Shooting Stars


“The per patient expenditure for your assigned patient panel the last quarter was up by $XYZ, so we will be dropping your rating on our website from five to four stars. Your patient satisfaction and preventive care scores remain outstanding. We will re-evaluate your rating at next quarter.” A letter from one of the big insurance companies a few weeks ago.

You know what? Bite me. To my knowledge I am not wasting money. I take appropriate care of my patients.

But then it occurred to me, do patients even know that this is what those stars mean? How much money they and their physician cost the insurance company….



I gave my daughter the Lime Chiffon doll that I played with as a kid. Lime Chiffon was friends with Strawberry Shortcake, and the only doll out of that collection I ever received. Remarkably, it still has its pink shoes and green and white striped stockings still intact. My daughter carries it around with her everywhere. To the mall, to church, to the opera….

A doll that is about 35 years old.

You know what is depressing about that? A mere toy, a plastic doll for crying out loud, has held up better than I have. Just when I think I am at peace with the whole aging thing, a toy reminds me just how old I am and that I am not going to get any younger.

Would you judge me harshly for wanting to scream, “You bitch!” at the doll?


Well, I didn’t do it. But I sure did want to.

I have some consolation, however: The doll is not likely to survive the love of this new little girl. Not for long anyway. 


(Death to the plastic toy!!!!! I will have my revenge…)

Now, back to the opera. Did you roll your eyes when I threw that into the opening paragraph? Did you think I was trying to be snooty? Let me say a few words about that…

I love the opera. It is a fantastic place for people watching. Generally an opera is good for a couple of entertaining scenes. The rest of the time it would be boring as hell except that the people in attendance are so much fun. I love the people who attend operas!

My kids know that mommy attends the opera from time to time and that she really dresses up for it so it holds some mystique for them. There happens to be a series of operas put on for kids so I took mine for the first time this weekend. I wasn’t sure what they would think but it thrills me to no end that I can give my kids cool experiences like that. What kind of person would I have grown up to be had I been able to go to the opera as a kid?

Um, don’t answer that…

Fortunately, this opera was only 30 minutes long. These people are not fools. They know you cannot hold a kid’s attention on opera for much longer. Bless them for that.

What did my kids think? 

They said they loved it. But turns out, it wasn’t the opera itself that they loved. Oh, no. It was the chandelier going up into the ceiling before the performance that was so frickin’ awesome. That, and the fact that we spent the entire morning of singing everything in “opera”.

Life. Life is a perpetual lesson in humility. Once you have learned that lesson, you die.

Happy Monday. 


Chicago skyline from Sears Tower
A sudden squealing of brakes and a dull thud caused me to glance up. Nothing…. at least so far as I could see through the two dozen heads waiting to cross the intersection with me.

Engrossed in my phone again, I checked a news app, scrolling through the stories. More election drivel. I gave up and slipped the phone into a pocket. There were a few seconds of dysphoria after I looked up as my eyes took in the surroundings again and my brain processed where I stood.

The corner of Harrison and State Street.

The light changed.

I started to walk. People parted ways ahead of me, some going right and some going left. Some stopped and stared. I kept walking until I finally registered that something blocked my way. A dark figure lay sprawled in the intersection, his right leg bent weirdly. 

Someone behind me screamed.

The man lay so terribly still on the asphalt. There was a bright pool of crimson growing around his mangled leg, a gory halo of sorts, offset further by the sliver of morning sunlight that crept between the skyscrapers to fall across the road exactly where he rested.

Damn it.

This was going to make me late for my shift. Again.

A man stood nearby with a 911 operator on speaker phone.

I could just keep walking. No one would know who I was…

Like I could do that.

I stepped forward and knelt by the body, checking for a pulse. It was thready. Instinct took over as I dropped my leather bag and worked to stabilize him. He was barely breathing. I ripped his gashed pants leg and found the artery in his leg that was severed, holding it tight with my fingers. He had a large gash over his left cheek that exposed the bone. His belly was rapidly distending, no doubt bleeding internally.

His eyes looked through me, unseeing. 

A groan.

Within minutes I could hear the sirens, though they were still far away. I looked down at my blood covered hands and then glanced up at the crowd of faces staring down at me. I saw shock, concern, hope…

But there was nothing more to be done. Not here in the middle of the street at least.

His eyes focused on me for a moment of lucidity, knowledge flickered across his face as he understood he was dying.

“Tell her….” The sounds came out barely audible as he formed the words around the blood bubbling over his lips. “Tell her it was the pearls in Paris.”

Wife? Girlfriend? Who?

“Sure, I’ll tell her,” I soothed. No further sounds came. His chest moved rapidly as his breathing quickened, getting more and more shallow as the belly expansion pressed against his diaphragm. 

I hope they hurry. He needs a hospital STAT…

I checked his pockets with my free hand after wiping it on what remained of his suit coat and found a wallet and phone. 

Why don’t I carry gloves?!?!!? 

No photographs in the wallet. No one ever carried real pictures anymore, did they? His driver’s license. Joseph Spellman. A stack of business cards. Mr. Spellman was a computer consultant. I slid a business card into my pocket.

There was the hushed whisper of a voice behind me, “Did she just steal his money?!?!” I turned my head to make eye contact and glared at the elderly man who had spoken. He hung his head guiltily.

All of a sudden the area was crawling with police and EMTs. I stood and stepped back as they took over, stretching. My knees hurt from kneeling on the asphalt. I looked around for something to wipe my hands on, then noticed that my bag was gone.

A man in a black suit touched my arm and pulled me back. “Ma’am. Could you come with me please?” His voice demanded compliance, his face stern. 

I needed to call the hospital to let them know I was going to be late. 

Very late.

“Wait. My bag…”

“I already have it.” He pulled on my arm again. 

“Where are they taking him?” The man shrugged. I turned to an EMT standing at the background. “Where are you taking him?”


I nodded. My hospital. I could find out what happened to him later.

“Ma’am. You must come with me.” 

“Do you have something I can use for my hands?”

Independent motion – can you help?

Why does adaptive equipment have to be so costly? Check out this post about Sue Vincent’s son, Nick Vernon.

Sue Vincent - Daily Echo

What would you give to make a dream come true if you woke to find yourself living a nightmare?

What would you feel if you could never again walk on a beach? Or go out alone in the snow…feel the stillness of a wood or cross a field?

And then, you found a way…

In 2009, my son was a successful young man with a bright future… until he was stabbed through the brain in an unprovoked attack and left for dead in an alley.

He was found almost immediately by passers-by who saved his life. By the time we arrived at the hospital, Nick was being prepared for emergency brain surgery. We were allowed to see him, for a few minutes, to say goodbye. He was not expected to survive…

Over the past couple of years, many in the blogging community have come to know my son and know…

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In Credibility 


“I want to lose weight.”

“How are you doing on your diet and exercise?” 

“Well, Doc, I do have a Fitbit,” she offered, then shrugged.

“Are you using it?”

“Sure! I do challenges all the time,” she said enthusiastically. “My friends and family all do it.”

“How many steps are you averaging per day?”

“Well, I don’t know actually…” Her voice trailed off. Then she brightened. “Sometimes I get in 10,000 steps, though!”

Ah, that magic number….

“Are you counting calories? Eating plenty of fruits/veggies? Decreasing portion sizes?”

“Nah. That’s waaaaaayyyyyy too much work. Don’t you have a pill you can give me?”

“You know, we are going to have to work on the diet portion of things. The weight isn’t going to come off without it.”

She looked me up and down critically, then glared. “Whatever, Doc. What do you know? You’re already skinny. I can’t lose weight.”


I get this all of the time. I just sighed.

Just so you know, I am not a wisp of a woman. I have hips. And a butt. Some might call it a large butt. AND she has no idea what I have looked like in the past, no idea how hard I work to keep my size where it is. I count calories obsessively. I exercise daily. It is incredibly hard. I come from a long line of morbidly obese people and it is a daily fight. It doesn’t come easy.

I understand more than my patients realize.



I had not seen a certain pair of gold earrings for a couple of weeks. They were a gift and very dear to me, but I’ll be danged if I could find them anywhere, no matter how hard I looked.

You know how it is, when lost things have a sentimental value beyond their monetary value. It eats at you, day and night and night and day.

Last night, somewhere in that semiwakeful stage between one dream and the next, I thought about the last time I wore them, the night I was given another pair of earrings. I was in a hotel, eating dinner from room service. 

That was when it hit me. 

I sat bold upright in bed. 

They had to be in the box the other earrings had come in. Surely that is what I would do, putting the old earrings in the new box after I put the new pair on.

My heart sank. I must have thrown away that box. I threw away a box just like it a couple of weeks ago. It was long gone to the landfill, I was certain.

It made me rather sad.

BUT, by a strange turn of events, the gift bag I had put that box back in, that had held other gifts, was beside my bed. I could reach in there to check, couldn’t I? Yet if I did and confirmed that it really was gone, I would feel even more lost. So instead I lay there in bed, willing myself to go back to sleep. That never, ever works, does it? Why do we even try? Finally, I just gave up and dug through the bag.

Please, please let them be there…

Ah, HA!

I held them up victorious, admiring the golden shine in the moonlight. Peace at last.

So there it is. At 2AM, I found the missing earrings and lost several hours of sleep.

On The Clock


I felt as if I had been kicked in the chest. My face flushed. We were in the midst of a staff meeting, going over the patient satisfaction surveys as mandated by corporate. I was fresh out of residency, trying to make a good impression…

“She didn’t spend enough time with me and didn’t answer any of my questions.”

The truth was, I knew who wrote it. The surveys are not anonymous…. Not really.

Over the previous month I had spent about 45 minutes with her. Twice. I was only supposed to spend fifteen. Each time, after we had worked our way through her list of 7-8 items, I summarized the plan and asked if there were any questions.

No, she said, she didn’t have any.

After the initial embarrassment wore off, I felt defensive. Angry. I tried to explain the circumstances to everyone in the room. I wanted them all to know it was not my fault…. All of the other docs in the room just nodded their heads in supportive understanding.

This was my introduction into one of the many laws of medicine:

It is always the patients that I spend the most time with who are the ones who feel I have not spent enough time.

A wise friend said recently, “With certain patients I have found that the visit will end the same whether I spend five minutes or an hour so I try to keep it closer to five minutes for those kinds of patients.”

I will admit that I, myself, am terrible at cutting people off. 

When patients are upset about how long I spend with them, generally speaking, it is not at all about time. Not really. There is something else going on. A personality conflict perhaps. They don’t want a collaborative relationship with their physician, instead they want to be told what to do. Or maybe they want to tell me what to do. They want a solemn, quiet physician and not someone who laughs and smiles and uses their hands when they talk. Maybe they have unrealistic expectations or a past history of bad experiences with other physicians that has left them with trust issues that I cannot break through.

For many years I struggled with this. I wanted everyone to like me. I am competitive. I wanted perfect scores on everything. In the end, though, I finally realized that I cannot be all things to all people. I pick what I am good at, try to help as many people as I can, accepting that sometimes I won’t be that patient’s favorite person. 

All I can do is my best and make sure that patients understand that I care even if I am ultimately not the right doctor for them.

In Hiding 

screens at Versailles

I have a habit of checking the State Medical Board discipline postings whenever they come out to see if anyone I know is on there. 

Typically there is no one. In fact, I can’t remember the last time I found someone that I knew.

This time, however, I found two.


The first I recognized as an old classmate of mine from medical school. He lost his license due to substance abuse… alcohol specifically. Several DUIs. A failed treatment program. I wondered when that issue started. In medical school he never seemed to be a partier. There were those but he did not run with that group. He was quiet. Studious. Funny. I liked him back then. What happened between then and now? All of those years of training and sacrifice. What is left of his life? His family?

The other was a man I had worked with as a partner for a number of years. He pled guilty to Medicare fraud. It startled me because he was heavily involved in his church all those years that I knew him. Not to say that religion makes you perfect. Hardly. Still, it shocked me. You think you know someone and WHAM! You find you don’t know or understand anything. Was it greed? Desperation? His wife was so nice. His kids. What is happening to them? 


We want to judge harshly….

I always remind myself that I am only one bad decision away from being on that or some other list myself. We all are. We like to believe that we are above that sort of thing, that there is something about us that is more perfect. We couldn’t possibly have a character flaw, a weakness that makes us vulnerable. And yet each of these people thought the same thing about themselves at some point. 

That doesn’t make what they did right and it doesn’t mean they shouldn’t be punished.

It just helps to remember that we are all human.


paor of dead flowers leaning on each other
His guilt always took the form of diamonds.

This was how she knew when he had been with another woman. The next morning there would be a sparkling apology waiting next to her coffee cup. 

I prefer words.

There was a vast collection now, a fortune in fact, lining the velvet boxes stacked in her custom designed closet next to the designer purses and dresses.

She never, ever wore the jewelry. To do so would be to acknowledge, to give permission to, his infidelity… something she swore she would never do.

So day after day, week after week, year after year, she waited while her hatred grew. She had no family, no children, no skills, no education… no independent finances. Thus, she endured his touch, biding her time. The trophy wife who was no longer a trophy.

Finally, the day came. 

Heart pounding, she loaded all of his guilt up into two large suitcases and took them downtown to a jeweler for appraisal.

It made her nervous carrying that much “money” in public. She glanced around furtively as she lifted the suitcases out of the trunk of her sports car and during the short trek across the parking lot, sighing in relief as she stepped through the door.

The young woman at the counter stared at her suspiciously when she explained what she needed. 

You are still pretty. Just wait. The 40’s will come for you, too, and then you will understand…

Anticipating a life of luxury from the proceeds, she fidgeted anxiously as she waited.

The gray haired man in the back had deep creases in his face. He sat hunched over a workbench, examining each piece carefully in turn while squinting through his jeweler’s loupe. Sometimes he would glance up at her before picking up another item. 

When he had examined each one, he bundled everything back into the suitcases almost carelessly and brought them back out to her.

She felt a horror and dread rise up from within, even before he spoke. He held pity in his eyes, as if he understood why she was really there but knew some other terrible secret.

He waited a moment, then spoke.

“Those are not real diamonds at all….”