up that June morning, many having traveled (on our dime) from distant parts of the state.  They donned their uniforms and badges, and set off in company cars to enact a raid on my family practice medical clinic, all "in the line of duty."  It is my impression that FBI agents aren't paid to think, or to second-guess their superiors.  They are well-trained in the art of following, and they're good at forceful self-preservation.  They are taught to expect confrontation, and to meet it squarely.  But they don't question their superiors, and in this way they aren't really "American," i.e., helping to make the country better, by challenging its systems.  They are watchdogs, and sometimes they are bullies.
     There was no reasoning with the government agents that day, not with all the guns in their holsters, nor has there been a chink in the armor of the two prosecutors, who should be able by now to state their grounds for sullying my name and impeding my ability to run a business.  They violated certain constitutional rights;  therefore, I am joining forces with four others whose businesses were similarly raided and harmed, in a class-action-type lawsuit aimed at limiting the powers of government agents who otherwise will keep having license to trample on (they call it, "investigate") American citizens.
     The Patriot Act, War on Terrorism, and HIPAA have accorded government agencies far more power than was ever intended by the fathers of the Constitution, except during times of war. 
     Our incipient lawsuit against the government aims:  1)  to seek the return of raided goods and funds;  2)  to seek other damages pertaining to loss of revenues and functionality directly related to the raids;  3)  to seek damages for difficult-to-quantify losses, including losses to our local reputations;  4)  to reinstate important limitations placed on the federal government by the authors of the Constitution;  5)  to reverse liberties that were granted to federal agents and prosecutors when our country was (purportedly) in crisis, after 911--because it is no longer in crisis;  6)  to question the motives of the Department of Justice, and how they are at odds with the stated intentions of the current administration (if Obama wants to encourage small and mid-size businesses as the backbone of America's economy, does it make sense to be ransacking those same businesses without proof of criminality?)
     Twenty months ago my clinic was raided.  Six weeks later all the working capital in my personal and clinic bank accounts was confiscated.  Since then it has been impossible to hire professional staff (doctors, nurse-practitioners) to help run the clinic, because the raid and "investigation" have frightened them away.  Who wants to work for someone under investigation by the government?
     As it turns out (from a report leaked onto the Internet by Justia.com) the government began its investigation of my medical clinic thirty-two months ago, in response to a persuasive but prevaricating report by a woman, Pat McCullough.  She was either an agent of the government (unlikely) or an opportunist, because she purchased my prior clinic in Hawthorne, seized the assets and made them disappear, and failed to pay off loans (that she was deft enough to persuade banks to extend, based on false representations about the clinic's likely profitability after her takeover).  She had no intention of running a clinic.  She used past performance (under my ownership) as "collateral" for loans, with no intention of paying them back.   Not long after she made a down payment for the Hawthorne clinic (but after securing as much loan money as possible) she declared the clinic a failure, accused me of fraud, filed and was granted bankruptcy, and now hopes to profit from a whistleblower suit.  She understood the politics of the DOJ:  Medicare fraud is the crime du jour, so Pat could profit by pointing a finger at me, and at the same time deflect attention from her own wrongdoing.  The government has little to gain, monetarily, by investigating her.
     You'd think thirty-two months would be ample time for the FBI, backed by the money and power of our government, to ascertain the merits of Pat's accusations against me, or even to undertake an inquiry of her.  But when asked for a status update (by my lawyers, or the press) the prosecutors' response is always the same:  the investigation is still in progress.
     I closed my medical clinic two weeks ago.  Today the last items--boxes of charts--were hauled away.  Half a million dollars of equipment was donated to needy clinics, mostly in Guatemala and Honduras.
     I am retiring from medicine at a time when America needs family doctors more than ever.  The government's raid and forfeitures are directly responsible for my decision to go out of business, although my medical license, insurance credentialing, and other certifications are all intact.
     Pat McCullough, the sleuth-like Iago in this drama, has positioned herself very well.  If I should be forced to settle with the FBI (my lawyers suggest it might be expedient), she'd pocket a handy little sum under the whistleblower program.  It doesn't matter that I haven't committed a crime, haven't failed to pay taxes, haven't been fraudulent.  The Department of Justice has instructed federal agents to "go after Medicare fraud."  Perhaps what this means is "go after businesses with money, and find a reason to take it."  Like the soldiers commissioned to go after Iraqi "weapons of mass destruction," our obedient, single-minded federal agents. do what they're told, whether the evidence supports it or not.
     They've got to find something, or it will come out that they're wasting taxpayers' money, and destroying businesses that create jobs, and violating the Constitution, and overreaching, overreaching, overreaching.   
       

Grief

     Six brawny men and two eighteen-wheelers arrived today at eight.  By noon the four-thousand square-foot clinic was gutted and its body parts stowed like the shanks and entrails of cattle at a slaughterhouse.  The floors were littered with debris, and although it was mostly shreds of paper and cellophane that I kicked around in the shocking stillness after the trucks departed, it seemed more like bits of bone and sinewy tendon that had been shed in the execution of the move-out.
     All the life was taken out of the clinic in those few hours.  I walked about in a fog, carrying a black Hefty bag and filling it with exsanguinated KOH and Hibiclens bottles, dislocated printer parts, ligamentous telephone cords, boxes that had been excoriated from their original contents.  Those boxes used to hold antibiotics, IV tubing, spirometry mouthpieces, EKG leads, IUD's, Coban, Kerlex, syringes, medicine--the apparatus of healing.
     Alone with the clean-up, I had time to think.
     But I couldn't think.  I was like a sleepwalker, going back and forth from the clinic to the dumpsters, to the clinic, to the dumpsters, flattening cardboard, gathering paper clips, peeling tape off walls, sweeping, wiping, checking, rechecking.  I hosed out the garbage cans.  I tore up signs.  I watched as the space inside these walls seemed to expand and then merge into a great void.
     It seemed to me that without things in the building, there could be no thoughts.  My mind was blank.  Without the people and things which had afforded me the possibility of being someone, I was no longer a differentiated human being.
     Is this why God created the world: to have things in order to manifest his thoughts?  To have people who could reflect, by way of being, aspects of the divine?  This is that old philosophical question about objective reality.  Without things or beings to manifest the divine, would God exist?  Without people, is there God?  If a tree falls in the forest, and no one observes it, has it fallen?
     When I returned home, there was a drizzle of rain so delicate it wasn't falling, but stayed suspended in the air.  My face and hair got misted as I stood in my driveway.
     Then I walked to the garden, unlatched the gate, opened the chicken coop.  Every evening when I come home, I let the chickens out to free-range until dark.  This week, I've been hoeing a spring garden into being.  There are so many weeds strangling the earth that it seems an impossible undertaking.  But if I clear three square yards a day, in a month I'll have a garden plot that's ninety square yards--enough for vegetables all summer.  It's satisfying to hoe, despite the blisters.  It's cathartic to yank out the gangly roots of bahia, to rip open the seams of centipede grass, and to unearth so much rattlesnake root that I can eat the white tubers to stave off thirst.
     Tonight I stayed in the garden long past when the chickens went inside to roost.
     I stayed through the arrival of the mosquitoes, and past when they departed.  It got so dark I couldn't see what I was doing.  Rain began to fall in earnest, but still I didn't go inside.  I hoed with resoluteness.  I hoed as though something momentous depended on it.  I hoed without thinking any thoughts.  I hoed and hoed, until my shoulders ached.

A Deposition for Fallgatter

     "I'll be out of this deposition in an hour or so," I told my office staff, " then, I can help pack up things at the clinic, or call patients to come pick up their charts.  I have a short deposition to attend."
     I must have forgotten that lawyers are like magicians with time, taking an hour's worth of work and turning it into eight.  In fact, I think if my lawyer and I hadn't been so impatient--asking repeatedly, How much longer is this going to take?--Mr Catlin wouldn't have minded spending the entire night with us, in that purple-walled conference room with the  long, wooden table and comfortable swivel chairs, asking questions of a most irritating nature.
     Mr. Hal Catlin is a genial sort of guy.  He probably doesn't mean to be an irritating lawyer.  His father had been a marine corps fighter pilot (he told me, "off the record"), and I got the impression that Mr. Catlin, the son, had a lot to live up to.  He wasn't likely to risk sacrificing meticulousness for creativity.
     He wore the classic blue, Oxford cloth, button-down shirt with single-button barrel cuffs, under a color-coordinated, navy, V-neck cashmere sweater.  He also sported the requisite khaki trousers (were ducked-tape loafers too casual, I wondered, for this meeting?) and an impressive gold university ring, making him the Brooks Brothers custodian of traditional preppy values.
     He happens to be Mr. Fallgatter's partner, which doesn't exactly earn him points for fairness.  But, hey, who's talking fairness?   This is the legal profession.
     Remember Mr. Fallgatter?   He's the lawyer who wrote a motion for an emergency hearing on my behalf, not long after the raid and forfeitures of my clinic.  The point of such a standard type of motion was to get the judge to reconsider his decision to seal the affidavits in my case, and to ask him to return enough capital (and, incidentally, the 3,000 seized patient charts) to prevent my clinic from going broke and closing.
     Mr. Fallgatter managed to rack up, with this motion and hearing, a whopping $87,000 in charges, in a matter of weeks, and now thinks he can justify his charges on grounds that he was "investigating the government's actions" for me, right from day one.  Why waste time "investigating," I asked, when we might have gotten the answers we needed at the hearing, had the judge permitted the affidavits to be unsealed?
     I suppose that was an impertinent question, on my part.
     Mr. Catlin started by asking me to look at the contract I had signed with Mr. Fallgatter.  He brought forth two copies:  the faxed one, and the original.
     "Is that your signature?" he asked.
     "Yes," I said.
     "So, you agree it's your signature?"
     "Yes," I said.
     "You mean, it's not anyone else's signature?"
     "No, it's mine."
     "Are both of these your signatures?"
     "Yes."
     "Therefore, you signed these contracts?"
     "Yes."
     "You agreed to the terms of the contract?"
     "Yes."
     "No one else signed them?"
     "No, I see only one signature, don't you?"
     "And it's yours?"
     "Yes."
     "No one else's?"
     "No."
     "And you signed twice?"
     "Yes.  Mr. Fallgatter wasn't satisfied with the faxed signature."
     "So you signed the original, too."
     "Yes."
     "And you retained Fallgatter, Farmand & Catlin to represent you?"
     "Yes."
     "Do you have any problem with that?"
     "No."
     "Do you have any issue with your signature on this contract?"
     "No,"
     "Are you sure?"
     "Mr. Catlin, I have no problem saying that I signed this contract!" I answered, raising my voice.
     (Don't be impatient, and don't be sarcastic, my lawyer advised.  It won't look good to the judge, if we go to a hearing.  She was sitting to my right and, like a bodyguard, intervened several times:  "Objection!  You already asked that!  She gave you her answer!"
     "So, you signed it."
     "Yes, I did."
     "Okay," said Mr. Catlin, "that's good."
     But he didn't seem quite satisfied.
     There was a pause, as he ruffled through his papers.
     "Mr. Catlin, I'd like to point out something in this contract which, as you determined, I signed. "
     He didn't interrupt me, so I went on.
     "The contract says, Our time will be billed against [the] retainer.  You will be provided with monthly invoices reflecting the fees, costs and expenses.  If it appears the undertaking set forth herein may require additional retainer funds, you will be so notified.  Mr. Catlin, I wasn't given an invoice, nor was I notified that the $20,000 retainer your partner received had been used up.  In fact, Mr. Fallgatter only told me he needed an additional $26,000 the night before the motion was supposed to be filed. He had used up $46,000 in two weeks."
     "I didn't ask you about that," Mr. Catlin said.
     "But didn't Mr. Fallgatter breach his own contract?"
     Mr. Catlin kept his attention on the pile of papers he was moving about.
     "Wouldn't you say Mr. Fallgatter's insistence that I give him another $26,000 before he would agree to file the motion, might be considered a form of extortion?"
     A chill went through the room.  I hadn't brought a sweater.
     "This is my deposition, not yours," Mr. Catlin answered stiffly.  "I'm the one asking the questions, here."
     And, so it went.
     My lawyer, Kim Israel, called for a few recesses, termed "bathroom breaks," so we could talk.
     "Go ahead," Mr. Catlin said, generously.  "I don't want you to spring a leak." 
     At one o'clock, we broke for lunch.
     Isn't it funny, how two opposing lawyers can be the best of pals, over lunch?  It's sort of a game, isn't it?
     Mr. Catlin and Ms. Israel went to Starbucks together, and stood in line for coffee, yogurt and sandwiches.  I took a walk in the sunshine, by myself, and mused over my long-ago decision--perhaps an unenlightened one--to become a doctor, instead of going to law school.
     "You should be a lawyer!" my mother used to say--as do so many mothers of bright, irritating, argumentative, obstreperous children.  I had chosen, instead, to develop a capacity for compassion.  But I wasn't feeling particularly compassionate, today, toward Mr. Catlin.
     Except when he brought forth his "exhibits."
     As it turns out, besides the contract mentioned above, all the exhibits happened to be blog posts I had written.  There were twenty-nine of them, to be exact.
     "Wow!"  I said.  "You've been reading my blog!"
     "Yes, I have," Mr. Catlin answered.
     He had triplicate copies:  one for me, one for himself, and one to enter into the court record.
     "I'm very honored," I told him.  "But I don't see that you've copied any of the recipes."
     "I didn't copy them," he said, "but I do read them."
     "Have you made any of the dishes?"
     "Not yet," he said.  "My wife has me on a low-carb diet."
     I realized, sadly, that he wouldn't be able to appreciate the recipe for strawberry shortcake I was about to post.  Too bad.
     One by one, we went through the blog posts.  He was very methodical.
     "Did you write this?" Mr. Catlin asked, about each one.
     "Yes, I did."
     "No one else wrote it?"
     "No."
     "Are all of these your words?"
     "Yes."
     "Are you sure?
     "Yes."
     "What about this line?  Did you write it?"
     "Yes."
     "And that one?"
     "Yes."
     "Did anyone help you with this?"
     "No."
     "Does anyone else have access to your blog and password?"
     "No."
     "So you wrote this post?"
     "Objection," Ms. Israel would interject.  "You asked that already."  And we both stifled yawns.
     "Maybe this is his plan," I wrote, passing notes back and forth, like two girls in junior high.  "He wants to bore us."
     "I don't think he considers it boring," she answered.
     "Since it's my blog, I guess I should be flattered."
     She smiled and shrugged.
    Then, Mr. Catlin moved onto the next post.  Had I written it?  Was it mine?  Could anyone else have sneaked in and written any of it?  Were those my words?  All of them? 
     What a trip, I thought, the things they teach students in law school, to transform them into lawyers...especially lawyers who can manage really complicated cases like mine.

Closing Shop

     You know what it's like to move.  We simply have too many things in America!  Scads of stuff show up in closets and cabinets--so much that you wonder how you ever managed to breathe in your own quarters.  You find stashed-away items you don't even remember buying;  you pile it in hallways and on tables;  you package it in boxes;  and the whole while you wish it would all just disappear so you could sit down with a cold beer and heave a sigh of relief.
     Since I'm giving everything away, at least I won't need to rent a storage unit--which I consider a sure sign that people have too many things for their own good.
     The eighteen-wheelers are arriving in two days, and we're just about ready to fill them with medical and office supplies.  A local dentist, Jay Garlitz, made donations of dental equipment, and the U-Haul dealership down the road donated a truck for a day, making it easy to get the dental items from his office to ours. 
     The waiting room looks like a warehouse for an auction company.  Patients arriving to pick up their medical records have to tread a narrow path between boxes stacked to the ceiling and weird-looking instruments lying on their sides like unclothed mannikins.
     We're almost finished  with the task of calling every single patient, urging each to stop by the clinic to claim his or her chart.  This has amounted to thousands of calls, but at least I'll have peace of mind, knowing that patients won't have their records confiscated again.
     Taking a break from the monotony of the phone calls, I started emptying cabinets in the front office.  So much junk! 
     "That's not junk," said Celeste Segrest, my long-time nurse-practitioner and the impetus behind donating all this equipment to Paramedics for Children.
     Celeste has been volunteering with this organization for five years, making regular trips to Central America with supplies donated by my office to do pediatric and gynecologic care.
     Paramedics for Children is a charitable organization funded solely by private donors, including a bed-and-breakfast in Copan Ruinas, Honduras.  The non-profit provides free--or nearly-free-- (vegetables can be used for payment) medical care to women and children in rural Honduras and Guatemala.
     Whenever Celeste makes these philanthropic trips, she does Pap tests on women who may have borne twelve children, but never had a Pap.  The women who line up for medical help are often those who know from their symptoms that they have a serious problem;  therefore, many of the tests come back positive for cancer.  At that point, the women might qualify for referral to a specialist in the city.  It is basic medical care that is lacking in these countries, as well as health education, for mountain dwellers who have subsistence-level farming lives.  These people need immunizations, blood pressure and diabetes screening, nutrition counseling, eye exams, Pap smears, and TB tests.
     I was throwing out lots of things--such as half-used post-it notepads, and scratched-up, plastic in- and out-boxes, of the type used in offices before electronic records.
     "Don't throw that out!" Celeste kept reprimanding me, and then she'd retrieve the item from the trash bin.
     She was putting together boxes of supplies for schoolteachers in the mountains.
     "People in America don't realize what nothing is," she said.  "Nothing really is nothing."
     Then she recounted the times she had seen teachers who were doing their jobs without pay, because the government had stopped issuing paychecks.  The reasons were political and, as usual, senseless--but that didn't stop the teachers. Without money, space or materials, they continued their commitment to teaching.  Children gathered at their feet, extremely polite, aware that education, for them, was more important than anything else.
     Getting donations of reams of paper, file folders, hole-punchers, post-it notes, pens and pencils, Sharpies, envelopes, labels, staplers, Scotch tape--even buckets--will mean a lot to these teachers, Celeste explained.  I know she's right.  I've spent enough time in developing countries to know that small things can make a big difference.
     "What about this?" I asked, holding up a box of plastic page-protectors. "Do they have any use for these flimsy things?"
     "Definitely, she said.  "They'll take them."
     "How about these paper clips I swept off the floor and picked off the charts?"
     "Oh, yes," she said.
     "Okay, but not these bottles of White-Out, or the chart-holders, right?"
     "They can use them!" she said, taking the White-Out.  Then she told Kathryn, our CNA, to find a drill in our tool box, and unscrew all twenty-four wooden chart-holders from the walls.
     The rooms don't seem like exam rooms any more.  They have the look, oddly, of prison cells.  No color, no bulletin boards, no laughter, no light, no spirit.  I don't know whether the experience is sad or liberating. 
     "These three-ring binders are too ratty to send," I said, schlepping to the dumpster with a tower of them in my arms .  These notebooks used to hold the clinic's "policies and procedures," test logs, calibration measurements, refrigerator temperatures, maintenance reports, lab results, CLIA, HIPAA and OSHA manuals, patient education materials, and copies of our documentation forms.
     "Stop!" said Celeste, blocking my path.  "They can use those notebooks in Guatemala--and I've got the perfect box for them!"  She even took one that was broken, the metal rings having separated from their vinyl spine
     After awhile, I got tired of checking in with her, so I made pyramids of all kinds of doodads, and watched them disappear into boxes, which she labelled carefully in Spanish.
     Finally, as I was cleaning out a front-desk drawer, I found a leather-bound copy of The Book of Mormon.   
     How on earth had we acquired that?
     Inside was the inscription:  To all of you, that you may know the truth and become believers.
     I handed it to Celeste, but she ignored me.
     "Don't you want this?" I asked.
     Still, no answer.
     "Celeste," I prodded her.  "I'm giving this to you."
     "Okay," she said, inhaling deeply as though the decision took will-power.  "We've got to draw the line somewhere.  And I'm drawing it here."


    

Strawberry Shortcake

Strawberries are all over the farmers markets this week--go get some!  Look for pesticide-free berries (unfortunately, they're not fungicide-free).  This is the biscuit-style shortcake I make every year, without a recipe.  Therefore, the measurements are approximate.  Use your judgment, but by all means, err on the side of too much!

3 cups flour
1/2 cup butter (1 stick), softened
1/4 cup shortening (Spectrum is non-hydrogenated)
1/2 cup sugar
2 tsp baking powder
1 tsp baking soda
1/2 tsp salt
1 cup buttermilk, more or less

6 pints strawberries, washed, hulled, sliced
1/2 cup sugar
(1/2 tsp vanilla)

1 pint heavy cream
2 Tbsp powdered sugar

Put the dry ingredients into a bowl.  Cut in the butter using a pastry blender or fork.  Gradually toss the mixture as you pour in the buttermilk, slowly.  Add enough buttermilk to make a dough that is not sticky.  Press it into a 9-inch round or square pan.  (Or use a drinking glass to cut the rolled-out dough into 1/2-inch biscuits and put them, double-decker, into the pan.  Bake at 350 degrees til golden but not dry--about 15 or 20 minutes.

Meanwhile, macerate half the strawberries in a bowl with sugar.  Add the other sliced strawberries and vanilla, and stir.  Whip the heavy cream in a chilled bowl, adding powdered sugar toward the end.

Cut wedges of the warm biscuit (or separate the tops and bottoms) and place on a plate.  Top with lots of strawberries and their juice, then pile on the whipped cream. 

Remember, this only happens once a year!

Which Health Claims Should You Believe?

     Perhaps it's always been this way, because the worries people harbor about their health are a perfect set-up for profiteers.  Despite the inroads of science over the past century, there is still no end to the claims for sure-cures, and they target people who want an easy answer to wellness.  A great deal of money is spent on glossy pamphlets rife with testimonials claiming that this or that product, or diet, or gizmo, or exercise regimen, or tincture will change people's lives, give them tons of energy, make them feel twenty-five again, or cure every ill.  Such investments in advertising must be cost-effective--I imagine their company CEOs sitting like fat cats on sunny yachts in the Caribbean--because the infomercials and bulk mailings keep on coming.
     Which ones have any merit?  Let me try to give you some advice.
     What works for one person is not likely to work for the next.
     This is true, even though our bodies are very similar.  (Consider, for example, that humans are so much like the rest of the living world that we share 50% of our DNA with cabbages, 55% with bananas, 60% with fruit flies, 98% with chimpanzees, and 99.5% with our parents and children.)  It's the tiny differences among us that make, it turns out, all the difference. 
     I recommend taking an inventory of your health, and doing the same with your first-degree relatives (biological parents, children and siblings).  The illnesses or symptoms these relatives have experienced are likely to reflect your propensity for disease, whether you like it or not.  Provided you share their DNA (keeping in mind, disturbingly, reports showing that one-third of us don't have the biological fathers we think we have) (access to over-the-counter paternity testing is available for those brave enough to challenge parenthood assumptions), you also share an "apple-doesn't-fall-too-far-from-the-tree" predisposition to certain disease-states over others.
     This isn't hard to accept, when you consider that Caucasians share a melanin-producing gene that makes them more likely to develop skin cancer, Asians probably share a bone-density gene that makes them more likely to develop osteoporosis, and Ashkenazi Jews share a gene that puts them at higher risk for Tay-Sach's disease.  You are more likely to develop the diseases your parents and siblings get, so those are the ones you need to target.  Here are some examples of how to choose among the diets, interventions and panaceas clamoring for our attention every week.
     If you or a family member have had gallstones, kidney stones, gout, calcific tendonitis, or Dupuytren's contractures, you should follow an "alakalizing diet."  Ninety percent of the foods you eat should have an alkalizing effect on your physiologic state, and only ten percent an acidifying effect.  You can find lists of "akalizing" foods on the internet, but examples include kale, collards, spinach, onions, carrots, broccoli, cabbage, olive oil, tofu, almonds, lentils, lemons, limes, tomatoes and avocados.  Bad ("acidifying") foods for someone with your constitution include corn, barley, oats, wheat, butter, cheese, alcohol, coffee, sugar, chicken, fish, strawberries, oranges, peanuts and beef.
     If there is osteoporosis in your family, you should start a weight-lifting program (at a gym, or with dumbbells at home) and continue it for the rest of your life.  Aerobic exercise is good, too, but only if it's the weight-bearing type--like jogging, jumping rope, tennis, or mountain climbing.  In addition, you need supplements like calcium, vitamin D, and magnesium every day.  You might consider strontium, as well.
     If you have heart disease, or if it runs in your family, you should follow either a plant-based diet or the Mediterranean diet.  In 1991, Dean Ornish published studies showing that a plant-based diet would prevent or reverse arterial blockages.  More recently, the China Study demonstrated similar benefits from a no-animal-food regimen.  There are also a few supplements that can reduce your chances of developing heart disease:  flax oil capsules, garlic, CoQ10, resveratrol, aspirin, and guggul.  Drinking one or two servings of alcohol a day (not more!) prevents heart disease, too.
     If you are prone to frequent illnesses or infections, you should consider following a detoxification program for one week, four or more times a year.  This means buying a vegetable juice extractor--the best for the money ($100-$200) are the Breville, Omega, or Krups.  A detox diet gives your body a break from the arduous process of digestion, especially if you are prone to overindulgence, and supplies large quantities of micronutrients--enzymes, vitamins, minerals and cofactors which are important for proper immune functioning.   Drink nothing but fresh-pressed vegetable juice (e.g., kale, carrots, apple, ginger and lemon make a good one) for the entire week.  In addition, make sure you get plenty of sleep every night, consider taking a midday nap, spend at least thirty minutes a day outdoors, and make a tea of dried maitake or reishi mushrooms (boil two large caps in three quarts of for 1 hour, strain, chill) to drink (a quarter-cup serving every day or two) for the times when you're not on the detox program.
     If there is cancer in your family, the China Study showed that a diet with no animal fat--including no dairy, not even non-fat dairy foods--slows the growth of cancer cells.  An alkalizing diet may be advisable, and taking supplements like probiotics, medicinal mushrooms, astragalus, and vitamin C can help reduce your chance of getting cancer.  Consider taking up yoga or getting regular massage therapy, as there are studies showing that both these techniques can enhance the immune system in ways that make cancer less likely.
     If you need to lose weight (or obesity is in your genes) you may be prone to overeating because you are calorically overnourished and cellularly undernourished.  You need foods that have a high nutrient-to-calorie ratio.  People who are deprived of micronutrients either feel hungry all the time, or don't have an internal mechanism telling them they have had enough.  In fact, they truly haven't had enough, however many calories they eat, and are craving the deficient nutrients.  Drinking freshly-pressed (organic) vegetable juice every day can make a difference, because over time it will supply an abundance of the missing nutrients.  The hormones leptin and gherlin, which regulate appetite and fullness, may also function better when deficiencies are corrected, thereby leading to weight loss.   Taking vitamin supplements or drinking bottled or canned juices is not effective, since most of the living nutrients required for normal metabolism have been pasteurized out.  In addition, start running--but do it outside, not on a treadmill.  No activity is better for stimulating a person's general health, burning calories, boosting the metabolism or inducing an overall sense of well-being, than running.  Being outdoors is the "supplement" for what is now recognized as "nature-deprivation syndrome," a condition that may result in hibernation, depression, and a sluggish metabolism.
     If you or your family members suffer from arthritis or fibromyalgia, exercise is the most important factor in reversing or preventing the condition.  Non-weight-bearing exercise is probably best:  swimming, bicycling, jumping on a trampoline, and rowing are the activities to take up.  Supplementing the diet with ashwaganda, ginger, turmeric, MSM, and boswellia has medical research behind it, and doing acupuncture, meditation, and positive-imagery have been shown to reduce pain and slow progression of arthritis.
     If anxiety, hyperactivity, insomnia, phobias, irritable bowel syndrome, or asthma are familial problems, stress reduction techniques are key to calming the mind and body.  You should avoid Type A jobs, get plenty of sleep, enjoy sex frequently, take up a creative hobby, do guided imagery, meditate regularly, avoid stimulants like caffeine, ginkgo, gotu kola and ephedra, and find ways to laugh at least seventeen times a day (one study shows that people who laugh more than this, live longer!).  Laughter and sex increase endorphins in the body, meditation reduces stress hormones, and plenty of sleep gives the adrenal glands a rest, thereby preventing irritability and overstimulation of the nervous system.
     If you really want to go the distance when it comes to preventing illness and living longer than your peers, try moving to one of the Blue Zones.  These are five geographical areas which lay claim to having the longest-lived people in the world, according to the journalist and longevity researcher, Dan Buettner.  They are:  Barbagia, Sardinia; Okinawa, Japan; Loma Linda, California; Icaria, Greece;  and Nicoya, Costa Rica.

* For further reading, get The Secrets of People Who Never Get Sick, by Gene Stone.