60 Minutes

"We've heard no decision yet. Everybody is milling around on the FIELD—AND THE BEARS!! THE BEARS HAVE WON! The Bears have won! Oh, my God! The most amazing, sensational, dramatic, heart-rending... exciting, thrilling finish in the history of college football! California has won the Big Game over Stanford! Oh, excuse me for my voice, but I have never, never seen anything like it in the history of I have ever seen any game in my life! The Bears have won it! There will be no extra point!" Cal Broadcast Reporter

In the famous college football game between Stanford and Berkeley on November 20th 1982, 'The Play' ranks among the most controversial and compelling football stories of all time. With four seconds on the play clock and poised to lose a key game to the Stanford Cardinals, the Bears recieved a squib kick and, won the game by completing five lateral passes and eventually scoring the winning goal. While the film footage has been viewed and reviewed thousands of times I am most impressed by what the Berkeley Bears coach said to his winning team after the game was over.

Coach Joe Kapp gathered his team in the locker room after the game and reportedly said to his elated players, "A football game lasts for 60 minutes, not 59 minutes and 56 seconds. The game lasts for 60 minutes." This statement is significant and I often think of it as a metaphore for the hardships that often occur in life. While it is too simplistic and naive to hope that patients suffering losses and struggling with disease could hope to draw strength from this phrase, there are moments when doctors need to help their patients rally and fight. Sports metaphores are often helpful in this regard because cheering for our favorite athletes and teams offers us a vehicle for self introspection and our heroes are often a source of personal pride.

The game of life does not end at 59 minutes and 56 seconds.

The game of life lasts for 60 minutes.

Click here to see 'The Play': http://www.youtube.com/watch?v=0fZCCAqoSwY

Caravanserai

Beyond the daily commute and the crowds of people who work every day in all of our cities and towns, there exists a vast sea of invisible aid workers out there who work under adverse conditions and often risk their safety to help people in the US and in developing countries and who are the victims of war and natural disasters. The American Red Cross, the Peace Corps, the International Red Cross, Partners In Health, Flying Kites Global, Doctors Without Borders, Catholic Relief Services, Amnesty International, UNICEF, AMREF and thousands of other relief organizations help hundreds of thousands, if not millions of people recieving little or no thanks and often laboring for years in obscurity.

Recently, one of these organizations has decided to give something back to the volunteers and relief workers. This organization has decided to set aside a plot of land and build a retreat for their own aid workers and have offered this service to workers from other organizations. I hear that in the woods of New Hampshire a small farm or community will be developed solely to create a place of respite and a place to heal for the men and women who have given so much to others. Post traumatic stress disorder, nightmares, depression and family discord are often the reward these workers recieve for months and years of living among the poorest and most desparate people in the world. These workers often surrender any hope of living a normal life after some of their experiences and need a place to meet and regroup before heading out to live and work among the poor again.

A 'caravanserai' is a designated place where generations of Asian and African nomadic traders and travellers would stop and restock their stores, trade goods and share news of the road ahead. While we all need some type of place to go when the stress gets to be too much, those tens of thousands of invisible samaritans who live and work to bring hope, food and medicine to the refugees, victims of war, political instability and the economic hardship need a place of their own more than any of us. These workers see things and experience a level of human tragedy that we in America can only imagine. I for one am glad to hear about this type of resource to help support aid workers and I hope that this effort on their behalf leads to more support for their important work abroad.

Photo: S. Butler: Beersheva, Israel 1980

The Daddy School

I think I'll start the Fundamental School for New Dad's.

The New Dad's daily schedule and curriculum of classes will look something like this:

8:00am: Speed Diaper Changing 101

8:30am: Coffee Break (and call home to see how your wife is doing).

8:45am: "Goo Goo, Ga Ga" -Basic Communication Skills

9:00am: How to Power Nap

9:15am: Power Nap Practice Session

10:00am: Coffee Break (and call home again).

11:00am: Exercising with Your Baby (former title; Basic Rough Housing)

11:30am: Sports, Fighting and Aggressive Posturing

12:00: Lunch (and call home again).

12:30pm: Daddy Fundamentals -

Compassion and Respect for the In Laws

Goofy Faces and Other Stress Relievers

1:30pm: How to say, "Yes Dear" (like you mean it) with practice time.

2:30pm: Baby Culture Sessions:

Stroller Etiquette - Tricks for Going Uphill and Downhill

Pacifier Sharing - Learning How to Spot the Sucker.

Ketchup for All Seasons - The Perfect Food Group

Vegetables are Our Friends - Mr. Broccoli and 'Here Comes the Airplane!"

Professor the Messer - a symposium on baby food flinging techniques

3:00pm: 'Drool, Pee and Poop' - Bodily Fluids and Their Hidden Dangers

3:30pm: How to Shop for Groceries

A Guide to Searching the Entire Store for One Lousy Item

4:00pm: Homework Assignment, Evening Prayer and Dismissal...then call home...again.

5:00pm: Drive home to begin the evening shift but bring a coffee for the road to stay awake.

Rasta La Vista, Baby!

My daughter came up with this great 'Rasta la Vista' slogan today so I had to write it down. The kids and my wife lived on a Caribbean island for seven months when they were five years old and knew many rastafari there. Sometimes, these men and women would bring small gifts to the children and they were always evident in the town, in parades and on the media. Bob Marley is like a god in many parts of the Caribbean so followers of the Rastafarian faith identify powerfully with his music and legacy. My daughters even had Caribbean accents by the time they came home after living there and going to the local school with the island children.

Stepping off the plane on one of my visits, I would be absolutely enchanted by my nut brown little girls scampering towards me with their little sandals and platinum blond hair hugging me tightly and squealing, "Daddee! We miss yoooo!" Those days are thankfully over and we have been all together again for several years back home.

If Bob Marley were alive today he would probably have smiled and nodded in appreciation at how his music and culture still impact visitors and island experiences. Rastafari are a small group and are marginalized in many Caribbean cultures but to my little family for those months these men and women were always kind and thoughtful towards us during our long, hot, sleepy visit to a beautiful leeward island.

A Job Well Done

"I feel like I'm pretty much who I am, for better or worse, whatever that is. I'm trying to coach a football team. I'm trying to get them ready to play and...win. That's what my job is."
Bill Belichik - Head Coach of the New England Patriots

"We could be heroes, just for one day."

Heroes - David Bowie

As a husband, father, brother, son and doctor I have had to come up with a way to compartmentalize my life so that my day can run smoothly and all of the tasks and projects can be completed efficiently.

Job: My 'job' can best be described as the way I choose to conduct my life. My job in life is to be; healthy, be a good husband and father, to be productive, creative and to basically look out and protect my physical and emotional health for the longest time possible. This is the most important category because if I do not conduct the fundamental aspects of my life in a healthy way then the other two parts of my life will not work. My 'job' includes; exercising, eating correctly, sleeping soundly, taking time to laugh, spend time with my family and cultivate meaningful relationships.

Business: My 'business' is running my medical practice every day. This is what I do to generate income for my family, and it is where I work closely with other people. My business is what I do every day in the community that require people skills, management skills and conflict resolution skills. The business is the venue where I practice my profession and spend capital I have built in the life that I have created by doing my 'job'.

Profession: My 'profession' is to be a medical doctor. This required years of study, sacrifice and comittment to achieve. Now my 'profession' requires daily practice and dedication to constant learning and development within this complex and demanding line of work.

Summary: We are all given a set of gifts, skills and opportunities in life. We all face challenges, defeat and disappointment from time to time. Some of us are born into wealthy families, some into poor, chaotic and dysfunctional families. Many people are exposed to drugs, violence and abuse and face tremendous obstacles in life. The manner in which we conduct ourselves and our attitude towards our life work and our personal journey helps to determine our life choices, our health, success and happiness.

Shut Up and Eat Your Snowshoes!

"Laughter is a strange response. I mean, what is it? It's a spasm of some kind! Is that always joy? It's very often discomfort. It's some sort of explosive reaction."

Madeline Kahn

Many films and television shows are created to be funny and I often think that visual media is how many of us experience humor. When you are tired of watching TV and are ready for a good fun read, I have a book for you. 'Shut Up and Eat Your Snowshoes!' by Jack Douglas is long out of print but this guy was a comedic genius. Douglas was a sought after writer in his day for the Jack Paar Show. He had traditional Japanese wife named Reiko and together, they bought a home in the snowy wilds of Canada. If you are familiar with the television, radio and film celebrities of the 1950s you will recognize the cast of characters that parade through the home in search of cocktails, broads and a swingin' swell time away from the stress of Hollywood and New York. The next time you are tired of watching 'Family Guy' and 'The Simpsons' on TV see if you can get a copy of this book and sit down for a good old fashioned belly laugh.

Be Brillig!

"`Twas brillig, and the slithy toves Did gyre and gimble in the wabe: All mimsy were the borogoves, And the mome raths outgrabe."

Jabberwocky, Lewis Carroll

This famous poem has been studied, dissected and analyzed for years in high school english and college english literature courses. The poem is loaded with nonsensical words and phrases that nontheless paint a picture of the legendary mythical monster and describe the fear and terror of the beast in vivid (if abstract) detail.

Fear of the unknown is one of the most powerful and crippling forms of terror. Fear, anxiety and panic are thought to be neurochemically driven responses that are encoded in our DNA as a survival mechanism. It has been said that the body retains no memory of pain. We can recall pleasant times when we felt relaxed, calm or secure but to call up an accurate memory of physical pain is difficult. Ask a mother if it is easier to relive the pain of her baby's delivery or remember the feeling she had watching the sun set from the deck of a cruise liner she was on many years ago and she will recall the pleasant memory much faster. Fear, has an achilles heel.

To me being 'brillig' is to be on guard, to draw a deadly weapon, wait calmly for an attack and to be the first to strike when the monster lunges. I don't know if it is an adjective or a noun. I don't really care (and neither did anyone else in my high school english class). The poem is still a classic.

Never mind the mome raths!

BE BRILLIG!!

T'ween and Teen Media

Children, especially between the ages of about 10 to 13 have had a complicated relationship with adults when their stories are being told in film and on television. The tween demographic is a compelling one because so much is happening with these children developmentally. There is conflict, a need to assert independence and, of course young romance.

Years ago, Walt Disney approached his stories about tweens by featuring orphans as the lead characters. Films like, 'Pollyanna', 'Toby Tyler', 'Tom Sawyer' and even, 'Cinderella' placed the orphan in a unique position in society and allowed spectacular and even unbelievable adventures to occur because there were no invested adults to interfere and no family structure to foil the plot. The orphans could get away with things that kids with parents could only dream about but Walt was always careful to show the lonliness and self doubt that his characters felt.

In the 1970's, 'Little House on the Prarie', 'Eight is Enough', 'The Brady Bunch' and 'The Partridge Family' and many other shows put the tween characters solidly back in the bosom of a lively and caring family. The stories involved parents and showed how families solved problems and still bonded as a family. The parents were part of the story line and the child's family unit was often portrayed as a fully developed character all it's own.

My kids watch two television shows in particular that feature tweens who have very busy, uninvolved parents and who have virtually no supervision in school or at home. Shows like 'Zack and Cody' and 'iCarly' casts boring adults only as fumbling, babbling idiots who have no insight or experience and offer nothing (even a coherent conversation) to the child actors. The plots of these shows feature the kids solving their own problems in spite of the interference of the adults around them. The kids feed themselves, get themselves to school, call each other on their cell phones and put themselves to bed often for days on end without an adult in evidence.

Walt is probably turning over in his grave.
Even Mr. Rogers is trying to channel the Children's Television Workshop (and his focus was on very young children).

In the book, 'Strong Fathers, Strong Daughters' by pediatrician, Meg Meeker, MD, we are advised to have a very involved role in the lives of our children right up through the teen years because teenagers "have not fully developed the ability to think reasonably and abstractly." When television marginalizes and downgrades the parent to further the plot, effectively causing the children to behave as though they really are orphans, a curious dynamic unfolds and the tween viewer envisions in the story the empowerment of self worth without paying the price of self doubt. In 21 minutes on a television screen chock full of ads aimed at blowing out their developing frontal lobes, kids rule and adults play the fool.

Mr. Rogers and Walt Disney are hopefully up in heaven right now negotiating a reincarnation.

Medical Diet Review

A recent article in the New England Journal of Medicine compared and contrasted four different diets. The conclusion of the article, which studied the results of various dietary combinations in 811 participants was that diets with reduced calories were the most successful regardless of the percentage of fat, protein and carbohydrates.

"Among the 80% of participants who completed the trial, the average weight loss was 4kg; 14 to 15% of the participants had a reduction of at least 10% of their initial body weight. The diets improved lipid-related risk factors and fasting insulin levels. At 2 years, 31 to 37% of the participants had lost at least 5% of their initial body weight, 14-15% of the participants in each diet group had lost at least 10% of their initial weight and 2-4% had lost 20kg or more." The average calorie allowance for the subjects was between 1900-2500 calories per day throughout the two year study.

The results of this study indicate that we should all pay closer attention to our portion sizes and have an accurate count of the number of calories we take in each day to achieve meaningful weight loss.

Reference: New England Journal of Medicine, February 26, 2009. 360;9 pp. 859-873
Photo Credit: http://www.MyPhotoDiet.com

Bungee Maestro

"Life is a short event, and at the end of it, you have to have had a good run for your money."

David Kirke

David Kirke is credited for creating the idea of bungee jumping. He and his friends came up with the idea to jump from a suspension bridge in North Somerset, England. One of the founding members of the Dangerous Sports Club while at a student at Oxford, he and his friends decided to try the idea out using elastic cords over a 245 foot drop. In April, 1979, while spectators looked on, Kirke, dressed in a top hat and tails and clutching a bottle of champagne did a back flip from the bridge and excecuted the first successful bungee jump in history.

Now 63 years old Kirke is proud of his idea and legacy for thrill seekers everywhere. On April 1st, the sport of bungee jumping will be 30 years old. If you are a regular bungee jumper your knees and back will feel 50 years old.

Reference: The Week. March 20, 2009

Political Muscle(s)

There has been some recent discussion about aspects of Michelle Obama's wardrobe. Not that I am any authority on women's clothing but the interest seems to focus on the fact that she buys sleeveless dresses. Michelle Obama lifts weights and, as a result has sculpted arms and wears outfits to showcase her hard work in the gym. Personally, I think this is a good thing. The First Lady should be more than a talking hat rack or philanthropic extension of her husband's office. She should serve as a role model to women from all walks of life in more ways than just her actions. The First Lady can have muscles so can you! Nancy Reagan would not have been caught dead in a sleeveless dress. Laura Bush would have been hacked to pieces by the media for wearing so much as a t shirt. Ladybird Johnson? Nah!

Obama is smart, professional, savvy and fit. Leading by example is the best kind of leadership.

Arnold Schwarzenegger look out. There's a new Terminator in town...and she wears a dress!

The Children's Time Zone

As my children are a bit older now I have found out something very interesting that is very different from the time when they were babies. As children age, they seem to spend their day at a pace that approximates my pace.

Let me give you an example. When children are babies, they spend all day in one spot and all of the care and attention are delivered to them day and night in one slow, drawn out sequence of events. Feeding, burping, changing, tickling, sleeping, laughing and crying occupy the baby's time completely. The parent is used to a different pace of life altogether. An adults life inherently has more stimulus and complexity. Adults need creative input, conversation, future plans, happiness, sorrow, sleep and so on. Adults in America are used to having more of everything and having it faster. Babies grow into children and their world broadens to puzzels, games, books and school. They are catching up but still occupy a relatively small space and are entertained by activities that often seem dull to an adult. After all, how many times can an adult do the same horsie or duckie puzzle without being bored even if we are sharing the wonder and amazement of our children?

We would all agree that life on a remote farm in the midwest has a different rhythm than life in Manhattan. The adult is sort of like the person from New York and when they have a baby it is like one long visit to the farm. Sure there are cows and corn and fences to fix but the adult misses the bright lights, the noise and the excitement of living in the city. Now that my girls are older, we can do more together as a family. Their lives have speeded up and become more complex. This may be why experienced parents with older children will often cringe at the thought of having a newborn child once theirs are older.

Even though raising babies and children is the greatest joy I can imagine, now that my kids are a bit older I am glad to be able to at least visit the city and leave the farm behind.

The Rand Corporation

There has been a shift in the television commentary these past few days about our economy. A few clever pundits have dusted off their old copies of 'Atlas Shrugged' by Ayn Rand. Atlas Shrugged tells the story of an economy in chaos and the decision by the wealthy to strike and disappear rather than continue to use their money and influence to support the poor and the sinking economy. In my opinion, the politics of altruism are complex and too simplistic to be applied in the context of a macroenconomic crisis, especially since the world we live in now is so different from the world created by the characters in the story and Hollywood in the 1950's when Rand lived there.

“From each according to his ability, to each according to his need,” a scheme that resulted in enslaving the able to the unable. The first man to quit was a young engineer, who walked out of a mass meeting saying that he would put an end to this once and for all by “stopping the motor of the world.”

Quoted from 'Atlas Shrugged'

We are all in this together and if our elected and appointed leaders can't get us back on track then we all need to work harder and invest our time, vision and money in wiser ventures in the future.

Ayn Rand was born in St. Petersburg, Russia, on February 2, 1905. At age six she taught herself to read and two years later discovered her first fictional hero in a French magazine for children, thus capturing the heroic vision which sustained her throughout her life. During her high school years, she was eyewitness to both the Kerensky Revolution, which she supported, and—in 1917—the Bolshevik Revolution, which she denounced from the outset. In order to escape the fighting, her family went to the Crimea, where she finished high school. When introduced to American history in her last year of high school, she immediately took America as her model of what a nation of free men could be. Long an admirer of cinema, she entered the State Institute for Cinema Arts in 1924 to study screenwriting. In late 1925 she obtained permission to leave Soviet Russia for a visit to relatives in the United States. She spent the next six months with her relatives in Chicago, obtained an extension to her visa, and then left for Hollywood to pursue a career as a screenwriter. On Ayn Rand’s second day in Hollywood, Cecil B. DeMille saw her standing at the gate of his studio, offered her a ride to the set of his movie The King of Kings, and gave her a job, first as an extra, then as a script reader. During the next week at the studio, she met an actor, Frank O’Connor, whom she married in 1929; they were married until his death fifty years later. Ayn Rand lived from 1905-1982

Quoted from AynRand.org

Cartoon Credit: Lawrence Gilson

Dénouement

The saying goes, "ontogeny recapitulates phylogeny" and it is within the context of this complex biologic process that all is made clear and the sequence of life becomes a fully realized entity. Humans are, after all are a product of all the elements, chemicals and influences that have occurred in our lives. Our abilities, our weaknesses, our inspirations and the forces that plot our downfall and demise are wrapped up in a giant primordial stew of events and subplots that help mold and shape us and then follow our course through life to continue the process minute by minute until the very end.

Philosophy is not my strong suit but I can appreciate the applications of this phrase as I sit in front of my patients charts, trying to sort out my daily decisions for their health and safety. Medicine as a science and the daily practice of patient care commits a doctor to a life of endless decisions, the assumption of often agonizing risk and the constant need to plot solutions, redefine boundaries and negotiate skillful contracts and detailed instructions with patients. A doctor cannot practice medicine simply by decree or by force of will. There are too many elements to the patient's story and there are too many forces that are at work that impact on the successful outcome of a treatment strategy. If ontogeny really is the process that an organism passes through to achieve it's evolution then our human story and the final dénouement are also part of that process. It is the job of the physician to steward that journey to a successful outcome.

The theory of recapitulation, also called 'the biogenetic law' or 'embryological parallelism', and often expressed as ontogeny recapitulates phylogeny, was put forward by Étienne Serres in 1824–26 as what became known as the "Meckel-Serres Law" which attempted to provide a link between comparative embryology and a "pattern of unification" in the organic world. In 1866, the German zoologist Ernst Haeckel proposed that the embryonal development of an individual organism (its ontogeny) followed the same path as the evolutionary history of its species (its phylogeny).

Reference: Wickepedia

de·noue·ment (also dé·noue·ment)
a. The final resolution or clarification of a dramatic or narrative plot.
b. The events following the climax of a drama or novel in which such a resolution or clarification takes place.
2. The outcome of a sequence of events; the end result.

The Blond Goddess

I was just reading the obituary of the most famous female bullfighter in the world. Conchita Cintron lived from 1922-2009. She fought professionally and won legions of fans all over the world for her bravery and skill. Her legend was established when, in 1940, she was gored in Guadalajara, Mexico and collapsed. She was carried unconcious to the infirmary where she subsequently regained conciousness and returned to the bull ring, killed the bull and then collapsed again in the ring. Cintron was nicknamed, la Diosa Rubia (the Blond Goddess) and enjoyed a storied career before retiring at age 27 to Portugal to live with her husband.

Bullfighting is a sport that, in its pure form is truly dangerous and sometimes costs the bullfighters their lives. The sport pits the bulls against the human matadore (or matadora) in a death struggle on foot (as in the Spanish style) or horseback (as in the Portugese tradition). Cintron died of a heart attack last week.

Reference: The Week, March 6, 2009

Pilot Fish

Wherever you see people who seem to break away from the pack you will find the sneaky, opportunistic 'pilot fish'. If you are Barak Obama, Oprah Winfrey, Angelina Jolie or Warren Buffett then the swarms of pilot fish are endless. If you are the recently unemployed, George W. Bush then the pilot fish have moved on.

Ponzi investment schemes, shopping sales and traffic patterns all rely on our innate biological survival mechanisms help us to navigate in the midst of chaos. Pilot fish can quickly turn into a herd and are sometimes investors, sometimes homemakers and, in times of great economic or political hardship they are the unemployed and displaced who will migrate far and wide looking for work. People who watch the Home Shopping Network or live to strike it rich on eBay or the Antique Roadshow exhibit a herd mentality. When a person hits the lottery at a local convenience market, this triggers a rush by the other gamblers to gravitate to that shop in hopes of striking it rich. When my patients decide to stop their medication on their own because their postman told them of a 'better' medication their great aunt was on, these people are just following their instincts. The pilot fish is veering off to find a new herd.

Being a pilot fish is human nature. We humans survive better, live longer and happier lives if we take notice of what others are doing and follow their lead. In the case of taking medication, however, it is not always the person at the sales counter, the blogger from Arkansas or the lady in line at the bank who should lead the pack.

Bodysurfing Medical Research

Bodysurfing is a previously unresearched temporary cure for seasonal allergies. Some day in the spring when your allergies are killing you, try going to your local break and rip out a few waves. All the collected allergens in your hair and skin will be power washed off and your nose will be completely ripped out with the worlds most invigorating salt water rinse. Allergies gone!

Other cures found while engaged in the sport of body surfing include; a cure for boredom, a cure for aggravation, and a cure for lethargy. You do need to be a little careful of broken bones, teeth and sprained backs not to mention drowning (a bit) but these trifles are barely worth mentioning as you put your life, soul and body back into shape riding a wave to the beach.

There is a new bodysurfing magazine at http://bodysurfing.com.au/.
For those of us who love bodysurfing there is a great blog about the sport at http://bodysurfnow.blogspot.com/.

Photo: Greg Deets

"That's the fact, Jack!"

Colonel: "Soldier, do you mean to tell me that you finished your Basic Training on your own?"

Winger: "That's the fact, Jack!"

Stripes - 1981

Our movies and stories are stocked to the rafters with anti heroes. Anti heroes are people who, in spite of themselves seem to be able to pull off some sort of near miracle against all the odds. We love anti heros in our country. Our founding fathers were all anti heroes.

Steve Martin, Bill Murray, Adam Sandler, Buster Keaton, Laurel and Hardy, Charlie Chaplin and hundreds of other actors told us stories on the screen that allowed us to hope that someday, we too could save the girl, kung fu the bad guy and drive off in the Maserati with all the cash.

The next time you are looking for someone to emulate, you do not have to look farther than your own children, your spouse or co workers. The anti hero lives in all of us. We may not make it to the silver screen and probably no one will come up to us to shake our hands or slap our backs for a job well done. There are not many ticker tape parades for the every day anti hero anymore. My suggestion is to keep looking for ways to help an elderly person in your town, praise your kids a little more for their every day accomplishments and bring a surprise bouquet of roses home for your wife (who had a tough day too). You will get that warm, fuzzy 'anti hero' glow just like they do in the movies. In that moment, you will have become a better hero than of any of Hollywood's characters.

Labradoodle-palooza

Our neighbors have a very friendly but odd looking dog. Apparently, the labradoodle is a popular breed to own. The dog was very cute when it was a puppy but now that it is a tall dog it looks....strange. The hair appears coiffed and fluffed even though the dog has not been groomed. The dog seems to bounce all over the yard instead of just run. When deer amble through the yard, the labradoodle throws it's tongue out and springs up as if to say, "Hey guys, wait up!" The dog appears somewhat embarasses by itself sometimes and I often wonder if it is lonely watching all the other regular dogs walk by in the neighborhood. The labradoodle is very social and outgoing. This dog needs friends. Lots of friends.

My neighbors own an event planning business and would be perfect to host the first informal gathering for dogs and their owners. We have a Folk Festival in town along with the Newport Jazz Festival every summer. Why not a arrange little Woodstock for dogs? A Labradoodle-palooza would be great! Kids, soda, popcorn, dogs, music and...oh yeah...poop. Lots of poop.

Forget it.

Bud

Many of my patients come to the office and ask me to put them on antibiotics early in their illness before it becomes worse. These patients will always say the phrase, "I want to nip it in the butt."

Just to set the record straight, the phrase is, 'nip it in the bud.' This is a horticulture metaphore that indicates that we are trying to stop something that may develop into something else before it has time to blossom.

Nipping something or someone in the 'butt' is more of an animal husbandry metaphore or plastic surgery metaphore.

On second thoughts lets just skip all these metaphores to save time and just get right to the symptoms!

Guerilla Parenting

My children recently tried to sit and listen to a reading of the classic story, 'Alice in Wonderland'. Needless to say, (especially in an abbreviated version) the story of the March Hare, the Queen of Hearts and the rest of the nutty characters running around yelling nonsense and forcing Alice to perform any number of strange contorsions and privations to navigate the creepy landscape of 'Wonderland' in search of God only knows what, led my girls to ask the question, "Why was this book so popular?"

I took this opportunity to inform my daughters in my best fatherly voice that, I did'nt know why the book was a classic but the important thing here is to see how "this is how people think and behave when they take drugs!" The confusion of poor Alice mirrored the confusion on my daughters faces and, since Alice was totally at the mercy of creatures who had no basis in reality and who spoke a dialogue that also had no basis in reality, I am pretty sure that this impressed them greatly.

Score one for Dad!

To make my message about drugs really stick, next week I plan on showing them a videotape of a Pink Floyd concert.

Quantum of Solace

In the actual short story, 'Quantum of Solace' by Ian Fleming, James Bond finds himself listening to a tale of desparate hope and lost love as told to him by a retired colonial official from Jamaica. The story involves a civil servant and his airline hostess wife. She goes off and has various affairs with other men while they are married and living in the Bahamas. He finally comes to his senses and puts her through a long period of suffering to make her pay for her disregard for him and his feelings.

The story points out that the true fault for the tragedy lies with the parents of the husband. In Ian Fleming's opinion, it is their fault that they failed to educate their son successfully in the ways of the world so that when he found someone who paid the least attention to him he mistook this for romance and acted on it with a marriage proposal. As the marriage degenerated, he was unable to salvage anything from the wreck which, in turn prompted severe and crippling revenge upon the wife who considered herself "just being naughty."

The quantum of solace is the phrase given to the resulting interplay of negative emotion when one partner snubs, disrespects and ignores the other. It is an expression which describes the consequences of distain.

As we see in the story, the wife initially imparts this to her husband who, in turn reciprocates the unkindness...in kind.

Tips from the Airline Industry

It occurrs to me that airline stewardesses and stewards are not that different from the staff who work in medical offices, dental offices and other service industries and that we would do well to share some of our professional ethics and 'people skills'. The most demanding aspect of working in a plane, it seems to me is that all of the people are packed in, uncomfortable, tired, cranky and bored. The stewardess must somehow convert that experience into one that the passengers will feel is at least slightly memorable and not completely negative.

Think about how you interacted with the stewardess the last time you flew in a plane. She was engaging, polite, she leaned in to listen to your concerns and if she could not address the question directly she always offed to "get back to you". She was dressed professionally, she was constantly visible and seemed to be doing something while you sat and suffered with the crying 15 month old in the seat behind you. That the stewardess was not simply lounging in a chair up in first class but was seen to be at least appearing to be busy is important. After all if we are miserable we do not want to see anyone else who is not miserable.

Our patients will relate to the professional TLC that airline passengers get and this makes the healthcare experience easier and smoother for everyone. While there are some cranky airline stewardesses out there, they are not representative of the profession and flying with a courteous and professional attendant always makes the trip pleasant even if the 15 month old in the seat behind you never stops crying the whole flight....ever.

Disarming

Bart: [low voice] Hold it! Next man makes a move, the n------ gets it!
Olson Johnson: Hold it, men. He's not bluffing!
Dr. Sam Johnson: Listen to him, men. He's just crazy enough to do it!
Blazing Saddles

The art of 'disarming' is one of the greatest skills anyone can develop. Author and lecturer, Sam Horn wrote a book called, 'Tongue Fu' that I recommend to many patients who come into my practice struggling with family or job related stress. The idea of disarming is that you can take almost any accusation, insult or confrontation and move the interaction through to a calm place by skillfully taking apart the antagonists demeanor and disassembling the attack.

In an office setting disarming this is very useful. Patients are often rude and accusatory toward the receptionists and nurses but by the time they have gotten around to seeing me they are smiling and congenial. Medical practice is a 'people' business. We have to deal with all of the patients and take whatever they bring and convert the disease, attitude or other affliction into a healing and wellness mode using medications, counselling, diagnostic imaging or just straight talk. Patients come into our office chock full of biases, preconceptions, private agendas and pages downloaded from the internet. Disarming is part of the healing and redirecting process.

Bugs Bunny is the ultimate disarming machine. Calm when needed and wiley when required, Bugs will make corn beef hash out of the bluster and spit of Yosemite Sam and the slow, destructive programmed mind of Elmer Fudd. Think about how you would tackle your next altercation with a patient, client or rebellious teenager and then think of how Bugs would do it.

To learn more about this remarkable technique visit: http://www.tonguefu.com/

Dr. Butler's Diet: "Give Up to Get Down!"

I think I have discovered the secret to successful behavior modification, at least for people who are on a diet. Instead of showing people what to do and then expect them to do it, people seem to have to want to sacrifice or endure a tiny deprivation to help them to invest in the weight loss process. Diets that require a person to give up something can create a buzz and a feeling of excitement because there is a challenge to the person's self esteem. I don't mean give up chocolate or cookies either because that is just a given.

If I were a religeous person I might roll the dice and create The Lent Diet (avoid whatever Catholics traditionally give up for lent). Racing fans might like The NASCAR Diet (eat only what you can grill and nothing else). The Cricket Diet could limit all of your calories to beer and potato chips which is what you would eat while watching a 12 hour cricket match (or you could simply live by eating a lot of little crickets). The Golfer's Diet would demand that people give up one food group for every bogey and if they missed a little old granny putt they would have to eat their scorecard. It's an incentive kind of a deal.

Maybe I could invent The Dr. Butler Diet. My diet would require the dieters to eliminate anything that they could not easily be transported on a bike, in a car or in the pockets of a lab coat. This would certainly cut down on preparation and portion size. If this got too boring, once or twice a week the dieters would be allowed to go into a local hospital and swipe something to eat from the nurses station and then run away. The running part would be part of the diet because of the exercise you would get and....that would cause you to lose weight.

On second thought lets just keep this our secret.
Nurses hate having their food swiped.

"You Curtsy, I'll Bow"

The small town of Westminster West, Vermont where our family lived was unique in that many of the townspeople had a relaxed outlook on life. Even now, going back to visit after 30 years it is plain to see that no one has bothered to mow the lawns, trim the trees or paint the barns after all these years. To do these things would take them away from...relaxing.

One of the cultural features of the town is that everyone in town called everyone else by their first names. Kids often referred to their own parents by their first names and when we were speaking to each other about adults we never referred to them as 'Mr." or "Mrs." In seventh grade the principle of the Putney Grammar School was called, Whit. The librarian was referred to as, Dorritt. Our grammar school English teacher was the voluptuous, Silvia Smith (who made us read a really terrible book called 'The Marble Faun' by Nathanial Hawthorne). My friend Richard's father was named, Simon and our second grade teacher was simply called, Claire. My mother was, Ann and my father was, Russ and so on. Our neighbor, Samuel would go on to found Stonyfield Farm and our eighth grade teacher was simply known as, Bob.

Think of what it must have been like to be a kid in a town that sometimes seemed like a sort of hippie commune. The whole village would go up on a hillside and camp out in the high summer or go sledding in the winter. If I missed the bus to school I had to hitch hike to get to class. There were real town meetings and Halloween gatherings in the village Grange Hall with bobbing for apples and everything. That was in the days before herpes so you could get away with sticking your face in a warm tub of water full of half chewed apples and everyone elses drool floating on top.

It seemed that this creative and imaginative culture would serve the kids well to help deconstruct the notion that adults were an authority to be feared in the world. The kids in our town related to adults without fear or intimidation and I remember it being a really wonderful and enriching environment. My brothers are now respected artists, my sisters are health care professionals, my father has worked in broadcasting his whole life and my mother is a well respected author and lives on the West Bank in Israel. We are all creative and imaginative people who have managed to navigate life's hills and valleys with some success.

Life's journey is rough enough so giving the kids a culture to grow in without authority figures or titles is an interesting way of empowering them and preparing them to meet challenges as adults.

Ṻber Worker

"Put me back in, Coach!"

Anonymous

"You don't understand, I am a drivers wife.... I don't work."

Talladega Nights

In these harsh economic times with a soaring unemployment what really matters is that people have the willingness and desire to work. Just in the past few months as the spectre of unemployment seems about to pounce on every household and threatens to undermine the economic stability of every family, I have seen my injured and sick patients ask to be allowed to return to work sick rather than taking time out to recover. This is in stark contrast to years past when even a stuffy nose would be a cue for some people to look for an extended leave of absence. Things are different now. People still get sick, they still get banged up and bruised but this winter has brought out a desperation in people and they are asking not to be taken out of their jobs. Being the kind of employee that shows up for work on time, works hard and shows the best attitude and initiative possible translates into job stability if there is any to be found.

This change in our economic climate means that change also extends to the management as well since they are expected to lead by example.

Force of Will

"You may not be intrested in war but war is interested in you."

Leon Trotsky.

In an article recently published in Newsweek a retired lieutenant general and author of a book on President Ulysses S. Grant asks the question, 'How does a president become a great commander in chief?' This is a paraphrase on the old adage that says, 'Some are born into greatness, some achieve greatness and some have greatness thrust upon them.'

Just because a person is seemingly gifted and almost mandated by his or her extraordinary power does not mean that all of these gifts and promises will be realized. It is sometimes presumed that great leaders accomplish great things by the force of their will but it would be wrong to forget that often even the greatest achievers in history spent years struggling for recognition and acceptance. To reach the top takes perserverance, luck and an almost maniacal dedication to your cause or idea. If you are Saddam Hussein it helps to be born with the personality disorder described as 'malignant narcissism' and to be raised in a culture of violence and abuse. If you are Tiger Woods it helps to be possessed of supreme focus and concentration. Matt Lauer was fired from four other network anchor jobs before joining the Today Show thanks to his relentless perserverance. Clearly, Barak Obama will need to pull out every weapon in his tremendous personal arsenal to achieve greatness and save all of us in the coming years from our economic peril. We anticipate that he will use his gifts to achieve greatness for all of us.

In the meantime, we can all help by being the best people we can be. As stated so poetically in a classic Keanu Reeves movie, "Be excellent to each other."