Oops. Shouldn't have hired George.

I have discovered what is wrong with the health insurance industry.  It appears that George Costanza is working at one of the major insurance companies.  See the photo below of actual correspondence from one of our insurance companies.



  "Oh, no!  I'm sorry.  It's the Moops.  The correct answer is the Moops."
Thanks to Dr. Carrie Kelly for finding this.

"Disinfecting" pacifiers

No offense to parents who have done this, but:  When your child's pacifier falls on the floor, putting it in your own mouth to "clean" it is probably not helping the situation.  I recommend soap and water.

Newest Insurance Outrage

While I am on the topic of bad behavior by insurance companies, check this out:

A preteen girl in my practice needed antibiotics for a urinary tract infection.  The antibiotic was chosen based on the sensitivities reported by the lab (this means I was choosing an antibiotic to which this child's bacteria was know to be sensitive).  Of all the choices, I chose the antibiotic with the least side effects, which also happened to be one that has existed for quite a while and therefore has a generic version.  In the real world (meaning the world in which someone pays the pharmacy directly for their medicine at the full price), this should be the cheapest medicine.

So, I am practicing really good medicine here, right?  I chose the cheapest antibiotic with the fewest side effects, and I know from the culture that this medicine will work.

To borrow from Lee Corso:  Not so fast, my friend.  The insurance company, who will remain nameless, apparently doesn't have a special deal with the maker of GoodCheapMed, so they deny the med.  Unfortunately for the child, the insurance company decides this at 6:45 p.m. on Friday evening and notifies us by fax only.  No call to the on call physician for the weekend.  No call to the off call, but prescribing, physician.  The only notice is by a fax to an office that the insurance company KNOWS will be closed until Monday.  The child then goes the entire weekend without an antibiotic because of the misbehavior of her insurance company.  The situation is discovered on Monday and the child receives a different, but still effective, antibiotic and finally receives the needed treatment.

Two general lessons from this story:
1.  Do not EVER think that your health insurance company cares about your health.
2.  If your doctor prescribes a medicine for you that gets denied, call your doctor (even if it is the on call doctor) so that they can address the situation.

Insurance Company Logic: Reject First, Then Overdose

I have not often talked about the myriad ways that insurance companies interfere with the practice of good medicine, in part because I don't have enough time to recount every story.  I had an infuriating dealing with a company this past week, though, that I think speaks volumes.

The short story is this:  The patient is a two-month-old breastfed baby with gastroesophageal reflux which has not been controlled with "reflux precautions" (feed smaller volumes, burp well, keep upright after feeds, and elevate head of bed to 30 degrees) or with Med A.  Med B has a number of negatives as an alternative or adjunctive medicine, so the next most appropriate medicine is Med C.

Since this is a young infant, I prescribe a dose appropriate to the baby's size and, surprise of all surprises, the insurance company denies the prescription because it will cost them more money.  Never mind that it is the appropriate medicine at the appropriate dose in an appropriate form for an infant.

So, what is the insco's reasoning?  The patient must first try OTC Med C.

Oh, you say, that's not so bad.  Shouldn't patients try OTC meds first anyway?

Well, maybe in some situations, but the OTC med in this situation would be a dose about 8 times higher than the patient should have (and would require the two month old to swallow pills).

To bypass the INSURANCE COMPANY'S RECOMMENDED OVERDOSE of my infant patient, I have to spend my time waiting on hold with the insurance company, so that I can eventually talk to their employed physician, who does not actively practice medicine and is most likely not a pediatrician, and try to convince him or her that it is bad medicine to overdose my patient.

Oh, the joys of practicing medicine in the U.S.

One Year

It has now been little over a year since we left the U.S. for the month in Kenya.  We were hoping to make it back there by now so we could serve again while Amy's cousin was still there and are disappointed (though not surprised) that we have not been able to do so.  We still find ourselves longing to go back and serve in a place where there is such great need.  As demanding and difficult as our trip was, we knew that what we were doing was meaningful and needed.  Though the medical work was often stressful, it was still enjoyable.

There is much that we miss about Kijabe specifically and Kenya in general.  We definitely miss the pace of life that we had there.  We had a lot of family time and few extracurricular activities.  I was able to eat lunch with Amy and the kids on most days and was usually home by 6 for dinner and family time in the evening.  Rift Valley Academy was a short walk up the hill if we wanted to play on the playground or make use of their beautiful campus.  

We miss the fact that life was relatively "unplugged".  We had electricity, a cell phone, and limited dial-up internet access.  It was just enough to communicate with those at home, but too frustratingly slow to waste a lot of time on the internet.  The kids played with each other a lot and used much creativity in their play.  Very little time was spent around a screen, and that was refreshing.

Medically speaking, I miss the opportunities I had to use a greater proportion of my training than I get to use here.  I miss the opportunity to help train the residents there.  Nothing makes you learn a topic as well as having to teach it.  I miss the opportunity to learn from some of the most talented physicians and devoted believers I have ever been around.  I miss working in a place where I know that what I am doing facilitates bringing others to Christ and discipling them.  I am very happy with my practice here and am blessed with a great partner and great staff, but I do miss many things about working at Kijabe.

Kenyans value relationship greatly and sincerely want to converse and get to know you.  A quick, obligatory "fine" in response to being asked how you are just won't suffice.  You must shake hands, make eye contact, and actually speak thoughtfully.  

We miss the opportunity to worship with the Kenyan believers.  Attending hospital chapel was one of the highlights of my time there.  We miss the joy with which the Kenyan believers live their lives.  Though many suffer hardship and (at least in American terms) poverty, their faith and joy shine through.  

Oh, if life here could be more like life there.  

Ill with want...

Those of you who are Avett Brothers fans will recognize the title of this post as the the title of one of their songs. As I listen to the song again tonight, I am struck again by the profound truth of their lyrics.  That phrase, ill with want, is an accurate description of what plagues us here in America.  We have a nearly insatiable appetite for things.  Our happiness seems to depend on whether we are able to accumulate as much stuff as our neighbors.  Because there is always someone else with more, we are never really happy.  Meanwhile, our more distant neighbors around the globe are suffering from exposure, hunger, and oppression.

We are unhappy if we can't get away for a round of golf once in a while.  Many in this world are hoping to have a full plate once in a while.  We NEED the latest iGadget (I am guilty here, myself), the latest fashion, or the latest adjustable driver that corrects for our uncorrectable slice.  Meanwhile, a large minority of the world NEEDS food, clothing, and shelter.  We plan to retire at 65 and hope to retire earlier.  They hope to be able to work until they die so they can feed themselves and keep themselves clothed.

We are indeed ill with want.

A Day in the Life...

Ever wonder what your pediatrician does all day?  Ever wonder why you sometimes have to wait to be seen (or, in my case, many times)?  Doesn't he or she just spend 8 hours a day at the office and then go home?  Why does he sometimes seem a little tired?  How can she be tired if she only works 4 days a week in the office?

If you have ever wondered about those things, I am going to give you a peek into what my typical work day looks like.

6:00 a.m. - Get up and get ready for the day. (If I am really disciplined, I will get up at 5:00 or 5:30 so I can exercise.)
6:45 - Leave for the hospital
7:05 - Arrive at first hospital, make rounds in newborn nursery, then move on to the pediatric ward to round on inpatients.
8:00 - Leave first hospital and go to second hospital.  Repeat the above.
8:45 - Leave second hospital and drive to office.

Note:  I do not always have patients at both nurseries and both pediatric wards.  I do often have to go to both hospitals, though.  If I don't have patients at both hospitals, I go get some coffee and spend some quiet time before the office.

9:00 - Arrive at the office to start the office day.  I am usually met with multiple questions that relate to patients who might need to come in immediately but don't want to, or who must have this form now or they won't be able to go to football practice (but they didn't bring it in until this morning), or I find out that a staff member won't be at work today because they are sick or something urgent happened.  Or, if it is winter, "The schedule is full already, where do you want to add sick patients?".

9:05 - Start seeing morning patients.  I will generally see an average of 4 patients per hour.  In winter I may see 6 per hour.  In summer, I may see 3 per hour, depending on the type of visits.  Between patients, I am usually greeted with more questions about where to fit someone in, presented with more forms to sign, forced to be cordial to the drug rep who is bringing in the samples that we need and has her boss with her, have to call back to the hospital about a patient, or have to argue with an insurance company about approving the MRI that our patient desperately needs to prove she does not have a brain tumor or spinal injury.  Along the way, I do have the great privilege of conversing and playing with lots of fun little kids while making the best medical decisions for them that I am able.  The relationship with the kids and their parents is what makes all the other hassles worthwhile.

1:30 - I finish my "morning" after 6 1/2 hours of work.  I then move on to my lunch "hour", which is usually less than 30 minutes and is spent reviewing labs, returning phone calls, and signing forms while shoveling in whatever I happen to have available for lunch that day.

2:00 - I start the afternoon and do more of what I did from 9:00-1:30.  The after school phone calls begin and we work to try to fit in those kids who got picked up from school sick.  If our schedule for the afternoon is already full, we usually add those kids on anyway and stay late to see them, unless I have a firm evening commitment that requires me to leave by a certain time.  Right before closing is when the asthmatic in severe respiratory distress walks in and must be urgently treated in the office while arranging for admission to the pediatric ward.

5:00-7:00 - I will finish seeing patients somewhere between 5 and 7, depending on the time of year and day of the week.  Once all patients have left the office, I will usually still be at the office for another hour or two finishing documentation and making phone calls.  If I admitted someone, I will also dictate the admission note and follow up on any admission orders that I have done.

6:00-8:30 - I finally make it home somewhere between these hours, depending on time of year.  My family has usually eaten dinner already, so I will either eat quickly and start hanging out with the kids, or I will hang out with the kids and then eat dinner once they have gone to bed.

9:00-11:00 or 12:00 - The kids have made it to bed and I can then start handling the personal responsibilities that I have that are not directly related to seeing patients, like paying bills, catching up on medical reading, working on "maintenance" of my board certification, and, oh yeah, actually having a conversation with my wife.

11:00 or 12:00 - Finally I go to bed so I can repeat the above tomorrow.  I will probably get about 6 hours of sleep, though I need about 8.

Not every day is this way, but many are.  Once the kids are in bed, I may do some kind of leisure activity instead of the work-related things mentioned above, but this is a fairly decent representation of my average day.  Since my partner joined the practice last year, I do have more time for leisure activities since she splits the hospital duties and phone calls with me.  My days and weekends off are usually spent hanging out with the kids and taking care of office planning activities that I can usually not accomplish if I am scheduled to see patients.

So there you have it.  A typical pediatric work day for me.  Some pediatricians will work longer hours than I work.  Some will work fewer days and fewer hours than I do.  Most will have a similar set of responsibilities that they must somehow manage while seeing patients in the office, making the right medical decisions, and not getting too far behind schedule.

Despite how hectic things can sometimes be, I am glad to be a pediatrician and I don't know what else I would do with my life.  The whole professional athlete plan just didn't pan out, although some of those NFL kickers manage to keep kicking until they are 50...

Good from Bad

I had the opportunity recently to view "Soul Surfer", the film that tells the true story of the teenage surfer who lost her left arm to a tiger shark while surfing near her home in Hawaii.  I would venture to say that it tells one of the most remarkable "overcoming the odds" sports stories you will ever come across, and is worth watching just for that.

Spoiler Alert:  If you intend to see the movie, watch it before you read further.

The plot centers around a girl named Bethany Hamilton, who is one of the top-ranked junior surfers in the world at the time of her accident.  The fact that she did not die from the attack is miraculous in and of itself, since they were quite a distance from medical care when the accident happened.  Quick action on the part of those who were surfing with her at the time allowed them to get to the hospital in time to save her life.  She reportedly lost about 60% of her blood volume before she reached the hospital, making her survival even more remarkable.

The film then follows her return to life and the trials of learning to do everything one-handed.  

I won't rehash the entire movie here, but I did want to share a few thoughts.

First:  To be able to surf one-handed is an impressive accomplishment.  My appreciation for Bethany's achievement is heightened by the fact that I had my first opportunity to surf this past January at Pismo Beach, California.  I would equate this to the way that you gain a greater respect for what a professional golfer can do with a golf ball once you have played for a while and realize how difficult it is to put the ball where you want it and to intentionally hit a draw or a fade or put backspin on the ball.  It took quite a while for me to get up on a long board using two arms, though I did manage to have a few decent (for me) rides before it was all said and done.  I can't imagine how difficult it would be to paddle out and then catch the wave and get up using only one hand.  Having had this experience recently, Bethany's achievement in not only learning to ride again, but becoming a competitive professional surfer, is truly extraordinary.  

Second:  Although the film focuses on Bethany's return to competitive surfing, it makes the point that life is about far more than surfing.  Although Bethany was "born to surf", surfing is not God's primary purpose for her.  After her first unsuccessful attempt to return to competitive surfing, Bethany is discouraged and wants to stop surfing.  She participates in a mission trip to Thailand to help tsunami victims and discovers that she can use her surfing to  point others to God.  This trip rekindles her desire to return to surfing as she can finally grasp how Romans 8:28 applies to her situation:  God can cause all things (even shark attacks) to work together for the good of those that love Him and are called according to His purpose.  Her return to surfing inspires multitudes around the world, including many who are also disabled, and she points them to God.  That is God's purpose for her.

The correlation in our lives is that even the struggles and tragic events with which we are faced can be used for our good by God if we love Him and seek His purposes.  What disability in your life does God want to use for good?  What might his purpose be?

Anticipatory Silence

Wow.  I am flabbergasted and disappointed by what has happened in Florida and what is being advocated now in other parts of the country.  For those who may have missed it, Florida has passed a law that says that a pediatrician is not allowed to ask a parent if there are guns in the home.  This bill was a joint effort by the National Rifle Association and the Florida Medical Association.  Proponents of the bill apparently fear that the questions that physicians ask in the setting of a confidential medical visit will be used against them by the U.S. government at some point in the future.  Let me preface the rest of this discussion by saying that I support the second amendment and the right of Americans to bear arms.  My objection to the Florida law is its interference in the patient-doctor relationship.

Former Georgia congressman Bob Barr has written a blog post criticizing pediatricians for asking the question and proposes that pediatricians should concern themselves only with recognizing and treating illness, rather than preventing illness.  As a practicing pediatrician who politically falls on the spectrum between libertarian and conservative, I believe that the government should interfere with citizens' personal lives as little as possible.  I believe that law and order, the common defense, and the provision of public necessities, such as the highway system, should be the primary focus of our government.  I believe the Constitution, with its amendments, is one of the greatest achievements in human history.  I believe the Constitution should be respected by our congress and by our courts and that alterations to our constitution should only be made by the prescribed constitutional process and not through activist judges.

Bob Barr claims to be a libertarian, yet his support for this misguided Florida law reveals him to be a libertarian in name only.  A true libertarian would not advocate for the protection of one constitutional right (the Second Amendment) by unconstitutionally limiting another (the First Amendment).  A true libertarian would not support governmental interference in the doctor-patient relationship, but would recognize the importance of confidentiality in that relationship.  A true libertarian would say that what a physician discusses with his or her patients is none of the government's business.

Bob Barr makes a number of ridiculous statements in his blog on this issue, such as the assertion that you will see your pediatrician for an illness and be asked if you have a gun.  He also suggests that pediatricians ask children to snitch on their parents with regard to the presence of guns in the home.  If he had been to a pediatrician's office in the last 20 years, he would be aware that pediatricians are so busy making sure they cover all the things they are supposed to cover that they really aren't going to waste their time interrogating parents and their children about guns. Pediatricians may counsel about gun safety verbally or, more likely, in written format, because prevention of injury is part of what we do. We will also warn about the dangers of certain sleep positions, we will advise the use of helmets when biking or skating, and we will counsel about water safety. Apparently though, Barr also objects to any discussion of safety since he doesn't want pediatricians talking about pools either. For his blog on the topic, go here: http://blogs.ajc.com/bob-barr-blog/2011/05/02/“say-‘ahhh-’-does-daddy-have-a-gun

Barr further asserts that all pediatricians believe that no one should own a gun. He states "Apparently, the Hippocratic Oath taken by these pediatricians includes a footnote to ignore the Second Amendment guaranteeing Americans the right to own a firearm." Mr. Barr neglects to acknowledge that this legislation is an infringement to the First Amendment's guarantee of freedom of speech and also fails to recognize that pediatricians are not agents of the federal government (although I would love to be able to take advantage of the federal holiday schedule).

Leaving the fact that Barr's position on this issue reveals him to be just another politician who will say whatever he thinks will bring him popular support, let's move on to the question of whether a pediatrician should only be concerned with treating disease and not preventing it, as Barr asserts in his blog.  This logic, if applied to medicine in general, would be catastrophic.  Vaccines, probably the single greatest medical achievement in history, would not exist.  Countless multitudes of people would have already died or been permanently disabled just since the advent of the modern vaccine era in the last century if vaccines had not come to be.  Countless more would never have been born to begin with, since one or more of their parents would not have been able to conceive them.  You and I might not be around to even have this discussion.

According to the CDC: Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States. Before measles immunization was available, nearly everyone in the U.S. got measles. An average of 450 measles-associated deaths were reported each year between 1953 and 1963. If vaccinations were stopped, each year about 2.7 million measles deaths worldwide could be expected. Before Hib vaccine, Hib meningitis once killed 600 children each year and left many survivors with deafness, seizures, or mental retardation. Since the introduction of conjugate Hib vaccine in December 1987, the incidence of Hib has declined by 98 percent. Prior to the licensing of the chickenpox vaccine in 1995, almost all persons in the United States had suffered from chickenpox by adulthood. Each year, the virus caused an estimated 4 million cases of chickenpox, 11,000 hospitalizations, and 100-150 deaths.

Besides the overwhelming success of vaccines, there are numerous other successes achieved by practicing preventive medicine and providing anticipatory guidance (anticipatory guidance is the practice of providing advice to parents to help avoid injury, illness, and other negative events that may compromise the health of children).  Since pediatricians began to recommend putting babies to sleep on their backs, cases of Sudden Infant Death Syndrome have declined by 60%-75%.  Since removal of lead from paint and gasoline, cases of true lead toxicity in the U.S. have decreased dramatically, except in certain limited geographical areas.

Preventive medicine is the cornerstone of pediatrics, particularly in the United States of America. It is far better to prevent illness and injury than to treat it once the damage has been done. Perhaps I should frame this in a way that a politician can understand: Is it better to do damage control once your extramarital affair has been discovered or never have the affair to begin with? Is it better to defend yourself before a grand jury regarding the funds that you misappropriated or is it better not to misappropriate the funds to begin with?

If you would rather that your state and federal governments not interfere with what you can say to your doctor and what your doctor can say to you, please let your representatives and senators know that this kind of intrusive legislation is not acceptable.  Our politicians need to know without a doubt that passing laws such as these will be detrimental to their careers.

Shoplifting

Since I am on the topic of funny grandparent stories and since Mothers' Day is coming up, I will share one of the best stories involving my grandmother, whom we called MaMa.

When I was very young, MaMa worked at a factory in Augusta as a seamstress.  She came home one day and told my grandfather about a rough day she had.  I will do my best to tell it from her first person perspective, with explanatory comments in parentheses.

"I stopped by J.M. Fields (a discount department store, which was a kind of "supercenter" predecessor) on the way home from work.  Now when I go shopping, I usually pick things up, look at them, and put them back down again.  Since I was on the way home from work, I had my big purse that I carried all my sewing equipment in.  Well, I was just shopping when this security guard came up to me and said, 'Miss, I need you to come with me.'  I didn't know what he wanted, but I followed him and he took me to this room and said, 'Wait here', and closed the door.

I looked around and there was another lady sitting there.  She asked me what I was there for.  I said, 'I don't know, this guy just told me to follow him and I did'.  She said, 'Well, they've got me here for shoplifting.'  I thought, 'Oh, goodness, I hope they don't think I've done anything.'  Then I realized I had put something in my purse while I was shopping.

The other lady, who was a lot bigger than me, said, 'I don't know about you, but I ain't waiting around here for the cops to come.'  She then moved a chair over to the window, climbed up, and pushed the window open.  She said, 'Give me a boost,' so I did.  She managed to get out the window with a little help from me.

I looked around and thought, 'Well, I'm not waiting here to get arrested.  I didn't steal anything.  It was an accident. If that big ol' lady can get out that window, so can I' (My grandmother was kind of a large woman herself). So I climbed up on that chair and started to climb out that window.  Just then, the man came back and said, 'What are you doing?" and grabbed my leg.  Well, I kep' trying to climb out and he kep' pulling on my leg.  I started pulling harder and he kep' holding on and he was pulling on my leg, just like I'm pulling your leg".

She told that story to my grandfather first and he was so mad he wanted to go to the store and let the guard have it.  He was ready to walk out the door until MaMa repeated that last line, "He was pulling my leg just like I'm pulling your leg" and he realized he'd been had. Over the next 30+ years she told that story dozens of times and always managed to suck people in and then gave them the punch line.

We wanted her to tell the story on camera last year before she passed away, but we weren't able to make it happen.  My written words do not do justice to her storytelling ability.

Athens Food Tours, Part Deux

After leaving Jittery Joe's, the next stop on our food tour was Whiplash Cafe, just a little farther down the street. Whiplash served us two different pizzas and one of their pasta salads, as well as providing a selection of beverages. One pizza was their Jersey Turnpike pizza which had salami, bacon, and jalapenos or banana peppers. The other was a Hawaiian pizza with ham and pineapple, I believe. The pasta salad was a chicken caesar pasta salad, which was very good, though they say that their house pasta salad is even better. We will definitely have to visit Whiplash Cafe again.

After Whiplash, we made our way up the hill and around the corner to Square One, the relatively new seafood restaurant on Thomas Street. At Square One, we were served a little jerk steak, which was spicy and flavorful, and oysters Bienville, which was rich and savory. This was my first experience with oysters, and it was a good one. This was also something that I would probably not have selected from a menu, but I decided to try them since previous ventures into the culinary unknown had been handsomely rewarded, in the form of escargot in Bermuda, sushi in Berkeley, molletes and street vendor hot dogs in Mexico (I can hear the collective gasp of germophobes everywhere), and samosas and chipatis in Kenya. The oysters was followed with a taste of an orange-based dessert, which was rather refreshing.

After finishing at Square One, we made our way to Yoguria, a locally-owned frozen yogurt shop at College Square, for the final stop on the tour. This was not TCBY. This yogurt, though frozen, retains the health benefits of the refrigerated yogurt you might buy from the grocery store, but is much flavorful. Yoguria had several flavors I had never previously tasted, including taro and bilberry. After sampling each of the flavors, I settled on bilberry with kiwi, bananas, and blackberries and was quite pleased with the result. I highly recommend Yoguria if you are looking for a cool treat that is still good for you.

Our Athens Food Tour was a great experience. Mary Charles is a phenomenal hostess and does a great job of stimulating conversation among the food tour participants, while keeping the interactions informal and relaxed. Her food selections were all delicious and allowed us to try new restaurants and new foods that we might otherwise have not known about or selected. If you are looking for a fun way to try a variety of local restaurants, try Athens Food Tours. Athens Food Tours offers a variety of tours, including several downtown itineraries, Normaltown, and Five Points. Check them out at http://www.athensfoodtours.com/

Athens Food Tours, part 1

And now, for something completely different...

This weekend Amy and I had the opportunity to take part in an Athens Food Tour, compliments of my brother, Mike.  For Christmas this year, Mike gave us, my parents, my other brother, and my sister-in-law a gift certificate for an Athens Food Tour.  Athens Food Tours (find them at http://www.athensfoodtours.com/)was begun last year by my brother's friend, Mary Charles, who is also co-owner of their joint pet-sitting business, Five Points Four Paws (http://www.fivepointsfourpaws.com/).

The seven of us and eight others met at the arch Saturday evening to begin the tour.  The first stop on the food tour was actually a vintage clothing store, Community.  Why, you might ask, would a food tour stop at a vintage clothing store?  Good question.  It turns out that this particular store sells hand-made chocolates in addition to the eclectic collection of clothing.  Flavors included dark chocolate caramel red sea salt, Grand Marnier truffle, and Jim Beam truffle.  Amy and I split the caramel sea salt and a Grand Marnier truffle and both were outstanding.  To wash down the treat, Mary Charles had picked up watermelon lemonade from Clocked, which was unique and quite delicious.  Our tour then continued down the street to the Jittery Joe's roasting house.

Jittery Joe's roasting house is quite possibly the best smelling place on earth.  Before you walk through the door, you are greeted by the wonderful aromatic scent of roasting coffee, which only increases in intensity as you enter and tour the building.  At this stop we were offered an opportunity to try various coffee-based beverages.  Mary Charles also provided several local beers to sample, including the Terrapin Sunray wheat beer, the special edition Georgia Theater brew, and an Abita strawberry beer.  Mary Charles acknowledged that Abita is not from Athens, or even from Georgia, but since Abita is a southeastern company, their strawberry beer is seasonal, and it happens to be one of her favorites, she decided to include it as a selection.  

To accompany the beverage selections provided at this location, Mary Charles had brought along perhaps my favorite food of the night, dates stuffed with goat cheese and celery from The National.  It is likely that I would never have ordered this from a menu, but it was one of the most delectable treats I have ever had.  I am craving one even now as I write this post.

Following our treats, we were taken on a tour of the facility by Charlie, the roaster for Jittery Joe's.  He showed us the raw coffee beans, talked us through the roasting process, and demonstrated the canning process by sealing my sister-in-law's phone in a coffee can, which she was happy about since it was her work phone.  Charlie explained some of the intricacies of the roasting process and then proceeded to demonstrate his skill as he smelled the roasting beans every few seconds waiting for a particular smell to disappear.  Before our next stop, Mary Charles informed us that the chaff from the coffee roasting process is a great substance for storing bulbs, in case anyone has a greener thumb than I.

More to come on the tour in my next post.

Planning for Retirement

The days are evil:

Ephesians 5 warns us to walk as wise, not as unwise, redeeming the time because the days are evil.

A friend of mine shared with me a sermon he gave when returned from a trip to Zambia about a year and a half ago.  He had taken the  trip with his eldest daughter and came back with a new passion for advancing the kingdom of God to the uttermost parts of the earth.  He runs a successful business, but returned with almost a distaste for this business.  His business revolves primarily around providing financial security for retirees, but his perspective has changed dramatically since his trip.  One of the questions he now has is why believers have hundreds of thousands to millions of dollars tied up in 401(k) plans and other retirement accounts when there are billions of people in the world who suffer in poverty and who need to be introduced to Jesus.

I think his question is valid.  Is saving for retirement biblical?  This is a difficult question to answer.  Proverbs provides biblical wisdom for the management of personal finances and certainly seems to imply that saving is a good thing.  Jesus, on the other hand, tells of the rich man who must build new barns to store his produce from an abundant harvest.  This man finally decides that he has enough stored that he can take his ease, retire,  and eat, drink and be merry.  Jesus call this man a fool because he will pass away that very night.

What are to make of this?  Is it bad to have a 401(k)?  Should we save at all?  Jesus also states that we should not spend our time worrying about what we will wear or what we will eat.  If God will clothe and feed the birds and the flowers, will He not much more provide for us?  I believe God does want us to save for our future, but with a much longer term plan than we have.

Matthew 6:19-21  Do not lay up for yourselves treasures on earth, where moth and rust destroy and where thieves break in and steal, but lay up for yourselves treasures in heaven, where neither moth nor rust destroys and where thieves do not break in and steal.  For where your treasure is, there your heart will be also.

Now that is planning for retirement.

Why Your Doctor Chose to Be Your Doctor

Probably the most common answer in medical school interviews to why someone is interested in entering medicine is “to help people".  The reason it is such a common answer is not that it is the "right" answer.  In fact, most interviewers would probably rather hear something different than "to help people", just to relieve the monotony of the interviews.  The reason it is a common answer, though, is that you have, at a minimum, seven years of physically and intellectually demanding education and training above and beyond your undergraduate education before you begin to practice independently.  By the time the training process is completed, you will have devoted 24-28 years obtaining the education necessary to enter your career. 

While you are devoting upwards of 100 hours per week for at least seven years to your courses, study, and training, your friends are enjoying their twenties.  They are earning a living, going out, attending sporting events, traveling, dating, marrying and starting families.  They are no longer accumulating educational debt.  They are beginning to pay off the debt they do have.  They are advancing in their careers.  

You are struggling to get enough sleep to stay awake in class the next day, or during the seemingly interminable internal medicine rounds (which involves a short time seeing patients at the bedside and a great deal of time sitting in dimly fluorescent-lit conference rooms discussing those patients and their extensive lists of problems and medicines).  You are spending your nights and weekends trying desperately to prepare for the next anxiety-producing board exam, the next presentation before your attending physicians who are ready to pick apart whatever you present, or trying to unravel the mystery of the dying patient that just doesn't seem to respond to anything you do.

The reason "to help people" is the most common reason for wanting to pursue medicine as a career is that you must make tremendous personal sacrifices just to begin your career.  Friendships must be discarded or neglected.  Entertainment and other enjoyable activities must be greatly reduced for quite a long time.  Marriages are strained and often fail during this period.  Indeed, certain residency programs have a greater than 100% divorce rate.  You must truly believe that what you are pursuing is a worthwhile endeavor in order to make such great personal sacrifices.  

One and Done - I'll take it, for now

The Dawgs made it back to the NCAA tournament this year for only the fourth time in the last 11 years and only the eighth time since 1990.  Coach Mark Fox led the team to the dance in his second year as head coach, quite an accomplishment given the troubled history of the program.  The team struggled in the early '90s under coach Hugh Durham during my time as a student.  I loved basketball but was forced to endure some of the most pitiful displays of basketball in the history of the school.  Things began to look up when Georgia hired Tubby Smith away from Rick Pitino and the University of Kentucky.

Great progress was made during Smith's tenure, but the team had the rug pulled from under it when Tubby signed a contract extension with UGA and then abandoned ship to take the head coaching job at UK.  I thought the move was a mistake for Tubby at the time, since he could have become a legend if he had stayed at UGA and turned the program into a contender.  Tubby performed well at UK, but, as often happens when you follow a legend, he could never live up to the expectations of Kentucky fans.  Tubby's reign at UGA was followed by the painful Jirsa years and suffering was again the theme of Georgia basketball.

Fortunes seemed to turn when Jim Harrick was hired in 1999.  He took the Dawgs to the tournament twice in his four year turn at the wheel, only to leave the program in shambles following an embarrassing scandal.  Dennis Felton then took over the program in 2003 and appeared to have the Bulldogs on the right track after a miraculous SEC tournament in 2008, which the Dawgs won after playing 4 games in 3 days in the conference tournament that was disrupted by the tornado that tore through downtown Atlanta and the Georgia Dome.  Felton could not recapture the magic that happened during that historic tournament and was fired mid-season 2009, leaving the program again searching for a leader.

Enter Coach Mark Fox, who took over the program for the 2009-2010 season after Pete Hermann finished the 2008-2009 season.  The 2009-2010 team was very inconsistent, but showed moments of promise which lead to a degree of anticipation for this season.  Overall, I am pleased with the progress that has been made in the short time Coach Fox has had with the team.  21 wins.  Wins against Tech and Kentucky this year.  Near misses with Florida, Vandy, and Notre Dame.  An NCAA Tournament appearance.  Not bad for a second season as head coach.  There is again hope for the UGA men's basketball program.

African Cats

We saw the preview for the new Disney Nature movie, "African Cats", today, and it really stirs strong feelings.  They say it was filmed in the Masaai Mara, which is where we were when we went on our safari in Kenya.  I can not wait to see this film when it comes out in April.  The beauty and wildness of the Mara is incomparable, and to see it again on the big screen is exciting.  I am not sure if this feeling is just due to a fond memory, or if it is a call to return to Kenya.  It is almost a homesickness for a place that has not been my home, yet.

Amy and I are taking a class right now, "Perspectives on the World Christian Movement".  I am going to quote from one of this week's readings. The author is Samuel Zwemer and this was written in 1911 in an article called "The Glory of the Impossible".

"Is there a more heroic test for the powers of manhood than pioneer work in the mission field?  Here is opportunity for those who at home may never find elbow-room for their latent capacities, who may never find adequate scope elsewhere for the powers of their minds and their souls.  There are hundreds of Christian college men who expect to spend life in practicing law or in some trade for a livelihood, yet who have strength and talent enough to enter these unoccupied fields.  there are young doctors who might gather around them in some new mission station thousands of those who 'suffer the horrors of heathenism and Islam,' and lift their burden of pain, but who now confine their efforts to some 'pent-up Utica' where the healing art is subject to the law of competition and is measured too often merely in terms of a cash-book and ledger.  They are making a living; they might be making a life."

Wow.  That is as applicable today as it was 100 years ago when it was originally written.  One of the things Amy and I discussed after our trip to Kenya was that, although it was certainly stressful, I felt like I was practicing real medicine and was fulfilling something of what I had spent the last 14 years training to do.  Certainly what I currently do is too often measured "in terms of a cash-book and ledger".  Perhaps I need to consider more often lifting "the burden of pain" of those who may not have ready access to healthcare.

Africa - Some Ways You Can Help

It has been a while since my last post, primarily because we have been quite busy.  All the kids are playing basketball and I am head coaching one team and assisting another.  Amy and I are taking the Perspectives on the World Christian Movement class for the next few months (which we would highly recommend to others).  That has turned out to involve a large amount of reading.  I have been struggling each week to get the homework done in time.  Even with the extra work that the class involves, it has been worthwhile.  The class from this past week was especially thought-provoking.  Oh, yeah, I work, too.  With my plate so full, it has been hard to find a time to blog.

I know the title of my last post implied that I might be done writing about Africa, but I can't seem to get Africa off my mind or out of my heart.  Amy and I continue to be burdened by the tremendous physical and spiritual needs that are so widespread in Africa.  We do not know yet what God has planned for us in relation to Africa, but we are certain that we will continue to be involved with Africa somehow.

I'd like to make mention here of several opportunities for others to get involved in some of the important work going on in Africa.  The ministries I will mention hardly scratch the surface of the needs that exist and the ways that one can help.

We went to Kijabe, Kenya with World Medical Mission, which is a part of Samaritan's Purse.  Both World Medical Mission and Samaritan's Purse have numerous opportunities to serve or give.  Opportunities can be found at http://www.samaritanspurse.org/ and http://www.samaritanspurse.org/index.php/WMM/index/ .  There are opportunities for medical and non-medical personnel to get involved.  Check them out.  There are needs for medical personnel, therapists, accountants, engineers, and virtually any other profession out there.  You can also give directly to Kijabe Hospital at http://www.kijabehospital.org/ or  http://www.bethanykids.org/ .

Some friends of mine have helped start a ministry to orphans in Uganda who are wrongly suffering imprisonment, often for no good reason other than the fact that they are orphans.  They are enduring confinement, neglect, abuse and injustice.  Check out SixtyFeet.org to learn more.  Financial support is needed for this ministry.  Consider getting your kids involved with a Cupcake Kids sale:  http://thecupcakekids.org/

Consider "giving a cup of cold water" to those who are thirsty by helping meet physical needs with http://thewaterproject.org/ .  How about Compassion International?  http://www.compassion.com/  They have numerous ways to help.  You can directly support a child and provide for physical and spiritual needs.  You can help fight malaria, still one of the most common and deadly diseases in Africa, by providing mosquito nets for those who are without them.  You actually help prevent a number of other mosquito born diseases at the same time (yellow fever, dengue fever, and various encephalitides).

There are numerous other possible ways to help.  Most of those that we consider poor in the U.S. would be considered wealthy in Africa.  We are blessed tremendously to live in the U.S.  Is that financial blessing really for our own personal benefit?  Pray about what God would have you do.  Does He want you to give?  Does He want you to raise funds?  Does He want you to go?

A few verses to consider:

Isaiah 1:17 Learn to do good; Seek justice, Reprove the ruthless, Defend the orphan, Plead for the widow

  New American Standard Bible : 1995 Update. LaHabra, CA : The Lockman Foundation, 1995, S. Is 1:17

Jeremiah 5:28-29 ‘They are fat, they are sleek, They also excel in deeds of wickedness;They do not plead the cause, The cause of the orphan, that they may prosper; And they do not defend the rights of the poor.  Shall I not punish these people?’ declares the Lord, ‘On a nation such as this Shall I not avenge Myself?’

New American Standard Bible : 1995 Update. LaHabra, CA : The Lockman Foundation, 1995, S. Je 5:28-29

Matthew 10:42  “And whoever in the name of a disciple gives to one of these little ones even a cup of cold water to drink, truly I say to you, he shall not lose his reward.”

New American Standard Bible : 1995 Update. LaHabra, CA : The Lockman Foundation, 1995, S. Mt 10:42

Matthew 25:31-40     “But when the Son of Man comes in His glory, and all the angels with Him, then He will sit on His glorious throne.     32     “All the nations will be gathered before Him; and He will separate them from one another, as the shepherd separates the sheep from the goats;     33     and He will put the sheep on His right, and the goats on the left.     34     “Then the King will say to those on His right, ‘Come, you who are blessed of My Father, inherit the kingdom prepared for you from the foundation of the world.     35     ‘For I was hungry, and you gave Me something to eat; I was thirsty, and you gave Me something to drink; I was a stranger, and you invited Me in;     36     naked, and you clothed Me; I was sick, and you visited Me; I was in prison, and you came to Me.’     37     “Then the righteous will answer Him, ‘Lord, when did we see You hungry, and feed You, or thirsty, and give You something to drink?     38     ‘And when did we see You a stranger, and invite You in, or naked, and clothe You?     39     ‘When did we see You sick, or in prison, and come to You?’     40     “The King will answer and say to them, ‘Truly I say to you, to the extent that you did it to one of these brothers of Mine, even the least of them, you did it to Me.’

New American Standard Bible : 1995 Update. LaHabra, CA : The Lockman Foundation, 1995, S. Mt 25:31-40

James 1:27 Pure and undefiled religion in the sight of our God and Father is this: to visit orphans and widows in their distress, and to keep oneself unstained by the world.

New American Standard Bible : 1995 Update. LaHabra, CA : The Lockman Foundation, 1995, S. Jas 1:27

Last Kenya post, maybe.

Ok, this post is primarily for my own benefit.  I wanted to compile, in one easily accessible place, a list of the different diagnoses, procedures, and other medical events with which I was involved while at Kijabe.  This will let me file away the little notebooks I kept while I was there so I don't have to carry them around anymore.

While in the nursery, diagnoses and procedures included all of the following:
Patient 1 G:  Intrauterine growth retardation, patent ductus arteriosus (unsuccessful indomethacin closure), pulmonic stenosis, congenital cataracts
Patient 2  I:  Jaundice, tachypnea, meconium aspiration, atrial septal defect, pulmonary hypertension, talipes equinovarus (clubfoot), hypoxia
Patient 3  T:  Neonatal sepsis (home delivery), jaundice, congenital conjunctivitis (likely chlamydia),
4  A :  28 week prematurity, GE reflux, bronchopulmonary dysplasia, neonatal sepsis, aspiration pneumonia (klebsiella), apnea of prematurity (treated with aminophylline), hypokalemia, intubated 2 different times, bubble CPAP  (amazingly this very premature baby did not require mechanical ventilation until he was about 6 weeks old) - passed away during the month after I left
5  J:  28 week prematurity, neonatal sepsis, GE reflux, apnea of prematurity (aminophylline)
6  D:  36 week prematurity, encephalocele, home delivery/neonatal sepsis,
7  V:  hypernatremia with phototherapy
8  N:  footling breech with severe neonatal asphyxia, was intubated then extubated to CPAP and passed away.
9  J:  hyperbilirubinemia, possible galactosemia
10  N:  33 week prematurity with probable neonatal sepsis, apnea of prematurity
11  L:  neonatal sepsis, hypoxia, neonatal jaundice s/p phototherapy
12  L:  sepsis, birth asphyxia, hypoxic-ischemic encephalopathy, seizures, hyperemic upper extremity (still don't know what that was about)
13  V:  sepsis, hypoxia, meconium aspiration
14  N:  32 week prematurity, neonatal sepsis, apnea of prematurity
15  J:  Encephalocele, birth asphyxia, neonatal sepsis, home delivery.  Intubated, ventilated, extubated - passed away from respiratory insufficiency
16  J:  Fever, neonatal sepsis, hypernatremia, dehydration
17  A:  Imperforate anus s/p correction
18  N:  hydrocephalus, spina bifida, neonatal sepsis
19  B:  fever, neonatal sepsis
20  S:  fever, neonatal sepsis, jaundice
21  G:  neonatal sepsis, 33 week prematurity
22  J:  neonatal sepsis
Other procedures and such: intubations, ventilator management, femoral stick, versed drips, CPR/bag and mask ventilation
Note:  There were other babies along the way with similar problems whose information I no longer possess.

Pediatrics:

Diagnoses and procedures included:  meningomyelocele (spina bifida - many cases), external ventricular drain, ventriculitis, malaria (many cases), hemolytic anemia, direct hyperbilirubinemia/cholestasis, hematuria, seizures, nephrolithiasis, brain calcifications, toxic shock syndrome, hypocalcemia with positive Chvostek sign (this patient passed away), hypoglycemia, severe rickets, severe malnutrition, diabetes mellitus, pneumonia, severe dehydration, hydrocephalus, thrush, peptic ulcer disease, dilated cardiomyopathy, congestive heart failure (several cases), glomerulonephritis, optic neuritis (probably due to quinine), hypokalemia, entamoeba, UTI with urethral strictures and vesicoureteral reflux, tuberculosis, pulmonary hypertension, cataracts, encephalocele (massive), acinetobacter ventriculitis, pericardial effusions, acute renal failure, periorbital mass (likely lymphoma), meningitis, peritonitis, paroxysmal nocturnal dyspnea, tonsillar/adenoidal hypertrophy, mydriasis, Burkitt lymphoma, VP shunts, eroded VP shunt with resultant sepsis and death, probable duchenne muscular dystrophy.

I probably missed a few kids/diagnoses in the above lists.  All of those kids were in the hospital during the 3 1/2 weeks I was at Kijabe.  In six years here in the U.S., I still have not seen the equivalent diversity or severity of illness that I saw during my short time at Kijabe.  There is much greater need for medical care in Kenya than there is here.

Anybody want to buy a house in Oconee County?

Note to those of you who bring your kids to me:  Don't freak out.  There are no immediate plans being made. But, if anyone would like to buy a house, we would love to downsize our mortgage so we can give or do more.

Noise

I am surrounded by noise.  Everywhere I go.  Every waking moment.  It keeps me distracted, preoccupied.  There is always something demanding my attention.  Many of these attention seekers are good things in and of themselves.  Children.  Work.  Church.  Music.  Small group.  Basketball practice.  Friends.  Many are neutral, but with potential negatives.  TV.  Music.  Movies.  Computer.  Internet.  Reading (depending on what you read). Friends.  My life seems to be dominated by noise.

I am convinced that we need to reduce the noise in our lives.  We need to unplug from the distractions, electronic or otherwise.  Our kids don't really need to play a sport every season, participate in all the plays and concerts, and go to all the birthday parties, do they?  To be more self-critical, do I really need to see the Orange Bowl tonight?  Will anything in my life change if Stanford wins or if Virginia Tech upsets them and I miss it?  Do I really need to see that new movie in the theaters?  What if I forget to set the DVR for "Chuck"?  It is a very diverting TV show that I greatly enjoy, but should I really allow all these diversions in my life?   Maybe I need to be a little less diverted and a little more focused.  One of the great things about our trip to Kenya was that most of these unnecessary distractions were nonexistent.

The trouble with all the noise is that it makes it more difficult to hear the important things.  What does my wife actually need or want from me?  How do my kids need to be led, encouraged, or corrected?  Do I need to sell this house?  If so, do we rent or buy?  More importantly, what is God trying to say to me?  Am I supposed to stay where I am?  Should I regularly take short-term medical mission trips?  Should I go long-term?  Should I go to seminary before a long-term commitment?  May I (and you all) be given ears to hear.