Friday, July 1, 2022

Taking Stock: A Hospice Doctor's Advice on Financial Independence, Building Wealth, and Living a Regret-Free Live Available 8/2/22 from Ulysses Press.

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.

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.
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.

Please click on the link below to see the book trailer and if resonates with you, please share the YouTube link!



Available for Preorder here.

Wednesday, April 18, 2018

The GoldiDocs Phenomena

The GoldiDocs Phenomena

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.  

I'm not talking about medical knowledge or clinical savvy. I'm not pointing to differences in  education or training.  

Bedside manner.  We're talking about bedside manner people! 

Dr. Too Grumpy

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.  

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.

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.  

She is perfectly capable, yet utterly unacceptable.

Dr. Too Nice

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.  

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. 

He hates confrontation and would rather pander than have an honest, open conversation.  Difficulty is his greatest adversary.  Not illness.  Not well being. 

He will tell you exactly what you want to hear.  Hold your hand.  Lie through his teeth.

He is a perfectly nice guy, yet the most dangerous provider you will encounter.

Dr. Just Right

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.  

They know how to just stand there and do nothing.  When nothing is called for.  

They may lecture you on diet and exercise, smoking and alcohol, stress and anxiety.

But you will know them when you see them.  

If you see them.

They're a dying breed.

If you want to hear more stories about medicine and personal finance, check out The Earn & Invest Podcast.




Friday, June 2, 2017

Swindled

You'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.

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.

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.

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.

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.

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.

Vitamin C, Vitamin E, Calcium?

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.

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.

I could go on and on.  Don't even get me started on antibacterials for non bacterial infections.

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.

And we are not being good advocates.

We are not shielding our patients from harm.

 

If you want to hear more stories about medicine and personal finance, check out The Earn & Invest Podcast.


Saturday, April 1, 2017

Letting Go

You can let go now!

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.

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.

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.

Why won't you take me?

They said she was a survivor.  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.

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.

Persistence had entwined her DNA, calcified her bones, and cascaded past blood cells forever traveling in circles.

Her body was failing, but her spirit couldn't let go.

No matter how much she begged and pleaded.

It didn't know how.


Five Moments, now available on Amazon.


Also available, I Am Your Doctor: and This is My Humble Opinion.


If  you want to hear more stories about medicine and personal finance, check out the Earn & Invest Podcast. 




Friday, March 17, 2017

Drip Drip

Get out.


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.


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. 


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. 


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.


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.


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.


Harvey died shortly thereafter.


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.


What surprises me, in retrospect, is how little he affected me.  How his anger didn't penetrate the hardened shell. 


Over my career I have been yelled at, cursed, blamed, hugged, and even loved by my patients.


And like the poor life force oozing out of Harvey's beleaguered body, it drip drips down my back.


 And into a forgotten puddle on the ground.


My new book:  Five Moments, now available on Amazon


If you want to hear more stories about medicine and personal finance, check out The Earn & Invest Podcast,



  

Monday, March 6, 2017

When A Loved One Dies

At 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.  

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.

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.  

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.

Interest and meaning return.  The sun rises and falls.  You will not break.

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.

I'm talking of guilt.

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.

And we can't control death.  So we feel guilt.

This guilt will plague you.  It will turn grieving from a process to a permanent state.

Don't let it.  Your loved one died because it was time.  Nothing you did would have changed that.

Forgive yourself.

Let this forgiveness be one last act to honor the dying.  


If you like this post, please order my new book of short fiction, Five Moments.


If you want to hear more stories about medicine and personal finance, check out The Earn & Invest Podcast.



Sunday, February 26, 2017

Neither Was Mine

There are parts of medicine that are horrendous.  Moments too painful to recount.  Events that will break even the most innocent participants.

And then there is unspeakable magic.

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.

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.

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.

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.

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.

On the triumphant drive home from the hospital, with the radio blaring, I remember the patient whose back such life saving knowledge was attained.

And I rejoice that all their suffering was not in vain, and neither was mine.