tag:blogger.com,1999:blog-62966691372997861552024-03-05T01:58:57.227-08:00In My Humble OpinionA primary care physician's thoughts on medicine and life.Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.comBlogger727125tag:blogger.com,1999:blog-6296669137299786155.post-79664205242396479692022-07-01T19:19:00.003-07:002022-07-01T19:19:23.364-07:00Taking Stock: A Hospice Doctor's Advice on Financial Independence, Building Wealth, and Living a Regret-Free Live Available 8/2/22 from Ulysses Press.<p><span style="background-color: white; color: #050505; white-space: pre-wrap;"><span style="font-family: arial;">Today I am announcing preorders of my book Taking Stock: A Hospice Doctor's Advice on Financial Independence, Building Wealth, and Living a Regret-Free Life. This is a moment of great pride for me as well as hope. </span></span></p><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="font-family: arial;">Pride because I truly believe that this book is the closest I can come to creating a true and succinct representation of my contribution. This is me unfettered. This is my legacy. I am humbled at the possibility and the role you all have played in bringing it to life. </span></div></div><div class="cxmmr5t8 oygrvhab hcukyx3x c1et5uql o9v6fnle ii04i59q" style="background-color: white; color: #050505; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="font-family: arial;">And hope. Not hope that I will make a lot of money (book writing is a horrible way to do that and I have enough money). Not hope that I will become famous (I won't). But hope that this book will reach as many eyes as possible and truly help people. My experiences with the dying as a hospice doctor give me a unique insight into money and life, and I want to share it. </span></div><div dir="auto"><span style="font-family: arial;"><br /></span></div><div dir="auto"><span style="font-family: arial;">Please click on the link below to see the book trailer and if resonates with you, please share the YouTube link!</span></div><div dir="auto" style="font-family: inherit; font-size: 15px;"><br /></div><div dir="auto" style="font-family: inherit; font-size: 15px;"><br /><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/ZG1SZtXbLig" width="320" youtube-src-id="ZG1SZtXbLig"></iframe></div><br /></div><div dir="auto" style="font-family: inherit; font-size: 15px;">Available for Preorder <a href="https://www.amazon.com/Taking-Stock-Financial-Independence-Regret-Free/dp/1646043545/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr=">here</a>.</div></div>Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com0tag:blogger.com,1999:blog-6296669137299786155.post-90620329215341185802018-04-18T18:40:00.001-07:002021-02-09T18:17:00.798-08:00The GoldiDocs Phenomena<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr6EQyads1S7aTOY70T1PGyLYs-9g2mljSw9WiWG9w324N07dcfmeBHv5_P4C-M3l6q7CN_ia4zsz5zsZ5HysM21lCdwQpCcwJOK7qdXuURQMmYZYYn8DgW-QBSW-V3RwnWQIepgeadjs/s1600/GoldiDocs.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="315" data-original-width="560" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr6EQyads1S7aTOY70T1PGyLYs-9g2mljSw9WiWG9w324N07dcfmeBHv5_P4C-M3l6q7CN_ia4zsz5zsZ5HysM21lCdwQpCcwJOK7qdXuURQMmYZYYn8DgW-QBSW-V3RwnWQIepgeadjs/s400/GoldiDocs.png" width="400" /></a></div>
<h2>
The GoldiDocs Phenomena</h2>
<div>
The world consists of three types of doctor. Three types of doctors who will grace your presence on any given stay in the hospital, foray into the nursing home, or visit to the office. You might have never given these archetypes a specific name, but they are immediately recognizable. </div>
<div>
<br /></div>
<div>
I'm not talking about medical knowledge or clinical savvy. I'm not pointing to differences in education or training. </div>
<div>
<br /></div>
<div>
Bedside manner. We're talking about bedside manner people! </div>
<div>
<br /></div>
<h3>
Dr. Too Grumpy</h3>
<div>
She storms into the room with her mobile phone glued to her ear. Or better yet, a blue tooth device. She spits sarcasm at the invisible nurse on the other end of the line, or medical assistant, or god forbid, patient. </div>
<div>
<br /></div>
<div>
She barely regards you as she types away at the electronic medical record. Questions are stated, not asked. Eye contact is minimal, and the exam is brusk. Mechanical. There is no discussion, just bald commandments. Patient centered care and shared decision making is scoffed at.</div>
<div>
<br /></div>
<div>
She will not describe to you the physiologic underpinnings. She will not discuss the pros and cons. And if you dare to delay her from attending to her next patient, she will regard you with scorn and sarcasm. </div>
<div>
<br /></div>
<div>
She is perfectly capable, yet utterly unacceptable.</div>
<div>
<br /></div>
<h3>
Dr. Too Nice</h3>
<div>
He will show his toothy grin as he coos in your ear. He will say that everything will be alright, even when it won't. His manner is soothing and infinitely gratuitous. You are the only one who exists at the moment. The only one he cares for. </div>
<div>
<br /></div>
<div>
He will give you narcotics if you ask for them. He will treat your common cold with antibiotics. The plan is to do what ever it takes for you to like him. For you to tell all your friends and keep coming back to his office. </div>
<div>
<br /></div>
<div>
He hates confrontation and would rather pander than have an honest, open conversation. Difficulty is his greatest adversary. Not illness. Not well being. </div>
<div>
<br /></div>
<div>
He will tell you exactly what you want to hear. Hold your hand. Lie through his teeth.</div>
<div>
<br /></div>
<div>
He is a perfectly nice guy, yet the most dangerous provider you will encounter.</div>
<div>
<br /></div>
<h3>
Dr. Just Right</h3>
<div>
There are, believe it or not, doctors who are both kind and calm, but firm and knowledgeable. They exist in every hospital, nursing home, and physician office. They might not be the favorite. They may upset you from time to time. </div>
<div>
<br /></div>
<div>
They know how to just stand there and do nothing. When nothing is called for. </div>
<div>
<br /></div>
<div>
They may lecture you on diet and exercise, smoking and alcohol, stress and anxiety.</div>
<div>
<br /></div>
<div>
But you will know them when you see them. </div>
<div>
<br /></div>
<div>
If you see them.</div>
<div>
<br /></div>
<div>
They're a dying breed.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_DnQN4BD4h5q5rCAvjtrAZ4lBIGhuyG7LFf7h33n_idmSFx6MjZWsnwTYYSJNXXCbQtesTRxnLJALXFIMEs9o2sRDZm07E8cTSQKLi0X8VGvpslb7agAowN9QT3Yb73e7qZ9pRB8uNL4/s400/Eand+I.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="225" data-original-width="400" height="142" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_DnQN4BD4h5q5rCAvjtrAZ4lBIGhuyG7LFf7h33n_idmSFx6MjZWsnwTYYSJNXXCbQtesTRxnLJALXFIMEs9o2sRDZm07E8cTSQKLi0X8VGvpslb7agAowN9QT3Yb73e7qZ9pRB8uNL4/w253-h142/Eand+I.png" width="253" /></a></div><div class="separator" style="clear: both; text-align: left;">If you want to hear more stories about medicine and personal finance, check out The Earn & Invest Podcast.</div><br /><div><br />
<br /></div>
<br />
<iframe allowfullscreen="" height="360" mozallowfullscreen="" msallowfullscreen="" oallowfullscreen="" scrolling="no" src="//html5-player.libsyn.com/embed/destination/id/826583/height/360/theme/custom/thumbnail/yes/direction/backward/no-cache/true/render-playlist/yes/custom-color/87A93A/" style="border: none;" webkitallowfullscreen="" width="100%"></iframe>Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com1tag:blogger.com,1999:blog-6296669137299786155.post-40381654218941028482018-04-14T04:13:00.001-07:002023-01-10T06:48:26.168-08:00What's Been Left Out<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXaAJTVcwxn7zH-BktAjhlSdOjJAyAtWk86n9x-s5qD4px_6142XnPKbCkp_w-NvBfAAs0gLMXX2K8NmwTGgNZDAiW07j4FB56NIptA2LpzRn1xXkKy6jFgMlvnEtzWcQACTRbc3jHDOM/s1600/Decision.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="315" data-original-width="560" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXaAJTVcwxn7zH-BktAjhlSdOjJAyAtWk86n9x-s5qD4px_6142XnPKbCkp_w-NvBfAAs0gLMXX2K8NmwTGgNZDAiW07j4FB56NIptA2LpzRn1xXkKy6jFgMlvnEtzWcQACTRbc3jHDOM/s320/Decision.png" width="320" /></a></div>
<br />
<h2>
Would You Do It Again?</h2>
Over on my other blog<a href="http://diversefi.com/">,</a> every Monday, I write Good Decision/Bad Decision posts. The idea is to dissect a decision, usually financial, from various viewpoints. Nothing we do in life is truly good or bad, there are always consequences. This week, I am going to tackle something a little more personal. Should I have gone to medical school?<br />
<br />
This question is fraught with emotional pitfalls. How could it not be? From the moment I can remember, I have wanted to be a doctor. It has been with me for every breath and aspiration. Now at the age of 44, Almost twenty years into my career, I can't help but look back and wonder. Was it all worth it?<br />
<br />
<h3>
What's Been Left Out</h3>
I love being a doctor. There are so many insights that I have gained by being on the edge of life and death with my patients. The privilege is such, that even my aptitude for verbosity, only manages to scratch the surface. I live a charmed life. I have been lucky.<br />
<br />
<b>But.</b><br />
<br />
Remember that when someone follows a statement with the word <i>but</i>, it means to forget every idea that came directly before. <br />
<br />
But, this profession has cost me dearly. <br />
<br />
It has cost time and money, strength and energy, character and innocence. I am not the man I once was. Not the man I would be if I chose business or law as my profession. There are many roads in life, who knows who we would have become if we chose the path not taken. <br />
<br />
<h3>
I know This Much</h3>
Medicine has hurt me. It has ruined my body and mind. I wake upon every morning fifteen years after residency with a shattered sleeping pattern. I go about my day immune to the everyday suffering of those around me. <br />
<br />
<i>You think... is bad. You should see the young guy I am taking care of with pancreatic cancer.</i><br />
<br />
I am impatient. Very impatient. Trained from years of arguing, demanding, and doing whatever it takes in minute allotments of time, I can barely wait in the grocery line without bursting into flames.<br />
<br />
And I am cold. So cold. Frigid. Wrapped in the blanket of ice of self protectionism. Surrounded by walls built and shattered so many times that there strength has doubled from scarring.<br />
<br />
You only have to feel responsible for one death. Only have to watch the tears of one family for a few minutes. Then try that a hundred times. Maybe more. Unlikely less.<br />
<br />
<h3>
Undone</h3>
We can't undo our decisions. I cannot just stop being a doctor. The practice of medicine is what I do, but quitting cannot unmake who I am or what I have endured.<br />
<br />
Medicine is a privilege. The ultimate privilege.<br />
<br />
But it comes with an unbearable cost. <br />
<br />
How the hell do I know if I would pay it again?<br />
<br />
<br />
<br />
<br />Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com2tag:blogger.com,1999:blog-6296669137299786155.post-85931605718804350982018-04-11T14:35:00.003-07:002023-01-10T06:48:29.999-08:00Isn't It Ironic, Don't You think?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhumnDL_x4Blcx6PDdEx0ZPns5J54mfzMYOLah0S7yGusZv51BhCRaxgM7PZ8S7qF2LDdJw76DTsTv4u_YZUNBiJYiHJNymz-7yq_0Qr-ugja6bVs6XfIY2jRfDeTpfTBcMlAxWnjkFIis/s1600/EMR.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="315" data-original-width="560" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhumnDL_x4Blcx6PDdEx0ZPns5J54mfzMYOLah0S7yGusZv51BhCRaxgM7PZ8S7qF2LDdJw76DTsTv4u_YZUNBiJYiHJNymz-7yq_0Qr-ugja6bVs6XfIY2jRfDeTpfTBcMlAxWnjkFIis/s320/EMR.png" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<h2>
I Hate EMR's</h2>
<div>
There. I said it. The bane of my existence, as a primary care physician, are the idiotic electronic medical records I have been forced to use. Lets see...I have mastered Epic, Point Click Care, All scripts, Practice Fusion, etc., etc. I can't even begin to remember all the different systems. </div>
<div>
<br /></div>
<div>
The one point that is glaringly clear, they have added pain, frustration, and increasing amounts of time. But none, I said none, have actually improved patient care. I have spent thousands of dollars and countless hours using electronic medical records. They have altered my work flow, disturbed my connection with my patients, and otherwise consumed more time than actual patient evaluations. </div>
<div>
<br /></div>
<div>
In case I haven't said it before on this blog, EMR's were one of the main reasons I decided to leave my traditional primary care office and start a a home based concierge practice. Even if I still had to participate in the folly of governmental mandates, I at least had more time to count my clicks and argue with my patients over signing up for the patient portal. </div>
<div>
<br /></div>
<h3>
Meaningful Use, MACRA</h3>
<div>
I have fully complied with meaningful use and MACRA. I have received bonuses over the years. These payments were made on the back of my poor patients who had to suffer through the pointing and clicking. </div>
<div>
<br /></div>
<div>
I finally gave up. I stopped seeing outpatients this January and now do nursing home and hospice work only. I chart on the medical record in the nursing home which is owned by the facility, and thus I cannot submit any data. Medicare doesn't recognize the difficulty of this situation. Starting in 2020 they will cut my payments until they whittle off 10%. To start with.</div>
<div>
<br /></div>
<div>
The truth is, I really don't give a flying #$#@. As I have <a href="http://diversefi.com/">documented elsewhere</a>, I no longer practice to make a living anyway. I have that covered. So if Medicare wants to cut my payments, so be it. </div>
<div>
<br /></div>
<div>
<i>Have at it Medicare. I give up.</i></div>
<div>
<br /></div>
<h3>
The Last Laugh</h3>
<div>
Since I was still seeing patients in 2017 and charting on my own EMR, I decided to try to comply with MACRA. I could submit at least one piece of data so that I could maintain current payment levels in 2019 for my nursing home billings. For the first year of MACRA, the bar is quite low. </div>
<div>
<br /></div>
<div>
My personal assistant convinced me to send in a whole 3 months of data.</div>
<div>
<br /></div>
<div>
<i>Just in case, you never know.</i></div>
<div>
<br /></div>
<div>
I got a letter today from the EMR company. Apparently my data was good. Great even. I am going to get a 4% bonus above the baseline for 2019. This is more than I expected. I was just hoping not to be cut. </div>
<div>
<br /></div>
<div>
It's irony, isn't it? When I was working hard to meet the governments needs, I was barely getting by. </div>
<div>
<br /></div>
<div>
Now I have decided to give them the middle finger.</div>
<div>
<br /></div>
<div>
And I'm getting a 4% bonus. </div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<br />Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com1tag:blogger.com,1999:blog-6296669137299786155.post-63876668280889626312018-03-24T16:12:00.002-07:002023-01-10T06:48:32.711-08:00That Which I Miss Most<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUq_ZhMWj3b8J6bSlASqZdWNS56Caz9XXq7DTzlrK5W69Ka0W-SOiC8DADqKcrOuT-EyQowQWKOdYte1-Q1-GDyQ3J1MY3mTPBEhkODBOFhbJ0vPcAbBlfBogjlWCQhNe6iz57g51RPKY/s1600/IMHO.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="315" data-original-width="560" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUq_ZhMWj3b8J6bSlASqZdWNS56Caz9XXq7DTzlrK5W69Ka0W-SOiC8DADqKcrOuT-EyQowQWKOdYte1-Q1-GDyQ3J1MY3mTPBEhkODBOFhbJ0vPcAbBlfBogjlWCQhNe6iz57g51RPKY/s320/IMHO.png" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<h2>
Empathy</h2>
<div>
My eyes glare across the table. I can feel his shoulders hunch forward as he subconsciously recoils in preparation for my response. The room becomes thick. Nurses, social workers, a chaplain. Everyone waiting for the doctor.</div>
<div>
<br /></div>
<div>
Not just the doctor, but me. Sixteen years out of residency. Battle scarred and warn by PTSD. The images from residency still so clear. A gasp, a gurgle, flat line. Wailing family members, angry nurses, and an uncompromising chief. </div>
<div>
<br /></div>
<div>
They died so much more easily back then. The young, the old, the unwanted, and the uncared for. The academic medical center with it's social mission. The Veterans Administration with it's untethered and unloved. </div>
<div>
<br /></div>
<div>
Practice. We practiced for lack of a better word. We stumbled into situations too big and too great for our burgeoning grip on competence. We learned as we taught. We taught as we mastered. We mastered in the single digits. </div>
<div>
<br /></div>
<h3>
Battle Worn</h3>
<div>
Emerging from training was like a breath of air. But not clean air. Smog. The same thickness. Life's murkiness banished to that protected oasis long hidden in the recesses. Just out of reach. </div>
<div>
<br /></div>
<div>
Schedules fill. Patients to <i>squeeze</i> in. The morass of physical and emotional trauma. Ducking from the base insults hurled at our backs, and delivering the same into the next examining room when patience grows thin. </div>
<div>
<br /></div>
<div>
Dragging such toxicity home on the belabored backs of our families. Of our children. The raspy voice declares death over the phone with cold and surgical certainty while the kids watch cartoons on a Sunday morning. Clear eyed retribution turns to tears when the story line on the big screen goes awry. </div>
<div>
<br /></div>
<h3>
That Which I Miss Most. </h3>
<div>
In this beloved room full of colleagues battling to make the last gasps of life bearable. Is the softness. The weakness of heart and the quietness of spirit. The empathy that lifted those around me instead of made them cower. </div>
<div>
<br /></div>
<div>
The absence of fear, and anger, and helplessness.</div>
<div>
<br /></div>
<div>
Not of battling life or death. Not of winning or losing. But of learning to feel unhindered. To feel again.</div>
<div>
<br /></div>
<div>
I defang my claws. Drop my shoulders and consciously restrain the edge in my voice.</div>
<div>
<br /></div>
<div>
And I do my best to fake it.</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div>
</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<br />Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com1tag:blogger.com,1999:blog-6296669137299786155.post-68555772268214191902018-03-22T19:28:00.000-07:002023-01-10T06:48:35.454-08:00Something Different<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhp9WVLaNH_ZZm6PZZkhd4DspWFQhGHde6K8jwtTyBTxBhv1K14mcQ3x2CQgafdMt4ytaiO4l_TawTXI4twnQihWKZvGwJWohFGjd0CZG52UmWyz98WO2dTs3yLwqWLtzdRcgSPaT8fjmg/s1600/Dam.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="315" data-original-width="560" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhp9WVLaNH_ZZm6PZZkhd4DspWFQhGHde6K8jwtTyBTxBhv1K14mcQ3x2CQgafdMt4ytaiO4l_TawTXI4twnQihWKZvGwJWohFGjd0CZG52UmWyz98WO2dTs3yLwqWLtzdRcgSPaT8fjmg/s320/Dam.png" width="320" /></a></div>
<h2>
And the dam breaks </h2>
Because it always does. As the rebellious seas churn and the indelible cracks breach at the base, a web of infirmity spreads it's lacey tendrils unloosening the mooring of a once sturdy structure. The cackling of unhinged cement, the prepubescent rejoinder to the whoosh as the frothy waters churn past what once was solid, absolving the absurdity of insincere firmness. That which was an obstacle, now a conduit. <br />
<br />
The mark of the trainee. The years of suffering, and sweating, and staring down disaster with a stiff upper lip and trembling twenty-four hour knees. The abuse. Rampant abuse. From patients. From colleagues. From the dumb luck of being on the opposite side of death. A familiar foe with unbearable strength and agility.<br />
<br />
The self effacement. The drowning of ones own needs. The rumpled collar, greasy hair, and lazy eyes of a night on call. Sleep abandoned. Needs betrayed. Humanity unraveled into a dream laden schedule. Every few days.<br />
<br />
A calling. A calling to duty. A call to sacrifice.<br />
<br />
<h3>
And the dam breaks</h3>
Because it had to. Patients replaced by computers. Insurance forms and boxes to check, and minutia upon minutia. Upon minutia. Until the little becomes so big that you become little too. With tiny pitiable goals and aspirations.<br />
<br />
Far from a healer. You are a generator of paper. A signer of forms. A whipping boy for an ungodly mechanical voice heard disjointedly from somewhere up above.<br />
<br />
<i>That drug is not formulary!</i><br />
<i>That admission is an observation!</i><br />
<i>That is not a C3, it's a C2! Run to the fax machine.</i><br />
<br />
Suggestions become commands. Commands become dictates. Dictates become laws. <br />
<br />
Laws we abide while sneering. Pitiful sneers that make us hide from the reflection in the mirror. The reflection in the eyes of those we had sworn to serve.<br />
<br />
<i>I'm sorry you're having the most shitty day of your life. But I can't seem to remember how to order that coffin in my electronic medical record. What's the ICD-10 for death?</i><br />
<br />
<h3>
And the dam breaks</h3>
Because the words stop coming. There is simply nothing more to be said. There are only so many eloquent ways to talk about something that is broken. Smashed to pieces. The whole no longer exists. <br />
<br />
<br />
<br />
Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com1tag:blogger.com,1999:blog-6296669137299786155.post-13599656664294402362017-06-02T10:48:00.001-07:002021-02-09T18:19:19.485-08:00SwindledYou've been swindled. At least that's the conclusion I've come to. It wasn't the hucksters or the snake oil salesman. It wasn't big business, big medicine, or some greedy hospital administrator. It was most likely pharma with a large dose of helping from your doctor. Plain and simple. <br />
<br />
I've learned quite a bit being a hospice medical director. Covering dozens of new admissions a week has given me much insight into doctor prescribing habits. Often it is my job to decide with meds are necessary and covered by hospice, which are necessary but not covered by hospice, and which are useless. <br />
<br />
Do you have any idea how many useless and often harmful meds our patients are on? I'm not just talking about end of life, but healthy patients to.<br />
<br />
Can we talk multivitamins? Almost every patient I encounter is prescribed a multivitamin. Healthy, unhealthy, living, dying. When your in the grasps of stage five thousand and one lung cancer and your brain is riddled with mets, you have no business being on a multi. It's not going to help you. It's not going to provide that last bit of energy to overcome the calamitous collapse that is approaching rapidly. In fact, there is plenty of data to suggest multivitamins are harmful if not neutral at best. Even in healthy people. <br />
<br />
How about Vitamin D? I swear to g-d, every patient I encounter is on some sort of D supplement. Never mind that the vast majority of medical evidence implies that supplementation is unhelpful in most disease processes. Yes, there is osteoporosis, but otherwise, it is a non starter. <br />
<br />
Aricept in patients who don't walk, don't talk, and barely interact with the world around them? Again, started often because there is no other treatment, profound dementia patients are submitted to a host of side effects including diarrhea and syncope without the faintest glimpse of medical benefit. <br />
<br />
Vitamin C, Vitamin E, Calcium?<br />
<br />
How about statins in patients without a history of coronary disease with end stage-opathies and malignant cancers. Do we really think we are going to cut down on cardiac events in the fleeting few months that these patients have to live? Is there any data to support this? You better believe that these patients get myalgia and other side effects. <br />
<br />
Antibiotics for foul smelling urine, screening urine cultures without symptoms, or agitation in an already agitated patient. It seems that treating non-utis has become the national past time of our healthcare system. <br />
<br />
I could go on and on. Don't even get me started on antibacterials for non bacterial infections. <br />
<br />
The point is, we are not being careful with our prescribing habits. We are not taking into consideration the wealth of evidence and data regarding some of these treatments. <br />
<br />
And we are not being good advocates. <br />
<br />
We are not shielding our patients from harm.<div><br /> <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_DnQN4BD4h5q5rCAvjtrAZ4lBIGhuyG7LFf7h33n_idmSFx6MjZWsnwTYYSJNXXCbQtesTRxnLJALXFIMEs9o2sRDZm07E8cTSQKLi0X8VGvpslb7agAowN9QT3Yb73e7qZ9pRB8uNL4/s400/Eand+I.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="225" data-original-width="400" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_DnQN4BD4h5q5rCAvjtrAZ4lBIGhuyG7LFf7h33n_idmSFx6MjZWsnwTYYSJNXXCbQtesTRxnLJALXFIMEs9o2sRDZm07E8cTSQKLi0X8VGvpslb7agAowN9QT3Yb73e7qZ9pRB8uNL4/w258-h145/Eand+I.png" width="258" /></a></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">If you want to hear more stories about medicine and personal finance, check out The Earn & Invest Podcast.</div><br /><div><br /></div></div>
<iframe allowfullscreen="" height="360" mozallowfullscreen="" msallowfullscreen="" oallowfullscreen="" scrolling="no" src="//html5-player.libsyn.com/embed/destination/id/826583/height/360/theme/custom/thumbnail/yes/direction/backward/no-cache/true/render-playlist/yes/custom-color/87A93A/" style="border: none;" webkitallowfullscreen="" width="100%"></iframe>Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com4tag:blogger.com,1999:blog-6296669137299786155.post-42062410024998023082017-05-17T10:41:00.000-07:002023-01-10T06:48:38.564-08:00 And We Must BreatheAsk any parent. Having children is a supreme act of faith. This revelation does not come easy to one who is particularly uncomfortable kneeling at unfamiliar alters. It hurts my knees. Yet there is no more durable truism. <br />
<br />
It starts with birth. The awareness of our own unique helplessness is overwhelming. We are a slave to our children's genetics, environment, and wholly uncontrollable luck. We skitter to command a million details to defray the constant anxiety of that which can't be governed. We worry, lose sleep, and panic till the day we feebly shrug our shoulders and accept. Then we defer to faith. Because faith is air, and we must breathe.<br />
<br />
As my daughter has grown, that faith has transferred from the intangible nebulous, to the burgeoning humanoid sprouting at my feet. A far more comfortable leap, a sense of control sets in. As parents, we can lead by example, teach, shape, and mold. Destiny has temporarily released her grasp. My daughter can learn not to climb on the hot stove, to look both ways before crossing, to stop, drop, and roll.<br />
<br />
So you would think it is the consequential stuff that I struggle with, but often the ephemera nips just as gratingly at my heels. <br />
<br />
A few weeks ago, my daughter informed us that she wanted to perform in the annual school talent show. Each year, we battle to convince her to play the violin, something she actually holds a sprinkling of talent for. Sometimes we win, others we lose. <br />
<br />
This year she decided that she would perform a solo dance routine, and no matter how much I tried, she could not be dissuaded. My anxiety rose as I pondered our weekend dance performances in the family room. Rhythm, it turns out, may not be at the top of my daughter's otherwise many talents. <br />
<br />
Much discussion was had, videos were You Tubed, lists were made. And two days before the performance, it was clear that her best option was to <i>free style</i> the whole routine. My heart raced as I pondered her up on that stage in front of hundreds of people, awkward, and embarrassed. This has been a hard year for her at school, and the last thing I wanted was for it to end in shame. <br />
<br />
My daughter, however, was implacable. She repeated over and over again:<br />
<br />
<i>I got this!</i><br />
<br />
The day of the event, she pushed us out of the way and applied her own makeup. I marveled at the mix of eye liner and lipstick (something we otherwise would never let our daughter wear). She looked fierce. <br />
<br />
When she took the stage at the tail end of the show after fifty other acts, I stood nervously with camera in hand. She awaited patiently through three attempts to queue her music correctly. I could no longer control the fluttering in my chest. <br />
<br />
I keenly felt at that moment something, in retrospect, I have always known. <br />
<br />
That I will follow this girl with all my heart down whichever path she leads. And I will have faith even though the journey will often be awkward and painful and sometimes...<br />
<br />
Sometimes joyful and wondrous. <br />
<br />
<span id="goog_2064652538"></span><span id="goog_2064652539"></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen="" class="YOUTUBE-iframe-video" data-thumbnail-src="https://i.ytimg.com/vi/xf71tGEFCGs/0.jpg" frameborder="0" height="266" src="https://www.youtube.com/embed/xf71tGEFCGs?feature=player_embedded" width="320"></iframe></div>
<br />Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com5tag:blogger.com,1999:blog-6296669137299786155.post-72909820836241567602017-05-05T08:28:00.000-07:002023-01-10T06:48:40.700-08:00Changing LanesI drive a fast car. Which if you know me, is quite uncharacteristic. I would say that it is one the few possessions that generally doesn't reflect upon who I am. How I chose this car, the make, and model, are a long story not to be discussed here. But let's just say that it has quite a kick. <br />
<br />
These thoughts jostled through my mind this morning as I pulled into the hospital parking lot. A recent momentous decision, I surrendered my privileges at this hospital and started using the hospitalists. It had all become too hard. The inane compliance issues with the new EMR. The ER attendings admitting my patients without calling me. The slew of protocols, documents, and attestations at this institution recently became particularly onerous. The administration was pushing out the primary physicians with the indignation of a million not so subtle pinpricks. <br />
<br />
I was making a courtesy visit. I had asked the Emergency Room physician to have the hospitalist call me the night before. I knew this patient exceedingly well over the years, and had a good impression of what had happened. I was unable to relay this information, however, because I never got a phone call. <br />
<br />
I didn't agree with the diagnosis or treatment plan. The admitting hospitalist was no longer available and the nursing staff had no idea who to call. I carefully documented my knowledge of the patients past medical history, exam, and my thoughts in a progress note. I also left my mobile number and begged the rounding physician to call me. I am not hopeful. Eventually, after much searching and paging, I will likely reach the physician by the end of the day. Que sera, sera. <br />
<br />
This hospital is in the midst of a major rebuild, and part of the process is a new entrance to the expressway adjacent to the parking lot. The beauty of this new pathway is that following a few careening turns, the entrance ramp is a straight shot for a few hundred feet.<br />
<br />
This morning, I came to a full stop after those turns, and waited for the cars on the expressway to pass at 60 mph. I put all four windows down. Then I put the pedal to the metal. <br />
<br />
10, 30, 50, 70mph, I sped past all the cars ahead of me. The wind blowing into the car and smacking me in the face. Power, speed, freedom, joy!<br />
<br />
Eventually I merged left and began the process of applying the brakes. I was coming up quickly on a series of cars driving at more conventional speeds. <br />
<br />
The fun is over. It couldn't last forever.<br />
<br />
It seems it's no longer our patients that we answer to.<br />
<br />
Because I've been told, in no uncertain terms, it's time to stop bucking the system.<br />
<br />
And get back into my appointed lane. Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com3tag:blogger.com,1999:blog-6296669137299786155.post-16799439420147231042017-04-01T13:37:00.004-07:002021-02-09T18:13:47.408-08:00Letting Go<i>You can let go now!</i><br />
<br />
As Hannah's granddaughter clutched at her skeletal fingers, the blanket fell to the side revealing the faded serial numbers on her forearm. The family gathered, yet again, to say goodbye. This time her acrid breath had lost humidity, her respirations dry and raspy, the extremities mottled with a bluish tinge. <br />
<br />
Death had visited the neighborhood before. Lounged in the parlor. Nibbled on crackers and tea. But letting go was not so easy. Sure the signs were there. There were the bouts of unconsciousness lasting days. The hours of irregular breathing with long gaps. The clutching of chest and recitation of prayer. All followed by merciless, unrelenting recovery.<br />
<br />
Hannah wanted to die. At least that is what she told the doctors. She sang it in her sleep and whispered to the hallucinations that pranced on her pillow. She refused medications. She spurned nourishment. She pulled at the tube thoughtlessly plunged into her abdomen a few hospitalizations prior. She hissed at the Rabbi as he entered her room.<br />
<br />
<i>Why won't you take me?</i><br />
<br />
They said she was a <i>survivor</i>. A code they used in order to avoid talking about dark things. Guilty things. She was forever marked by the fact that she didn't succumb. She didn't die. She was scarred somewhere deeper, more profound, than the ugly thing on her forearm. She was marred by persistence. <br />
<br />
Most of her family died decades ago during the war. A whole lineage erased. And yet she persisted. Her colon removed, her brain stroked, her heart fibrosed. And yet she persisted. The years passed, friends and lovers gone, a child or two perished. And yet she persisted. <br />
<br />
Persistence had entwined her DNA, calcified her bones, and cascaded past blood cells forever traveling in circles. <br />
<br />
Her body was failing, but her spirit couldn't let go. <br />
<br />
No matter how much she begged and pleaded. <br />
<br />
It didn't know how.<br />
<br />
<br />
<a href="https://www.amazon.com/Five-Moments-Short-Works-Fiction/dp/1543037747/ref=pd_sim_14_1?_encoding=UTF8&pd_rd_i=1543037747&pd_rd_r=5R3CJZYPCEFFYZ54EK1M&pd_rd_w=iZfJ8&pd_rd_wg=oDQDe&psc=1&refRID=5R3CJZYPCEFFYZ54EK1M"><span style="color: #d52a33;">Five Moments</span></a>, now available on <a href="https://www.amazon.com/Five-Moments-Short-Works-Fiction/dp/1543037747/ref=pd_sim_14_1?_encoding=UTF8&pd_rd_i=1543037747&pd_rd_r=5R3CJZYPCEFFYZ54EK1M&pd_rd_w=iZfJ8&pd_rd_wg=oDQDe&psc=1&refRID=5R3CJZYPCEFFYZ54EK1M"><span style="color: #d52a33;">Amazon</span></a>. <br />
<br />
<br />
Also available, <a href="https://www.amazon.com/Am-Your-Doctor-Humble-Opinion/dp/150842439X/ref=tmm_pap_title_0">I Am Your Doctor: and This is My Humble Opinion.</a><div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXIBREoHVQjLkuMwc6wLkC3PkYnGqyT628dofLqt4unI3psgkDcbFtoKG8xol8Uq8B8NVCOTM2zLS7yig8sCyu_T0NKc-AnWggUWPr_5FnpsAKKeuR9LHj6YzPwq9FOohjM97-K0aSHXk/s400/Eand+I.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="225" data-original-width="400" height="164" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXIBREoHVQjLkuMwc6wLkC3PkYnGqyT628dofLqt4unI3psgkDcbFtoKG8xol8Uq8B8NVCOTM2zLS7yig8sCyu_T0NKc-AnWggUWPr_5FnpsAKKeuR9LHj6YzPwq9FOohjM97-K0aSHXk/w291-h164/Eand+I.png" width="291" /></a></div><div class="separator" style="clear: both; text-align: center;"><span style="text-align: left;"><br /></span></div><h3 style="text-align: left;">If you want to hear more stories about medicine and personal finance, check out the Earn & Invest Podcast. </h3><div class="separator" style="clear: both; text-align: center;"><br /></div><div>
<br />
<br /></div></div>
<iframe allowfullscreen="" height="360" mozallowfullscreen="" msallowfullscreen="" oallowfullscreen="" scrolling="no" src="//html5-player.libsyn.com/embed/destination/id/826583/height/360/theme/custom/thumbnail/yes/direction/backward/no-cache/true/render-playlist/yes/custom-color/87A93A/" style="border: none;" webkitallowfullscreen="" width="100%"></iframe>Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com0tag:blogger.com,1999:blog-6296669137299786155.post-53612809671568575252017-03-17T08:32:00.001-07:002021-02-09T18:21:11.232-08:00Drip Drip<em>Get out.</em><br />
<br />
<br />
It was not so much the words as the overall tone of the interaction. The doctor-patient relationship had been generally affable. There was the usual exchange of pleasantries over the years. Questions about family, children and grandchildren. It was a good relationship. Until Harvey got sick, that is.<br />
<br />
<br />
Originally there was weight loss and fatigue. The initial physical exam and slew of testing showed nothing but a frail, cachectic, middle aged man. A few cat scans later and he was in the oncologist's office discussing chemotherapy. A regimen was decided on, and therapy began the next day. <br />
<br />
<br />
Therapy was hard. Nausea. Retching. More weight loss. Far from feeling better or cured, Harvey could feel the clothes slipping from his emaciated body. It was as if life itself was drip dripping away as the chemo bulldozed into his broken veins. And this pissed Harvey off. <br />
<br />
<br />
He lashed his family. He cursed his friends. He spun into a whirlwind of the most resistant depression. A depression, his therapist would later tell me, whose only salve was anger. While the anger allowed him to carry on, often he left those around him scorched.<br />
<br />
<br />
His doctors were no exception. We often spent half of each visit withstanding abuse before getting down to the business of the appointment. He blamed us for the cancer. He blamed us for the lousy response. He blamed us for the side effects of his abysmal treatment.<br />
<br />
<br />
So when I walked into the hospital room to tell him the scans showed his latest chemotherapy had failed to stem the red tide of death, I have to admit that I had already somewhat detached. How could I not? Although he was fairly lathered by the results, it was the mentioning of hospice that finally led to my expulsion. His wife ran after me with tears in her eyes. I'm quite certain that she paid dearly for her kind act of decorum.<br />
<br />
<br />
Harvey died shortly thereafter.<br />
<br />
<br />
I am prone to remember the pleasantries Harvey and I enjoyed before his health deteriorated. I am neither disturbed nor saddened by the anger. I cannot even say that I would not have been the same way if I had been lying in his hospital bed.<br />
<br />
<br />
What surprises me, in retrospect, is how little he affected me. How his anger didn't penetrate the hardened shell. <br />
<br />
<br />
Over my career I have been yelled at, cursed, blamed, hugged, and even loved by my patients.<br />
<br />
<br />
And like the poor life force oozing out of Harvey's beleaguered body, it drip drips down my back.<br />
<br />
<br />
And into a forgotten puddle on the ground.<br />
<br />
<br />
My new book: <a href="https://www.amazon.com/Five-Moments-Short-Works-Fiction/dp/1543037747/ref=pd_sim_14_1?_encoding=UTF8&pd_rd_i=1543037747&pd_rd_r=5R3CJZYPCEFFYZ54EK1M&pd_rd_w=iZfJ8&pd_rd_wg=oDQDe&psc=1&refRID=5R3CJZYPCEFFYZ54EK1M"><span style="color: #d52a33;">Five Moments</span></a>, now available on <a href="https://www.amazon.com/Five-Moments-Short-Works-Fiction/dp/1543037747/ref=pd_sim_14_1?_encoding=UTF8&pd_rd_i=1543037747&pd_rd_r=5R3CJZYPCEFFYZ54EK1M&pd_rd_w=iZfJ8&pd_rd_wg=oDQDe&psc=1&refRID=5R3CJZYPCEFFYZ54EK1M"><span style="color: #d52a33;">Amazon</span></a>. <div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_DnQN4BD4h5q5rCAvjtrAZ4lBIGhuyG7LFf7h33n_idmSFx6MjZWsnwTYYSJNXXCbQtesTRxnLJALXFIMEs9o2sRDZm07E8cTSQKLi0X8VGvpslb7agAowN9QT3Yb73e7qZ9pRB8uNL4/s400/Eand+I.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="225" data-original-width="400" height="138" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_DnQN4BD4h5q5rCAvjtrAZ4lBIGhuyG7LFf7h33n_idmSFx6MjZWsnwTYYSJNXXCbQtesTRxnLJALXFIMEs9o2sRDZm07E8cTSQKLi0X8VGvpslb7agAowN9QT3Yb73e7qZ9pRB8uNL4/w246-h138/Eand+I.png" width="246" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;">If you want to hear more stories about medicine and personal finance, check out The Earn & Invest Podcast,</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><br /></div><br /> </div>
<iframe style="border: none" src="//html5-player.libsyn.com/embed/destination/id/826583/height/360/theme/custom/thumbnail/yes/direction/backward/no-cache/true/render-playlist/yes/custom-color/87A93A/" height="360" width="100%" scrolling="no" allowfullscreen webkitallowfullscreen mozallowfullscreen oallowfullscreen msallowfullscreen></iframe>Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com1tag:blogger.com,1999:blog-6296669137299786155.post-77992609543887717312017-03-12T17:54:00.001-07:002023-01-10T06:48:44.825-08:00Five Moments Book Excerpt<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhae9rYsJ8Vr9MZKtHUkW-RZazZdTevCBTyLVXNXWaOKWK0DNr0k7f1Qj1mMgjuoYGn5QlHMB8x4iwipioYJxjer5KBjksZB49UHhvt68CcvUqwyQWwgR719feYQpGGFJk_Cqx-MuWmi48/s1600/Five+Moments+Image.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhae9rYsJ8Vr9MZKtHUkW-RZazZdTevCBTyLVXNXWaOKWK0DNr0k7f1Qj1mMgjuoYGn5QlHMB8x4iwipioYJxjer5KBjksZB49UHhvt68CcvUqwyQWwgR719feYQpGGFJk_Cqx-MuWmi48/s320/Five+Moments+Image.jpg" width="213" /></a></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;">“Dad . . . you can let go now.” </span><span style="color: black; font-family: Times; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;">Thomas heard his daughter’s voice from a distance. It
awakened him from his reverie. He relived those five moments of life and took
their lessons seriously.</span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="text-indent: -0.25in;">Rejoice
in the ordinary as if you were a child seeing everything for the first time.</span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="text-indent: -0.25in;">Unconditional love can lift
you up. </span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="text-indent: -0.25in;">Forgive yourself over and
over again. </span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="text-indent: 0.25in;">No matter how much we deny
it, we are who we are.</span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
Some of the most difficult
battles are those in which we choose not to fight.</div>
<div class="MsoNormal" style="line-height: 14.0pt; margin-left: .25in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;">Thomas opened his eyes and smiled. He looked at the faces
of his family before him. After all these years he finally got it. He
understood the meaning of existence that eluded him till now. </span><span style="color: black; font-family: Times; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;">Eternity . . . Immortality . . . </span><span style="color: black; font-family: Times; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;">His family was now joined by numerous others. Thomas’s
friends and colleagues, his patients and students, even the man he once gave a
five-dollar bill to on the street. They were all there. He gave a part of
himself to each of these people. And each of them had given a part of
themselves to others. There were thousands, if not millions, of people in the
room with Thomas. </span><span style="color: black; font-family: Times; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;">His life had meaning. Like a rock falling into a pond, his
goodness made a small splash with the people around him. But the waves from the
rock rippled throughout the pond. Thomas would live forever. Parts of him were
dispersed into the world. And those parts would live and thrive. Thomas’s body
was dying but his soul was strong. He felt oneness with his fellow man. </span><span style="color: black; font-family: Times; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;">For a moment Thomas thought if he just had enough strength
he could share this beauty with his family. But then he realized this was not
the sort of thing someone could teach. Each person had to experience it
himself. </span><span style="color: black; font-family: Times; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;">Isabella’s word’s came back to him as he drifted off.He
remembered sitting on the kitchen floor with his daughter and granddaughter the
day she almost choked to death. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;">“See, Dad? It wasn’t all in vain.” </span><span style="color: black; font-family: Times; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;">Thomas experienced one last thing before he died.A cool
sensation started at the back of his head and washed over his cheeks,
shoulders, body, and into his toes. With pure joy, he recognized this as the
first sensation he felt upon exiting the birth canal. </span><span style="color: black; font-family: Times; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;">Beginning and End. Birth and Death. They were all
intermingled in this beautiful dance called Life. </span><span style="color: black; font-family: Times; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;">Thomas’s heart stopped. </span><span style="color: black; font-family: Times; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: black;"><br /></span></div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
Taken from <a href="https://www.amazon.com/Five-Moments-Short-Works-Fiction/dp/1543037747/ref=pd_sim_14_1?_encoding=UTF8&pd_rd_i=1543037747&pd_rd_r=5R3CJZYPCEFFYZ54EK1M&pd_rd_w=iZfJ8&pd_rd_wg=oDQDe&psc=1&refRID=5R3CJZYPCEFFYZ54EK1M">Five Moments</a>, now available on <a href="https://www.amazon.com/Five-Moments-Short-Works-Fiction/dp/1543037747/ref=pd_sim_14_1?_encoding=UTF8&pd_rd_i=1543037747&pd_rd_r=5R3CJZYPCEFFYZ54EK1M&pd_rd_w=iZfJ8&pd_rd_wg=oDQDe&psc=1&refRID=5R3CJZYPCEFFYZ54EK1M">Amazon</a>.</div>
<div class="MsoNormal" style="line-height: 19.0pt; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<!--[if gte mso 9]><xml>
<o:DocumentProperties>
<o:Revision>0</o:Revision>
<o:TotalTime>0</o:TotalTime>
<o:Pages>1</o:Pages>
<o:Words>339</o:Words>
<o:Characters>1934</o:Characters>
<o:Company>Home Base Medical, SC</o:Company>
<o:Lines>16</o:Lines>
<o:Paragraphs>4</o:Paragraphs>
<o:CharactersWithSpaces>2269</o:CharactersWithSpaces>
<o:Version>14.0</o:Version>
</o:DocumentProperties>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
<w:UseFELayout/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0in 5.4pt 0in 5.4pt;
mso-para-margin:0in;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;}
</style>
<![endif]-->
<!--StartFragment-->
<!--EndFragment--><br />
<div class="MsoNormal">
<br /></div>
Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com0tag:blogger.com,1999:blog-6296669137299786155.post-54511514405790165412017-03-06T09:10:00.003-08:002021-02-09T18:23:40.215-08:00When A Loved One DiesAt first you'll query reality. You will hear your own words, but they will be foreign; apart from you. The ground will still reassuringly push back against your toes when you walk out the room, but you will wonder if they are your feet-your ground. Like in a movie, you will negotiate the world convincingly. Yet, you are an actor playing a part. A role. It is not the real you. <br />
<br />
Be assured that this will pass. Life has changed incomprehensibly in a fraction of a moment. It will take a few more moments for your psyche to advance accordingly. This is not disconnection. This is not denial. It's shock.<br />
<br />
Grief will not be far behind. Overwhelming, discoloring, disjointed grief. Some will try to ignore it. Others will wallow. How you manage this grief says more about who you are and less about the gravity of the loss. There is no correct way to map this journey. We each travel this road separately. <br />
<br />
My gentle advice to you dear traveler, is remember that separate does not mean alone. Others will not feel what you are feeling, but that does not prohibit sharing parts of your journey. The most arduous, at least. Surround yourself with people and things. Even if they have lost your interest. Even if they have lost meaning. <br />
<br />
Interest and meaning return. The sun rises and falls. You will not break.<br />
<br />
By far, the greatest danger lies ahead. In the days and weeks and years. You may be plagued by a demon so fastidious it will devour your hours, conscious and otherwise. It will haunt long nights and merciless days. It will cause the ground to shake relentlessly under your feet, knocking you off balance. <br />
<br />
I'm talking of guilt. <br />
<br />
You will feel guilty for not spending enough time, or spending too much. For not calling the nurse right away, or calling too quickly. For pushing the morphine that last time, or withholding it. Even the quiet and peaceful deaths end here. It is loves last grappling with earth-shattering loss. We are not programmed to let go of that which we cannot control. <br />
<br />
And we can't control death. So we feel guilt.<br />
<br />
This guilt will plague you. It will turn grieving from a process to a permanent state. <br />
<br />
Don't let it. Your loved one died because it was time. Nothing you did would have changed that.<br />
<br />
Forgive yourself. <br />
<br />
Let this forgiveness be one last act to honor the dying. <br />
<br />
<br />
If you like this post, please order my new book of short fiction, <i><a href="https://www.amazon.com/Five-Moments-Short-Works-Fiction/dp/1543037747/ref=sr_1_2?ie=UTF8&qid=1488455081&sr=8-2&keywords=jordan+grumet">Five Moments</a></i>.<div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_DnQN4BD4h5q5rCAvjtrAZ4lBIGhuyG7LFf7h33n_idmSFx6MjZWsnwTYYSJNXXCbQtesTRxnLJALXFIMEs9o2sRDZm07E8cTSQKLi0X8VGvpslb7agAowN9QT3Yb73e7qZ9pRB8uNL4/s400/Eand+I.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="225" data-original-width="400" height="143" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_DnQN4BD4h5q5rCAvjtrAZ4lBIGhuyG7LFf7h33n_idmSFx6MjZWsnwTYYSJNXXCbQtesTRxnLJALXFIMEs9o2sRDZm07E8cTSQKLi0X8VGvpslb7agAowN9QT3Yb73e7qZ9pRB8uNL4/w255-h143/Eand+I.png" width="255" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><h3 style="clear: both; text-align: left;">If you want to hear more stories about medicine and personal finance, check out The Earn & Invest Podcast.</h3><br /><div><br /></div>
<iframe allowfullscreen="" height="360" mozallowfullscreen="" msallowfullscreen="" oallowfullscreen="" scrolling="no" src="//html5-player.libsyn.com/embed/destination/id/826583/height/360/theme/custom/thumbnail/yes/direction/backward/no-cache/true/render-playlist/yes/custom-color/87A93A/" style="border: none;" webkitallowfullscreen="" width="100%"></iframe>Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com0tag:blogger.com,1999:blog-6296669137299786155.post-9378449071379253602017-03-01T17:25:00.000-08:002023-01-10T06:48:47.590-08:00Five Moments Now Available<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9BLSqxykEoLMfTTWygWU0RWxtngwstA7a_vcL5yoTy-O6J3k6n-vHNxsBGecs3o6b3vO_BFPV29HEs2ZZGORNfn7N81xToaaniZWoEBFBMZaDqUYEYcTDg4yMZgzSJ_ACy1IVN09vdzw/s1600/Five+Moments+Image.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9BLSqxykEoLMfTTWygWU0RWxtngwstA7a_vcL5yoTy-O6J3k6n-vHNxsBGecs3o6b3vO_BFPV29HEs2ZZGORNfn7N81xToaaniZWoEBFBMZaDqUYEYcTDg4yMZgzSJ_ACy1IVN09vdzw/s320/Five+Moments+Image.jpg" width="213" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
<!--[if gte mso 9]><xml>
<o:DocumentProperties>
<o:Revision>0</o:Revision>
<o:TotalTime>0</o:TotalTime>
<o:Pages>1</o:Pages>
<o:Words>43</o:Words>
<o:Characters>247</o:Characters>
<o:Company>Home Base Medical, SC</o:Company>
<o:Lines>2</o:Lines>
<o:Paragraphs>1</o:Paragraphs>
<o:CharactersWithSpaces>289</o:CharactersWithSpaces>
<o:Version>14.0</o:Version>
</o:DocumentProperties>
<o:OfficeDocumentSettings>
<o:AllowPNG/>
</o:OfficeDocumentSettings>
</xml><![endif]-->
<!--[if gte mso 9]><xml>
<w:WordDocument>
<w:View>Normal</w:View>
<w:Zoom>0</w:Zoom>
<w:TrackMoves/>
<w:TrackFormatting/>
<w:PunctuationKerning/>
<w:ValidateAgainstSchemas/>
<w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
<w:IgnoreMixedContent>false</w:IgnoreMixedContent>
<w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
<w:DoNotPromoteQF/>
<w:LidThemeOther>EN-US</w:LidThemeOther>
<w:LidThemeAsian>JA</w:LidThemeAsian>
<w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript>
<w:Compatibility>
<w:BreakWrappedTables/>
<w:SnapToGridInCell/>
<w:WrapTextWithPunct/>
<w:UseAsianBreakRules/>
<w:DontGrowAutofit/>
<w:SplitPgBreakAndParaMark/>
<w:EnableOpenTypeKerning/>
<w:DontFlipMirrorIndents/>
<w:OverrideTableStyleHps/>
<w:UseFELayout/>
</w:Compatibility>
<m:mathPr>
<m:mathFont m:val="Cambria Math"/>
<m:brkBin m:val="before"/>
<m:brkBinSub m:val="--"/>
<m:smallFrac m:val="off"/>
<m:dispDef/>
<m:lMargin m:val="0"/>
<m:rMargin m:val="0"/>
<m:defJc m:val="centerGroup"/>
<m:wrapIndent m:val="1440"/>
<m:intLim m:val="subSup"/>
<m:naryLim m:val="undOvr"/>
</m:mathPr></w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
<w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="276">
<w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" Priority="39" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" Name="toc 9"/>
<w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" Priority="10" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" Priority="1" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" Priority="11" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" Priority="22" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" Priority="0" Name="Normal (Web)"/>
<w:LsdException Locked="false" Priority="59" SemiHidden="false"
UnhideWhenUsed="false" Name="Table Grid"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/>
</w:LatentStyles>
</xml><![endif]-->
<!--[if gte mso 10]>
<style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0in 5.4pt 0in 5.4pt;
mso-para-margin:0in;
mso-para-margin-bottom:.0001pt;
mso-pagination:widow-orphan;
font-size:12.0pt;
font-family:Cambria;
mso-ascii-font-family:Cambria;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Cambria;
mso-hansi-theme-font:minor-latin;}
</style>
<![endif]-->
<!--StartFragment-->
<!--EndFragment--></div>
<span style="font-family: Arial; font-size: 14.0pt; mso-bidi-font-family: Arial;"><i>If
Thomas were to write his own eulogy, these surely wouldn’t be the five moments
that he picked. In fact, it’s safe to say that these were memories tucked
away in his subconscious. Yet as he lay on his bed anticipating death, he
relived these precious minutes as if they just happened...<o:p></o:p></i></span><br />
<span style="font-family: Arial; font-size: 14.0pt; mso-bidi-font-family: Arial;"><br /></span>
<span style="font-family: Arial; font-size: medium;">And so begins my new book of short fiction, <i><a href="https://www.amazon.com/dp/1543037747/ref=sr_1_2?ie=UTF8&qid=1488416627&sr=8-2&keywords=jordan+grumet">Five Moments</a></i>. </span><br />
<span style="font-family: Arial; font-size: medium;"><br /></span>
<span style="font-family: Arial; font-size: medium;">This collection of short stories approaches the foibles of the human condition, often as seen through a physicians view point. Crafted over years, each draws from my experiences as a caregiver, a parent, and human being. </span><br />
<span style="font-family: Arial; font-size: medium;"><br /></span>
<span style="font-family: Arial; font-size: medium;">During the marketing of my last book, <i><a href="https://www.amazon.com/Am-Your-Doctor-Humble-Opinion-ebook/dp/B00TSRYJBW/ref=sr_1_1?ie=UTF8&qid=1488416627&sr=8-1&keywords=jordan+grumet">I Am Your Doctor And This Is My Humble Opinion</a></i>, I found that above all the interviews, reviews, and assorted media-It was you, the reader, who carried the greatest impact. </span><br />
<span style="font-family: Arial; font-size: medium;"><br /></span>
<span style="font-family: Arial; font-size: medium;">So if you like what you read here week to week, please...</span><br />
<span style="font-family: Arial; font-size: medium;"><br /></span>
<span style="font-family: Arial; font-size: medium;">Buy the book!</span><br />
<span style="font-family: Arial; font-size: medium;">Share on Facebook!</span><br />
<span style="font-family: Arial; font-size: medium;">Tweet on twitter!</span><br />
<span style="font-family: Arial; font-size: medium;">Rate on Amazon!</span><br />
<span style="font-family: Arial; font-size: medium;">Post to Linkedin!</span><br />
<span style="font-family: Arial; font-size: medium;"><br /></span>
<span style="font-family: Arial; font-size: medium;">You are the most effective marketing force. Your help is much appreciated. </span><br />
<span style="font-family: Arial; font-size: medium;"><br /></span>
<span style="font-family: Arial; font-size: medium;"><i>Five Moments</i> can be purchased <a href="https://www.amazon.com/dp/1543037747/ref=sr_1_2?ie=UTF8&qid=1488416627&sr=8-2&keywords=jordan+grumet">here</a>.</span><br />
<span style="font-family: Arial; font-size: medium;"><i>I Am Your Doctor And This Is My humble Opinion</i> <a href="https://www.amazon.com/Am-Your-Doctor-Humble-Opinion-ebook/dp/B00TSRYJBW/ref=sr_1_1?ie=UTF8&qid=1488416627&sr=8-1&keywords=jordan+grumet">here</a>. </span><br />
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<br />Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com0tag:blogger.com,1999:blog-6296669137299786155.post-33269439363083596402017-02-26T18:23:00.001-08:002017-02-26T18:23:24.880-08:00Neither Was MineThere are parts of medicine that are horrendous. Moments too painful to recount. Events that will break even the most innocent participants. <br />
<br />
And then there is unspeakable magic.<br />
<br />
I live for the days when a patient comes to the office with a particularly vexing set of symptoms. Specialist after specialist bows their head in disagreement. Laboratory values whisper falsehoods with jeering tongues. Symptoms are transient, physical exam signs inconsistent, and in the midst of head scratching an answer mysteriously appears. Maybe a common presentation of a rare disease. Or a rare presentation of a common disease. <br />
<br />
Explaining with words so fast that sentences jumble. Ideas merge. The patient shakes their head enthusiastically less because of deep understanding, and more because they know that my excitement means that finally the answer will unfold like a blossoming flower selflessly bearing its pollen. I will eventually slow down enough to present a cogent explanation. And things will get better.<br />
<br />
It lifts me up when a patient sits down beside me after yet another round of chemo. When, at the end of the day, I have a sparing moment to settle in for intense conversation. I bite my tongue, become quiet, and listen. I hear of hopes and dreams. I hear of pain and suffering, joy and fear. We talk like doctor and patient. Like friends. Family members. <br />
<br />
We get past the intangibles of life and death, and move on to the more palpable like dignity. Upon finishing, we leave the room in strength. We leave the room with resolve. We leave the room with tears in our eyes. All of us. <br />
<br />
And I love when an unwitting pattern is recalled from the deepest depths of memory. The clock is ticking. Heart beats rise and fall rapidly. Knowledge accrued from past struggles presents itself at the most opportune time, and a life is saved. <br />
<br />
On the triumphant drive home from the hospital, with the radio blaring, I remember the patient whose back such life saving knowledge was attained. <br />
<br />
And I rejoice that all their suffering was not in vain, and neither was mine. <br />
<br />Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com1tag:blogger.com,1999:blog-6296669137299786155.post-80367974659330283232017-02-22T19:17:00.002-08:002017-02-22T19:17:47.521-08:00A Difficult PatientI have come to believe that humility is an essential component of wisdom. Never have I found this more true than in the practice of medicine. In fact, for almost every atrocious professional error in judgment I have made, I can pinpoint the exact moment where I stopped being humble.<br />
<br />
Yet time and time again, humility quickly disappears when dealing with the difficult patient. In fact the label, <i>difficul</i>t, assumes the problem lies within the patient and not the technique being utilized by the care provider. Already blame is turned outward and personal responsibility abandoned. <br />
<br />
A few years ago, when I was in a group practice, one of the senior partners had a particularly needy patient that somehow showed up on all our schedules from time to time. Her aged joints carried her into the exam room to their own particular hobbled rhythm. She paused before each sentence, her voice barely above a whisper. <br />
<br />
Her litany of issues was long and nonsensical. And this was always the precise moment when humility left the room. We all became convinced that her complaints were largely psychosomatic. And we were right. It still amazes me at how cavalier I can be when I think a solution is either simple or non physiologic.<br />
<br />
It was only after several visits that the need for a thorough exam became apparent. I tapped my feet and waited outside the door for what seemed like an eternity as she undressed and climbed into the unflattering gown. My stethoscope stumbled over the heart as if its mighty muscle had not thumped hundreds of thousands of beats. Auscultated the lungs absentmindedly untouched by the unmeasurable volumes that glanced the porous surface.<br />
<br />
My hands fumbled over the fibrosed joints that absorbed the shock of a child's prance, a young athlete's stride, and an ancient shuffle.<br />
<br />
My conceit, however, unshakable as it was, was shattered by the faded serial number tattooed on her forearm.<br />
<br />
And my humility, once again, was restored to a respectable level.<br />
<br />
Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com2tag:blogger.com,1999:blog-6296669137299786155.post-28995787479555928022017-02-19T14:31:00.002-08:002017-02-19T14:31:57.538-08:00No Longer ThereThe phone is ringing.<br />
<br />
The phone is ringing.<br />
<br />
THE PHONE IS RINGING!<br />
<br />
I sometimes feel my heart race. In the middle of the night. When I get a phone call. Or during the day. While taking a leisurely walk with my family by the lake. The sun streaming through clouds on a brisk morning, interrupted by a fall in room 36. An abrasion. A cardiac arrest. One phone call on top of another, Occasionally so many that the calls on hold are dropped. Or not so occasionally.<br />
<br />
During dinner. While in the shower. Sitting on the toilet. Day and night. A faint pain in the ear where the blue tooth rests. Even when it is charging on the bedside table. A hallucination. The feeling of something that is no longer there. Of something that is undeniably no longer there.<br />
<br />
The vexing confusion on the other side of the line when I answer professionally, and the call is personal. An even greater confusion when I answer personally, and the call is professional. Straining to hear life altering results in a crowded restaurant. Above the raucous sounds of my frolicking children. In the car when the light is changing. <br />
<br />
A bad connection. The basement where there is never reception. At the car wash when the blue tooth flips from my ear to the car, giving the employees an unexpected treat. Or the waiter who stammers through my conversation concerning constipation, or blood in the stool, or foul smelling urine. To return to ordering a hamburger, after telling a family member that their loved one has just died. <br />
<br />
Upon realizing a few minutes after being woken unexpectedly in the middle of the night, that a pertinent detail was missed. Waiting several minutes to get the nurse back onto the phone. And languishing the next few hours restless. despite great fatigue, because now the mind has started spinning uncontrollably. <br />
<br />
Distracted conversations with my wife. Consistently interrupted. By a patient's emergency. <br />
<br />
The ire I feel receiving yet another text. To only discover. That it is just my precious daughter. <br />
<br />
Telling me she loves me.<br />
<br />
In the middle of a blog post...Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com1tag:blogger.com,1999:blog-6296669137299786155.post-56826244689288341122017-02-16T12:17:00.000-08:002023-01-10T06:48:51.573-08:00Five Moments-Coming Soon<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAPfNV3ui6KjFPKRgv-jSZvM_T1cdrT_lB_h3B0TR38sQ7_21d-oaElFHMojuwH-RrpfzWVuoa20GVNW6TOWRe575wlcD-tphs8MYZ6yuwGWVz9lLsYC4uwCIcV4AbHNRgalq3xYMoaPs/s1600/IMG_0223.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAPfNV3ui6KjFPKRgv-jSZvM_T1cdrT_lB_h3B0TR38sQ7_21d-oaElFHMojuwH-RrpfzWVuoa20GVNW6TOWRe575wlcD-tphs8MYZ6yuwGWVz9lLsYC4uwCIcV4AbHNRgalq3xYMoaPs/s320/IMG_0223.PNG" width="230" /></a></div>
<br />Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com0tag:blogger.com,1999:blog-6296669137299786155.post-5050931965798070562017-02-14T15:46:00.000-08:002017-02-14T15:46:01.632-08:00I Don't Understand BurnoutI have a confession to make. I don't understand the concept of burnout. I mean, I get the idea. Medicine is, at least when you are the kind of doctor who deals with life and death, inherently stressful. And I feel the stress. It's as if someone applied a vice grip to my insides in the middle of medical school, and it has never let up since. The pressure is unrelenting, progressive, and downright painful. It has gotten worse with every successive career milestone. <br />
<br />
Brutal. It's brutal. I new it would be after a few weeks of rotations on the medical wards. The more responsibility I gained, the worse it got. And I guess I entered the profession knowing this. There was no expectation of reprieve. No belief that I would be let off the hook. I assumed that it was my cross to bear, my burden to shoulder. As the burden became heavier, I learned how to amble through hospital halls with a stooped posture. <br />
<br />
I just don't know if it could be any other way. I can think of no relief from the burden of making life and death decisions. What we do. What we do matters. A wrong turn, a flip on the ideological scale, can have devastating consequences for those we care for. There is no escaping this responsibility. No blunting the effect. You can't go half way. You can't stand in the middle of the road. You either make definitive decisions with definitive consequences or you get out of the business. There is no such thing as sleeping peacefully for a physician. <br />
<br />
So why are doctors committing suicide? Why are doctors leaving medicine in droves? It's not burnout. A small part of the reason is wrong career choice. A young doctor realizes quickly that they didn't know what they were signing up for.<br />
<br />
For the rest, it's external. It's not the stress of caring for people or even making life and death decisions. This is part of our genetic makeup. Part of our training.<br />
<br />
It's everything else. It's the paperwork. It's the meaningless paperwork. It's the droves of administrators and clerical staff thwarting us at every turn. It's the government and endless regulations, and rules, and threats. It's the loss of respect, loss of standing, and loss of confidence that we feel everyday from our community. It's economic distress. <br />
<br />
We won't fix this by training our young people about burnout or haranguing them with some odd belief in resilience. They made it through medical school, they already are resilient. <br />
<br />
You want doctors to be doctors again? You want us to love our jobs again?<br />
<br />
Simple. Get out of the way.<br />
<br />
And let us do what we were trained to do. Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com3tag:blogger.com,1999:blog-6296669137299786155.post-38109639970975718732017-02-10T07:23:00.002-08:002017-02-10T07:23:55.808-08:00JuxtapositionMy son,<br />
<br />
You will face this. You will stand at the crossroads of skill and preparedness. Although your heart may tremble, your hands will be still. Although your thoughts may race, your mind will be firm. Each one of us must enter the coliseum unadorned from time to time. Over and over again, we do battle. Skill and knowledge spring forth from failure, not success.<br />
<br />
I can help prepare you for this moment. I can congeal my accrued wisdom into consumable morsels for you to chew. I can arm you with knowledge and skill. But I cannot do battle for you. Not this time. I will bring you to the trough, but now you must drink. <br />
<br />
Drink from the well of fear and incertaintude. Imbibe from the ocean of insecurity. Place your head forward and savor both the bitter and sweet,<br />
<br />
For you will be tested. Again and again. There are times when you will be ready, and times when you will not. But there is strength deep down inside of you. A voice that will lead the way. Listen to that voice. Follow its dictates. Let your mind and heart propel you together.<br />
<br />
You must become the clearest when you are down. It is when you are most beleaguered, that wisdom dribbles in. Be open to it. Watch for it in the deepest pits of despair. It will be you ladder. It will be you life raft.<br />
<br />
And you will succeed. Maybe not this time. Maybe not the next. But eventually.<br />
<br />
So, my son, I want you to go to school today and rip that math test apart. I'll be thinking of you.<br />
<br />
<i>Thanks dad, I will. No biggie. </i><br />
<i><br /></i>
<i>I hope your day at work is okay too. </i><br />
<i><br /></i>
<i>Hope none of the sick people die!</i><br />
<br />Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com0tag:blogger.com,1999:blog-6296669137299786155.post-41182117008130815042017-02-06T10:57:00.000-08:002023-01-10T06:48:56.391-08:00How the patient ends up on the wrong end of the stickIt would never have gone down this way ten years ago when <i>length of stay</i> was all the buzz. The Cat Scan would have been done in the emergency department, and the patient would either have been discharged or admitted for a a quick observation stay. Bing, bang, boom. One, two three.<br />
<br />
Instead, the CT was pushed until morning. A resident saw the patient at midnight and then not a single practitioner note in the EMR for nearly eighteen hours. The hospitalist eventually deferred on the scan and called for a consult, which was scheduled for the next day because of the late hour. <br />
<br />
After a busy day of surgery, the specialist showed up at 8pm and OK'ed the patient for discharge without any further studies. But it was almost midnight, better to wait till the next day. The social worker, in meetings all morning, didn't get the paperwork out to the nursing home till mid afternoon. The nursing home accepted the patient, but only if delayed once more night due to poor staffing.<br />
<br />
In all, the patient endured four days in the hospital without a significant diagnostic nor therapeutic intervention. He did, however, sustain a third degree decuibitious ulcer which would take weeks of wound care to heal. <br />
<br />
I'm not sure when exactly the <i>length of stay</i> vs <i>hospital readmission</i> switch flipped. I have a sneaking suspicion that with all this talk of readmission rates, the focus and priority of the hospitals and their hospitalist programs have changed. Once again we have traded one slave master for another with untold and often unstudied consequences. <i>Don't be too hasty to discharge</i>, we are told, y<i>ou wouldn't want the patient to bounce back. </i><br />
<br />
This dance we dance with Medicare is complicated, The incentive game sounds straight forward, but often is not. While the hospital or doctor may be the recipient of all the carrots, the patient often finds themselves on the wrong end of the stick.<br />
<br />
These are grand experiments we are forcing on our patients. Unproven and untested, we must be aware that in the name of quality, we may be undoing much good. Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com1tag:blogger.com,1999:blog-6296669137299786155.post-75291326574416488732017-02-04T14:53:00.000-08:002017-02-04T14:53:20.863-08:00Turned Away<i><span style="background-color: white; color: #222222; font-family: arial, sans-serif;">Too many times I feel </span><br style="color: #222222; font-family: arial, sans-serif;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif;">We are losing time once shared </span><br style="color: #222222; font-family: arial, sans-serif;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif;">And only when you're in ecstasy </span><br style="color: #222222; font-family: arial, sans-serif;" /><span style="background-color: white; color: #222222; font-family: arial, sans-serif;">You seem to really care</span></i><br />
<span style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: x-small;"><br /></span>
<span style="background-color: white;"><span style="color: #222222; font-family: arial, sans-serif;">I recognize the song immediately. Chuckii Booker. <i>Turned Away</i>. Not the regular version, but the extended. As the words rush over me, caressing my nostalgia, a memory, a moment comes back. </span></span><br />
<span style="background-color: white;"><span style="color: #222222; font-family: arial, sans-serif;"><br /></span></span>
<span style="background-color: white;"><span style="color: #222222; font-family: arial, sans-serif;">I was standing behind the counter at Homer's Ice Cream on a brilliant summer morning before the doors opened. We were setting up. One of the managers turned the volume up, and the radio blared through the speakers. The shades had been pulled back from the storefront windows, and light streamed through the door and onto the wooden tables in the adjacent dining area. A veteran, the summer year before college, I had mastered almost every job in the restaurant. Served ice cream. Fry maker. Head grill master during rush hour. I inspected almost every inch of the building. Polished every spot. Cleaned the bathrooms and emptied the dreaded metal containers found only in the girl's room.</span></span><br />
<span style="background-color: white;"><span style="color: #222222; font-family: arial, sans-serif;"><br /></span></span>
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;">My collared work shirt held the italics <i>Homer's</i> logo in red over the breast. I rolled the sleeves up and squared them off above the biceps. I like to envision my arms bulging with arteries popping at just the right places. There was a pull-up bar in the storage room, and we often ran back if we saw a pretty girl approaching. Quickly, we would squeeze out a few reps before returning to the front with sweat falling from our brow. </span></span><br />
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;">There were all sorts of other hijinks. I was seventeen and unsure of myself. My heart had been broken already once or twice. So I acted out. Had shake eating contests when the manager was otherwise occupied. Gave away free food to my friends, only to find that it was deducted from my paycheck weeks later. I caroused with my fellow employees, many of them older than I, in search of alcohol and adventure. We broke the law occasionally; got caught from time to time. </span></span><br />
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;">It was all an act. Artificial bombast to divert from insecurity. At the time, the lyrics stung, but were an anthem played over a killer track.</span></span><br />
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;"><i>Turned away. Turned away. Why did you have to turn away? Turned away from love.</i></span></span><br />
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;">Like so many young people, I was convinced that I was unloveable. I ached for a idealized connection. A connection that both I and the objects of my affection were too immature to grasp. Surrounded by a family that adored me, I moped at home day after day both dreading and hopeful for my upcoming departure to college. </span></span><br />
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;">Those words, that tune, stuck with me. Long after I had successful relationships and realized that I was worthy of love. Even after I got married and had children. </span></span><br />
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;">Those words still move me. My body still sways back and forth and I feel both the pain and joy. </span></span><br />
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;">And my children mope around the house much as I had. Younger than I was at the time, but no less struggling to find their way through a confusing and cold world. </span></span><br />
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;">I turn the radio up and let the words spray from the speakers and drip onto their growing bodies. </span></span><br />
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;">We dance around the room with complete abandon,</span></span><br />
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;"><br /></span></span>
<span style="color: #222222; font-family: arial, sans-serif;"><span style="background-color: white;">and I momentarily believe that everything will be okay. </span></span><br />
<span style="color: #222222; font-family: arial, sans-serif; font-size: x-small;"><span style="background-color: white;"><br /></span></span>Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com0tag:blogger.com,1999:blog-6296669137299786155.post-53114907516812170272017-02-01T12:22:00.001-08:002023-01-10T06:48:58.894-08:00Opt OutIf you are planning on complying with MACRA, make sure to allot the appropriate time and funding necessary to update/upgrade your practice. Realize that the measures will be arbitrary, the data implementation arduous, and the moments for live patient care fleeting. Expect that no matter how Herculean the task may be, the finish line will move often and unexpectedly. Prepare to get discouraged when your software needs to be updated, maybe every year, at a cost. At least someone will be profiting from all this wheel spinning. <br />
<br />
Check, double check, triple check the data. There will be a host of governmental administrators waiting to disqualify your practice based on technicality. Dot all the i's, cross all the t's. Remember that somewhere out there is a person whose sole purpose is to find error in your work and punish you. Their bonus depends on it.<br />
<br />
Above all, don't forget that it is your patients that are most important. All these extra hours and dollars won't make a spit of difference in their well being. So you may want to squirrel away more personal time to do what you used to do all day long, before you agreed to these fanciful rules and regulations <br />
<br />
Best of luck,<br />
<br />
If you are planning to join an ACO or Medical Home, consider hiring more staff to manage the extra burden. What with the health coaches and life experts, it is guaranteed your payroll will swell. When not conducting team huddles and combing the data for <i>trendspotting</i>, you, of course, will get back to the business of helping patients with those burdensome medical problems. You might feel the urge to expand to cover increased costs, but in reality you will be pushed to have smaller panels and see people less often. Why have a billable visit to a physician when the government can get off cheap by using a coach instead? They should be able to handle heart failure, right?<br />
<br />
The bonus payments will cover the shortfall. At least fifty percent. The first year. Until the requirements get harder, <br />
<br />
But it's all for the greater good.<br />
<br />
So you'll work it out somehow.<br />
<br />
If your goal is to sell your practice to a big medical group, congratulations. Don't expect to receive more than pennies on the dollar. The days of getting a fair market value are long gone. There are federal regulations, you know? You wouldn't want to be accused of inducement. I'm sure the transition will be flawless and your salary guaranteed. For a time. <br />
<br />
You might get to keep that favorite nurse or secretary. Much everything else will change though. Your medical record, your hours, your payer mix. You will work more, for less pay, and lose much control over your day to day activities. At some point you may realize that all that money you are making for the practice is now going to some administrator or another. Definitely not to you. <br />
<br />
At least someone else will have to worry about all those details you loathed so much. You are paying them to.<br />
<br />
If you are working towards completing your maintenance of certification activities for the ABIM...<br />
<br />
Wait. Wait. Does this all sound fairly miserable to you? It does to me. So do something!<br />
<br />
Opt Out. <br />
<br />
I'm not talking about filling out a silly form and sending it to the government (although that sometimes works too). <br />
<br />
Remove yourself from the abuse. Extirpate your income from Medicare and insurance companies. It's more possible than you think. There are at least a hundred different ways to do this. <br />
<br />
I'm doing five of them right now. <br />
<br />
Are you going to role over and play dead? <br />
<br />
Or are you going to do something?Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com0tag:blogger.com,1999:blog-6296669137299786155.post-85907814174023388822017-01-30T07:44:00.000-08:002017-01-30T07:54:53.052-08:00A Stitch in TimeAt first I thought the beeping was coming from the television. I had just settled back into the couch after tucking my daughter into bed for the second time. Her tummy was hurting. It had been doing that a lot lately. Especially on Sunday nights with the specter of Monday morning looming large. She was getting headaches, stomachaches, nausea. It had been going on for some time.<br />
<br />
My son is similar. His headaches and bellyaches come and go. He is famous for vomiting at any given moment and then feeling fine the next. And to think of it, we have all been under the weather lately. Our house, as so many, has been caught up in the hacking, runny nose, sore throat plague making its way though our neighborhood. Katie was lethargic and had a headache almost everyday last week. <br />
<br />
We were all coping though. Getting better slowly as the body is wont to do. There were no emergency room visits or trips to the pediatrician. But we were all tired after a busy week and a hectic weekend. <br />
<br />
So when the incessant beeping started, the first thing Katie did was turn down the volume on the TV. When it stubbornly persisted, I grumpily made my way down to the basement to investigate the culprit. Once in the basement, I tried to triangulate from which hidden corner the beeping was coming from. The boiler? The water heater? The fire alarm? The beeping no longer felt benign as I held my fingers to my ears to keep from permanent hearing damage. It was about when I focused on the CO sensor, that Katie called down to me. <br />
<br />
It was the alarm company. Our Carbon Monoxide levels were too high, and they called the fire department. I rushed up the stairs, opened the house doors, and we gathered the children and coats. Katie and the kids waited in the car, and I went to the front of the house and flagged down the fire truck.<br />
<br />
It was not a false alarm. The Carbon Monoxide level in our basement was 108 PPM. According to the paramedic, one can survive in this range for about 10 to 15 minutes. Katie's office was the next highest at 40 PPM (it usually takes about 8 hours for a person to be overcome at these levels). The kids bedrooms were in the 30's.<br />
<br />
The Firemen shut down the boiler and the water heater and opened all the windows. Within minutes the levels had fallen to zero. We slept last night in a chilly home using our backup heating system that is meant for only half the house. Slept is a loose term, I mostly tossed and turned. We will see if the headaches and nausea disappear.<br />
<br />
It's disturbing to think of all the possible scenarios that could have played out without the benefit of that CO detector.<br />
<br />
Did I mention that we just installed it a few months ago?Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com2tag:blogger.com,1999:blog-6296669137299786155.post-22300754619334357782017-01-28T13:22:00.001-08:002017-01-28T13:22:49.945-08:00An American Story<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmwHmALmHcXXjhC3CR8UwEabnZWFdKMEdhABS92At2cZ28OSotumgNeCbYdgSXBtrSNPAuvd2TUREV0k4T2kn8AHT5NoZVJJn6be9m2fvcsHoOe2slCBkrC-rzL4gWxgLLO5CDN5nRjPM/s1600/IMG_4419.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmwHmALmHcXXjhC3CR8UwEabnZWFdKMEdhABS92At2cZ28OSotumgNeCbYdgSXBtrSNPAuvd2TUREV0k4T2kn8AHT5NoZVJJn6be9m2fvcsHoOe2slCBkrC-rzL4gWxgLLO5CDN5nRjPM/s320/IMG_4419.JPG" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
Sitting in the waiting room of the Oval Office surrounded by his family, Sam found it both fortuitous and ironic that he had changed his name years ago. Amongst a flurry of millions of pressing yet inconsequential decisions, Americanizing his Iranian name, Saeed, would later save him some grief during 9/11. He looked up at the line of government workers and their families wending it's way through the hallways and ending abruptly at the President's office. One of the security guards had taken pity on Sam. His eighty year old body hobbled by a bad knee, broken years ago in a tunnel explosion during his years as a foreman in Tehran, bought him a front row seat to the festivities.<br />
<br />
Sam loved Iran. His mind could draw a straight line from a childhood spent sleeping on Hamedanian rooftops to his ascension as CFO of a multinational company. His success and wealth, however, all crumbled that day he was jailed by the henchman of a new Ayatollah who was deeply suspicious of his bosses political leanings. He won't tell us the details now, but his release, ushered by Shah loyalists at the prison, likely spared his life.<br />
<br />
Months later, with visas obtained in Italy, Sam, his wife, and three children boarded a flight into the unknown. His wealth, property, and status remained in the country he loved. There was a pact that if they were detained at the airport, his wife and children would flee to America alone. A pact that would thankfully be allowed a single day reprieve. One of Sam's colleagues was detained the next afternoon and never heard from again. <br />
<br />
America was not easy. Brutal in fact. Sam's position as CFO carried little weight in the US. He traveled hours on public transportation to jobs he was overqualified for to receive paltry wages. His wife, a teacher in Iran, became a manicurist. They survived day to day in a tiny two bedroom apartment. The Iran hostage crisis insured that there was no shortage of discrimination and racial slurs thrown their way.<br />
<br />
But Sam had no time to complain. He was caught up in the most American of pastimes-providing a life for his three young children. So he found a way. When his shoe stores failed he scraped enough money together to buy an apartment building. And they had enough. Never a lavish life like he had in Iran, but there was always food on the table.<br />
<br />
Sam's eldest daughter became a lawyer and eventually worked for the government. She had given much to her country including years of service in a very dangerous Afghanistan. It was at her invitation that three generations of his family were gathered to meet our great leader. <br />
<br />
As he walked into the oval office, Sam adjusted his eyes to the splash of light and color, flash bulbs and smiles. A man who was forced to flee a country he loved for dubious political reasons, was now face to face with the leader of his adopted country. Ironic that he hadn't voted for this president, or agreed on so many issues. This was allowed here. Celebrated.<br />
<br />
It had never been easy. Sam's family was nearly deported a few years after emigrating. He had been held up at gunpoint in his shoe store twice. He was a victim of far more crimes than any petty moving violation he may have committed while driving absentmindedly. His family faced discrimination of almost every stripe. <br />
<br />
America, however, was also a country of unthinkable kindness and good intention. Her actions were often flawed, but her principles were unflappable.<br />
<br />
At least until recently. <br />
<br />
Sam's youngest daughter, my wife and mother of my two children, accompanied her father that day in the oval office. <br />
<br />
He waited in line with the rest of his family. He smiled when the President stood in front of him, and offered his hand. His English still broken after all these years, his voice was almost a whisper as he spoke his given name in greeting. <br />
<br />
<i>I am Saeed.</i>Jordan Grumethttp://www.blogger.com/profile/12566078305685946261noreply@blogger.com4