Daring Greatly

"The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs and comes up short again and again...who spends himself in a worthy cause; who, at the best, knows, in the end, the triumph of high achievement, and who at the worse, if he fails, at least he fails while daring greatly."

Theodore Roosevelt

The concept of 'daring greatly' is one I try and inspire in my patients on a daily basis. When patients who are in pain come in for treatment I try to elevate them to new heights of committment to their recovery. When smokers are trying to quit, hypertensive patients are trying to lose weight and when patients who have sustained some injury in the course of their work, I try to help focus them to move the patients to a successful conclusion to their problem. Getting our 'game face' on as we turn and walk back into the fire to face more bullets is important in the healing process.

Too often in life, we all get dragged down by misery and drudgery especially when struggling with a health issue. It is part of the doctor's job to prescribe treatment to be sure but our patients rise to the challenge and succeed much better when they are infused with a do-or-die attitude and a fighting spirit.

The next time your doctor starts you on a medication, fixes a laceration or tells you that you have a new health challenge to overcome, remember that there is some fight in you and that going down swinging is better than just going down quietly.

Once more into the breach, dear friends!

Special Purpose

Navin: "Wait a minute - what's happening to my special purpose?"

Patty: "What's your special purpose?"

Navin: "Well when I was a kid my mom told me... there goes my special purpose! And someday I'd find out what my special purpose was!"

Patty: "Today's the day!"

Navin: (the whole trailer shakes) "Hey, this is like a ride!"

The Jerk - 1979

Now that my family is getting older and my kids are starting to wise up to "things", I find myself reaching back for humorous references to sex as a way of comforting my soul. Father's are not supposed to be very comfortable with explaining these things to their daughters. I would think that with all of my experience, it would be pretty simple. But my insides get all twisted up and I find myself wanting to just change the subject when it comes up or when I think the conversation will suddenly lurch towards human reproduction.

Kids just spring this stuff on you without warning. One minute you are talking about math homework or the gravity on the moon and the next minute you are comparing tampons to pads. I paste a stupid smile on my face and say, "Gee, I'm not sure how much a tampon weighs on the moon" and they look at me like I'm someones poor, lost, injured, ugly cat.

Guess I'll just practice my lessons on life in the mirror just in case so I don't look too much like an idiot to my daughters. That would not be cool.

Thank goodness for Steve Martin.

My Vermont Neighbors

Samuel Kaymen, Founder of Stonyfield Farm, was born and raised in Brooklyn, New York. Samuel founded Stonyfield Farm in 1983. Samuel, his wife Louise and their six children milked, fed and cared for the small herd of Jersey cows, and made the first batches of Stonyfield FarmYogurt in a little room off their barn. After 17 years in the yogurt-making business, Samuel is going out to pasture with the rest of the cows!
Samuel and Louise are growing their own food, cutting their own firewood and getting their electricity from the sun.


This an interesting biography to me because I knew Mr. Kaymen back when we were all growing up in southern Vermont. He was a very high energy sort of fellow who was always out with his cows and carrying milk pails. Later, when I was in high school at a Waldorf School called, High Mowing School in New Hampshire, Sam's children attended and he worked on the farm there teaching the students basic animal husbandry. It is interesting to contemplate how someone so ahead of his time in the area of organic and sustainable food sources could have built a national brand based on his idea.

At the same time our family lived near the Kaymen family, my parents started a health food store called, The Butler's Pantry in Westminster West, Vermont. The store was one of the first in the state to offer grains, dried peas, lentils and so forth in bulk. Customers could purchase grains by the pound by scooping these from large bins. This was very unusual concept at that time. We ultimately built our own home and heated and cooked with firewood. We had indoor plumbing but there was also a hand pump in the back yard. We had a garden and would drive to a small dairy in Brattleboro with our gallon jars and the farmer would fill these up with fresh milk for us to take home.

Our childhood friends were David and Stephen Major who lived up the road. David started a very successful sheep cheese business and Stephen became a large animal vet. The sheep cheese is an award winning product and is carried in exclusive shops all over the US and in Europe. The cheese is cured in a cave built for this purpose and here is a photo of the actual cave they constructed in Vermont. The following is a brief description of their enterprise;

The Majors have been extremely successful in recent years, receiving numerous awards for their cheese, including the prestigious “Best of Show” award at the 2000 American Cheese Society’s competition at Sonoma, Calif., and best U.S. Sheep Cheese at the 2001 U.S. Championship Cheese Contest.



Another friend and neighbor was Jesse Haas who is a successful and award winning childrens author. Her website is, http://www.jessiehaas.com/


Yet another was Philip Price who is a musician and whose father was a screenwriter for film and television. You can hear his music on: http://www.philipprice.com/


My mother, Ann Johnson emigrated to Israel and became a successful author in her own right. She has written four books and has done book tours and written articles for several publications. She lives on the West Bank in Israel and holds dual citizenship.

Miryam of NazarethWoman of Strength & Wisdom
Author : Ann Johnson
Format: Quality PaperbackPages: 128Dimensions: 6x9ISBN: 0-87061-233-6Published: Jul 2005
2006 Benjamin Franklin Award Winner for "Cover Design: 1-2 Color"
Woman of prayer, faith, and confidence--this is the Mary of Nazareth we meet in Ann Johnson's contemporary portrait of the mother of Jesus. Miryam of Nazareth is told in three parts: prayer reflections on the women of the Old Testament; a collection of Magnificats that use gospels events for personal spiritual enrichment; and a description of Mary's life among the followers of Jesus in Jerusalem after the resurrection of Christ. These three parts combine to reveal new depths for understanding Mary as a Jewish woman and the mother of Jesus.

Summary: The most astounding thing about these people is that we all lived in the same village in Vermont at the same time all within two miles of each other. It was no accident that there seemed to exist this creative pool of artists, writers and craftspeople. Vermont at that time was a sort of mecca for people who wanted to return to a simpler life and create a quality family environment. Westminster West, Vermont is such a tiny village that it has no stop sign and no store. The nearest town is Putney which is famous for it's co operative health food stores, the Putney School, cross country skiing and home to a Nobel Peace Prize winner.

The First Fifty

"I have enjoyed greatly the second blooming that comes when you finish the life of the emotions and of personal relations; and suddenly find—at the age of fifty, say—that a whole new life has opened before you, filled with things you can think about, study, or read about."
Agatha Christie (1890-1976)

In less than a week I will be turning 50! This means that most of the very active first half of my life is over and I will be starting off on the second half. I have a few regrets about the first fifty years, regrets about all the ways I treated others;

- That kid at summer camp who I picked on and teased? I really should have gone a step further and really made him pay for picking on that other kid.

- That girl in high school (I never remember her name) should have gone out with me instead of that guy who I punched and told he was a real loser (I always forget his name too).

- That kid I gave the bloody nose to in second grade because he was picking on some other kid? He should'nt have climbed up that tree where I could throw road apples at him all day until he cried. (I was only in second grade but it was too good an opportunity to pass up).

There are other regrets but if I listed them here it would make me look like a softie and I'm a really tough-as-nails doctor.....okay, okay... family doctor (we can't all work in the ER).

Fifty is going to be really cool. I still have pretty good knees and my eyes are still okay as long as my bifocals don't turn into trifocals. My kids think I should get a tattoo and an eye patch so that will be pretty fun then I can be a Dad and a pirate. My wife still thinks I'm still handsome and now that my hair line is receeding things are really going to heat up at my house around Valentine's Day (if you know what I mean) and as long as my back does'nt give out, I'll be able to still do some killer pushups at the beach in front of the refreshment stand when everybody is watching.

Anyone interested in doing the half Ironman in July in Providence should sign up since I'll be racing this summer. I'll be the one at the starting line on the beach getting ready for the swim with the red Superman cape around my neck and an ego as big as a house.

Note: I would like to thank my parents, brothers, sisters, wife and children for putting up with me and for being such a great support. I try to call my family on birthdays and holidays but I sometimes forget. It must have been a trying first 50 years for them so I pledge that the next 50 will not be so difficult. I'll change and try and be a better son, brother and husband. In the next 50 years, my family will not recognize me because I am going to be less egotistical and pay a lot more attention to them. Because they are all very important to me and besides....I might need someone to help me find my trifocals.

Fatherhood and The Crackpot

"Everybody has the right to express what he thinks.

That, of course, lets the crackpot in.

But if you cannot tell a crackpot when you see one, then you ought to be taken in."

Harry S. Truman

I worry about my daughters and fret over the partners they will choose as adults. It is intensely interesting to me to hear how others have coped with this source of stress and to be an observer as young families in my practice grow and disperse. The life stories and experiences that people have are far more interesting than the life events of the rich and famous in the tabloid magazines that seem to appear in our office lunchroom. I was speaking to a patient today whose daughter has recently been married. The patient seemed pretty pleased with the match but is not sure how things will work out. This daughter has been in my practice for several years so hearing that she had survived her teen years and gone on to forge a serious relationship and ultimately become married was a great relief. I do not have any sons so I have no idea how fathers and mothers cope with the hazzards and trials of growing teenagers. I do recall being one once but it was a lot more fun being an adult.

The wiley 'crackpot' is always out there, lurking in the malls and college campuses. This chap may look like an upstanding citizen and may have a pedigree or resume that proclaims him to be someone who might impress me as a future father-in-law. But I have a sneaking suspicion that my young daughters will have a few bumps along life's road as they navigate along, veering around the various crazy people, crackpots, co dependents and other types that threaten to derail their happiness along life's highway. As a professional 'Crackpot Spotter' I will be ever on the alert for these ne'er-do-wells that may come along. My daughters are just going to have to put up with my superior judgement and go along with my suggestions as they grow older.

Father knows best....not!

*Cartoon Credit: Lawrence Gilson

Revenge of the Community

"If it was revenge, it was the revenge of the community."

Ian Fleming.

Recently, I have talked with several people who have been affected by close friends who have committed suicide. There is nothing subtle or petty about this incredible act of self destruction. This single act has left those behind without any mooring or compass with which to navigate the rest of their otherwise human experience. It is not only the family and associates of the victim who are affected but it is the community at large that suffers when a person takes his or her own life. Doctors also are often at a complete loss to comfort or aid those left behind, so overwhelming is this final act of one individual person.

Murder and aggravated assault have not been occupying my thoughts recently although when these occur in the community, it is equally devastating and there are even more victims involved. The community tries to right itself and go on as before but there is always and forever a void and a failing that lives within the people associated with these tragedies.

We humans are, by our nature so protective of our community of people. The "revenge of the community" in the opening quote might be simply a call to rally around the victims left behind in these tragedies and renew our committment to watchfulness and focused intervention when a member of our community begins to drift away. As a family doctor, I percieve these great upheavals in our town and among my patients and can only stand back and catch my breath like everybody else and wait for the storm to subside on the horizon.

Jackie Chan vs. Ozzy Osbourne

Sometimes the winds of fortune simply blow someone's way and sometimes a person has to sail their boat into the great storm of fate, risking life and limb just to have a chance at a lucky break. Let's examine and contrast the lives and careers of two famous people to see how they have achieved success.

Jackie Chan has become famous all over the world for his daring stunts and action movies. He is one of the first Chinese actors to cross over from the martial arts genre popular in the Far East and to make a name for himself in Hollywood. Jackie works when he is injured, he works when he is sick and he does everything he has to do to excel on the screen and to become an entertainment icon.

In contrast, Ozzy Osbourne seems to have been given a golden ticket in life. While he grew up in poverty and found his way to fame with his band, Black Sabbath, Ozzy seemed to lack a certain 'panash' for hard work and self promotion. His rise to fame and fortune seemed to rely mostly on the work of others, most notably, his wife and promotor, Sharon. Now well into middle age and an admitted alcoholic and drug addict, Ozzy still seems to drink from the well of life despite his infirmity and limited ability to cope with the basic tasks of daily living.

In a side by side comparison, let's see how these two stack up:
Jackie makes movies.
Ozzy makes....music.
Jackie has several black belts in all forms of martial arts.
Ozzy has several black belts.
Jackie's hair defies gravity.
Ozzy's hair does not defy gravity.
Jackie can jump up walls and kick over trucks to save the girl and get the bad guy.
Ozzy clings with both hands to his microphone stand....so he does not fall down.
Jackie has his own production company and works tirelessly to further his career.
Ozzy has...Sharon....and the kids.

Fate has been very kind to Ozzy who has managed to be in the right place at the right time despite his relentless attempts at self destruction. Ozzy has made a successful career of co dependency, on everything and everybody. Jackie Chan has taken falls, broken bones, taken personal and professional risks and sacrificed a great deal to ascend to the heights of fame and popularity. Fate is very strange that way.

So, the next time you are relaxing at home watching 'Rush Hour' and listening to an old Black Sabbath LP on your turntable, you might want to reflect on these two vastly different people, now in the twilight of their careers (especially Ozzy) and thank your lucky stars that you don't have to work that hard (e.g,Jackie) or be that lucky (e.g, Ozzy) to be happy and successful.

"Tea with Jesus"

At home, I have a whole book of toasts, anecdotes and proverbs. These tiny nuggets of sentement help define and construct a context for life changes and transitions. One of my patients, yesterday informed me that he thought his chest pain was so bad, "I thought I was going to be having Tea with Jesus." People articulate and anticipate upcoming life events, even tragic ones with varying degrees of anxiety and even humor. The way in which they express themselves offers a doctor a window into the patient's psyche and helps us to steward them through their transition. Even if the transition is their own pending death.
Here are some of my favorite toasts and anecdotes about the end of life:

"Here's to Luck and hopin' God will take a likin' to us!"
Cowboy Dakota

"Here's that ye may never die nor be kilt 'till ye break your bones over a bushel o' glory!" Old Irish Toast

"Here's a health in homely rhyme
To our oldest classmate, Father Time;
May our last survivor live to be
As bold and as wise and as tough as he!"
Oliver Wendell Holmes

"Here's to all of us: may God love us and the Devil respect us."
Unknown

"Here's a glass to the dead already-
Hurrah for the next that dies!"
'Cholera Hymn' of the British troops in India

One toast that dates back at least a century reads;
"A toast to our Doctors. May they never become friendly with our undertakers."

Cartoon Credit: Thanks to Lawrence Gilson.

Lyrics of the 1940's

The fellow on the right leaning into the microphone is my Dad, Russ Butler. He has been around radio and performing on the air since he was a teen ager. He built his own radio in his home and operated this small station in Jamaica Plain, Massachusetts until a couple of tough characters from the federal government knocked on the door. The story goes that my grandfather was given a choice of either going to jail or surrendering the radio my father had built. My Dad spent less time on the air after that and more time riding his bike.

My Dad still performs on the air and can be heard on 'Songbook America' which is streamed over the internet on an online music station called, Boston Pete (http://bostonpete.com/). He specializes in songs from the 40's and 50's and has a personal collection that he travels with and stores wherever he goes. My brothers and sisters and I have fond memories of listening to his programs and watching him do live 'remote' broadcasts over the years. He also worked in television off and on and would put us in commercials and fit us kids in somehow to what he was doing. We are very proud of our Dad and his career in radio. But the words to some of those songs are really...well....memorable.

Here are some interesting and fun titles and lyrics from the 1940's.

We're Gonna Hang Out The Washing On The Siegfried Line. Sung by Flanagan & Allen written by Jimmy Kennedy & Michael Carr.

Ain't Nobody Here But Us Chickens. Louis Jordan & His Tympany 5.

Powder your Face with Sunshine. Evelyn Knight- words and music by Carmen Lombardo and Stanley Rochinski
"Powder your face with sunshine
Put on a great big smile
Make up your eyes with laughter
Folks will be laughing with you in a little while
Whistle a tune of gladness
Gloom was never in style
The future's brighter
When hearts are lighter
Smile, smile, smile!"

Perry Como sang, Chi-baba, Chi-baba
"Many a year ago in old Sorrentoa certain ditty was quite the thing
Whenever a mother rocked her baby in Sorrento
this little ditty she used to sing:Chi-baba, chi-baba, chi-wawaAn' chi-lawa kook-a la goombahChi-baba, chi-baba, chi-wawamy bambino go to sleep!"

Louis Primo belted out, "Hey, Ba Ba Re Bop Hey! Hey! Ba-Ba-Re-Bop (Hey! Ba-Ba-Re-Bop) Hey! Ba-Ba-Re-Bop (Hey! Ba-Ba-Re-Bop) Yeah, my baby knows Matilda Brown told ole' King Tut Say if you can't pay me five, just keep your big mouth shut."

Managua, Nicaragua- words by Albert Gamse, music by Irving Fields- as recorded in New York November 15, 1946 by Guy Lombardoand His Royal CanadiansManagua,
"Nicaragua is a beautiful town
You buy a hacienda for a few pesos down
You give it to the lady you are tryin' to win
But her papa doesn't let you come in."

I don't know about you but I think someone should remake some of these great songs! Keep up the great work, Dad!

Operation Redemption

When you travel, work and live outside the borders of the United States, (keep in mind that I'm not talking about vacationing in Cancun or a cruise to the Mediterranean) the world appears to be a very different place than the one we know. Our standard television news sources in the U.S are generally considered to be among the poorest in the world so we subsequently have little news of events that do not directly concern us. Whenever I am in the public library or the bookstore I like to pick up a copy of the International Herald Tribune or the Christian Science Monitor to get some perspective on the world outside of the borders of America and to read about events that never make it into our press. The BBC World Service is generally more informative than many of the news programs especially about the events in remote corners of the world. National Public Radio offers very detailed and informative news about people, places and newsworthy events. The stories are not limited into segments lasting 15-30 seconds and are not sponsored by commercial ads. Network television news in America limits itself to only a few minutes of international news and only to the stories that American's would be interested in. After the news is over the networks return to entertainment programming.

We have recently elected a President who, by his race and multi cultural upbringing, represents an amalgamation of a greater international community and is, for these same reasons, exactly the polar opposite of the type of man we have elected to the office in all of our history. President Obama is not white, he is not a product of the Washington beltway and he does not come from American aristocracy or a powerful family. Mr. Obama is the kind of President that the rest of the world will regard seriously because he is so different. As a result of President Obama's election, we American's will be held in higher esteem by the rest of the world because we have chosen him as our President even when we were offered a more traditional, white conservative male as one of the front runners. As an exceptional orator and communicator, President Obama should be the able to help convey our views and opinions to the rest of the world. His presence as our Commander in Chief cannot help but elevate our image to those who we must do business with and communicate with in the critical years to come. The election of President Obama by the people of the United States, whether we agree with his policies and opinions or not will make the day to day business of living in the world community easier and safer for all of us.

The world is a very different place than it was in the days of FDR, JFK and even Jimmy Carter. The world is smaller, more efficient and more accessible. Barriers that once defined a nation or a group are being redrawn with the new tools of the global internet. Commerce, war and nation building are happening on a scale that bears no resemblence to the world of even ten years ago and if we do not have the tools as a nation to forge alliances and plot new solutions to our problems, we will continue to be dominated by countries that have developed these solutions. In my opinion, as we move ever more precipitously onto the world stage and find fewer and fewer ideas to grasp onto that we once thought of as purely American, we are lucky to have this articulate, serious, pensive and dedicated President to lead us where the old guard never could.

The Valley of Fear: Part 2

I have 'issues' with floor vibrations and deep thumping sounds.

In 1982 I finally left northern Israel after living on the northern border on the Golan Heights for two years. During those years, my settlement in the Gallilee was exposed to Katyusha rocket fire, terrorist infiltrations and Syrian and Lebanese tank deployment and other military posturing for nearly the entire time. Those years of explosions, nights in the bomb shelters and near misses in the fields near South Lebanon left me with an aversion to loud noises and shaking floors and walls. I stayed on as a volunteer for the first three months of the Lebanon War and then returned home to America to pursue my college education. I will always regard those volunteer years as some of the best and most important years of my life.


At 5:04pm on the afternoon of October 17th, 1989 while in organic chemistry lab, I found myself ducking for cover under my lab bench as my University and, the whole Bay area was struck by a 7.1 magnitude earthquake. The epicenter of the quake was near my home in Santa Cruz, California. The area would rumble for weeks and hourly records of the aftershocks would be printed in the morning paper each day. We had no water or electricity for over a week and both my home and the hospital where I worked suffered major structural damage. Students who lived near the epicenter had to sleep on living room floors of their friends near the University so they could attend classes because Highway 17 which connected Santa Cruz to the central valley was erased by landslides. I was reacquainted with the strange feeling of dread sleeping out in the backyard as aftershocks rocked our damaged home night after night.

A recent study at Oxford University poses an unusual therapy for people who have just gone through a trauma or stress that is likely to leave them with fear and anxiety. The therapy consists of playing a video game. According to researchers, people who are asked to play the popular game, 'Tetris' soon after psychological trauma are less likely to live with post traumatic stress disorder. The theory is that if the victim is forced to play the game for a couple of hours soon after the event, the game will limit the possibility of the brain developing the well worn pathways it needs to establish a post traumatic stress disorder. Tetris requires the player to recruit so much of the brains resources to play the game that, "the brain would be unable to form the memory links that form the basis of a trauma flashback" according to the New Scientist publication.

Children and adults who grow up in and around violence or disaster suffer nightmares, anxiety and panic disorders, mood disorders, eating and sleeping problems and so on. They perform poorer in standardized tests and have difficulty concentrating on tasks and problem solving.

When we have the option to speak a little quieter and a little kinder to one another and to make a little less noise in the world, then we should take that opportunity. Some of us value a little peace and quiet.



Photograph Notes: These photos are from my personal portfolio of some of the settlement children during one of their trips to the firing range near Kibbutz Gonen, Israel and of scenes in the town of Santa Cruz, California during the earthquake in 1989.

The Valley of Fear: Part 1

"Tramp-tramp-tramp; thats the dead; tramp-tramp-tramp; the're coming after me; but I won't go-Oh, they're here! don't touch me-don't! hands off-they're cold; let go- Oh, let a poor devil alone!"

Quote from 'Huckleberry Finn' by Mark Twain

There are currently over 1000 billionaires in the United States. A billion is equal to one thousand million: 1 000 000 000 or 10 to the 9th power. Last night I was watching a television show about the 'super rich', how they live their lives and spend their money. It turns out that the billionaire that was profiled on the show made his money buying and selling companies for a profit and he continues to do this even though he clearly has lots of money. He continues to work, "because it is challenging." I watched this businessman board his private jet and fly to his yacht in Florida with his friends. I learned that this person has four children and is divorced and suddenly, I found myself thinking about fear. What could this person be afraid of with all of his wealth, connections and power?

As a college student in San Jose, California I had a chemistry lab partner named, Penny who later went on to become a physician. Penny was 'bookish' and slightly built with a pixie haircut and large round glasses. You might see her in passing and think that she should be a librarian or a kindergarten teacher. She was quiet with a wry sense of humor. She had a boyfriend somewhere and seemed to do well on her chemistry tests. I always asked her how she was doing to make polite conversation. As the weeks and months went by I learned that Penny was addicted to gory, slasher movies. 'Halloween', 'Halloween II', 'Night of the Living Dead' and movies like that were her genre of choice. Penny did'nt just rent these films she would actually go out and walk the streets of downtown San Jose (not known to be a quaint, safe town in those days) buying tickets to go into dark movie theaters in the middle of the night. She would sometimes finishing one horror movie, leave that theater and go out to find another one the same night in a different theater!

I spend a good part of each day with my patients discussing, processing and grappling with fear and anxiety. The physical and emotional manifestations of fear constitute the majority of my work as a doctor. Fear begets anxiety which leads to perseverating thoughts which lead to sleeplessness, poor nutrition, gastritis, chest pain, headaches and....more fear.

I came to the conclusion (after seeing the billionaire on his jet and yacht and walking around in one of his mansions) that his fears are probably the same ones that plague us all and that his money has not granted him any more peace than the rest of us have. My lab partner, Penny must have her own tidy packet of fears but these do not, obviously include the fear of being surprised in a dark room and hacked to death with a pair of pruning shears. The internet is a great place for people to discuss their fears and to find communities of like minded anxious and fearful people to commisurate with. Fear is a defense mechanism but I wish there was a way we could just snip that gene out of our human DNA and just get back to the old 'fight-or-flight' problems that the gazelles and the gophers have to deal with.

Author's Note:

I've never actually seen a slasher movie or met a billionaire (but movies that feature pruning shears give me the willies.)

Holes to Heaven

"There were so many fewer questions,

when stars were still just the holes to heaven."

Jack Johnson

I stand in awe of pediatricians. In my opinion, this particular specialty of medicine requires such an amazing personal and professional skill set and such focus that there are times when healing children seems almost like divination. To be a good doctor you have to have what is called a 'fund of knowledge' which is acquired over years with constant study and practice. This database of experience and wisdom comes to live deep down in the pit of a doctor's stomach and launches whispers and warnings to the brain day and night. Every doctor lives with the doubt, fear and anxiety that comes with the responsibility of caring for people and safeguarding the health that is entrusted to them. Pediatricians must face the additional challenge of gleaning information from their small patients with little verbal communication. At least thats how it seems to an outsider. Pediatricians must learn to speak 'baby talk' and communicate with children on a whole different level than they do with adults.

To be a good doctor, it is vital to develop a sort of sixth sense to percieve the patients symptoms and exam findings on several levels that will lead to a correct diagnosis. Along with a fund of knowledge to relate the physical findings to, doctors have to have a finely developed afferent sense. To be truly afferent is simply to be remarkably intuitive. To be aware of the sensory data you are picking up and to be able to organize these data and formulate an opinion and act on it to bring about the health of the patient. Pediatricians have to be the most intuitive doctors in all of medicine. Their patients are small, they have developing organ systems, they are poor verbal historians, the historian may be an unreliable, anxious or biased parent, the childs exam may be altered by several medications that have been tried at home and, to top it all off, the list of possibilities for a given list of symptoms may include five or six different critical illnesses. The pediatrician must bring their intuitive senses to work every day and even if they can't hit the ball out of the park, the pediatrician must at least get on base every time they step up to the plate.

As a family practitioner I have chosen not to include small children in my practice. While I am an intuitive doctor, work hard at my profession and bring my 'A Game' to each patient encounter, those whispers in my head at 2am that come up from the pit of my stomach don't launch me into a panic anymore and I can, at least try to go back to sleep.

The next time you see your child's pediatrician, remember that you are seeing an extraordinary doctor who has chosen to care for the most important members of our society and must do this with kindness, grace, a whole barrel of knowledge and an almost mystical intuition.

In the science of neurology there are two types of nerve pathways; 'efferent' and 'afferent'. Afferent: 1. (physiology) of nerves and nerve impulses; conveying sensory information from the sense organs to the central nervous system; "afferent nerves"; "afferent impulses".

Rocky Goes Down

Our office has a storied past and the staff that work for me have a long history together. In times of stress or when they have a few minutes to relax during the course of our busy office day, the staff love to get together and remember the good old days and to share a laugh or occasionally a tear as they look back on their years together and the memories that they hold dear.

The staff in my office had a sort of communal pet once. He was not much of a pet but he was quiet and resided in the back of the office. He lived in a vase of water. He was a silent, slow moving fish named, Rocky. Rocky had bulging eyes and a hopeful, fishy demeanor and offered constant comfort to his friend, Dave. Dave is our lab technician and who raised Rocky from the time he was just a young fish. Rocky, like most fish had a retentive memory of approximately 3 seconds so in all likelihood, each time he laid eyes on his friend, Dave, Rocky considered him a new friend. To Rocky, the world outside his vase was just chock full of brand new friends every day. He must have felt very loved. He must have been....happy.

One day, Dave decided to change Rocky's water. Since Rocky swam in a vase full of water, the easiest way to get the old water out was to pour the water out of the vase before putting fresh water in. Poor, trusting Rocky. Nobody knows for sure what happened that fateful day. Rocky could have been a little too close to the rim of the vase. He could have thought he was going to get a bit of fish food so he swam slowly up to the surface before the water was to be changed. No matter what the cause, Rocky went out with the water into the office sink near the lab.

In his final moments before plunging down the sink drain, Rocky seemed to come to the realization that his most recent friend (of the past three seconds) was doing him a grave injustice. Rocky went down the drain quickly yet he seemed to look over his shoulder as he disappeared into the small, dark drainhole. As the story goes, Rocky cast one reproachful (yet panicky) eye back up at the disappearing sky and peered directly into the soul of the friend who had cared for him since birth. In a last desparate act, Rocky seemed to flick one of his pectoral fins in the air as though flipping a last fishy 'bird' at the world before descending forever. Then he was gone.

Dave was inconsolable...for about three seconds.

The Mind of a Brain

The more I think about it, the more I am convinced that the brain has a mind of it's own. We are in possession of a miraculous organ in our bodies that can reason, act, sleep, create, dream, run a gazillion different bodily functions and cause us to cry when Old Yeller gets killed at the end of the movie. Humans with brains that they are in control of can accomplish anything. Anything. When the brain begins to change or to behave in strange ways then the human it controls also begins to act in strange ways. The forces that act on our brains have great impact on the neuro hormonal 'landscape' that the brain uses as it's triggers and pathways.

One of the landmark behavioral studies was done using beagle dogs many years ago. The dogs were happy and friendly and well adjusted when the experiment started but due to the external forces that the dogs underwent during the course of the experiment the dogs behavior and overall health changed. This experiment called for the dogs to be placed in a cage which had a floor which could have a low intensity shock run through half of the cage leaving the other half without any shock. The beagle would be primed with a flashing light and within a predetermined number of seconds, the half of the cage would have a current run through it for a few seconds. The dogs remained happy and healthy because these variables were predictable and the dogs could control the stimulus by simply recognizing the signs and moving to the other side of the cage to avoid the shock.

The experiment changed after a time and the dogs were put in a chaotic situation. The signals were all mixed up, either side of the cage could now have a current run through it so from minute to minute the friendly beagles were subjected to intense stress. The stress then caused them to be anxious, sleepless, to lose weight and to develop other conditions that we now can find in humans.

Examples of social stress, substance abuse and all manner of insults to the brain have long been documented. We are really at the mercy of our brains and in the final analysis, the brain holds all the cards. This simplistic narrative is one I always consider when treating patients with chemical addiction. The neuro hormonal landscape has changed for these patients sometimes forever. When the brain is repeatedly introduced to cigarettes, alcohol or drugs (including many prescription drugs) it becomes acclimated to the substance and begins to make a place for the substance within the milieu of the brain. Too much substance causes change and change is a bad thing for the brain.

We are uncovering more and more about how our minds work and while I see many people each week for stress related illnesses, it is always important to try and help the patients to get to the root of the problem if possible and reduce the stress or the unpleasant condition that is causing the reaction if possible. People with many types of depression and anxiety, bipolar illnes and a hundred other conditions try to live each day with the neurons and synapses that they were born with. These people did not cause their conditions, they inherited them.

A healthy brain with all cylinders firing correctly can achieve great things. A person who struggles with mental health conditions often has the most devastating type of disease of all. When you can't trust your own internal compass to guide you and run your body reliably, the world becomes a very scary place indeed.

The Gilligan Factor

Gilligan's Island is an American TV sitcom originally produced by United Artists Television. It aired for three seasons on the CBS network, from September 26, 1964 to September 4, 1967. It was sponsored by Phillip Morris & Company and Proctor and Gamble. The show followed the comic adventures of seven castaways as they attempted to survive and ultimately escape from a previously uninhabited island where they were shipwrecked.
Gilligan's Island ran for a total of 98 episodes. The first season (consisting of 36 episodes) was filmed in black-and-white though they were colorized in later syndication. However, the next two seasons (62 episodes) and three TV movie sequels were filmed in color.
Enjoying solid ratings during its original run, the show grew in popularity during decades of syndication. Today, the title character of Gilligan is widely recognized as a comedic American pop culture icon.

Executive producer Sherwood Schwartz believed in avoiding exposition, and so he composed the sea shanty-style theme song, "The Ballad of Gilligan's Isle", as a capsule summary of the castaways' predicament. This was done so that first time viewers would instantly understand the premise. He took the same approach with the themes to "The Brady Bunch" and "It's About Time".

Quoted from Wickepedia

Gilligan's Island almost never made it past the first pilot episode. The shows creators had latched onto a great concept and had produced the show well, the character development was there but the audience was not drawn in and the early audience tests floundered. The key to the success of Gilligan's Island lay in the theme song. The producers discovered that the audience needed to be oriented each time the show aired so that they could have that 60 second explaination to allow themselves to be transported to the remote desert island. Without that psychological push, the audience could not make the emotional journey to join with the castaways. Without the theme song, the show began too abruptly and the audience could not get settled into the plot.

When Sesame Street was getting ready to air, the producers and consultants felt strongly that the puppet elements should be separated from the 'real' street and human elements of the show because the child psychologists who were involved with the concept felt strongly that mixing these two elements would confuse the child viewers. As Malcolm Gladwell details in his book, 'Blink' with only six weeks to the air date of the first show and with six episodes of Sesame Street already taped, their early testing was disappointing. Children would tune into the program when the puppets came on and would become disinterested when they saw only children and adults interacting.

These are not just stories about television shows, they are also a reflection of how humans engage and are brought together to experience a common idea. Teachers, doctors, parents, police officers, social workers and all of us who work fundamentally in the communications business, in direct contact with people as caregivers and communicators need to pay attention to finding the key that unlocks the message for the audience. For doctors, finding that key element to communicate the standards of health care to our patient makes the difference in the health of the patient. Empathy, active listening and compassion are part of this rapid communication strategy. Using the space within the treatment room, recognizing and disarming patients' preconceptions and biases are also keys to the success of a good communicator.

If it had not been for the theme song, audiences may never have been drawn to Gilligan's Island. If the puppet elements had been left off of Sesame Street and large, interactive puppets such as Big Bird and Oscar the Grouch had not appeared on the same set as the human cast, then the empire that would become the Children's Television Workshop might never have happened. Mr. Rogers' Neighborhood relied on close intimacy to join with the small children who constituted his audience. Fred Rogers was a gifted communicator and visually utilized the space within his home to physically stay close to the ground (where children spend most of their time) so as to appear less threatening. If you watch tapes of the show you see that he values direct eye contact and brings himself up to his full height physically when he is proud of something or wants to convey a message of the importance of self esteem and self worth.

Sometimes when I am speaking with a child I recall the demeanor of Mr. Rogers. There are times when I am trying to find ways to communicate with a difficult patient, I think of the creativity of the Sesame Street producers.

(I'm still pondering the many facets of Gilligan's Island.....)

"Most Peculiar, Mama"

John Lennon is considered by many to be one of the greatest performers and songwriters in our modern era. His work will live on for generations for it's creative and inspired lyrics and imaginative progressions. I was listening to a compilation of his songs this morning on the way to work in my car and something struck me as....odd. John Lennon seems to be able to say almost anything in his lyrics and get away with it, even if it sounds, well, not like a real song lyric.

Let's review lyrics from some of Lennon's most popular songs;

"Instant Karma's gonna get you"

"When they've tortured and scared you for 20 odd years,

then they expect you to pick a career"
"Yoo Hoo!"

"O' sanity, o' sanity, What am I to do with you"

"Rocky Raccoon, fell back in his room"

"When you get to the bottom you go back to the top of the slide"

"We all live in a Yellow Submarine"

"Ob-la-di, Ob-li-da life goes on"

Lennon and the Beatles created music that spoke to a world of listeners on a visceral level and this is evidenced by some of the strange music they produced and made wildly popular. As I listened on the way to work this morning I found myself thinking that the music and the arrangements were so well constructed that poor old John could have sung the lyrics to 'Do You Know the Muffin Man' backwards and it probably would have sounded really snappy.

I often think that John was playing his little joke on us mere mortals and it must have amused him to create great music and then populate the tunes with really strange lyrics. He would smile and put on his round dark glasses and stand in the back of a music festival and listen to thousands of young people sing out with all their hearts, holding hands together, eyes closed and tears streaming down their faces;

"Happiness is a warm gun...bang bang, shoot shoot..."

If I were to try and write a memorable lyric it might be something that I could sing to my wife on our 60th wedding anniversary. Lyrics that I could be proud of. My song (dedicated to my wife) would go something like this;

"Grow old along with me

Whatever fate decrees

We will see it through

For our love is true

God bless our love

God bless our love"

(Oops, these lyrics were also written by Lennon. Damn!)

Mary Poppins' Baby

P.L Travers is the creative author of the children's book, 'Mary Poppins' and the sequel books about this famous character. In the story, 'Mary Poppins Comes Back', a newborn baby in the Banks home named Annabel delivers a detailed description of her own recent birth experience. Keep in mind as you are reading this transcription that the narrator is a newborn baby girl and that the book was first published in 1935. In the story, the newborn is actually talking with a bird who has lighted on the windowsill and that the narration is being overheard by Mary Poppins who understands the language of animals, birds and, apparently, newborn babies.

Annabel moved her hands inside the blanket. "I am earth and air and fire and water," she said softly. "I come from the Dark where all things have their beginning. I come from the sea and it's tides, from the sky and it's stars. Slowly I moved at first," said Annabel, "always sleeping and dreaming. I remembered all I had been and I thought of all I shall be. And when I had dreamed my dream, I awoke and same swiftly. I heard the stars singing as I came and I felt warm wings about me. I passed the beasts of the jungle and came through the dark, deep waters. It was a long journey." Annabel was silent.

What is amazing to me as I read this story to my young daughters before bed is that the description is one that they can visualize even if they are really too young to fully understand the birthing process. At storytime tonight, my daughters looked curiously over at me but did not really ask specific questions like they usually do. The girls simply closed their eyes and accepted this unusual narrative as told by a baby to a nanny and a little bird in an English nursery long ago. The elegance of this type of fantasy storytelling and the gift of P.L Travers is that by creating a very simple dialogue, the reader is transported, abandoning reality altogether. As I read the story to my daughters, I became aware that this simple narrative was believable and compelling even though it was only a few sentences long. My girls believed it and enjoyed hearing the story for its prose and grace and are sound asleep as I write this entry.

Note: P.L Travers (1899-1996) was a drama critic, travel essayist, reviewer, lecturer and the creator of Mary Poppins. Travers wrote eight Mary Poppins books among her other works for adults and children.

The Buddhist Family Christmas Letter

Close friends of ours have a son who is in graduate school to earn his advanced degree in Buddhist Studies. I have changed the name of the student but have recreated the family Christmas letter.

"The last time Joshua had a grip on reality occured when he was beginning high school and agreed to eat a plate of pancakes, even though one pancake had a clearly visible blueberry protruding from it's edge. For the last year and a half, Joshua has been living on the upper west side of Manhattan while taking courses in Tibetan, Sanskrit, and Buddhism, and earning an A+ on his recently published paper, entitled, 'If There is No Reality, How Can There Be Reality Shows?'. To create the illusion that he is earning money, he has been moon-lighting as a Buddhist country and western song writer. His most recent song, 'Take This Reality and Shove It' promises to be a big hit in the Red states and with his mother although she encouraged him to change the title of the song to 'Take This Reality and Maybe Don't Think About It So Much' in order not to offend anyone. Joshua's father feels that the song title should be changed to, 'You Can Take Your Reality and Shove It, But Keep Your Hands Off Mine'.

Reprinted without permission (but I'm sure it's okay). 2009

Fall Down Seven Times, Get Up Eight Times.

"In dealing with disappointment we build strength and character. How we approach life's disappointments is just as important as the victories, and it occurred to me in Kona that maybe the two aren't so different after all. We humans like to label things as "good" and "bad." In reality, there is just stuff that happens, and we must deal with it. There is no intrinsic positive or negative value to events, only to our own interpretations."

Ironman Triathlete Samantha McGlone

In 2003, I completed the Ironman triathlon in Lake Placid, New York. I crossed the finish line after swimming 2.4 miles, biking 112 miles and running 26.2 miles 15 hours and 20 minutes after the race began at 7am. Racing from 7am to almost 10:30pm is a humbling experience and when I say 'racing' this means going as fast as I could go even if it was a slow walk at times. The Ironman triathlon is the premier distance event in the world. Those months spent training and sacrificing the time and energy to get to the starting line, compete and ultimately finish the race constitute one of my best achievements. This race offers the chance for an athletic 'nobody' to toe the line and compete with some of the finest athletes in any sport. It is a chance to achieve a level of personal gratification that goes beyond almost any other accomplishment I have attempted. Finishing the Ironman was my finest moment as a 'nobody athlete'.

Special olympic athletes, wheelchair athletes, athletes racing in memory of their loved ones, for fund raising or racing toward their personal recovery from an illness such as cancer bring a whole new dimension to sport and competition. The photo you see above is of a brave Ironman triathlete named Jon Blais from Seekonk, Mass. Jon raced the Ironman in Kona, Hawaii in 2005 and finished his race in the most memorable way possible, he rolled his body across the finish line and was met by his sobbing mother and father waiting for him at the end of the race. You can watch the You Tube video of his amazing story at the Ironman World Championships by clicking on; http://www.youtube.com/watch?v=9Vrjp2P0GlE. Bring a box of kleenex and prepare to watch a true athletic hero race and complete the premier endurance event in the world while suffering from Lou Gehrig's Disease.

Jon passed away from ALS on May 27, 2007 and while he is missed dearly by those close to him, his spirit and the lessons he has taught us all live on. Jon always believed in ending your story with a quote. Others have already said it best, so it's better to remember those and go out strong. So here goes… “The meaning of life is to live life”.

http://www.alswarriorpoet.com/