Dr. Iconoclast

My left atrium

This is a video of my left atrium. I had an ablation with Dr. Ashish Bhatia in Buffalo. Most atrial fibrillation is caused by little electrical signals coming down from the four pulmonary veins, so they zap little scars around the pulmonary veins to stop the signals from coming in.

I didn't get a chance to say on the radio today how important vitamin D is to people of color. Vitamin D discriminates racially. Darker-skinned people have a bigger problem because the ultraviolet rays are blocked by melanin in the skin. So African-Americans, for example, really, really need to take vitamin D to be healthy. The other side of this situation is that I, who am almost an albino, have to wear sun block if I go to Africa.

And you see very high rates of cancer, diabetes, heart disease, and arthritis in the African-American population of Buffalo. I don't think this is some kind of genetic thing, or some kind of supernatural curse - this is just vitamin D working in its hundred different ways.

"People forget where they come from." A statement by a custodian here at the hospital, who is getting a surgical tech degree, and notes that people are harsh on newcomers.

It's the human condition, isn't it? Psychologically we live with our past - it shapes our thoughts and reactions. But we like to forget the past sometimes. And when we don't remember it, and we don't meditate on it from time to time, it can control us in ways that are suboptimal.

Similar processes occur in history, and in the flow of human culture. Every word we speak is a metaphor invented by someone in the past, maybe a thousand years ago. Without looking at the origins of our culture, we risk being captured by its dark side, and making mistakes that we could avoid.

Saving the body, not the brain

You've heard about how huge amounts of money are spent at the end of life. That's my job. I'm the guy who spends the money.

It's fun to say, "Hey, it's not right to spend that kind of money. Somebody should do something about it."

But when it gets down to reality, it's not so clear-cut.

If there is any hope of recovery, even less than 1 percent for a 95-year old person with 12 chronic medical conditions, the American healthcare consumer (and their family) currently has the right to demand unlimited care. Would you like to be the person to say that we don't want to spend any more money on Grandma? I'm not interested in that job.

Because we are strident individualists and don't trust each other, any attempt at cutting back on care in these situations is seen as "rationing" and a conspiracy.

I hope I don't appear vain when I say I've gotten good at preserving the biological life of the human body in situations of extreme illness.

Unfortunately, sometimes the brain gets injured in the process.

I do not like to disrespect the dead, so let me say respectfully the following to the world: John Gardner's vision of Batavia, NY in the book The Sunlight Dialogues is not charitable, and not too accurate.

vacuum of honesty

One really interesting thing about being a doctor is that people tend not to tell you the truth so much.

This is apart, of course, from being lied to by patients about things they don't want to talk about, like sex and drugs.

I mean what people tell me about myself. I could have toilet paper stuck to my neck and for most of the day people won't tell me about it. Or I can tell a joke that, in retrospect, is really not funny, and people will laugh.

So I run the risk of making a total ass of myself. I guess this is the historic problem of "telling truth to power": it can get you in trouble, so people tend not to do it. 

dying for health insurance

Number of people who died in front of me in 2007 from diseases that could have been managed, had they had health insurance:   2.

fun contradictions in the ER

"I don't have money for the Tylenol for my kid," the parent says, holding a pack of Marlboros and a lighter.

email on vitamin D

SPhillips@opschools.org wrote:

Dear Dr. Merrill,

I want to thank you for your article on aging. My 91 year old mother has been hospitalized since February 14, 2007. She was transferred back and forth to both XXX and XXX Hospital, then to XXX.  She was on morphine , then Darovet, which are drugs she can't tolerate. They admitted  her as "comfort care" only, figuring she would die within weeks. The opioid analgesic medicines made her hallucinate and tremble. She was always crying. I had to write a letter to her doctor at the nursing home to take her off these drugs and give her plain Tylenol if she was experiencing pain.

During this time, I read your article which included information on Vitamin D deficiency. We had been told my mom would never walk again. I showed them the article and asked them to try giving her this vitamin. They acted a bit insulted that I was trying to tell them how to do their job but they complied. Within a short period of time, my mom was back to her normal mental condition and doing well at physical therapy. She is now independent in her room and will be coming home next week. I can't thank you enough for your insight. It is too bad that more people in nursing homes don't have family members to advocate for them. 

Sincerely, 
Sue Phillips

fun is morally necessary

I'm reading this book with my friend Bob.

Recently it is socially and morally important to have fun. There is tremendous peer pressure to spend distinct energy and money on this. I personally don't feel like I'm anybody because I haven't been on a cruise.

Why should something so personal become a mandated activity on a society-wide basis?

Short answer: the needs of the service economy.

Longer answer: Morality, like it or not, is about what is good for humanity as a whole. Somehow the zeitgeist, or the collective unconscious, has figured out that in order to keep everybody in a job, people have to spend money on things that previously were considered frivolous. So we have mandated fun from the service industry.