Saturday, December 19, 2009

Crazy Aunt Maryly and Charlie

Stop 1 of our Christmas road trip was my Aunt Maryly. Charlie asked her to read "One Fish Two Fish Red Fish Blue Fish." This is her version. I'll keep you updated as we cross the country! Made it from Ohio to Illinois so far! Tomorrow, Iowa then Nebraska.

Sunday, November 22, 2009

You want us to READ the health care bill??

I heard a few days ago that Senator Tom Coburn (R-OK) was planning to force the clerks in the Senate to actually read the entire 2,074 page health reform bill on the Senate floor before they'd be allowed to vote on it. See that article here.

Now, I'm reading that he likely won't do that, in fact. See this.

What are your thoughts on that? Senator Coburn is one of two physicians currently in the Senate, so naturally I already like him :) Actually, I hadn't heard of him, before this, but I read up a bit on him, and he sounds like a pretty good guy. As for reading the health bill, it SOUNDS like a bit of a no brainer! Shouldn't you read a bill before you pass it? But, I'm not a politician, nor do I have a firm grasp on the details of politics. Apparently he's changed his mind at least in part due to concerns that it would not be productive. Well, I certainly don't want to advocate wasting the Senate's time, but at the same time I have to wonder, what better thing do they have to do? Your thoughts?

Sarah Palin

Well, Sarah's in the news again, with her new book coming out. I wonder, as I write this, what proportion of you think I do or do not support her. I would think most of you would think that I support her.

I DO like her. However, that is not enough. Her perspective on things in last year's election, and her energetic attitude was quite refreshing. Unfortunately, I require more than that from a politician. I need results, I need intelligence, I need an ability to either effectively play the game, or effectively circumnavigate the game.

There were a lot of things that I liked about George W. Bush (please don't hate me). One thing that I never could get over, though, was his inability to make a speech. I cringed every time I heard him say "noo'-cyu-lar". He came across to people as a hokey, uneducated ignoramus, and the media devoured him for that. Sarah has a similar problem. Her politics and whatever the truth may be put completely aside, she has allowed the media to portray her as a simpleton, as a "Miss Alaska" beauty pageant queen. In order to be an effective politician, you need to be able to get your points across effectively. You can be the most principled person in the world, with the absolute best ideas for how to fix up this country's problems, but if you can't get people to rally behind them, all your ideas are worthless. I'm glad I am not a politician, for I fear that that simple concept would be my own undoing.

I really want to like Sarah. In fact, I actually do like her, as a person. From what I can see about her, she seems to be a very principled, driven woman. It sounds as if she did some pretty good things for Alaska, until she stepped down as governor (What was up with THAT?). I think she's probably a wonderful person, and I applaud many personal decisions on her part. I like that she stuck by her principles and did not have an abortion. I like that she has chosen to love and support her daughter, despite the stupid things that she's done (shouldn't all parents do that?). If she chose to resign for her family's sake, I like that as well. All of these things make me like her as a person, and certainly earn my respect.

That does not convince me that she would be a good or effective politician, however. Has she demonstrated that she knows enough about current events to be able to intelligently engage the current world scene? Not to me, at least. Has she shown herself to be effective at transcending the media's desire to splatter her name? No, she has not. Could she prove, in the future, to be an effective politician? ABSOLUTELY. If she were able to do so in the future, she would likely have my support. However, I do not see any good reason to support her, politically, at the moment, unless it would be for lack of someone more qualified.

Saturday, October 24, 2009


Hey "all"! Sorry I've been out for know how it is. This time, instead of me rambling on, I thought I'd ask for some open discussion. I'm thinking about getting a tattoo (well, there are many tattoo ideas I have, and I've been thinking about them for a few years), but I thought maybe "you" would like to discuss a few things:

A) How do you feel about tattoos for a Christian? (I'm a Christian).

B) How do you feel about tattoos on doctors? (I'll be a doctor in two more years!)

C) What designs do you like/are significant to you?

D) What do you think about tattoo location (on the body)?

E) Anything else tattoo-related you'd like to talk about.


I'll update later on with some of the ideas I've had.

Tuesday, August 25, 2009

Quick Primary Health Care Article

You should read this article. I'd write my thoughts on it, but I'm moving this week so I'm really busy. But it really sums up a LOT of our health care problems. Read it!

Monday, July 20, 2009

In Cancer News...

TIHS article reports on the AMAZING discovery of a group of Jewish-American scientists. According to the article, the scientists have discovered a protein that turns off the cell suicide mechanism that is turned on my radiation therapy. The results are astounding, and the trials conducted so far indicate that it is very safe. If approved, this drug could allow much higher doses of radiation therapy against certain types of cancer! It would also provide protection against victims of nuclear fallout in the event of a nuclear attack, or the use of a "dirty" bomb. Exciting!

One Thought (With Which I Agree) on Universal Health Care

The title pretty much says it all. THIS is an excellent article, written by a bioethics professor at Princeton University, making the case for the rationing of health care, essentially setting a price tag on a human life. I agree with his excellently made points. I normally like to give you a synopsis of the article, but you really should read it yourself. It's worth your time.

His main point: We already have set a price tag on human life/safety, in other realms. We need to do so, openly, in health care.

Saturday, June 27, 2009

Proud Daddy Update

Just a quick update to brag and say that my 17-month old son is now wearing underwear and getting potty-trained. He's awesome :D

Friday, June 26, 2009

Father's Day Part 2, et. al.

Just some photography from Father's Day. We had a great time. My wife, feeling guilty about having forgotten our 2nd anniversary (I TOTALLY surprised her by getting a babysitter and taking her to a Japanese Steakhouse), made an astounding 6-course dinner while I played outside with my boy, Charles :)

She so nicely made sure not to include anything with caffeine in it, because I've made a vow to be caffeine-free this summer. I was drinking way too much to keep up with school and child, etc, and I realized it just wasn't good. Interestingly, this article popped into my inbox this morning. She probably could have used some, though!

This is another article that popped up this morning. Researchers looking for a "happiness gene". Interesting, I thought. Then I read the line:

We may be a long way off from being able to genetically engineer happiness...


That is all. Back to working on my physics syllabus, coordinating shadowing times and interviews with doctors, playing with my kid and having lots of godly sex. Bye for now! :D

Sunday, June 21, 2009

Father's Day Post 1

Tomorrow, I plan to write a more substantive post on Fathers, but for now, I'm just sneaking a few minutes while my fabulous wife is cooking an extravagant feast in my honor, and my son sits in his high chair eating noodles.

I'm going to link you to a good article from the Washington Times about a side that is not often mentioned.

**DISCLAIMER** I am well aware that this is a very biased opinion, and that there exist valid counterarguments to the views presented. It's just an oft neglected view, and I wanted to air it.

More tomorrow, with pictures!

Wednesday, June 17, 2009

Today's Thought from Oswald Chambers' "My Utmost for His Highest"

June 17: "Judge not, that ye be not judged." --Matthew 7:1

Jesus says regarding judging-Don't. The average Christian is the most penetratingly critical individual. Criticism is a part of the ordinary faculty of man; but in the spiritual domain nothing is accomplished by criticism. The effect of criticism is a dividing up of the powers of the one criticized; the Holy Ghost is the only One in the true position to criticize, He alone is able to show what is wrong without hurting and wounding. It is impossible to enter into communion with God when you are in a critical temper; it makes you hard and vindictive and cruel, and leaves you with the flattering unction that you are a superior person. Jesus says, as a disciple cultivate the uncritical temper. It is not done once and for all. Beware of anything that puts you in the superior person's place.

There is no getting away from the penetration of Jesus. If I see the [speck] in your eye, it means I have a beam in my own. Every wrong thing that I see in your, God locates in me. Every time I judge, I condemn myself (see Romans 2:17-20). Stop having a measuring rod for other people. There is always one fact more in every man's case about which we know nothing. The first thing God does is to give us a spiritual spring-cleaning; there is no possibility of pride left in a man after that. I have never met the man I could despair of after discerning what lies in me apart from the grace of God.

Thursday, June 11, 2009

Just This

Hi All, sorry I haven't been around. Tomorrow is the last day of the first year of medical school!! But, I came across this, thought it looked (note: I haven't done anything but glance at it!) awesome, and thought I should share it!!

Sunday, May 24, 2009

Just Stopped in to Say... are you all? It's been very interesting to watch the results come in for the poll on the right (if you haven't voted yet, please do so!) I've been pretty busy myself, lately, but I did very well on my Neural Science exam on Friday! One more exam to go, so in 3 weeks I'll be done!

Looks like I'll have a pretty packed summer. I'm working two jobs at least, and in the process of applying for a third. I'll be teaching a high school course on physics through the OSU Office of Minority Affairs, and doing a physician interview program through StoryCorps as well. I'm applying to teach a post-bacc summer course on immunology through the med school. Interview on Wednesday--we'll see how that goes! I'm already trying to re-study immunology in case I do get to teach that one.

It's been warm--hot even! here in Columbus. The difference between here and CA is that it's humid here! But, we've been taking Charlie out to the park a lot, as you can see from the pictures!

Great news financially is that we got a scholarship through the university, so between that and my jobs, we shouldn't have to take out any extra money this summer. We should be completely paid off with our credit cards by August, which is fantastic, because our car has been falling apart and we really really need a new one! We plan to get another truck (YAY!!) in August, using the excuse that it will help with our move, to our new house in a quieter part of Columbus.

I continue to have no idea what I want to specialize in, though my latest serious consideration is anesthesiology. My hope is to do a lot of shadowing this summer in an attempt to get a better idea of what I want to do.

Charlie continues to be the rascally little boy that he is, making his daddy so proud. He truly is a boy's boy, and I'm just tickled to death with him. He's learning a lot of new words, and he loves to run around outside, especially to play with rocks. He's always grabbing our fingers and dragging us to the door.

Well, that's all I have time for now--I'm not sure when I'll have time to write anything more "substantial", but you know that's always the way with me :) Take care for now!

Friday, May 15, 2009

Capital Punishment

I'm adding a new poll on the right, sparked by a discussion on Facebook. I'm not going to discuss the topic yet, because I want to see your "unbiased" responses at this point. I hope you will vote! It's totally anonymous...

Wednesday, May 13, 2009

The Frustrations of Trying to Find Reliable Sources

BIAS!! AHH!! Misquoting, things taken out of context, exagerrations, even blatant fabrications! It's just SO hard to really just get down to the truth, anymore, it seems. That's the frustration I currently have, at least. And I simply don't have the time to do all the grunt work myself. Even "primary" sources, that should be reliable...are they? For example, with all the evidences of the FDA's...oversights? blunders? intentional overlooks?--can we really implicitly trust whatever they say? But on the other hand, who really has time to wade through the primary research into whether a drug is actually safe or not? Even if you did have the time to do that, do you have time to research the people who DID the research...are they getting funded by the drug company, thus making their "findings" biased? You see what I'm getting at?

Take 9/11--there are aspects of the "official story" that don't quite satisfy me. There are aspects of various "conspiray theories" that seem to have merit. But what about ALL the hodge-podge, whacky explanations, with little or no evidence for them out there? No one seems to take the time to carefully document their sources anymore. Perhaps I'm just a fuddy-duddy academic, but I want to see a WORKS CITED sheet, or some equivalent, before I take an article seriously! With such an array of "alternative explanations" out there, most of which can have holes poked in them by just looking at them, how can someone wade through it all and try to find "the truth"? Yet, should we just "give up" and simply trust that whoever's in charge will definitely tell us the whole truth? That kind of blind faith seems naive, particularly in light of history.

I don't want to be just another person saying, "The Bush Administration is responsible for torture and other war crimes!" with nothing to back me up. But, if someone is responsible for torture, or murder, particurly if children are involved, he should be brought to justice, regardless of who he is! There is never an excuse for torture (ironic, since I love the Fox TV show "24"). It's an ineffective interrogation technique, the "confessions" derived from it are questionable at best, and it is a hideous breach of humanity. You must not become evil, in the fight against evil. I read recently that over 100 terror-related detanees have died in US custody, but only 12 deaths resulted in punishment for anyone involved. I've read stories of terrorist suspects whose children were held and tortured to force confessions. Most of these stories I read were attributed to some government official or another who wished to remain anonymous. Understandable, but that doesn't help me in my search for objective evidence. If these astounding crimes are occuring, they must be stopped, and the perpetrators brought to justice. But what if a crusade is waged, only to find out that, in the end, no crimes were committed? Where does one even start?

There's the whole Israel/"Palestinian" mess. Some reports say that Hamas shoots rockets into Israel almost daily. Some say that these "rockets" are merely glorified firecrackers. Some say, Israel has a right to defend herself. Some say, these people have lived in this area for decades, and what right do the Israelis have to make them leave? I don't know what to believe.

And that's frustrating. Oh, for more time.

Monday, May 11, 2009

Ban Doctors!

My dad forwarded this to me, and I thought it was so hilarious, I had to share!! :)

(A) The number of physicians in the U.S. is 700,000.
(B) Accidental deaths caused by Physicians per year are 120,000.
(C) Accidental deaths per physician is 0.171.
***Statistics courtesy of U.S. Dept of Health and Human Services.***

Now think about this:

(A) The number of gun owners in the U.S. is 80,000,000.
(B) The number of accidental gun deaths per year, all age groups, is 1,500.
(C) The number of accidental deaths per gun owner is .000188.
***Statistics courtesy of FBI***

So, statistically, doctors are approximately 9,000 times more dangerous than gun owners.

Remember, 'Guns don't kill people, doctors do.'


Please alert your friends to this alarming threat. We must ban doctors before this gets completely out of hand!!!!!

Out of concern for the public at large, I withheld the statistics on lawyers for fear the shock would cause people to panic and seek medical attention! Please write to your U.S. Congressman and U.S. Senator and encourage then to introduce legislation to ban or at least severely restrict our access to doctors. On second thought... I guess we are planning on doing that with our upcoming Obama Universal Healthcare legislation initiative.

Saturday, May 9, 2009


I cried this Thursday morning at 7:30am. I thought I'd be ok, but no, apparently not. You see, my son was going into the OR for surgery. No, nothing invasive, no huge procedure. They only knocked him out for 5 minutes, actually. He's been tongue-tied since birth, and his tongue had been getting more and more dimpled as his frenulum held it back. So the otolaryngologist said we could bring him in to just have it cut. Simple procedure.

That's what I kept telling myself. Charlie had to fast from 11pm the night before, and we had to show up at 5:30am for processing. I had everything all set, so all I had to do was change his diaper and carry him to the car. He ended up waking up in the hospital as I filled out forms, giving my consent for these strangers to take my baby away from me and take a scalpel to him. I double-checked his ankle-bracelet to be sure his name was right. I interrogated the anesthesiologist: what are you giving him? How long will he be out? I made sure the doctor doing the procedure looked at Charlie, so he would recognize his face in the OR.

The whole time, Charlie is running up and down the halls, laughing and smiling. Jumping in his pre-op crib, reading books with me, flirting with the nurses. Then a nurse comes, and I check to make sure she says his name, and has the right chart for him. We walk together to do the doors of the OR, and she keeps wheeling my son away in his little crib while I stay behind. He stands up, looks at me with a big smile on his face, waves and says, "Bye-bye!"

That's when I wept. He felt content and safe, because I had brought him here. He knew nothing here, but he knew me, and knew if I was ok with this place, he was ok with it. He trusts me not to let harm come to him. And oh, the trust I had to place in the nurses, and the doctors. 20 minutes later, it's all over and my son sits up when he catches a glimpse of me waiting for him. He didn't cry or fuss even once in the whole time we were at the hospital. Soon he was grabbing my finger and running up and down the halls again, while I held tightly to his wrist in case the anesthesia left him groggy and he collapsed. The nurse says: "So he's ready to go!" And off we went.

There were parents in the waiting room who wouldn't see their children for hours. I only had to wait 20 minutes, but oh the emotion of it. I'm not sure what my point is, in writing this. I can assure you, lessons like this I won't forget, when it's me that the parents are entrusting the welfare of their children to.

Friday, May 8, 2009

Medical Ethics

Hi all! I'm considering entering an essay contest by the AMA on a specific medical ethics problem, and I'm trying to get various perspectives on the issue. Would you read it and give me yours? If I do end up writing an essay on it, I'll post a copy here. The website with the prompt is Thanks in advance!

Monday, May 4, 2009

The Abolition of Man, a review

She beckons to me across the aisle, silently pleading for me to pick her up. I sidle on up to her, glancing around to see if anyone will notice. "I'm only 80 pages long," she whispers, seductively. I reason to myself, I've refused her dozens of times in the past, for some reason or another. Poor little book...a large essay, really. What harm could it do? Foolishly, I allow myself to be lured into the promise of a quick read. This is why I shouldn't be allowed into bookstores.

The book is C.S.Lewis' controversial work The Abolition of Man, and I must confess, the title gave me no indication as to what the subject matter was going to be. I began reading, finding myself being lectured about a high school grammar book, and I was thoroughly confused throughout most of its (81, as it turns out) pages. Only near the end did I really come to grasp the significance of this writing. I returned a few days later, eagerly devouring it again, finishing in less than an hour on a second reading.

There are two faces to this book's coin, the first being the argument: There are premisses which we must simply take for granted, which stand upon their own authority. To introduce this idea, Lewis criticizes an English grammar book on its treatment of a piece of literature (apparently well-known to his target audience...I had to search for it, and found it at this website). I'll let you read the story yourself if you wish, but the point that the grammar book (according to Lewis) makes about it is that in saying the waterfall is "sublime", the tourist makes only comments about his own feelings, thusly: "I have sublime feelings about this waterfall." They ridicule this "confusion" in the English language, implying that the waterfall has no intrinsic majesty. Lewis contends that the waterfall is in and of itself a beautiful thing, whether observers notice it or not. Tourists may view it with sublime feelings: if so, they are appropriate feelings; if with other feelings, they are less appropriate.

A lengthy example, perhaps, but Lewis then continues to apply this principle in broader strokes. He takes the example of a Roman telling his son, "It [is] a sweet and seemly thing to die for [your] country." Lewis points out:

Death is not something to eat and therefore cannot be dulce in the literal sense, and it is unlikely that the real sensations preceding it will be dulce even by analogy. And as for decorum--that is only a word describing how some other people will feel about your death when they happen to think of it, which won't be often, and will certainly do you no good.

Lewis uses this example to postulate: without the presence of real and true premisses, statements such as the Roman father makes are either foolish sentiments, or they are an attempt to manipulate and propagandize. He deals with the second alternative after further exposing the impossibility of the first.

I will try to summarize his argument into its basic logic, for sake of brevity. In the end, Lewis states: "We laugh at honour and are shocked to find traitors in our midst. We castrate and bid the geldings be fruitfull." The logic is thus: If it cannot be truly said that dying for one's country is an instrinsically desirable action, then perhaps you can say that dying for one's country is useful for the community's survival. But, "what is really meant is that the death of some men is useful to other men." This begs the question, "Why should I be one of them?". As Lewis states, "This will preserve society cannot lead to do this except by the mediation society ought to be preserved." This may seem to allow a way of escape, in that: Animal instincts, though baseless, are the foundations that we should follow. But, this cannot be so, for three reasons. First, it does not follow that I have this instinct THUS I ought to follow it. Second, as Lewis states of himself: "it is worth inquiry whether there is any instinct to care for posterity or preserve the species. I do not discover it in myself..." Thirdly, "Telling us to obey Instinct is like telling us to obey 'people'. People say different things: so do instincts."

This leads us to the disturbing alternative. We can theorize that there really ARE no intrinsically "good" values. With as much as we continue to conquer nature, especially that of the "human nature", Lewis theorizes a point where those who have the knowledge and power are finally able to condition further generations of the human race to value whatever they so desire. And why should they not, if there are no real values? And why should they choose any particular value system over any other, if they are all equally valuable...or invaluable? As Lewis states, the educational theory that real values exist "deals with its pupils as grown birds deal with young birds when they teach them how to fly," while the new theory would "deal with them more as the poultry-keeper deals with young birds--making them thus or thus for purposes of which the bird knows nothing." As with all power that "man" gains, "the power of Man to make himself what he pleases means, as we have seen, the power of some men to make other men what they please.

Lewis states that at this point, "Man" will cease to exist. Everything afterward will be seen in the light of the original Conditioners. Whatever they will to be "good" will be good, etc. The "Man" after that will be a new creature entirely.

This is, of necessity, a very brief synopsis. If you can, I highly encourage you to go out and read it in its really is "only" 81 pages long. I hope to hear your comments soon!

Wednesday, April 29, 2009

Oh no! Swine Flu! Everyone panic!

I'm kind of sick of hearing about the swine flu "pandemic." Ok, there have been MAYBE 200 deaths associated with it. The big question is whether it will mutate to become more easily transmitted, more deadly, or resistant to antiviral drugs. Right now, none of those issues seem to be a problem. Put things in perspective: the CDC estimates 36,000 people die of the "regular" flu every year. Do we hear about those nonstop? Nope. I'm just saying--don't panic. Keep an eye on it, sure. But goodness, calm down.

On the other hand, I do find it strange that the virus seems to be a combination of three completely different strains? That seems highly unusual to me. Just makes me go, "Hmm."

Wednesday, April 22, 2009

That whole Ms. California thing

Come on now, really? In case you haven't heard about it, here's the story. I'm not going to get into the whole homosexuals should or should not "marry" because... thing. But, I did have to say: What's up with that whole freedom of speech thing? Seems we're for freedom of speech, as long as you say what's mainstream.

So, perhaps she could have stated her opinion more tactfully. Still, questioner Perez Hilton certain didn't show any tact at all in calling her a "dumb b___" or saying her response was the "worst answer in pageant history." He said, "She is not a politician, she's a hopeful Miss USA. Miss USA should represent everyone."

Well, with such polar views in America on homosexual marriage, it's not possible to actually represent everyone when asked such a question, unless you don't actually answer the question. You have to end up offending someone. Since he seems to think that the vast majority of Americans support homosexual marriage, let's set him straight. Here's a CBS News poll of Americans on the subject. Only 33% of Americans support the notion of homosexual marriage, in full equality with heterosexual marriage. (27% support civil unions and 35% support no legal recognition). So, actually, in her comments, she sided with the majority of Americans.

Just not the loudest ones.

Sunday, April 12, 2009

Personal Update

I rarely write about what's going on in my life, so I thought I'd just do a quick personal update, on this lovely Easter Sunday. Jesus is alive, Hallelujah!

It's been a pretty full but good day. We actually all got up at 9am today, had a good service at church today (message from John 3:16-18). Then we went home, and I made some Bantry Brown Bread for dinner tonight (a traditional sweet bread with currants). Then we went off and got our pictures taken, something we hope to make an annual tradition. We got 15 sheets of pictures! When I have them, I'll scan them and upload them here. Then we came home, and just relaxed! Called a lot of friends and family, my wife and I played some Halo 3 together (I got an Xbox 360 because studies show that surgeons who play at least 2 hours of video games a week make 36% fewer errors), and now the ham is in the oven for later!

NEWS FLASH: Medical school is HARD! So I failed a second exam on Friday. I failed Host Defense 1 and Host Defense 3. It's very strange for me, because I graduated UC Davis with a 3.92GPA. However, I am dealing with it and moving on. The topics were topics I'd never covered before (I never once had an immunology/microbiology course), and the most difficult aspect was that a lot of it was just straight memorization. Bacteria, viruses, drugs. In any case, from here on until summer, we'll be covering neural science, which was my major! Yay! I L-O-V-E the brain.

Charlie is, of course, the cutest little boy in the world! He actually has 4 new teeth coming in right now. He is VERY intelligent, and very much a boy. He runs around, grunts, climbs, falls over and picks himself up again. He asks me to read to him, is learning how to put block shapes into the right holes, and can figure out how to get into anything. He's almost 15 months old!

This summer, I will be teaching physics for disadvantaged Ohioan high school students! I know you all think I'm a nerd, but I'm so excited! I get to design my own curriculum and everything. Only 4 weeks, 6 hours a week, but it pays VERY well. Still, I'm way short on my summer budget, so I'll be taking out an extra loan to get us through the summer.

I've realized that I've been letting my spiritual life atrophy. I hardly remember the last time I read my Bible, my conversations with God are brief and hurried, etc. Not that I feel obligated to do those things, I just have been craving a stronger relationship with God. I got the book My Utmost for His Highest, which I've been thinking about doing for awhile. I also have some other ideas to set aside time for our relationship.

I've dived into two old hobbies again, which have been so wonderful for me. A month or two ago, I got a stack of bills in the mail, and I said to myself, "I'm sick of getting only bills in the mail!" I recalled the good old days of getting snail mail, and I realized, if I want to get letters in the mail, I need to send some! So I got some stationery and I've been writing letters! If you want me to send you one, just give me your address :D

I've also started up karate again! I realized I was getting stiff and fat (I was up to 195lbs, and I refused to cross 200!), and I remembered how stress-relieving it was, so I emailed my class and found someone who used to practice Shotokan, a VERY similar style to mine. We've been getting together twice a week to workout together, and it has been awesome.

So, that's basically been my life as of late! Lots of getting up at 5am, studying, playing with babies and kicking butt. Sometimes I feel pretty isolated all the way out here in Ohio, absorbed in my studies, so feel free to comment, send me emails, send me snail mails or just call me!

Sunday, March 15, 2009

The Long Awaited Abortion Post

Quick Personal Update: I'm on Spring Break!! Hallelujah, 7 entire days of no school! I passed Host Defense 2 with a 76% (I've never been so content with a 76% before!), and then we have only 2.5 weeks of Host Defense 3 before 3 neuro blocks come along, then summer vacation! Fantastic (I was a physiology major with an emphasis in neurobiology, so I'm pretty psyched). Both my wife and son have been quite sick the last week or so, but thank God, my immune system (I don't want to TALK about immune systems anymore!!!) has withstood the onslaught. Having gotten a glorious 8 hours of sleep last night, read Dr. Seuss' "The Foot Book" 5 times to my son who is now passed out on the floor, I write the post that has been on my mind for months. I hope it, at the very least, makes you stop and go, "Hmm." Bon appetit.

I have been against abortion my entire life. My earliest memories of this include standing on the sidewalk of a busy street, probably around age 5, holding an “Abortion Kills Children” sign with my parents, sister and dozens of other people. Of course, I really knew nothing of abortion at the time, and over the years, my thoughts and views have themselves developed, from embryo to fetus to newborn, all the way on up to, perhaps, young adult? I’m sure I have much more to learn and discover, and am never willing to definitively stake that, “Aha! This now, is the ultimate truth.”

I was raised in a home where Right was Right, Wrong was Wrong, and it was as simple as that. I have since discovered that the real world is not quite so cut and dry. I remember trying to explain Anakin Skywalker from the horrible movie Star Wars III: Revenge of the Sith to my young brothers. Their analysis of main characters was always “Good guy” or “Yucky bad guy.” For much of the movie, Anakin fit neither category, and I tried to explain this to my brothers by describing him as a “Yucky good guy.” Perhaps I’ll do a post someday on good and evil. But I digress.

I now consider myself a pragmatic optimist. I hope and strive for the best, but I’m also realistic. Thus, I (as a medical professional, for example) realize that, while everyone should brush his teeth, exercise regularly and eat healthfully, many (myself included) do not. While everyone should only have sex within the marriage relationship, many (myself included) have not. While everyone should realize that an abortion procedure ends a life, it’s also true that the situation is more complex than that.

I have long been frustrated with public perception of “The Pro-Lifers.” Equated with “The Republicans” and “The Religious Right”, the pro-life argument, I feel, is often dismissed out of hand. My goal here is to attempt to make you stop and think, and to at least reconsider why your views are they way they are. Is it because of your upbringing? Public image? The bedfellows of one view or the other? If you currently support abortion, I either want to convert you, or make you at least think about it enough to have solid reasons for your position. If you are reading this as someone who is against abortion already, my challenge for you is also to consider your reasoning. Be against abortion for a reason, not just because your parents are, or your political party is.

So now, with our automatic dismissal defenses turned down as low as we can get them, let’s consider what abortion is. I will not be graphic, as my goal is not to shock you over to “my side”, but to persuade you with reason. Let’s start with the relatively simple question of when does life begin. Well, quite simply, the scientific answer (I speak as a medical student) is that a new life begins at conception. With fusion of sperm and egg nuclei comes a new organism of the species Homo sapiens, whose complement of DNA is different than his father’s, or even than that of his mother whose body he is growing inside of. This is a simple question with a simple answer, but we are left with the more difficult question of, “What does that mean?

What I’ve learned after years of talking with people about induced abortion is that hardly anyone agrees on a “Do Not Cross” cutoff for when abortion “becomes” murder. When do we make the cutoff, then?

Some very reasonable people would suggest the cutoff of viability. That is to say, when the developing child is at an age where, if he was born, doctors would be able to keep him alive, then he should be protected. One of my problems with this position is that this landmark continues to shift. Fifty years ago, the point was about 30 weeks gestation. Thirty years ago, it was about 25 weeks, and it currently is around 20-21 weeks. Is it true that 50 years ago, fetuses were not humans worthy of protection until 30 weeks, but today they are now worthy of protection at 20 weeks? I hope you see the point I’m trying to make. Even still, if we had made the cutoff even 21 weeks, 1.4% of abortions in 2005 would not have occurred. Statistics obtained from the CDC, unless otherwise noted.

In embryology class, we learned that once the “fetal stage” of development begins, all the internal organs have formed, the developing child has the appearance of a tiny human, and from that point on, development consists largely of getting bigger and making the already formed organs mature. When is this point? 9 weeks gestation. Could we make this the cutoff? I believe we reasonably could. If we did, 38% of abortions in 2005 would not have occurred. If we make a beating heart the requirement, we’re talking 5 weeks gestation, and the elimination of more than 70% of abortions.

Personally, I’m not at all comfortable with all these random definitions of when life begins. I’m most comfortable just sticking to the plain science. Life begins at conception. But hey, if we can get everyone to agree to 9 weeks, when all the internal organs have established themselves, and cut out 38% of abortions, I’m all up for that. I’ll take what I can get. Really stop and think about these issues.

Now, that’s about as far as a lot of “Pro-Lifers” would go. Abortion is bad, it takes a life, end of story. Well, unfortunately, that’s NOT the end of the story, for millions of women. In 2005, 50% of women who had abortions were 24 or younger. I speak as a man who was 20 and whose fiancee was 19 years old when we (unintentionally) got pregnant: it’s not easy, even when high school is over, even when the guy is around, even when you have a support system. My heart truly bleeds for women in this situation.

This is where people from opposite ends of the spectrum can truly come together and make a difference! I’ve certainly not given up hope of one day changing the abortion laws, but I’m a realist, and I’m going to do what works. In my opinion, if I want abortions to stop, the realistic thing to do is prevention and support.

I might get a lot of heat from fellow Christians for this, but it’s what I believe, so here goes. I support full disclosure sex education. There comes a point where you have to accept that things are the way they are. Lots of people have sex who aren’t married. “Even” I, who didn’t have so much as a girlfriend until senior year in college, read every Joshua Harris book, was a Bible study leader in my campus Christian organization, had sex before I was married. It happens. Does that mean that parents shouldn’t tell their children not to? Absolutely not. I plan to tell my son how I did not wait, and then to encourage him to do so. However, I realize that, whether I like it or not, it’s going to be his decision. If he decides to, I want my son to use a condom. I want him to have all the relevant facts. I’m going to tell him that sex is fun, and I’m going to tell him that it can also be heartbreaking, and end up changing his life forever. It sure changed mine, and that’s an understatement, as those of you who know me well can attest. And I’m going to tell him that condoms can often protect against STI’s and pregnancy, but not against broken hearts.

Secondly, support. Churches, organizations, families, individuals ALL need to be there when a women gets pregnant. I’m so sick and tired of our American individualistic society. Gone are our community days. Everyone thinks he has to deal with his own problems by himself. We all need to step up and be there. Don’t be judgmental. There’s a time for everything under the sun, and the last thing she needs right then is a lecture. Fathers, mothers, take her in. Siblings, grandparents, friends, support her. Help her know she’s not in it alone. Encourage the guy to get and stay involved. Help her finish high school. Babysit her other children for her (59% of women who had an abortion in 2005 had at least one other child). THIS is where we ALL can come together and decrease the number of abortions that occur each year, a goal which I truly believe we share.

Let’s stop being so divided. Yes, I know how deep the difference is. But when the lives of so many babies are at stake, when so many women are scared and tired and alone, why can’t we just push past our differences and help them?

Thursday, February 5, 2009

Facebook Made Me...

There's a thing going around on facebook suggesting that you write 25 things about yourself, and then encourage your friends to do the same. After ignoring it for a week or so, I finally did it last night. Here's my definitely-not-all-inclusive list.

1. I'm indecisive. For example, I've been sitting her approximately 5 minutes trying to figure out what to write for #1.

2. I'll kill myself for you. Self-sacrifice is written into the core of my being, and I'll agree to do things without saying a word, even if I know I don't have the time or energy. Get that from my dad. It's why I'll make an awesome doctor. Doesn't matter if you shower me with praise or kick me when I'm down, I'll still kill myself doing anything for you.

3. I started dating my first and only girlfriend in October 2007. We started having sex in February 2008, engaged in April, pregnant in May, married in June.

4. I'm only 22, but I'm a husband, father of an awesome rascally 1-year-old boy, and a medical student.

5. I don't like dogs. In fact, I don't like animals in general. And yet, in the last year I've had over 40 pets, and currently have a doberman-shepherd mix.

6. I am a first-degree black belt in the art of Cerezo-ha Shito-Ryu Karate-Do.

7. I started Cub Scouts as a Tiger Cub when I was 5, and became an Eagle Scout on October 3, 2002. I've had most of the youth leadership positions, and several adult positions. I love the Boy Scouts.

8. At this point, I've had three last names in my life. Worley then Phillips then Gibson. I never plan to change my name again.

9. One whole section of my family boycotted my wedding. They still won't talk to me. Apparently that's something they randomly do: excommunicate family members (it's a lot more complex than that, but I don't want to get into it).

10. I hate the welfare system, yet I'm on food stamps, cash assistance and Medicaid.

11. My wife is the most creative chef I've ever met. Not only are her foods delicious, but the presentation is exquisite.

12. My greatest physical fear is that I'll lose my eyesight.

13. My greatest fear in general is failure. That I'll fail God, that I'll fail to be a good father, that I'll fail to be a good husband, that I'll fail at my job, that I'll fail my friends, that I'll never live up to half my potential.

14. I'm a perfectionist. It's really irritating. And I'm not as anal as I used to be. But still. Yes, all the fragments I just wrote irritate me.

15. My beliefs, both religious and political, surprise people. I'm a follower of Christ and pro-life, but I don't support abstinence-only sex education. I believe the Bible is literally true, but I don't have a problem with evolution. The list goes on.

16. I think we're living literally in the End Times. Following Biblical prophecy, events are lining up, and I am convinced that I will see the End in my lifetime.

17. I owned a truck for about 6 months, and had to sell it. I can't wait to get another truck.

18. I started reading when I was 4, and never stopped. I prefer non-fiction to fiction. I read biographies for fun. I read almost every genre.

19. I only have a few friends, but the ones I have, are true, loyal and I can totally count on them. You know who you are.

20. I love fruits and veggies. As much as I enjoy meats, if I had the time and energy, I think I could go vegan. It's actually tempting sometimes. For lots of reasons. It's just more of a hassle than I'm willing to put up with, at this point at least. And I really do love meat.

21. I'm the best liar you'll ever meet. Growing up in my family honed the skills. I try very hard to suppress it. But if I lie, it's so absolutely seamless, you'll never know. Really. I hate that about myself.

22. When I got my license, for years I absolutely refused to go even 1 over the speed limit. Then, I'd regularly drive 80+ on the freeways, because my mind works fast enough to process things at that speed, and I still maintain that I was a safe driver. Now, I have a wife and a kid, and I usually drive pretty close to the limit again.

23. I want to make a difference in the world. It's part of why I'm going to be a doctor. I don't want to live my life in the shadows, cruising along without leaving my mark.

24. My apartment burned down the day before Thanksgiving in 2007. It really wasn't as big of a deal as you'd think. Everyone pulled together for us, and we did just fine.

25. Some people say I'm "emotionally invulnerable" but that's not true. I give it to God, it's as simple as that. I'd probably be insane now, otherwise. But, knowing that I can just give it to Him, makes my problems melt away. His yoke truly is easy, and His burden light.

25b (Sometimes I hang onto my problems for awhile, and when I do, I'm SO stressed out. I don't know why I do it).

Saturday, January 31, 2009

This is Kinda Cool

I'm still working on a good long thoughtful post on abortion (as well as a dozen or so other posts), but I'm a week behind in my studies, got lots of extracurricular stuff to do as well, so for now I'll just leave you with this video, from Apparently it's an ad they tried to have aired during the Super Bowl but it got rejected. Anyway, it's kinda cool. Here it is.

Wednesday, January 28, 2009

Charlie's 1st Birthday!!

So, my son Charles turned 1 on Saturday!! I know you're all dying for some pictures, so here they are!

It was always tradition in my family to have the first birthday cake be a Cookie Monster cake, so Mandie got to work and produced this beautiful cake!!

"Gammy" & "Gampa" watched the eating of the cake via webcam. And boy did he enjoy his cake!

He decided to give Mama a sweet kiss:

He enjoyed his first bottle of cow milk (no more boobies for the big boy!!):

Aww, one big happy family!!

Tuesday, January 20, 2009

National Anthem Rant

I am appalled at this country. I watched the inauguration at the local bookstore. At its conclusion, the National Anthem was sung. I immediately stood up, and to my great dismay, I was the only one to do so. Not one sitting person stood up. Not one walking person stopped to stand still. This is our National Anthem, people!

For those of you who are ignorant of patriotic etiquette, when you're AT the location where the anthem is being played, you should stand up, cover your heart and face the U.S. flag. When you are ANYWHERE and you can HEAR the anthem being played, you should stand up, stand still and remain there until the anthem has been concluded.

When the flag is passing you, salute it with your hand over your heart.

My goodness, people.

Friday, January 16, 2009

Sophie Scholl

So, I saw this movie at the Blockbuster the other day, and it looked kind of interesting, so I picked it up. I put it in and realized it wasn't a movie my wife would be interested in seeing with me: the movie was in German with English subtitles, and the theme really wasn't her cup of tea.

So, I watched the movie in bits and pieces when my wife was elsewhere in the house, and I was absolutely hooked. What a fantastic movie. I honestly think you should all go out and rent it.

The movie is based on the true story of the last few days of Sophie Scholl's life. She was a student of the University of Munich in Nazi Germany, and a leader of the "White Rose" student anti-Nazi movement. She is arrested for distributing flyers that criticized Hitler, and the vast majority of the movie is her interrogation by the police examiner. There is absolutely no gore or torture in this movie, in case you were wondering.

Sophie is absolutely fantastic, beautifully articulate, unwaveringly courageous and wonderfully patriotic of a free Germany. I know a lot of you will think it's absurd of me to say, but there are a lot of parallels between current U.S. and pre-
WWII Germany. If I can ever get a chance (I'm averaging 3 hours of sleep a night), I'll write a post of comparison. Until then, I hope you'll watch the movie and be enlightened and emboldened by the courage of this amazing young woman.

Wednesday, January 14, 2009

Because I Want some Sympathy...

...Ok, and because I like to show off:

The following is just a very, very small TASTE of the material we're covering this block.

Sunday, January 11, 2009

Here and There

I know, I know, you think I've forgotten you again! My wife and son have been sick all week, so I've been taking time off from class to take care of them, and I've gotten behind in my classes because of that. It's going to be a difficult block for me--so much to do!!

Anyway, my sister is getting married today, and I just want to wish her the best in her new life with Kermit. I've been praying for her and will continue to do so. Marriage can be great, but it is also a lot of work! May God bless your marriage, Rachael.

Wednesday, January 7, 2009

Ethics Dilemma


The following is an essay that was written in the New England Journal of Medicine in March 1991. We read this essay in class today to discuss the ethics surrounding the situation. I post it here in order to further open the discussion. We were forced to choose to either "support" or "not support" Dr. Quill's actions. I'll hold back the way I voted for now, but hopefully you will contribute! Here is Dr. Quill's essay:

Diane was feeling tired and had a rash. A common scenario, though there was something subliminally worrisome that prompted me to check her blood count. Her hematocrit was 22, and the white-cell count was 4.3 with some metamyelocytes and unusual white cells. I wanted it to be viral, trying to deny what was staring me in the face. Perhaps in a repeated count it would disappear. I called Diane and told her it might be more serious than I had initially thought-that the test needed to be repeated and that if she felt worse, we might have to move quickly. When she pressed for the possibilities, I reluctantly opened to the door to leukemia. Hearing the word seemed to make it exist. "Oh, shit!" she said. "Don't tell me that." Oh shit! I thought, I wish I didn't have to.

Diane was no ordinary person (although no one I have ever come to know has been really ordinary). She was raised in an alcoholic family and had felt alone for much of her life. She had vaginal cancer as a young woman. Through much of her adult life, she had struggled with depression and her own alcoholism. I had come to know, respect, and admire her over the previous eight years as she confronted these problems and gradually overcame them. She was an incredibly clear, at times brutally honest, thinker and communicator. As she took control of her life, she developed a strong sense of independence and confidence. In the previous 3 ½ years, her hard work had paid off. She was completely abstinent from alcohol, she had established much deeper connections with her husband, college-age son, and several friends, and her business and her artistic work were blossoming. She felt she was really living fully for the first time.

Not surprisingly, the repeated blood count was abnormal, and detailed examination of the peripheral-blood smear showed myelocytes. I advised her to come into the hospital, explaining that we needed to do a bone marrow biopsy and make some decisions relatively rapidly. She came to the hospital knowing what we would find. She was terrified, angry, and sad. Although we knew the odds, we both clung to the thread of possibility that it might be something else.

The bone marrow confirmed the worst: acute myelomonocytic leukemia. In the face of this tragedy, we looked for signs of hope. This is an area of medicine in which technological intervention has been successful, with cures 25 percent of the time-long-term cures. As I probed the costs of these cures, I heard about induction chemotherapy (three weeks in the hospital, prolonged neutropenia, probable infectious complications, and hair loss; 75 percent of patients respond, 25 percent do not). For the survivors, this is followed by consolidation chemotherapy (with similar side effects; another 25 percent die, for a net survival of 50 percent). Those still alive, to have a reasonable chance of long-term survival, then need bone marrow transplantation (hospitalization for two months and whole-body irradiation, with complete killing of the bone marrow, infectious complications, and the possibility for graft-versus-host disease-with a survival of approximately 50 percent, or 25 percent of the original group). Though hematologists may argue over the exact percentages, they don't argue about the outcome of no treatment-certain death in days, weeks, or at most a few months.

Believing that delay was dangerous, our oncologist broke the news to Diane and began making plans to insert a Hickman catheter and begin induction chemotherapy that afternoon. When I saw her shortly thereafter, she was enraged at his presumption that she would want treatment, and devastated by the finality of the diagnosis. All she wanted to do was go home and be with her family. She had no further questions about treatment and in fact had decided that she wanted none. Together we lamented her tragedy and the unfairness of life. Before she left, I felt the need to be sure that she and her husband understood that there was some risk in delay, that the problem was not going to go away, and that we needed to keep considering the options over the next several days. We agreed to meet in two days.

She returned in two days with her husband and son. They had talked extensively about the problem and the options. She remained very clear about her wish not to undergo chemotherapy and to live whatever time she had left outside the hospital. As we explored her thinking further, it became clear that she was convinced she would die during the period of treatment and would suffer unspeakably in the process (from hospitalization, from lack of control over her body, from the side effects of chemotherapy, and from pain and anguish). Although I could offer support and my best effort to minimize her suffering if she chose treatment, there was no way I could say any of this would not occur. In fact, the last four patients with acute leukemia at our hospital had died very painful deaths in the hospital during various stages of treatment (a fact I did not share with her). Her family wished she would choose treatment but sadly accepted her decision. She articulated very clearly that it was she who would be experiencing all the side effects of treatment and that odds of 25 percent were not god enough for her to undergo so toxic a course of therapy, given her expectations of chemotherapy and hospitalization and the absence of a closely matched bone marrow donor. I had her repeat her understanding of the treatment, the odds, and what to expect if there were no treatment. I clarified a few misunderstandings, but she had a remarkable grasp of the options and implications.

I have been a longtime advocate of active, informed patient choice of treatment or nontreatment, and of a patient's right to die with as much control and dignity as possible. Yet there was something about her giving up a 25 percent chance of long-term survival in favor of almost certain death that disturbed me. I had seen Diane fight and use her considerable inner resources to overcome alcoholism and depression, and I half expected her to change her mind over the next week. Since the window of time in which effective treatment can be initiated is rather narrow, we met several times that week. We obtained a second hematology consultation and talked at length about the meaning and implications of treatment and nontreatment. She talked to a psychologist she had seen in the past. I gradually understood the decision from her perspective and became convinced that it was the right decision for her. We arranged for home hospice care (although at that time Diane felt reasonably well, was active, and looked healthy), left the door open for her to change her mind, and tried to anticipate how to keep her comfortable in the time she had left.

Just as I was adjusting to her decision, she opened up another area that would stretch me profoundly. It was extraordinarily important to Diane to maintain control of herself and her own dignity during the time remaining to her. When this was no longer possible, she clearly wanted to die. As a former director of a hospice program, I know how to use pain medicines to keep patients comfortable and lessen suffering. I explained the philosophy of comfort care, which I strongly believe in. Although Diane understood and appreciated this, she had known of people lingering in what was called relative comfort, and she wanted no part of it. When the time came, she wanted to take her life in the least painful way possible. Knowing of her desire for independence and her decision to stay in control, I thought this request made perfect sense. I acknowledged and explored this wish but also thought that it was out of the realm of currently accepted medical practice and that it was more than I could offer or promise. In our discussion, it became clear that preoccupation with her fear of a lingering death would interfere with Diane's getting the most out of the time she had left until she found a safe way to ensure her death. I feared the effects of a violent death on her family, the consequences of an ineffective suicide that would leave her lingering in precisely the state she dreaded so much, and the possibility that a family member would be forced to assist her, with all the legal and personal repercussions that would follow. She discussed this at length with her family. They believed that they should respect her choice. With this in mind, I told Diane that information was available from the Hemlock Society that might be helpful to her.

A week later she phoned me with a request for barbiturates for sleep. Since I knew that this was an essential ingredient in a Hemlock Society suicide, I asked her to come to the office to talk things over. She was more than willing to protect me by participating in a superficial conversation about her insomnia, but it was important to me to know how she planned to use the drugs and to be sure that she was not in despair or overwhelmed in a way that might color her judgment. In our discussion, it was apparent that she was having trouble sleeping, but it was also evident that the security of having enough barbiturates available to commit suicide when and if the time came would leave her secure enough to live fully and concentrate on the present. It was clear that she was not despondent and that in fact she was making deep, personal connections with her family and close friends. I made sure that she knew how to use the barbiturates for sleep, and also that she knew the amount needed to commit suicide. We agreed to meet regularly, and she promised to meet with me before taking her life, to ensure that all other avenues had been exhausted. I wrote the prescription with an uneasy feeling about the boundaries I was exploring-spiritual, legal, professional, and personal. Yet I also felt strongly that I was setting her free to get the most out of the time she had left, and to maintain dignity and control on her own terms until her death.

The next several months were very intense and important for Diane. Her son stayed home from college, and they were able to be with one another and say much that had not been said earlier. Her husband did his work at home so that he and Diane could spend more time together. She spent time with her closest friends. I had her come into the hospital for a conference with our residents, at which she illustrated in a most profound and personal way the importance of informed decision making, the right to refuse treatment, and the extraordinarily personal effects of illness and interaction with the medical system. There were emotional and physical hardships as well. She had periods of intense sadness and anger. Several times she became very weak, but she received transfusions as an outpatient and responded with marked improvement of symptoms. She had two serious infections that responded surprisingly well to empirical sources of oral antibiotics. After three tumultuous months, there were two weeks of relative calm and well-being, and fantasies of a miracle began to surface.

Unfortunately, we had no miracle. Bone pain, weakness, fatigue, and fevers began to dominate her life. Although the hospice workers, family members, and I tried our best to minimize the suffering promote comfort, it was clear that the end was approaching. Diane's immediate future held what she feared the most-increasing discomfort, dependence, and hard choices between pain and sedation. She called up her closest friends and asked them to come over to say goodbye, telling them that she would be leaving soon. As we had agreed, she let me know as well. When we met, it was clear that she knew what she was doing, that she was sad and frightened to be leaving, but that she would be even more terrified to stay and suffer. In our tearful goodbye, she promised a reunion in the future at her favorite spot on the edge of Lake Geneva, with dragons swimming in the sunset.

Two days later her husband called to say that Diane had died. She had said her final goodbyes to her husband and son that morning, and asked them to leave her alone for an hour. After an hour, which must have seemed an eternity, they found her on the couch, lying very still and covered by her favorite shawl. There was no sign of struggle. She seemed to be at peace. They called me for advice about how to proceed. When I arrived at their house, Diane indeed seemed peaceful. Her husband and son were quiet. We talked about what a remarkable person she had been. They seemed to have no doubts about the course she had chosen or about their cooperation, although the unfairness of her illness and the finality of her death were overwhelming to us all.

I called the medical examiner to inform him that a hospice patient had died. When asked about the cause of death, I said, "acute leukemia." He said that was fine and that we should call a funeral director. Although acute leukemia was the truth, it was not the whole story. Yet any mention of suicide would have given rise to a police investigation and probably brought the arrival of an ambulance crew for resuscitation. Diane would have become a "coroner's case," and the decision to perform an autopsy would have been made at the discretion of the medical examiner. The family or I could have been subject to criminal prosecution, and I to professional review, for our roles in support of Diane's choices. Although I truly believe that the family and I gave her the best care possible, allowing her to define her limits and directions as much as possible, I am not sure the law, society, or the medical profession would agree. So I said "acute leukemia" to protect all of us, to protect Diane from an invasion into her past and her body, and to continue to shield society from the knowledge of the degree of suffering that people often undergo in the process of dying. Suffering can be lessened to some extent, but in no way eliminated or made benign, by the careful intervention of a competent, caring physician, given current social constraints.

Diane taught me about the range of help I can provide if I know people well and if I allow them to say what they really want. She taught me about life, death, and honesty and about taking charge and facing tragedy squarely when it strikes. She taught me that I can take small risks for people that I really know and care about. Although I did not assist in her suicide directly, I helped indirectly to make it possible, successful, and relatively painless. Although I know we have measures to help control pain and lessen suffering, to think that people do not suffer in the process of dying is an illusion. Prolonged dying can occasionally be peaceful, but more often the role of the physician and family is limited to lessening but not eliminating severe suffering.

I wonder how many families and physicians secretly help patients over the edge into death in the face of such severe suffering. I wonder how many severely ill or dying patients secretly take their lives, dying alone in despair. I wonder whether the image of Diane's final aloneness will persist in the minds of her family, or if they will remember more the intense, meaningful months they had together before she died. I wonder whether Diane struggled in that last hour, and whether the Hemlock Society's way of death by suicide is the most benign. I wonder why Diane, who gave so much to so many of us, had to be alone for the last hour of her life. I wonder whether I will see Diane again, on the shore of Lake Geneva at sunset, with dragons swimming on the horizon.

Timothy E. Quill, M.D.

Printed in The New England Journal of Medicine, March 7, 1991, Vol. 324, No. 10, pp 691-694.