Success Defined. Differently

When I was in elementary school I loved classroom competitions. I looked forward to spelling bees, timed tests and word puzzles. One of my favorite educational games was “around the world.” The desks were arranged in a circle, with one student standing. The standing student would be paired with a sitting student and the teacher would hold up a flash card with a math calculation. The student who answered correctly first “won” and moved on to the next desk. The goal, for me, was to go “around the world”, to defeat every other student in the class. I loved the game, as I rarely lost.

Looking back now, I see the game was stupid. As fun and as challenging as it was to me, it had to have been demoralizing for those in the class for whom math was a struggle. I am sure many of them felt like not trying at all, seeing the “game” as just one more opportunity to be humiliated.

It had a negative impact on me as well. The game fed a warped sense of self, the idea that it was my academic performance that gave me value, that good grades made me special. Educational success, being smart, was a major component of my self-esteem. It left me with a precarious view of self that failure could easily destroy. 

It took me decades to realize that academic successes were nothing to brag about. My school acheivements were primarily due to genetics, not effort. I was the son of a brilliant man who passed his genes on to me. For me, being proud of my GPA would be like a 7 foot tall person being proud of their height. While intelligence and height can be advantageous and beneficial, they are not something anyone earns or works for.

I have finally reached the point in my life where I have learned to measure success differently. What is important to me are the things that I work for the things that do not come naturally, even in my medical practice. While making a correct diagnosis is important, even crucial, I am realizing this is not the best way for me to measure the success of a visit. I now measure success of a patient interaction on the things that take effort, the things that are challenging for me, such as the clarity of my communication and the patient’s comfort and understanding with what I say. If the patient is not satisfied with their care, I have not succeeded.

I need to do this in every area of my life. It is the successes I work for, the changes brought by diligent effort, of which I should be most proud.  When my worth comes from the things that I strive for and not just on the things I am born with, I know I am on the road to being a better person.

 - bart

Friend, Patient, Candidate

 “I’m running for city council!” KC’s words caught me off guard. Although I have lived in Huntington Beach since 1993 I have never been involved in city politics. My interactions with elected officials have been pretty much limited to waving at them as they passed by during the 4th of July parade. My experience with city hall is equally limited, centered around construction permits and business licenses.  It was surprising to realize that a friend of mine might soon be a part of city government. Yet as I thought about the man I know KC to be, it made sense.

I have known KC Fockler for over 20 years. Our kids played youth sports together and his son was on a baseball team I coached. I had a lot to learn about coaching and on one occasion my inexperience resulted in me being less than fair to his son. KC pulled me aside to talk it over. I do not remember the specific words he spoke but I have never forgotten the grace and kindness he displayed. He was right and I was wrong but he did not approach me with anger or condescension. He gave me the benefit of the doubt and treated me with respect. He had class.

A few years later KC showed up as a patient in my office. The fact that he trusted me as his doctor was further evidence that he had chosen to see the best in me. Over the years that followed I saw him for physicals and routine health care, with plenty of time for us to catch up on life and family. We talked about his job and our kids. It was clear to me that he was a good dad, a good teacher and a good man. He cares about people and he cares about our city.

In the few months since he told me about his candidacy we have talked more about his heart for Huntington Beach. One Saturday we met for breakfast so we could talk in depth about what he hoped to accomplish. I should not have been surprised, but he seemed more interested in my thoughts about Huntington Beach than he was in sharing his own. He came with a note pad and made notes of my questions and concerns.

When I asked about his plans his answers were straightforward and sincere. He wants to serve. He wants to help people get involved, to participate, to be invested. He wants Huntington Beach to be a city that feels more like a small town, where ideas are welcomed and citizens are served. He showed remarkable insight into the issues our city faces, from pension liabilities to homelessness, with a willingness to consider any solution.

A few weeks ago KC impressed me even more. I sat in his living room in a meeting he hosted with people interested in his campaign. He was once again in listening mode. I later learned exactly how intently he had been listening. Someone had brought up issues of trash in the local parks. It was a little thing, something that could be easily dismissed, but not by KC. The next day he made a call to Republic Services, the trash collection agency that serves Huntington Beach, and came up with a possible solution!

I am not informed enough to know how to solve the problems of my city. The issues are complex and challenging. I am nonetheless comforted in the knowledge that there is at least one good man with integrity who is willing to serve, a man I am proud to call a friend.

- Bart

Huntington Beach residents who want to know more about KC can call him at 714-722-1710, or visit his website at https://www.surfcitycouncil.org/about.html

Let Them Not Eat Cake

Why won’t the government let Jack be wrong?

This question has repeatedly run through my mind over the last few years as I have followed the story of Jack Phillips. Jack is the owner of Masterpiece Cakeshop in Lakewood, Colorado. He is a man of deep religious convictions who believes that marriage was created by God to be the union of one man and one woman. His beliefs are so strong that they preclude him from supporting gay marriage in his work. As a matter of policy he does not design wedding cakes for gay weddings. For this position he was disciplined by the Colorado civil rights commission which mandated he not only make cakes for same sex weddings but that he and his staff undergo sensitivity training. Convinced that complying with the commission would require him to compromise his beliefs he stopped wedding cakes (which were 40% of his business) and decided to fight the ruling in court. He appealed the decision of the commission all the way to the United States Supreme Court, which ruled narrowly in his favor.

The ink was barely dry on the Supreme Court decision before the Colorado commission again came after Mr. Phillips. His offense this time was a refusal to back a custom cake celebrating the male to female  “transition” of a transgender individual. It does not appear to matter to the commission that there are dozens of other bakeries who are willing to bake the types of cakes requested, nor that Mr. Phillips is being targeted by activists opposed to his views. In the eyes of the commissioners, Jack Phillips is a bad man who must be punished.

In understand why people disagree with Mr. Phillips, but I confess I do not understand why he is being singled out by a government agency. The question comes to mind, “Why won’t the commissioners let Jack be wrong?”

This question brings clarity to the debate. Countless columns, opinions and articles have been written about the Masterpiece Cakeshop case, each setting forth arguments as to the rightness or wrongness of Mr. Phillips’ position. I think they all miss the point.

The question is not whether or not Mr. Phillips is wrong in his position. The question is, why does the government care? People do wrong things all of the time. One might even argue that the freedom to do wrong and stupid things is at the heart of what it means to be free.

We can find stupid decisions almost anywhere. I recently went to visit a dermatologist who as a matter of policy refuses to see any patient who arrives at the office more than 7 minutes after their scheduled appointment time. The policy is rude, arbitrary, and unkind. No allowances are made for traffic or weather or forgetfulness. If you’re late, you’re not being seen. His policy has cost him patients and resulted in negative Yelp reviews yet he believes he is doing the right thing for his business.

I visited a church recently that has a flier in the pew that reads, “PLEASE, NO CHILDREN IN THE SANCTUARY DURING SERVICES… the age limit for children is 12 years and older…” I imagined how that might feel to a visiting parent of a shy 11 year old who wanted to sit in the service. While I understood the intention, the wording caught me off guard and I considered it offensive.

While I think that both the church and the dermatologist are “wrong”, I understand that they believe they are doing something right. They are free to make decisions in accordance with their beliefs and I have the right to choose to go elsewhere. If anyone forced the church or dermatologist to change their actions, they would no longer be free.

Living in a free society means that we will need to get along with people who disagree with us, people who do things differently than us and who believe differently than us. The day right and wrong are determined by majority rule, the day we are compelled to go along with the masses, will be the day freedom disappears for all of us.

Bart

PS- I don’t think Jack is wrong and I have donated to his cause. I am just wondering how we reached the point where our government is so hateful towards one man’s beliefs. 

A Diabetic on Parole, A Failing Healthcare System

Her blood sugars were terrible, more than three times the normal level. She was not a new diabetic, so to my thinking this was inexcusable. She should have known better. Frustrated, I told her she needed to get serious about her blood sugars and her diet. I told her to write down everything she ate into a log book along with the blood sugar levels I wanted her to check at least three times a day. I told her to follow up with the log book in a week.

A week later she was back in the office as requested,  the only part of my recommendations she had followed. Her log book was nearly empty, containing only four entries for the entire week. She told me that she had been “trying” but it was clear that our definitions of "trying" varied greatly. I reminded her that I could not manage her diabetes without information, that dosing her insulin depended on what her diet and sugars were. The displeasure in my voice was apparent as I told her again to write down everything she ate and all of her blood sugar measurements and to come back in a week. 

The next week's visit was not much better. There were a few more numbers but almost no dietary information entered. I repeated my previous admonitions and told I would need to see her every week until she had a better handle on things. Her response caught me off guard.

“I can’t afford to come back in a week,” she said.

“You can’t afford not to,” I replied, “you sugars are terrible and I can’t treat you without more information.”

“I know but I can’t afford the co-pay.”

“How much is it?” I asked

“It’s $10, but I can’t afford it. I just got out of jail and I don’t have a job and I can’t afford to keep coming in.”

I paused and looked at her, seeing her perhaps for the first time. Before me was a woman in her 40’s who looked as if she was in her 60’s. Some teeth were missing, her t-shirt was worn and had a few holes, and she wore no makeup. She was poor. As poor as she was materially I realized she was poor emotionally and intellectually as well. The stress of normal was almost more than she could handle. The added burden of checking blood sugars, of counting carbohydrates and adjusting medication levels, was beyond her reach. I realized that controlling her blood sugar would take a lot of time and effort and patience.

“Then I won’t charge you,” the words sounded right as they came out of my mouth, “I will see you in a week.”

The next week she returned, log book in hand. This time it was nearly half-filled with results. It was inadequate, but it was progress. Together we went over the log book as best as we could. As we did I pointed out how certain foods caused her blood sugar to rise and how the changes in sugar levels from one meal to the next helped me see that. I praised her progress and had her schedule another follow up appointment 7 days later.

Week after week she came, each time with more of the logbook completed and her sugars improving. After 2 months things clicked. She could analyze her results on her own, determine what she had done right or wrong, and come up with a plan for how she could do better. We started to space out her visits as he confidence increased.

Four months after our first interaction she went to the lab for blood work. To my great surprise it revealed that her diabetes was perfectly controlled. She had done it! At her next visit she was beaming with pride over her results. She was a failure no longer.

We scheduled a follow up visit for a month later. I was confident that she had turned a corner in her health and that her future was bright. I was wrong. She never came back.

She had lost her job and with it her health insurance. I offered to see her for free while she searched for another job but she did not come in. She never told me why, but I wondered if it was out of shame and embarrassment. Perhaps she was fearful in disappointing me. We had invested so much time, maybe she felt she was letting me down.

That was years ago. I never saw her again.

Her story illustrates much of what is wrong with medicine today. Our entire system is based on 15 minute visits spread out over time. While this works for many, there are those who need much, much more. People like my patient, for whom even small co-pays seem like mountains, whose health continually teeters on the edge of disaster, need more time and attention than out system is designed to provide.

People like her, whose life circumstances, educational background and emotional limitations make routine health decisions seem overwhelming, need more time, and time costs money.

There is no place for people like her in the American health system. Obamacare, with its $6500 deductibles and exorbitant premiums, provides no relief. Medicaid (MediCal in California) is a sham of a “solution”, paying a measly $24 for a routine 15 minute visit, forcing doctors to see a patient every 5 minutes in order to make a living and making good medical care impossible. Excessive regulation and documentation requirements make caring for the needy even more challenging.

I do not know what societal solution is needed. I only know what I can do, which is to make time when I can, invest time when I am able, care as much as possible, and fight off the sense of frustration and futility when my efforts prove inadequate. Every once in a while, I may be able to make a difference.

- Bart

A Tale of Two Lives

It has been a week for remembering.

In my Wednesday morning men’s group one of the young men shared stories about his grandmother who recently died from cancer. He had been raised by her, lived with her when his father was in prison while he was a child. She taught him about right and wrong, about what it means to be a person of faith. “If it isn’t in the Bible, I probably don’t know much about it,” was one his favorite grandma quotes.

She had been a source of strength and guidance for him, a constant presence of hope and faith. He told us of going through her things and finding the book in which she wrote her prayer list. The book was thick, its pages filled with handwritten names, many of whom he did not even know. Her passing meant there was now one less person praying for him every day.

Three days later I attended a memorial service for a patient, Mr. M, who had been my patient for 8 years. At his second visit I diagnosed him with a large melanoma. Within a week a surgeon removed it and for the next five years it seemed to be gone. The cancer was seldom mentioned when he came to the office. (He had a back that went out on him a few times a year, so I saw him often.)

Our conversations frequently drifted away from the medical. We talked of golf, family and work, and developed a mutual respect and friendship. We believed the cancer was in his past and that the future would be cancer free. That belief was shattered 2 years ago when a different kind of pain appeared in his ribs. An MRI scan revealed that the melanoma had invaded the vertebrae in his upper back as well as several of his ribs. It was a battle he could not win.

I sat in his service and listened as his best friend told stories of how they had met 20 years earlier and of the close friendship that followed. He spoke of the laughter, meals and motorcycle rides they shared,  and how ultimately they came to share faith in God. Mr. M’s brother-in-law shared how Mr. M had encouraged him in life and business, how he never would have achieved what he had without his input. His daughter spoke last, reading a letter she had written to her father a few weeks before he died. Through tear-filled eyes she described a man of love, dedication, strength and integrity. It was a lovely service. My eyes did not stay dry.

My patient and the grandma never met, but as I reflect on their stories I am confident that they will. The grandma lived a life of faith, daily serving God as best as she could. She died with the assurance of an eternity with Him. The patient traveled a different road. For much of His life he did not give God much thought. It was only in the last year of his life that he turned his attention to spiritual things. Nevertheless, in  the months before he passed he came to share the same faith as the grandma and the same assurance of eternity. They died within days of one another, brother and sister, adopted by the Father they were going home to meet.

Their stories move me. They remind me of both the transience and the importance of this life. My time here on earth will be brief, and may be over before I know it. Even though my days on earth will be few, the potential for me to have an impact on others is great. Like them, I want to live my life in a way that makes a difference.

- Bart