Building Up 

Chicago skyscrapers downtown

He watched intently as she took a sip of the wine, dark red liquid flowing past her lips. All she wore now was the diamond necklace he had given her at dinner.

She smiled at him over the rim of the glass, making him ache.

Her presence pulsed through his veins. 

The only thing he ever wanted was her. He had spent most of his life persuing her, even going so far as to ask her to marry him… more than once. She never said no but she never said yes, either.

They had made love countless times and each time was charged with a need that would not be sated. She was a drug and he could not get enough of her. He was willing to compromise who he was a thousand times over for just another taste.

Still, she was so far away, so distant. No matter what he gave, what he did, she remained shrouded and opaque. A wall, impenetrable, surrounded her. 

He was at a loss. What was she hiding? Why wasn’t he enough?

What she wanted to tell him was that she needed someone else to have control, someone to make her do things she did not know she wanted to do. She needed him to control her crescendos and decrescendos. She wanted him to want her enough to tie her up and make her stay. 

If she had to ask for it, though, she knew it would not be real. So instead she lay there silently under his touch, willing him to possess her, knowing that he never would.



My community opened a new hospital a while back. 

I live a few blocks from the old one. I chose this house for its proximity. For years I would crawl out of bed in the wee hours of the morning to go see a critical patient. I listened in the night for the helicopters and ambulance sirens, waiting for my pager to go off when I was on call. I remember the gentle sloping of the back hallway on the second floor, all of the nooks and crannies, smells, sounds. 

They are all ghosts now, as the building stands silent and empty.

I have a photography fetish. I love looking at photos of derelict, rotting buildings, imagining all of the lives that have passed through them, and I wish I were brave enough to trespass and take my own pictures. I imagine what this place will look like in a few years….

Birth. Death. Sickness and health. Love. Hate.

This building.

My son was born here. My mother got her new knees here. Who remembers these things but me? The walls do.

Those memories fade along with the building and it makes me sad. Or am I mistaking sadness for something else?

Nostalgia perhaps? 

A few decades from now there will be mold on the walls and ivy in the halls, and the place will crumble away just like me, becoming someone else’s fetish.

The Lost Dollars


So there is this thing in the US that you may not have heard about. ACO’s, Accountable Care Organizations, are groups of physicians that have “joined together to provide high quality care” for Medicare patients. So says the CMS (Medicare) website.

What does this mean for patients?

Hell if I know. I don’t practice medicine any differently than I always have except that I find myself spending more and more of my time clicking the requisite buttons in the EHR (electronic health record) so patients get less of me. Quality care is quality care and should be given across the board to all patients no matter what bonus structure happens to be in place. I do have suits that come out and flash PowerPoint slides at me that tell how many of my patients ended up in the ER over the past quarter but I don’t pay attention. Frankly, I should not be making a decision whether or not a patient needs to go the ER based on what my “numbers” may or may not look like. 

What does that mean for physicians?

Supposedly, I get money every year that I can demonstrate that I provided savings to Medicare. If Medicare does not spend as much money but patients still get their colonoscopies and whatever else done (I have no idea how that is supposed to work), then I get a share of the “savings.”

How big is that check?

It is not like winning the lottery, that is for sure. I resent the insinuation that I need to be paid extra to do the right thing, but that is beside the point.

The healthcare corporation I work for requires me to complete some…. tasks… before I get this check.

For instance, I have to attend quarterly regional meetings and log onto two separate websites each and every month. To be honest, none of the physicians I know look at anything on those websites. They log on and log off to get the credit. (Of note, I have asked why it has to be two websites. Why can’t it just be one? No one gives me an answer.)

All of this, if it actually improved patient care, would be fine. But it doesn’t. Not one bit. It turns physicians into cute puppies doing silly tricks for their next treat and I refuse to participate. 

By not participating, however, the corporation gets to keep that check. I might not care about that if I knew it was going to go to helping indigent patients get access to care or some other noble cause but I don’t have the foggiest idea what they plan to do with it…

Personally, I think it should go back to Medicare.


pink flower with raindrops

This part of the country has endured oppressive humidity and temperatures in the mid to high 90’s for months. Even last week running was miserable, despite doing it in the dark of night. It took me an hour in the air conditioning to stop sweating. 

Then BOOM! 

Rain. A cool front. 

This morning the air has a bit of a nip to it. 

No matter what kind of awfulness is going on around us, this kind of weather is like a healing salve. The Earth has a way of going on without us, in spite of us. In the grand scheme of the universe we are tiny specks who have no sway over the orbits of the planets or the brightness of the stars. The seasons will change whether we want them to or not.

Life will go on.

How’s that for a sappy, drippy post-debate post? 😊

Pushing Buttons

“This is none of your business!”

“Ma’am, I am trying to explain your benefits to you so you understand why you have the balance of $32…”

“Shut the F* up! I’m not paying anything. And you, little man, what the hell is your problem?” She turned from the front desk woman she had been yelling at to the office manager who had come to address the commotion.

Admittedly, he is a bit on the short side but who belittles someone to their face because of their height?

He identified himself. “You sounded upset and I thought I would see if I could help.”

“F* off!” She grew redder in the face and threw a clipboard at the check in window. “I am going to report you, you bitch!” Her voice rose, full of venom. “I am going to report the whole lot of you!”

Everyone stared, silent. Shocked. Finally, she turned and stormed out.

Later that day, she called the complaint line and raised holy hell. My staff and office manager were left to defend themselves to the higher ups, as if they were the ones on trial.

We have had a rash of verbally abusive patients over the past couple of months. I am not there to witness the interactions, but I do get to hear about them later in great detail. It is over silly stuff, like having to have a copy of the driver’s license of the person picking up a controlled substance prescription. 

Bullying. Almost daily. From new patients but also from people we have been seeing for years.

I realize that I talk about this sort of thing a lot. Healthcare is a tough field. You’ve got to have a thick skin or it will destroy you. Here’s the thing, though: I am used to these sorts of things happening from time to time, people are scared after all and there is nothing more frustrating than navigating the healthcare system, but I have never, in over twelve years of practicing medicine, ever witnessed the amount of abuse laid down over the past couple of months. I wonder why my staff even comes back every morning for another day of it. I am not sure we can ever pay them enough. The attacks are incredibly mean and ugly, more over the top than I am used to witnessing in past years. People are becoming more abusive, more hateful with each interaction and I don’t know where it is coming from.

If you work in healthcare, you are expected to maintain a perky and yet calm and meek facade at all times. We are to be patient, kind, respectful and never let our emotions show even in the midst of a brutal onslaught. If we crack, even just a little bit, suddenly the whole event becomes our fault. Let me tell you, that it is extremely difficult to maintain calm when you are getting beaten down every single day. I feel for my staff who absorb the brunt of it.

Why is this behavior even necessary? 

Is it a symptom of the political climate right now?



He fell to his knees, gasping for air.

A strange sensation at his fingers brought confusion and he glanced down at his hands. They were clutching a knife, his knife, sticky with blood. 

A dark crumpled form lay a few feet away, its face buried in the damp ground of the forest floor, deathly still. 

He tried to take longer breaths. He needed more air.

Shadows played tricks with his eyes in the twilight, making every tree seem a menace. Were they moving closer? 

Yes. Yes, they were.

He struggled to stand but found it was impossible as he still could not breathe. His chest felt as if it would explode. At the same time, all of his senses seemed to come alive. He could see things for what they really were. He could hear things he had never heard before. His hands and feet felt alive, somehow stronger. 

And yet, he still could not stand…

She had not really loved him. He knew that now.

A hike with his fiancé had seemed so romantic. A picnic lunch in the forest, in France. 

They had gotten lost.

She had belittled him. Told him he was stupid for getting them lost. She had taken the ring, his ring, and flung it into the trees. Then, the monster was there. It had devoured her. He had to save himself, didn’t he?

Oxygen. Where was the oxygen?!?!??!

His vision narrowed even as he could hear the leaves rustling in the trees overhead. The ground came up to meet him. He tried to claw his way forward before everything went black.

He woke in a room. Beeping. Something in his throat, pushing air into his lungs. A hospital? He tried to sit up only to find his wrists restrained. Panic set in. 

He had to get free!

There was a uniformed guard posted at the doorway, “for his own safety” he was told by the nurse who spoke remarkably good English. She tried to calm him down.

There would be an inquest, she said as she fiddled with an IV drip of cloudy white liquid that hung at his bedside.

He struggled to stay focused, alert, but drifted back into blackness anyway.

Days later, he awoke again. The ventilator was gone and the stream of visitors began. Gendarmes with heavy accents demanded to know why he was in the red zone. 

What red zone?

THE RED ZONE. Restricted because of the left over unexploded munitions left from World War I. He was lucky to be alive. Or so they said. Phosgene gas escapes from time to time from corroded shells. You can’t smell it. Not until you are already dead, they said.

Then they asked why he had killed his girlfriend. Stabbed dozens of times with his knife, the knife they had found in his hand. 

The crumpled body. The monster? 

It was her….?

He wished he actually were dead. A few days later he was able to get his hands on something sharp. They found him in a pool of his own blood, a crumpled body on the floor. 

Another casually of the war to end all wars, a hundred years later.


This post was brought to you by this article thanks to C. S. Boyack’s Idea Mill



“Um, Doc, I can’t do that.” A look of horror crossed her face.

“You are here for your physical, right?” I checked the schedule again to make sure I was not hallucinating. Then, I double checked her preventive care, just in case. She was indeed due.

“Well. I wasn’t expecting to have to do… that.

“Technically, I can’t force you to do anything. It IS your body, after all.” I shrugged, trying to use my body language to convey that I was not trying to pressure her. 

“It’s just,” she leaned forward and whispered, “I didn’t shave my legs.”

“Look, I haven’t shaved my legs in ages, either, so you have nothing to worry about.” I lifted a pants leg to show off a bit of scruffy ankle. “See? No judgement here!”

We both laughed.

She got her PAP done.


 “I thought you were engaged?” I had caught sight of her bare finger.

“Yeah. Well. Not anymore.” She gave a noncommittal shrug. 

“Oh, no! I am so sorry.” I searched her face looking for clues as to whether this was a good thing or a bad thing. 

She smiled. 

I felt relieved.

“Honestly, I feel like I dodged a bullet, Doc.” She stared at me for a second gauging wether or not she should share the rest of the story, then shrugged again. “One day he tells me that he has sworn off carbs. No more bread, rice, pasta, potatoes. He gets mad if I cook anything with carbs.” She laughed. “I have always made bread. From scratch. Fresh homemade pesto for my pasta. Roasted herbed potatoes. I love carbs, for crying out loud! So I wait, thinking this is just a phase. Months pass. He makes comments about how much weight I will lose if I just give up those carbs.” She laughed again. “Then I realize, this isn’t about the carbs. It isn’t about him. It’s about me. He thinks I’m too fat!” 

“Ouch.” I could feel the sting of that realization. 

A torpedo to the heart. 

She nodded. “After I sat down and thought about it for a bit, I could not imagine giving up carbs. Not for him, anyway. I would rather be a bit more… voluptuous… and happy with my carbs, than skinny and starved for love with him.”