The .Plan

My life is good and worthy of thanks giving. Because I…

• haven’t tried to commit suicide 7 times in the past 3 months.
  
• am not driven to sleeplessness by thoughts that the CIA has bugged my apartment and is monitoring my every move.
  
• don’t have a sister who used to turn tricks for cocaine before dying of a cocaine overdose.
  
• don’t have a girlfriend who e-mails me photographs of her having sexual intercourse with another guy while I am in the middle of telling her on the phone that I want to kill myself.
  
• don’t have next door neighbors who sexually abused me at the age of 8.
  
• don’t drink five 40-ounce bottles of malt liquor a day to dull my emotional pain.
  
• don’t have an uncle who raped me when I was 13.
  
• am not so tormented by voices that I would stick knitting needles in my ears in an attempt to make them stop.
  
• am not so tormented by the temptation to look at other women (who are not my wife) that I would gouge out both of my eyes.
  
• do not hear voices telling me that I am a failure and that I do not deserve to live.
  
• do not hear voices telling me to jump off of the Aurora Bridge.
  
• do not hear voices telling me to put the barrel of a .38 into my mouth and pull the trigger.
  
• do not hear voices telling me to swallow a 500-count bottle of Tylenol.
  
• don’t have a husband who beats me and whose employer (a local police department that will remain unnamed) covers it up, protects him, suppresses the evidence, and turns all of my former colleagues against me.
  
• don’t have a wife who is trying to take custody of my children away from me.
  
• didn’t grow up being punished by my parents for crying or showing the least bit of emotion.
  
• haven’t gotten evicted by my landlord for creating a fire hazard with my collection of 500+ Seattle Mariners bobbleheads.
  
• am not feeling so bad about my life that I would try to commit suicide only to realize that I don’t have enough money to do anything lethal except try to provoke police officers to try and gun me down.
  
• have enough problem-solving skills that “I’m going to kill myself” doesn’t present itself as the answer to every one of my problems.
  

Let everything that has breath praise the LORD. — Ps 150

New York Times, August 1, 2006
By ABIGAIL ZUGER

When people ask me to recommend a doctor for them, half a dozen spring to mind immediately.

They are all intelligent, kind and committed, intellectually imposing but down to earth, practical but visionary, and leavened with a good sense of humor. You couldn’t ask for a better person to oversee your health than one of them.

There’s only one problem: not one of them sees patients anymore.

No, they haven’t retired. They have simply moved onward and upward into the medical stratosphere. They have arrived at positions of power and influence; they do groundbreaking research, set policy, write guidelines and generally shape the health of the planet.

As for figuring out why you can’t stop coughing, forget it. They don’t do that kind of thing anymore.

Doctors without patients: can such creatures really exist? Or do they automatically negate themselves into some other sphere of existence, a cloudy existential plane where teachers without students and merchants without customers all wander around in search of a new identity?

It is a purely rhetorical question, because not only do doctors without patients exist, they thrive. They top most heaps: they are the administrators, the professors, the chairmen, the directors and the chief executives.

In fact, if truth be told, little baby doctors often go to bed at night thinking, I want to be just like them.

In the memoir “Teacher Man,” Frank McCourt described “the situation in the public schools of America: the farther you travel from the classroom, the greater your financial and professional rewards.”

The situation in the health care arenas of America may not be identical, but there are certainly parallels. Like the blackboard, the examining table is where the grunt work is done. Brilliant career paths often lead in the opposite direction.

Some medical movers and shakers head off without a backward look: they never liked that “say ahhh; where does it hurt?” business to begin with.

Some wax nostalgic: “If I only had the time,” they say, gesturing at the toppling piles of papers on their desks. “I miss patient care.”

But they never quite make it back to that buffer-free zone of the examining room, to that lonely hot seat where the decisions are all theirs, and the fallout is too.

Instead, their horizons expand, and in some sense, so do their patient loads. After all, to write an article establishing that one treatment is better than another is effectively to participate in the health care of millions. So is taking a new chemotherapy from test tube to pharmacy, or configuring an insurance company’s preferred drug formulary. And should something go wrong, the seat still gets plenty hot.

But the work is not quite the same. Most of medicine these days is based on the big picture — trends set by thousands of research subjects (or hospital admissions or insured lives) moving in synchronies visible only to high-speed computers. The patterns can look very different writ small.

In other words, a giant study may show that two pain relievers work about the same. But if only one helps Mrs. Jones (the gallant, delightful, terminally ill and utterly impoverished Mrs. Jones) and her insurer pays only for the other one, Mrs. Jones’s physician will quickly come to realize that they are not the same after all.

Doctors who never get to know Mrs. Jones seldom learn this lesson. In fact, after enough years away from the examining table, it is easy to forget that people like Mrs. Jones exist at all.

Some say that’s for the best. Many years ago, a famous professor and researcher interviewing me for a job remarked, in the tones of one imparting a secret of the universe, “Any idiot can make a patient feel better.”

Research was the key to medicine, he continued, to really making a difference. Otherwise, wishes and hopes and idiosyncrasies, both yours and those of your patients, would tangle you up so completely that you would never break free.

At least, I think that’s what he was trying to say. I actually never saw him again, deciding to take a job elsewhere, with a somewhat less famous man who still saw his own patients, one of the few graying heads in a sea of young medical grunts.

“Keeps you honest,” he said.

According to Newsweek, “hip-hop mass” is the new new thing among Christians. Rev. Timothy Holder (”Poppa T”) of Crossover Community Church in Tampa, Fla. even has his own version of Psalm 23:

The Lord is all that, I need for nothing.
He allows me to chill.
He keeps me from being heated
and allows me to breathe easy.
He guides my life so that I can
represent and give shout outs in His name.
And even though I walk through the hood of death,
I don’t back down, for You have my back.
The fact that He has me
covered allows me to chill.
He provides me with back-up
In front of player-haters,
and I know that I am a baller and life will be phat.
I fall back in the Lord’s crib for the rest of my life.
–Psalm 23 (Poppa T Standard Version, PTSV)

Holla.