Goodbye to the 612


I’m not sure how I’ll handle the separation, so I figured I’d reflect on the last month of living with dreamboatdrayton. The past few weeks  have thrown both the beauty and brevity of life into sharp contrast. I watched my impossibly stunning friend Grace get married as the pacific surf crashed behind her. On a cold gray day 72 hours later, I opened my phone and found out that another friend had passed away. This past month was split into a two week child psychiatry rotation and two weeks of construction work. After concrete ended, I packed up my Prius and drove far into the north country.


I spent the mornings of child psychiatry talking one on one with patients. Conversation bounced back and forth with footballs and soccer balls. Afternoons filled up with admitting patients and discussing cases with the two doctors I worked with. This was easily the most intuitive and heartbreaking work I’ve done in medical school. Every day I met with traumatized children who didn’t have the opportunity to see the world as the safe, loving place that I did growing up. I wanted to take each and every one of them home with me. On the other hand, it was astounding to see their capacity for introspection and tenderness. A young boy who was nonverbal and violent during admission would end up talking softly to me about his favorite foods the next morning. A high schooler who screamed at his mom and the staff on Monday, hung out with me on Wednesday, smiling shyly and laughing as we talked about school. I struggled through oragami and coloring but excelled in football and legos.


This rotation led to a conversation with a friend of mine about the ethics of medicating mental health conditions. He questioned the long term health effects of medications, symptomatic vs etiological treatment, and the pressure that we put on parents and their children to exist on the range of what “experts” have decided is normal. I agree that medicating children in hopes to achieve “normal” functioning can be dangerous, but I also believe that we need to do the best we can with what we have. I saw talented clinicians work with deeply troubled children who had become a danger to themselves and others. It was powerful to see the child after layers of illness were peeled back. That act of discovery made me want to come back for more.


All children should have a fair opportunity for success. All children should have loving and supportive families. All children should meet our world through thoughtful, educated teachers and police who take the time to see their goodness. That world doesn’t exist right now. I see my role as a doctor as pushing to better the world we live in while simultaneously treating patients in the context of our current and flawed planet. The literature is clear that besides inherently increased morbidity, mental illness is associated with decreased life expectancy. So why are there so few resources dedicated to mental health? How do we decide when to rehabilitate and treat people versus jailing them? How much autonomy should destructive parents (most likely suffering themselves) have over their children’s lives? Etc, etc, etc. Plenty of thoughts for the following weeks.

Five months ago, I staked out the two weeks after child psychiatry for blissful nothingness. It was my first time to relax in many months. But when my dad told me he could use a hand, and I fought against my inherent laziness and came out of retirement to work for Cousins Brick and Stone.


On Wednesday morning construction week two, we poured concrete at 7:00 am. The sky was dark and the air was cold. After ten minutes of wheeling cement, I stripped off my sweatshirt. The cold air hit my hot skin and I felt alive and deeply well.  Concrete work is fast and hard and it’s quickly obvious if you don’t know what you’re doing. Most of all though, it was a pleasure and unique opportunity to be able to spend time as a man working alongside my father. I still have much to learn from this man whom I’ve used as a model to mold my own life. I watched him design complicated structures while thinking about how they might need to evolve in the future. Driving from lunch buffets to steel yards I watched him embody his stated philosophy that “We’re only here for a short time so we might as well have fun.” He has friends scattered all over the city. Someone once told me that I was too hard on my dad. She was right. We can blow up at each other after less than a look. However, the flip side of being so similar is that we both work hard to cherish the time we spend together, comically quick to reconcile and tell each other that we love one another. These past two weeks were a priceless embodiment of that relationship.


Unfortunately, construction was short lived and I left the cold concrete to fly down to Malibu for a friend’s wedding. I watched my beautiful friend get married on a white sand beach. I panted through mountain runs with another friend who’s more like a brother. I found myself a part of a debaucherous dancing trio of men tearing up a gravel dance floor populated by women in their 60s. I passed out on a beach after being body slammed by the cold surf. Sunday morning I was already fantasizing about my future practice in Southern California. Everything about the weekend screamed life, but it’s hard to differentiate the fantasy from reality. I knew someone who hated when I constantly questioned and deconstructed pleasurable luxuries that fall my way, so she would have appreciated the unabashed exuberance of Malibu. However she would have quickly seen my misanthropy regain control when I found out my return flight was first class. I tried unsuccessfully to pawn my seat off on a few passengers and then the flight staff.


It wasn’t until I was sitting in my marginally wider seat back to Minneapolis that I fell to questioning the reality behind the white sand beaches and million dollar homes. On whose back is that kind of luxury built on? How can that kind of wealth justify itself?


Time unravels in front of me as I turn over these questions in Ely. The space heater rumbles next to my chair, warming my legs, sore after a long run alone in the woods. I’m happy up here in the cold, and the occasional pang of yearning I feel isn’t for beaches and bikinis. I feel content in these quiet moments with a glass of whiskey while reading or listening to NPR. Without the constant distraction of the internet or the pleasures of the city, I’m left with peace and a pleasantly melancholic pang for family, friends, and good moments of time since passed. This life here is another kind of luxury, one however that I hope is training and rejuvenation for a life of continued service.


For Ari, we will always love and remember you.


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I’m with her

It should have taken no more than 30 seconds of watching the debate to understand that there is not an option in this election. That being said, it shouldn’t have been a question in the first place.


Whether it’s fear of having a woman in office, fear of immigrant men, women, and children, or fear of people who look different from us, I hope Trump supporters can take just one moment to look inside themselves and reflect.  Are they modeling the kind of people that they hope their children will someday become? On which side of history do they fall?


I’m struggling with this question: At what point do “good people” who have different political beliefs than ourselves become “dangerous people” because their beliefs endanger the lives of others? How far does a candidate need to go before we reevaluate how we approach the relationships with people we love, but hold disturbing political beliefs.


I think back often on Nelson Mandela. He fought violently (literally) against a society and system of beliefs that were based on ignorance and oppression. However, he continued to strive for understanding and forgiveness for those same people.


I want to continue to understand and forgive people their humanity, but I will not accept these beliefs and attitudes in any form. It is my responsibility as a privileged and non-maligned member of society to fight as hard as I can against this fearful, hateful, and oppressive mentality. Over the next month I’m gonna make shit weird and uncomfortable  when talking politics. This will be going against my non-confrontational Minnesota values.
This election is different from others not just because of what might happen if a racist, sexist, demagogue gets elected. It’s different because supporting that demagogue means aligning with fear and hate. We must be better than this.

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Wake up call (revised)

“Sometimes there’s nothing more we can do,” my attending physician warned me as I sat in her office after rounds. We were talking about to her about the seemingly insurmountable battle my patient “Jane” was fighting in regards to her health. Jane was homeless and living out of a hotel with her children and grandchildren. She was wheelchair-bound from multiple amputations due to a rare illness caused by an allergy-like reaction to nicotine. Her health was further complicated by heart failure, high blood pressure, depression, narcotic abuse, and nicotine addiction. Over the past year Jane had been in and out of the hospital and non-adherent with her medication and follow up. She was recently fired by her home health service for lack of communication and refusal of services. Her survival easily be measured in months, and she wasn’t even 50 years old. It didn’t take a medical education to see that stable housing and strong social support were necessary for her health care, and she needed more than just pain control and medical stabilization.

So back to “Sometimes there’s nothing more we can do,” a comment from a physician for whom I cannot overstate my respect, but with whom I completely disagree. I selfishly chose medical school over other healthcare work because of the power and social capital that an MD can wield in terms of social activism. Jane’s story further reminded me of need to use that voice to speak truth to power. Nine days out of ten she was joined in the hospital by her daughter and two grandsons. The small hospital room had become their most stable home. On hospital day three, I took her grandson up to the seventh floor of the hospital to play cards and because he wanted a view of the new Vikings stadium. So I took this homeless 9 year-old Minnesota boy up to look at the stadium, which he’ll most likely never afford to enter, that Minnesota state and local taxpayers paid approximately 498 million dollars to build. So again I disagree, I believe that there is something we can do for the roughly 10,000 homeless people in Minnesota, over 3,500 of whom are children. For starters, we can house our neighbors with our taxpayer dollars instead of spending it on football. These numbers should make you sick to your stomach. The cost of this one stadium, let alone the tax breaks, equals to almost 50,000$ per homeless Minnesotan.

Lawmakers argue that they’re investing in the future, which will in turn bring more money back to the state. However the numbers don’t back this up. A 2007 (Culhane et al) study found that the cost savings of housing homeless patients in Hennepin County was over 100,000$ per patient per year just in healthcare costs. Not to mention savings due to reductions in HIV incidence, jail bookings, and school costs. It should enrage you that instead of spending money on entertainment and leisure after taking care of our vulnerable people, we spent half a billion dollars building a stadium that statistically (when looking at other comparable stadiums and cities) will not recuperate its costs. A paper from the International Association of Sports Economists showed a strong consensus among economists that stadiums are not worth their price and that the benefits they bring don’t match their costs. Furthermore, a new Taxpayer Alliance report showed correlation between public subsidization of new stadiums and lower medium incomes and higher poverty rates in those same cities.

The responsibility of this ridiculous situation is on every one of us. It’s on us every time we talk about, support, or glorify football in its current iteration. We can’t stand by anymore and blithely support through our words, dollars, views, and actions a sport that destroys the brains of the men who play it and bullies weak politicians out of taxpayer dollars. Because it’s a fucking sport that doesn’t matter and the costs are too high. Every once in awhile, the veil needs to be pulled back so we can glimpse our collective insanity. Grown men in fancy suits sit next to each other on TV and talk seriously about other grown men playing ball games. There’s nothing inherently wrong with this, and it would be nothing more than kind of pathetic if we lived in a society that didn’t have homeless and hungry children, poor public education, rampant gun violence, and pervasive discrimination regarding race, gender, sexuality, and religion. But all of these things do exist, so we need to re-examine where what we stand for as a society.

Before finishing my rotation in Medicine, I spent 3 weeks caring for Jane who, like I mentioned, was living with Thromboangitis obliterans (Buergers Disease). Buergers is a devastating illness in which your body has a more or less allergic reaction to nicotine that causes your small blood vessels to fibrose, leading to rapid loss of extremities to gangrene and amputation. The first time I met Jane she was sitting up on her bed when I walked into the room, crying and asking for pain medication. Her right leg was amputated below the knee, all five of her toes were amputated on her left foot, and she had open draining ulcers on both legs and where her toes used to be. The sour smell coming from her ulcers was something I would get used to over the next three weeks. We started her on IV antibiotics and began to treat her pain with opiates. Her pain was a complicated soup of Buerger’s disease (the nicotine causes pain crisis), open wounds, edema and inflammation due to heart failure, and opioid tolerance and addiction.

I began to quickly learn more about healthcare than I’d learned in months of medical school classes. Medically we were managing congestive heart failure, Buergers Disease, pain, hypertension, and COPD. Emotionally we were managing depression, narcotic and nicotine addiction, and anxiety. Socially we were managing homelessness, dependent children and grandchildren, poor follow up, and medication non-adherence. And personally she taught me about interprofessional collaboration, managing my own expectations, and the absurdity in the idea that physical, emotional, mental, and social medicine can be separated.

On the morning of hospital day two I ran into Jane being wheeled out of the hospital by her 9 year-old grandson at 7:30 am. This was ten minutes after having a half hour conversation with her about her illness and the dangers of having even one more cigarette. Nothing I could do in that moment would stop her from going outside to smoke, not even a promise of tea and a backrub. Later on that night, I realized that I was angry with her. I was angry because she woke up a nine year-old to take her outside to smoke, angry that she couldn’t do what seemed obvious, angry that children had to suffer for the mistakes and illnesses of adults, angry that she didn’t do what I wanted her to do. This was a manifestation of my own weakness.

I need to let go of my own need for control and just be the best doctor I can be. I need to redirect my rage toward a system that methodically discriminates against against poor, immigrant, female, and patients of color. I need to sublimate that rage into care and love for the patient in front of me. The relationship that Jane and I developed over her three week stay was complicated but rich. I began to understand that beneath the pain, amputations, and medications, she was just like any mother trying to do the best for her little clan. To the embarrassment of both myself and her daughter, she mischievously tried to marry us off, and I was reminded that I’m still a young man working for a grown woman who has a lifetime of knowledge and experience.

Her hospital course was rocky. Some days I came home inspired after seeing over a dozen brilliant people from different specialties (hospitalists, care coordinators, social workers, nurses, cardiologists…) all working hard towards a shared goal of getting Jane and her family back on solid ground. Other days I’d stop by her floor only to hear someone bitching cattily about her, find out she’d taken her whole family outside to smoke at 3:00 am, and see her sitting in bed sobbing, snowed with opiates, and begging for more pain meds while her two grandsons fought over a cell phone in the corner of the room.

By hospital day eighteen however, she started to turn a corner. She had diuresed enough fluid that her legs were less edematous and therefore less painful, and she was requesting less pain medication. She was also nine days cigarette free. Then came the shattering news that a routine ECHO showed that her idiopathic cardiomyopathy had lead to an 11% ejection fraction (normal is 55-70%). This meant that every time her heart squeezed to pump blood to the rest of her body, it was only able to squeeze out 11% of the blood from her left ventricle. Jane was now faced with an entirely new and pressing death sentence that had nothing to do with her lifestyle or choices.

We discharged her from the hospital with improved pain and controlled heart failure. She was given a comprehensive education regarding her illness, and coordination with social services for housing and home health. Furthermore, she had a nicotine cessation plan and was eleven days without a cigarette. As a team we decided to hold off on broaching the subject of palliative care because forward-thinking and medication adherence might be her best palliative option. At the end of the day, Jane isn’t a character that exists to teach me lessons, she is a flesh and blood human being that tragically exemplifies our society’s twisted values, both good and bad. Furthermore her story should serve notice for us to re-examine what we support with our words, dollars, actions, and to remind us that we live in the same city as a homeless woman with multiple amputations and terminal congestive heart failure living in a hotel while supporting her 2 children and 2 grandchildren because she can’t afford stable housing.

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Saturday afternoon


When I left the hospital today, black storm clouds framed the Minneapolis skyline, perfect running weather. Early this week when I went running with similarly threatening skies, the rumbling thunder gave way to sheets of rain and marble sized hail. It made for an exhilarating return trip and a meditation on the  power of nature. Today the weather held, so instead of meditating on life and death I thought back on an incident that happened one week before.

Last Saturday afternoon was gorgeous, I got an early admit so I was walking out of the hospital at 3 pm, 2 hours before I expected to. I snapped the pannier to my bike, rolled up my scrubs, and kicked off downhill towards the hospital entrance. As my bike lazily rolled towards the street, I heard yelling on my left and turned my head to see what was going on. Four security guards were standing around a young black woman who was crying and staggering towards the street, catching herself intermittently on the brick wall of the hospital and the concrete pillars holding up the parking garage. She was wearing shorts, a grey t-shirt, and hospital socks. She had spittle running down her shirt and foam in her mouth. She looked unwell.

I turned my handlebars and pedaled up towards the scene, leaning my bike up against the hospital wall and slipping on on my t-shirt shirt as I walked towards security. The girl was now sitting on the ground with her back to a post, crying and banging her head against the concrete. I could hear one of the guards angrily telling her that she needed to leave the premises as the others stood next to him and watched. As I approached, he turned to me and aggressively told me that I needed to “walk away.”

Now I’m a white man in scrubs and I shamelessly used that social capital, ignoring his command and continuing to walk forward. I said that I was a student doctor who worked at the hospital and asked what was going on. One of the other guards quickly stepped between us and told me that the girl was admitted for a seizure disorder, but that her ED workup was negative. He said she tried to leave the hospital on her own, and was eventually discharged AMA (against medical advice). He then handed me a plastic bag full of her medications, grateful for the chance to be relieved of responsibility. I took the bag and sat down on the sidewalk in front of the girl as the four guards walked away.

The girl didn’t like me. She didn’t like the fact that I was sitting with her. She didn’t like the fact that I put my hand between her skull and the concrete. She didn’t want to be in the hospital. She didn’t want me to call a cab to take her home. She didn’t know why her boyfriend wasn’t there. Every few minutes she stood up and staggered a couple feet only to sink back to the ground, sometimes spilling onto her back, shaking and spitting, her eyes rolling to the back of her head. These spells only lasted a few seconds, during which I tried to keep her from biting her tongue. She would then sit back up and start crying again, unable to articulate much beyond her emotions.

After 20 minutes or so of cyclical conversation and behavior, I was only able to elicit her name, her age, that she was close to her family but that they were on a camping trip, and that she just graduated from high school. When I started to feel like I wanted to pull out my own hair, I knew I had to check myself, so I sat back on my heels as she cried in front of me and ran through what I knew:

The patient was harming herself
She was vulnerable (18 year old girl, alone, no wallet, shoes, ID or phone)
She was either having seizures or some sort of conversation disorder
She was not behaving like a competent adult
She has family she’s close to
I did not have the skills, words, or knowledge base to resolve the situation on my own

She had stopped banging her head, and she didn’t look like she was going to be moving anywhere quickly, so I walked into the ED and asked the admitting nurse what was going on. She told me the same story I heard from the security guard, and when I said that I thought the girl was unsafe and should be readmitted, she asked me if I’d like to talk to the ER Doctor. I said yes, and he came out a few moments later with an irritated look on his face. When he asked me what I wanted, I told him that I was a medical student working at the hospital and that I became concerned when I saw the recently discharged patient outside the ED. As I began to tell him what I saw, he interrupted me.

He told me I had “no idea” about the patient or her history, and that what I was seeing was nothing more than an attention-seeking behavior problem. Stifling my reaction to the heavily race-coded phrase “behavioral problem,” I replied that I agreed with him that I didn’t know anything about the patient’s history and that he likely had a much better idea of the patient than I did. That being said, I followed, there’s a girl outside with no ID, no phone, no shoes, foaming at the mouth and harming herself by banging her head against the wall. “Stay away from her and get out of my face,” he snarled and walked back into the ED.

I might have stood for 10 seconds in disbelief with my hands pressed down against the admission desk. As I turned to leave, another bearded young white man, either a scribe or nursing assistant, I couldn’t tell by his scrubs, turned to me and said “we see these people all the time.” I let my frustration get ahold of me as I angrily asked what he meant by that and whether she would have been treated the same if she were white. His eyes immediately widened as he said “You can’t say that. You shouldn’t be saying that,” but I was already walking toward the door, trying to figure out where to go from there.

The girl was still sitting on the ground with her back against the wall. I squatted down in front of her trying to collect my thoughts when two other nurses, both men, came outside beside me. One of them sat down beside her and restrained her from banging her head against the wall, which she had started doing again as they walked up. The other had a wheelchair and spun it around so that it was in front of the girl. I asked them if they would take her back inside, and the one holding onto her head nodded. He said that was why they came outside, and that he thought she wasn’t safe and needed to be re-admitted. She initially struggled when they tried to get her up, but seemed to collapse into the chair once she was in it. As they wheeled her into the ED, I walked back inside to talk to the senior resident on call. The resident was going over notes with another medical student in the lounge when I walked in. I quickly explained what had happened, including what I thought went wrong.

I understand that dealing with patients who are that difficult must be frustrating, because they are the people who require the most complicated physical, mental, and emotional care.  I am also aware that I knew less about the patient’s story than the ER Doctor did, and I can imagine how frustrating it is to deal with a complicated patient and then have a 3rd year medical student question your decisions.

However, what I saw was a  scared, sick, 18 year old girl who was two months out of graduating from high school. She was harming herself, unable to articulate her needs, and extremely vulnerable. There are always options if we take the time to figure them out, even though this kind of problem-solving isn’t as sexy as diagnosing something rare like Pheochromocytoma. We could contact social work and psychiatry, bringing them in to to lay eyes on the patient and lend a different perspective. We could send an aid or sitter outside with the patient to make sure she doesn’t hurt herself. We could place the patient on a hold in order to do a further workup and contact her family. Or at the very least we could tell security that it is their job to make sure the patient stays safe and has a ride home.

I also know that there’s a good chance that the ED team went over all of those options and maybe more. However, I refuse to believe that with all of the options and brain power available, that there was nothing more that we could have done. Maybe I’m naive but I still think hospitals should strive to be a place of healing and caring for the whole person, not just their lab numbers. And I know I’m still learning, but from what I can tell, the line between mental health and behavioral decision-making is a fine one and probably not a line at all.

I spent a lot of time reflecting on this incident, and am still not sure whether or not writing about it is a good thing, because it’s hard not to make the story about ‘me,’ when the story really should be from the perspective of those who suffer the most. Because I’m so lucky, I biked home, went swimming, got drinks and dinner on a patio, woke up to a feast of a breakfast made for me because I had a long day, just in time to drive over so we could watch my mom win her age group in yet another triathlon.

I knew I wanted to write though, because I spent the following afternoon eating good food by the creek in my family’s backyard, holding my cousins new babies, and playing with their toddlers.  This afternoon reminded me that my generation has an obligation to fight to make their world into a better one.  I want them, as well as my future children, to grow up in a society that does all it can to hold up those in need. And I guess the first step for me is rattling the cage when I have the opportunity to, and taking on the responsibility of my profession by working to contextualize and humanize every person I work with,  striving to serve my community, and staying hungry for change.


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On Friday afternoon my 94 year old patient I’ll call “Betty” kissed me on the cheek as I said goodbye to her for the day. She winked at me as I left the room, her elvish eyebrows arching high on her wrinkled forehead. We had just finished a care conference in which she had elected to discontinue BiPAP and supplemental oxygen. This meant that in a few hours her oxygen saturation would begin to fall as carbon dioxide built up in her blood. When I quietly stepped into her room early the next morning she was already unconscious and unresponsive, facing the ceiling with her eyes closed and her mouth frozen open in a small “o”. After checking her pulse I slipped out of the room, only to immediately turn back around and sit on her bed for another minute or so to hold her hand. It’s cliche as hell, but I had to tell her how much she meant to me and let her know that she wasn’t alone. Her mind had already turned internally, but I needed that moment for me. Thirty minutes later I was sitting in the residents lounge writing up my notes for the morning, and I got a page telling me that Betty had died.

I had spent the past two weeks following Betty and getting to know her. From her admission, when I found her unconscious and struggling to breathe, my first real doctor moment as a med student, to checking in on her on the floor and eventually the ICU, where she would wake up with a smile that lit up the room. It was easy to love someone like her. I didn’t stand a chance in the face of her razor sharp mind, radiant smile, and squeaky voice that piped up from the bed to ask me how I was doing every morning before I got a chance to ask her how she was doing. What I didn’t anticipate however, was how difficult it would be to stay objective and medical with her at the end. As a medical student, my responsibilities consist mostly of knowing my patients, figuring out what’s going on, checking up on them, and offering suggestions or ideas. Being a part of a conference in which someone who is one 100% cogent and deciding whether or not she wants to continue a treatment that, if withdrawn, will ensure her death in the next day or so, isn’t something I’m used to. Struggling to keep back tears as I kissed her goodbye, I felt a faint whisper of the power and importance of this kind of decision making. Talking about death is possibly one of the most important human moments we can have, especially in an era in which we can prolong life longer than ever before.

No matter how advanced medical technology has evolved, we still don’t understand what it is to live and die. It’s the ultimate fear of the unknown, and this fear can easily tempt us into simplistic and reductionist thinking. What happens when we die, what does it mean to pass time on this earth, what’s important, do we have free will, can we really live in the moment, what does it mean to lose your mind, how much responsibility can we shoulder, how much responsibility can we assign to someone else? We reflexively pass judgements daily based on our own unconscious answers to these questions, often without stopping to reflect on them.

Two weeks ago I was on an early morning on-call team that rushed up to the ICU to admit a patient, an elderly native woman who presented to the hospital for septic shock due to suspected pneumonia. Her blood pressure was tanking, she had a fever, and she was drifting in and out of consciousness. Her chart indicated that she was an uncontrolled type II diabetic with a history of alcohol abuse who was living in an assisted care facility. Looking down at this sick woman who had sky high blood sugars and bacteria coursing through her veins, I couldn’t shake the feeling that she had been poisoned. She had been poisoned by a capitalist colonial system that eviscerated her culture, impoverished her, and then enticed her with liquor and cheap fake food. That’s how I saw it through my unexamined lens. Then as we were walking to round on our other patients, one of the residents coolly commented that I was just witness to what happens when people don’t give a shit about their health. That’s how he saw it through his unexamined lens.

These moments happen every day. Today a diabetic Somali man on dialysis who was taken off the renal transplant list because he ran off to Mcdonalds while NPO (nothing per oral) for a scheduled procedure, or last week a 60 year old anorexic smoker with a history of alcoholism who refused to have her labs drawn. Judgement is quick, easy, and laid down with force behind closed doors. And I get it, I get how frustrating it must be to devote your life to prolonging the lives of others only to watch in disbelief as they seemingly throw theirs away. The thing is though, we have no fucking idea. We have no idea what it is to walk in their shoes, to live in their skin, and to wake up every day in their sick and increasingly obese bodies. I think we’re frustrated in part because we’re frightened of our own mortality, and it’s easier to assign blame and get angry than face the reality that our control is a facade.

This past Memorial Day weekend was perfect, 60s-70s and not a cloud in the sky Saturday through Monday. I had just taken my boards on Friday, so Saturday morning I decided to go out for a run, and I just kept running. By the time I got home I had run 12 miles, probably around 4 miles longer than I had run in over a year. I felt fantastic and that night I slept on marshmallows. So Sunday I did it again, and like a drug seeker I wanted more. Sixteen miles later I stumbled onto my front porch, but this time it was all I could do to keep my eyes open for the rest of the day. The next morning I discovered a sore knee that ended up taking 8 weeks to right itself. In the intervening months, I’ve kept running hard, rolling cigarettes, drinking whiskey on my porch, staying up late, and waking up bleary eyed to spend 12 hour days at the hospital. Self-destructive behavior takes all shapes and sizes, but it paints different pictures on different bodies.

My sore knee, chronic exhaustion, and the scar on my leg from taking a motorcycle down to avoid being broadsided are all symptoms of my own discomfort with mortality, and my own ways of dealing with it. Hopefully however, reflecting on the reality of death and learning from people like Betty, will allow me to better empathize with the decisions of others. I’m also hoping, as icing on the cake, it will allow me to continue to wrest every moment from this beautiful existence without destroying myself in the process. That’s why I love Minnesota; this state forces us to be alive. Give me the bike rides to work in dress pants and no shirt because of the impossibly hot and humid summers. Give me the contemplative fall where air is crisp and the leaves paint the city and country both with brilliant hues, only to lose those hues to a gray and impending cold. And give me the cold north winter where the black night burns your lungs and deafens your ears with its silence.

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The Myth of The Persecuted White Man

I am not a white man. I am a man who believes himself to be white, and there are many people who believe it as well. I stole this language from Ta-Nehisi Coates, a writer far more articulate than me, but the idea has been tumbling around in my head for a while now. I am not rejecting my white male privilege, my white male experience, nor the experience of others who’ve benefitted or suffered from this malignant idea that is race. I am however rejecting its intrinsic reality because it dehumanizes our species.

I was seven maybe eight years old when I stood with my mom at the edge of human horror, the Guatemala City dump. Tin and cardboard houses rimmed the edge of a steaming garbage pit. Packs of dogs, spiraling vultures, and starving people all fought each other for the shit that others had thrown away. I remember wondering why my mom didn’t want me to touch the ground with my bare hands when I saw kids my own age living on that ground. Her expression told me she didn’t have a good answer. Why are we born to whom we’re born isn’t a question that has an answer, it’s purely random. We do nothing to deserve the privilege that our parent’s wealth, our statehood, or our genes happen to give us; that was my first lesson. My second lesson was simpler: just because I don’t see something happening in front of me doesn’t mean that it’s not happening somewhere. And as long as my lungs draw breath, my humanity is intrinsically tied to the humanity of those on whose backs my privilege rests.

We white men can’t help but be on the spectrum of narcissistic personality disorder. It’s hard not to feel in your bones that the privilege and power that comes with your every step isn’t god-given. When confronted with the painful reality that the world might not exist simply to serve our desires, we lash out. Poor uneducated white men who make up the vast majority of the voting block supporting the racist, misogynist, and xenophobic policies of Donald Trump are not intrinsically bad people. However, they are more viscerally confronted with the reality of their ordinariness than men of the educated and wealthy intelligentsia. Furthermore, they often lack an emotional and social toolbox to deal with this new reality. This impotent male rage played out in horrifying fashion recently in Cologne, Germany where immigrant men gathered in mass and sexually assaulted groups of women. These men are scum deserving prosecution to the fullest extent of the law, but they are also symptomatic of something more universal. They’re men who have held power over women their whole lives due to global misogyny, and suddenly they’re thrust out of their positions of power and forced to assume the role of refugees. When confronted by this new reality, they lash out like animals.

Men who believe themselves to be white in America are suffering another delusion about our whiteness: the myth that we are being persecuted. Talk radio, tv, country music, and political rhetoric all tell the same story: that traditional values are under assault, freedoms are being taken away, family values are disappearing, and that there is a culture of political correctness. This reaction shouldn’t be a surprise to anyone; white men have been running rampant over the world since time immemorial and just as society has evolved to legitimately push back against this injustice, there comes a man in Donald Trump who harnesses the impotent rage that has been building among those who are losing their power.

Fighting against oppression in language and structure isn’t political correctness or repression, it’s an acknowledgement of injustice and an important step to bettering the human race. There hasn’t been a legitimate debate in American politics since I’ve been alive, but up until now, through vague racism, half-truths, and remarkable leveraging of religious beliefs, the Republican party has been able to pass themselves off as more than greedy xenophobic evangelists manipulating uneducated whites to vote against their own interests. Today however, Donald Trump has wiped off the spit shine that has covered the pile of shit that is Republican politics. In one way, the anti-immigrant, anti-muslim, anti-women rhetoric spewing out of the republican primaries has led to possibly one of the most honest conversations our country has ever had.

When our country was founded, slavery was the law of the land. Then on May 9th 1865 the confederacy lost the civil war. Soon thereafter, Jim Crow laws were enacted and lasted one hundred years until 1965. Since the civil rights movement in the sixties, we’ve continued to have disparities in justice, incarceration, education, and housing policy, not to mention the vast inequalities and discrimination in regards to gender, sexuality, and religion. America was never “great,” but it’s always had the potential to be the very best. We have the potential to be great not because of some bullshit idea of American exceptionalism, but due to the fact that although our country was founded on slavery and the genocide of Native Americans, we are also a nation of immigrants who were given one of the most brilliant constitutions and forms of government the world had ever seen.

That brilliant government however, will only work if it’s held up by an educated and healthy populace that’s free from discrimination on the basis of gender, race sexuality, and religion. Lofty thoughts from from an armchair philosopher though, because on an individual level I’m not sure where to go from here. Starting tomorrow I’ll be working 12 hour days 5 days/week with a 24 hour shift on Saturday, work being an easy excuse to slide into the power and wealth that can seem natural and god-given to men like me. I’m under no illusion that I’m anything but fortunate however, because I’m finally out of the classroom and training in possibly the most interesting job in the world. However, it means that if I’m not intentional about staying engaged in the world around me, I’m going to find myself gliding along on that moving sidewalk without a thought to breaking it. Fortunately though, I have incredible examples in both my brother and mom who work for social justice with self-reflection and passion that feed off the energy their work creates. Furthermore, I have a father who reminds me through examples and words how important it is to carry myself with integrity and treat those around me with respect.

I’m writing today at the very real risk of mansplaining, so I can begin to formulate this conversation, a conversation I want to keep having as long as I can and as long as it’s necessary. I’m writing in honor of the people around me to whom this conversation and these values come without thinking.


I had to put this in here because she somehow stays ageless while I can’t even zip my fly consistently.

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American Healthcare



As a medical student at The University of Minnesota I’m learning that patient’s stories are not only a privilege to hear, but probably my best guide for being a good physician. I’m also learning that that these stories have as much to do with our broken healthcare system as the physical ailments themselves. I believe in my country, but I believe we can do better and that we as a nation must ask ourselves if this is the world we want to live in.

This past summer, while volunteering at a free clinic run by medical students from the University of Minnesota, I was walking a young mother through the process of applying for health insurance for her 4 year-old daughter. She is a child and citizen of the richest country in the world, yet she is not automatically enrolled in healthcare. Mother and daughter had to wait in a dank church basement, at night for over two hours, in order to have a first year medical student listen to her cough. This past year I often found myself providing first-line healthcare to men, women, and children without health insurance. This is an opportunity for me to practice clinical skills, and learn about both medicine and healthcare policy. This opportunity for privileged students like me to provide subpar care as a stopgap measure for our nation’s most vulnerable people is not only problematic, but shameful.

The facts regarding healthcare management are unambiguous, it would be cheaper and more effective to have single payer healthcare: a universal healthcare system in which every American would pay into a single government-run plan. Single payer universal healthcare is the American thing to do.

Single payer health care is the American thing to do because it frees employers from being mandated to pay for their employee’s health insurance and allows them to invest that money back into their businesses. It’s American because it insures that every man, woman, and child in the United States doesn’t have to worry about delaying care, being bankrupted by healthcare costs, and losing health insurance if they lose their jobs. The US spends twice as much per capita on healthcare as the average developed nation that provides universal coverage, and we rank dead last out of the top 19 highest income countries in preventing deaths amenable to healthcare (Nolte et al, 2008) (Woolhandler, 2002).

This summer I also interned at a rural hospital in northern Wisconsin where many patients had chronic diseases that couldn’t be fixed by a single procedure or pill, but required long-term health maintenance. One patient was a 67-year-old woman with uncontrolled diabetes. Before becoming eligible for medicare, she hadn’t seen a doctor for her diabetes because she couldn’t afford to buy good, low-deductible low-copay insurance. She is one more American paying the physical costs of our broken system, as our nations economic costs are rising as she begins to receive care to deal with her worsening chronic illness.

Single payer healthcare is American because it reduces unnecessary costs. The overhead of Medicare is around 2%, compared to an average of 13% for private insurance (Sullivan, 2013). The US would save an estimated 380 billion dollars anually if we instituted as single payer system (Woolhandler, 2011) (Lewin Analysis, 2012). Medicare is our grossly overburdened and inefficient government system that doesn’t have the benefit of young, rich, healthy patients, yet it is far more efficient than the private healthcare system. Single payer healthcare removes the middleman from between the consumer (the patients) and the providers (healthcare professionals). The middleman—the insurance industry—produces nothing, skims revenue off of this transaction, and disrupts the flow of the market. Furthermore, this middleman is currently telling the consumer what they can and cannot buy, as well as telling the provider what they can and cannot sell.

While at this hospital in rural Wisconsin, I also shadowed an internal medicine physician at the Bad River Indian Reservation. One of our patients came in with 3rd degree burns covering his hands that were so severe he couldn’t hold a cup of coffee. He had delayed coming into the clinic due to fears of high costs, and refused to seek further treatment at the burn clinic—after the doctor suggested it—due to high copays. He had insurance, but he was underinsured and suffering from it.

Most of all, single payer healthcare is the American solution because we live in a land of opportunity with the rights to Life, Liberty, and the Pursuit of Happiness guaranteed to us in our Declaration of Independence. Neither life, liberty, nor the pursuit of happiness is possible when we don’t have access to healthcare without the fear of being bankrupted and billed into poverty and ruin.

We are a nation that rewards innovators and fighters, those who strive to be the best that they can be. But how many young men and women are stopped from achieving their potential and bettering their country due to barriers to healthcare affecting themselves and their families? America can easily create the best healthcare system in the world because we already have what it takes. We have the top healthcare centers in the world—many of them here in Minnesota—and we already spend the money that would allow us fantastic coverage and care without the wait lines. What we don’t have however, are enough people in power that are courageous enough to fight for those who don’t have a voice and who suffer under our current system. We need to come together as a society to make this kind of change, because it’s the American—and the right—thing to do.



  1. Nolte E, Ph.D., and McKee CM, M.D., “Measuring the Health of Nations: Updating an Earlier Analysis,” Health Affairs, January/February 2008.
  1. Woolhandler S, M.D., et al. “Paying for National Health Insurance – And Not Getting It,” Health Affairs 21(4); July/August 2002.
  1. Sullivan K, J.D., “How to Think Clearly about Medicare Administrative Costs: Data Sources and Measurement,” Journal of Health Politics, Policy and Law, Feb.15, 2013.
  1. Woolhandler S. “Cutting Health Costs by Reducing the Bureaucracy,” New York Times, Nov. 20, 2011.
  1. Lewin 2012 Analysis: Beyond the Affordable Care Act: An analyis of a Unified System of Health Care for all Minnesota , Growth and Jestice
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