Friday, April 18, 2014

My "Thing" About Shoes

Lib in boots
I've got a "thing" about shoes. I never knew I did, not until a few minutes ago. Someone from a far place on the other side of the world read, "Wearing Mom's Shoes," last night -- though it was really this morning for them -- and that's when it hit me. I've written about my aunt wearing my mother's shoes, me growing into my father's, some that fit and some that don't. I've referred to distance runners and sprinters and they wear shoes of one sort or other, or most do.

In my only reasonably successful track event, I ran in stocking feet because the Converse "tennies" we wore at the time were worthless in a sprint. Once the weather warms up and I get the lawn freshly cut, shoes will get traded for bare feet. It only seems right, living in the country. Once I've traded life on the farm for a sojourn back in the city (residency training), that will seem slightly odd. Bare feet are for country boys, penny loafers for city mice. I know that's not strictly true, but it fits the stereotype.

But back to shoes, I notice them. What people are wearing and when, and I wonder why they've selected the ones they did. The big, block-like, square high-heeled sort that's back in style, pumps, boots, and so many kinds of tennis/hiking shoes an accountant couldn't keep track of them. If clothes make the man, shoes reflect the person. Too out of style and we're nerdy; too "in," and we're overly fashion-conscious. Most of us are in the middle, trying to get around without our feet hurting.

That's why I still love Skechers Shape-Ups, despite all the hype about false advertising. They're comfortable and good for long days on the hospital floors. My only complaint is they're not made anymore and finding the leftovers in my size (big) is a challenge. The company has a new one made with memory foam -- I may have to resort to those, if I can remember, that is. Maybe the shoes will help.

I guess all this came about from spending my youth in my father's retail western store/saddle shop. We stocked Western and English riding boots, in limited styles and quantities. We could special order anything, but customers like to handle what they're buying, so you've got to have at least a few pairs on the shelves. 

English boots are basically made of canvas (for summer), rubber (for barnyards), or leather (for everything else) and come in brown, black, or black with scarlet cuffs around the tops (fox hunting attire). Oh, and there are the little ankle length, jodphurs; can't forget them. Field boots have laces over the instep, dress (formal riding attire) are plain. English boots are like English food: there's not a lot of variety on the table, unless you're talking about pudding and we are definitely not talking about that.

Western boots, on the other hand, thrive on variety. Some have short, shoe-like heels and others the traditional cowboy style with three-four inch under-slung heels that angle downward in the direction of the toes. Tops can range from eight inches to knee length and toes can be rounded or sharp enough to use for a hole punch. And then there's the stitching or patterns cut into the top. They're decorative, sure, but also functional. The more rows of stitching there are, the less likely the tops will wrinkle around your ankles with age and the influence of gravity. If only faces had that advantage.

Colors abound as well as kinds of leather. Cowhide, water buffalo, or waxed calf for work boots; kangaroo, lizard, ostrich, fine calf, for "dressin' up and goin' to town," boots. I have a pair made from shark skin my father ordered for me during my first year in seminary and they still look good. I used to spend hours, when the store was empty and I should have been dusting or sweeping, looking through boot catalogs, wishing and dreaming.

So, yeah, I'm a "shoe guy," as well as a "car guy," and a "horse and dog guy," but I come by it honestly. There's no fetish here. The way to my heart is not through my feet. Invite me over for dinner and my shoes will be polished, but don't expect me to bring along my kit to do yours. A sincere compliment you'll get, but maintenance is up to you. My "thing" about shoes only takes me so far.    

(Creative Commons image by BCR Librarian via Flickr)

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Sunday, April 13, 2014

Parenting in "Star Trek" and "Man of Steel"

I'm a Star Trek and Superman freak. I wouldn't go so far as to call myself a "trekkie," though I did see the late James Doohan at the University of Texas a few years ago. I was so accustomed to his Mr. Scott, it was a shock to hear him speaking without an accent. I also saw George Tekei at a science fiction convention, once. Superman and I have yet to meet, but that doesn't rule out the possibility. You never know, he might decide my hayfield looks like a homey place to stop by, en route to an adventure somewhere else. 

I'm especially fond of the reboot versions that have appeared over the past couple of years and watch them every chance I get. As a matter of fact, I was watching Man of Steel (2013) for the umpteenth time this past weekend, when I began noticing similarities between Superman and Captain James T. Kirk, particularly in their relationships with fathers and father figures.

Both characters, for example, experienced the loss of their biological fathers at or near the moment of childbirth and under similar circumstances. Kirk's dies in the process of trying to secure the safety of his wife, newborn son, and crew, while battling the renegade Romulan, Nero (Star Trek, 2009). Superman's father, Jor-El, is killed by General Zod, while sending his son to safety on Earth. Both men are subsequently raised by step-fathers, with somewhat different outcomes.

Technically-speaking, Kirk never has a "step-father" in the sense his mother remarries. In Star Trek (2009), we find him, his mother and brother, living with an uncle with whom their relationships are conflicted. Our introduction to a teenaged Kirk occurs in the scene where he "steals" a vintage Corvette Stingray his uncle claims is "his," and drives it off a cliff. It looks like a typical case of adolescent acting-out, but as the deleted scenes indicate, the car actually belongs to Kirk and his brother, an inheritance from their father. Its destruction, however, reveals how much Kirk resents his uncle and the way he treats his nephews.

Superman is raised by adoptive parents after his spacecraft crash lands on their Kansas farm. In many ways, he has a far more functional family life than Kirk. He is the child his step-parents wanted and never had. He is loved and protected from the misunderstanding that may result from the premature use of his powers and his step-father frequently reminds him his presence here is for a reason. Although Superman ultimately learns the meaning of his potential from a holographic representation of Jor-El, his becoming a man of integrity results from the influence of his step-parents.

Kirk needs an experience like that of Superman, but it doesn't materialize until his early twenties. He's grown up a "genius-level repeat offender," with little concern for his future until he encounters Christopher Pike, an officer in Starfleet, following a bar fight. Pike offers Kirk what he's always lacked: a strong male role model who sees his potential and challenges him to develop it. 

In Star Trek: Into Darkness (2013), we witness Pike reprimanding Kirk for violating the Prime Directive on a recent mission. More importantly, he's angry and clearly disappointed because Kirk lied on his mission report rather than accept responsibility for his actions. Pike has expectations for Kirk that exceed those he might have for any other officer; they're the expectations a father has for his son. Nevertheless, when Kirk is relieved of command of the Enterprise, Pike goes out on a limb and argues he's worthy of a second chance. It reminds me of something I learned from my own father: dads never give up on their children.

Pike does, in essence, what no one has done before, in Kirk's experience. He requires him to live up to higher standards of integrity and behavior. He has confidence in Kirk but he knows his greatest weakness is his ego-centric immaturity. As a father figure, Pike also knows Kirk has yet to realize that mature masculinity must be rooted in something greater than himself. Pike's death is meaningful, not only because it entails losing the only functional father figure Kirk has ever known, but because it represents losing his closest connection with his biological father. His tears aren't for Pike alone, they're for the father he never knew and the life he never had.
Superman, in a similar manner, has to come to the place where his life is rooted in something transcendent. His earliest efforts to use his abilities are sporadic and situational. He rescues a crew from a burning oil drilling platform, then finds a job in a bar. He's still bound by his step-father's fears he will be rejected by the people of Earth. Superman's encounter with Jor-El helps him begin integrating who he is as Cal-El, with the life he's been given by his step-parents. In this way he is enabled to create his own vision of himself as one pledged to help humankind.

Death is a key player in the myths of Superman and Captain Kirk. Superman has to risk his life to prevent the destruction of planet Earth. Kirk literally does give his life to save the Enterprise and her crew. Both must also "die" to an immature understanding of themselves in order to become the person they were meant to be. Each received instruction in dying from a father who gave himself for those he loved. They received instruction in living from men who chose to be fathers for their sake. I'm not sure anything we do possesses greater significance than how we raise our children. Kirk and Superman show us why.  

(Creative Commons image of Man of Steel billboard by Victoria Pickering via Flickr)
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Saturday, March 29, 2014

Like Walking on Water

Walking on water is easy; it's when the waves turn into giants that things get sticky. ~ Beggar

I don't usually quote myself but since there was no one else to blame for my opening line, I figured I'd best come clean. Walking on water, metaphorically speaking, isn't hard, as long as the water's quiet and glassy smooth like the surface of a Colorado mountain lake on a summer evening. The storms that come from out of nowhere in late afternoon, however, before the evening calm, those are what separate the men from the boys.

That image has been running through my mind almost daily, the past few weeks. Walking on water, trying to "keep the faith" when all around the waves are lapping and a glance at my feet tells me I'm going under. Walking on water is precisely what seeking a residency position has felt like, walking on water without a life-jacket.

On March 9, 2010, I wrote a blog post entitled, "Medical School Through the Back Door," describing my experiences as a psychotherapy intern in the company of a group of  psychiatric residents. Back then, I was a street urchin off the pages of A Christmas Carol or Oliver Twist, my face pressed against a restaurant window, gazing hungrily while patrons dined sumptuously. The memory of that internship kept me going through medical school. I knew residency was out there, or at least I believed it was, it was just a matter of reaching it. That was in 2010.

2011 was different, or it looked to be, when I began clinical rotations. The basic sciences were behind me and board exams and I had battled it out, sword on shield, sometimes tooth and nail. Starting rotations in mid-cycle meant I wouldn't have a predictable schedule, resulting in graduation being pushed back a year. 2012 brought an unexpected gap between rotations and once again, I watched graduation skip away with the alacrity of a child playing hopscotch.

In 2013 I received my degree at long last and applied for residency. The Match came and went, leaving me without  "a date for the prom." I'm not sure there's much worse news for a fourth year medical student or recent graduate than, "We're sorry, you did not match with a program." As with any loss, your first reaction is shock and disbelief, followed by anger and frustration, and then despair sets in and you start wondering how you'll ever pay student loans. Hopefully, acceptance comes along soon, enabling you to regroup and get busy chasing available positions and contemplating Plan B or C.

The truth is, I was up and down. One day I felt optimistic, based on nothing more substantial than a phone call with a polite departmental secretary, and the next felt certain I was totally screwed. All the years I'd spent loving and learning psychiatry were circling the drain and there wasn't a single thing I could do to stop them. My Plan B involved a family medicine residency for a year and then reapplying for psychiatry. It had been done before, successfully, by others, why not me? If that failed, I'd go to Plan C: finish family medicine and see psychiatric patients. It was a good strategy, it was workable, but it really did feel lousy. It was like giving up and that's what hurt most of all.

Still, I had to face reality, painful or not, and so I began contacting family medicine programs about openings. Then a call came from the Midwest. I tried to sound casual and friendly, but I could scarcely contain myself as the voice on the other end said, "I'd like to offer you a position in our psychiatric residency program." Talk about the cavalry riding to the rescue. I even think I heard bugles blowing. Until that point, my "best day" was a Saturday morning in January, 2005, when I learned I'd been accepted to medical school. Now it had a contender.

I'm not sure what it's like to "walk on water" that's calm and placid. I'd like to find out. The past few years, though, it seems there's always been a storm brewing, either because of my own frailty or stupidity or because that's what storms do. I'm not complaining; it's better to have to negotiate a storm than sit on the bank, watching others make their way to the other side. That I've managed to come this far is a testimony to good people who stepped onto the water alongside me when the sky was at its darkest. Thanks in no small measure to them, when someone finally opened the door to a psychiatric residency, I was standing on dry land, free to walk through.

(Creative Commons image of Trout Lake, near Telluride, Colorado by Mountain Belle via Flickr)

Monday, March 3, 2014

Students With A Past (The Mythology of Medical School)

The things I remember. My childhood address, phone numbers for my dad's saddle shop, my aunt's for emergencies, the digits on my first driver's license. Considering my conflicted relationship with math, beginning with elementary school arithmetic and culminating in high school algebra, it's hilarious that I remember numbers so easily. Maybe it wasn't the numbers themselves, but their use that was a problem -- no pun intended.

I also remember a little sing-song ditty I made up during high school biology for the elements of taxonomy: Kingdom, Phylum, Class, Order, Family, Genus, Spee-sees (species). For someone who's mental hard drive has always seemed a few megabytes short of RAM, it's intriguing how bits and pieces of this and that are dredged up with ease.

It's encouraging, too, because I've never had a talent for memorizing. Spelling Bees were fun because I'd been taught the lost art of Phonics as an elementary student. Sounding out a word was as natural for me as mentally associating guitar chords with a song on the radio. It irritated other students because I spelled slowly and deliberately, rather than fire off the words from memory, but I frequently won. So, there. 

While memorization sometimes seems like my "Voldemort," learning has proven my magic wand. I'm mentioning this today because occasionally, someone who's contemplating medical school contacts me with concerns about their personal calender. Since it's turned over more often than other applicants', they're wondering how it might affect them or their performance. The doubts and fears that race through your imagination at times like this are so prolific it feels like you're possessed. The solution to possession is exorcism, but we don't need Richard Burton (The Exorcist, 1973) to banish our tormentors, instead, we need to re-tune our reality-testing skills to gain a different perspective.

There's a mythology associated with medical school, composed of assumptions, perceptions, and beliefs, some which are true, others partly true, and some downright false. Take, for instance, the notion of the "typical medical student." It's more accurate to say there is no such thing; there's only those who obtain admission and among them, you'll find so much variety you need a taxonomy to categorize it. Though still a minority "species," for several years nontraditional students have been the fastest growing one in the medical student populace. Women used to be the nontraditional applicant, now it's the student with a past.

Another assumption is medical students must be capable of memorizing vast quantities of material. I believed this once. There was also a time when I believed Viet Nam was a just war, so what does that tell you? It's true medical school does expose us to a great deal of information. That it all must be memorized is not true. Thanks to the demythologizing efforts of Dr. Francis, founder of the PASS Program in Champaign, Illinois, I came to realize how incorrect my beliefs about memorization had been. They were sincere, yes, but they were mistaken -- as mistaken as Linus, spending Halloween night in the pumpkin patch. Memorizing is important but it's not all-important. It's a useful tool but there are others that may be better.

The trouble with memorization is, it relies on short-term memory, which I called RAM (random access memory) earlier. Some students' short-term memory capabilities resemble the biological predisposition necessary for a runner to be a good sprinter. Distance runners don't sprint well because their muscles are built for endurance, not the short burst of speed. Many of us, particularly liberal arts majors, are "distance" rather than "sprint" learners. Our minds are more efficient at encoding material into long-term memory than an overloaded short-term memory. Dr. Francis taught me how to decipher the conceptual framework underlying medicine and use it to facilitate long-term memory storage. Learning 10, memorization zip. So, there.

A third popular false belief is medical students rarely sleep, nor do they have to, since they worship regularly at the Church of Starbucks. If you can't keep up with your bleary-eyed, robotic, hyper-active lab partner who gets perfect exam scores, you may as well forget it, or so goes this urban myth. Medical school is demanding, that's true, and sleep gets short-shrift now and then, but guess what? Who sleeps when they have babies waking them up every two hours? You get up, change and feed junior, then go to work. Students with a past are no strangers to the routine. 

The belief that medical students must be able to go on and on like the Energizer Bunny is a twist on a partial truth. Medical school is physically, as well as mentally, challenging. What the "bunny belief" doesn't tell you is how challenging it is for all students. By the end of each term and even before, everyone is weary. Younger, older, and those in-between. Those who graduate with their health intact generally eat (fairly) well, exercise (fairly) often, and do their best to get at least six hours a night -- the minimum for a full REM cycle, the key ingredient for effective learning. Energy is no more a gift than a silver spoon. It results from the desire to achieve and is maintained by common sense self-care. Students with a past can do this as well as anyone else.

Lastly, there is the assumption about flexibility. By this, I don't mean the fellow who crawls into a milk crate on Saturday afternoons on the Downtown Boulder Mall for dollar bills tossed into his tip jar. He's the only person I know who can do this and whatever he does the rest of the week, I'm sure it's not studying medicine. Flexibility as an urban myth concerns being set in one's ways and hints the less we've experienced, the more adaptable we are. Of course, that runs directly counter to nature's insistence that exposure is essential to adaptability. Exposure is how we develop an immune system. Exposure drives adaptation. Exposure motivates us to evolve.

Persons acclimate to rigid patterns of thinking and behaving in response to fear and uncertainty. Those who are resistant to new information are less likely to step outside their comfort zone and pursue medical school than those open to new ideas. Becoming entrenched is like psychopathology, it can happen to anybody under the right conditions. It's like falling back on memorization in a crunch. Students with a past may have to unlearn a few things, but that too, is part of being adaptable. Because you have a past doesn't mean you can't let it go.

There's more to medical school than its mythology in the same way there's more to us than appearances. Demythologizing is critical for evaluating one's potential realistically. Viewing yourself as capable is as important as envisioning the outcome as obtainable. Students with a past are as capable as their fellows. They just have to believe it. I'm living proof. 

(Creative Commons image by bfi Office Furniture via Flickr)
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Monday, February 24, 2014

Now You See Me -- Or Do You?

I am easily delighted. I'm also easily entertained, though when I was little, hearing the words, "I'm bored," exit my mouth was my mother's cue to reach for the Bayer (aspirin). My attention could be as difficult to hold as a kid's hand in an amusement park. I loved the films Houdini (1953) and The Great Imposter (1961), starring Tony Curtis, and still do. Both were about illusion, magic, "now you see it -- now you don't." The impossible becoming possible with the blink of an eye.

I remember seeing my first and only, sword-swallower in a traveling circus when I was five or six. We lived in the country, as I've mentioned before, and a circus, with three rings under the bigtop, arrived at our local fair grounds. They had all the acts you associate with larger operations like Ringling Brothers or the Shrine Circus, including a fellow who had himself shot out of a canon. A young, pretty, blond-haired girl astride a dappled Welsh pony, stole my heart and galloped through my fantasies for weeks afterward (sigh). 

I saw my first "Punch and Judy" puppets the same night, in the side-show. I remember how a devilish puppet, clad in black, crept onto the stage to scare Punch. With a menacing voice, he said, "I am the Devil." Punch responded, sarcastically, "Well, you look like the devil!" I'd heard my mother use that phrase often enough to get the hint. When Punch and Judy appear in The Santa Clause (1994) each Christmas, my mind replays that evening.

Anyway, like I said, that's also where I saw my first sword-swallower. He stood next to Punch and Judy's stage, and with great flourish, proceeded to swallow a decorative sword which he said was "only a toy," and then what he insisted was a "real" blade. He even stepped behind a flouroscope so the audience could see the instrument of death inserted vertically through his mouth with the tip resting benignly in the curve of his stomach. When medical school and gross anatomy entered my life a few centuries later, I realized there was no way on earth that sword could have done what the flouroscope displayed. It was a "trick," an illusion, but one that delighted me as a child and continues to do so when I think of it.

I'm certain this is why I love the film Now You See Me (2013) with an ensemble cast including Jessie Eisenberg, one of my favorite new actors. It just delights me. The story revolves around four magicians who have been mysteriously contacted about membership in a secret society called The Eye, which is dedicated to preserving pure magic, righting wrongs, and overcoming injustice. As the plot moves forward, it includes tricks worthy of David Copperfield, slight of hand, hypnosis, and has the lead characters pursued by the FBI. Honestly, I could scarcely contain my inner child the first time "we" saw it.

Some have described Now You See Me as evidence The Illuminati have taken over Hollywood in an attempt to pull the wool over our eyes, deceive our better judgment, and secretly promote a "New World Order." Critics proclaimed the film's illusions were unrealistic and its ending unsatisfying. Personally, I wonder if we were watching the same film. I was captivated from the outset and couldn't wait for the credits to roll before hitting the restart button. Once was not enough and the second, third, and fourth viewings triggered my sense of delight as readily as the first.

Now You See Me isn't merely a story -- it's a yarn, a rambling and implausible tale, according to the Concise Oxford, though the film doesn't ramble and any implausibility lies in the eye of the beholder. There is no moral, such as you'd expect from a fable, but it does make a point, i.e. the ego can be so wrapped up in its own perceptions that it prevents us from realizing we're one, two, three steps behind what's taking place right in front of our us. I've been there, haven't you?

It also reminds us that to be captivated by wonder, we need to have a little faith, to suspend our natural disbelief, and be willing to trust. Not everything needs to be explained, as the film urges, and some things are best left unexplained. I'd agree, particularly when they make us feel like children, fascinated by what defies reason and once again, believing that anything and everything is possible.

(Creative Commons Image by ictusoculi via Flickr)

Saturday, February 22, 2014

Michael Palmer. Any Age is Far Too Young

For years I'd entertained the fantasy of crossing the Colorado state line from wherever I happened to be, with the windows rolled all the way down and Rocky Mountain High blasting on the stereo. It was going to be my fanfare, like the opening bars of the Star Wars theme or Superman, announcing to the world I was home at last. 

On a warm Indian Summer day in October, 1997, I did that very thing, driving my Ford pickup truck across the invisible boundary between Wyoming and Colorado, leaving the East Coast behind, little knowing in a few years I'd find myself on the same highway, retracing the miles back. Also little knowing that in forty eight hours, I'd be awakened by a story on NPR's Morning Edition with news I never wanted to hear. John Denver had been killed in a plane crash. I felt like I'd crashed with him. 

It was the same autumn I met author Michael Palmer in print. Michael and I never met in the same way John and I had, but we corresponded briefly, discovering how our experiences dovetailed by email. He'd been involved in the Massachusetts Physician's Health Program, working with physicians, like himself, whose lives had been affected by psychiatric illness and/or substance abuse. As a psychotherapist, prior to medical school, I also worked with doctors enrolled in the Colorado Physician's Health Program. Michael was in recovery, as he revealed years earlier, and I was attempting to recover a life I'd never known. Michael was a writer, I was trying to become one, and he offered me generous encouragement.

I found his books while prowling the Boulder Public Library, looking to feed a growing interest in medical fiction. At the time, I wasn't convinced it was even remotely possible to include medical school in my future, though I wanted to, quite badly. Reading about medicine was becoming a kind of therapy, much as writing had been for Michael, and his books helped overcome my fear that, not only had I missed the bus marked "medical school," it was gone for good. I had yet to learn there is no optimal time for going after what matters most to us, there's only now and what we do with it.

Michael was my companion during the months preceding premed coursework, when I hung onto to the ridiculous fantasy that a doctorate in clinical psychology would be enough. He helped me face the inevitable truth that nothing would ever substitute for my becoming a psychiatrist and I'd best get on with it. I learned from him how recovering a life is just as grueling and just as rewarding as what he'd gone through himself.

I'm glad I shared some of these things with him, especially now. We never know how tenuous life is, not really. We go through the daily grind with the unconscious assumption time is on our side. We do this a lot when we're younger or at least I did. We think only older people die, whatever "older" means, and if it happens to a peer, unless we know them personally, we conveniently overlook the obvious fact it could easily have been us, had the cosmic tumblers turned up our numbers instead of theirs.

The reason I'm glad I shared those things with Michael is this afternoon I learned he passed away, quite suddenly, a few months ago. He'd been in Africa, on safari, and had barely gotten back to the States when he experienced a heart attack. I can't help but think how appropriate it was for him to have been on safari; for reasons I don't quite fathom, I've always associated him with Hemingway. Michael was 71 and far too young. I feel certain he would agree, any age is far too young.

(Obituaries for Michael Palmer, MD, may be found here: New York Times and Boston Globe. Michael's final novel, Resistant, can be accessed via

(Creative Commons image by cdrummbks via Flickr)

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Wednesday, February 5, 2014

Mission Impossible

It started out a typical morning -- Oh, you'd rather it was a dark and stormy night? Good idea. I like that; here goes...

It was a dark and stormy night. The wind was howling, trees swayed like hula girls (hula girls? In Maine? Maybe on a fuzzy dashboard.) and rain lashed my windshield as I pulled out of the parking lot. Eager to get home, I didn't notice the cassette lying on the seat next to me until I reached over for my gloves. It couldn’t have been mine; I hadn't listened to a cassette recording in years. Who's been in my car, I wondered, when, and why?

I pulled onto the shoulder and gave my discovery the once over. There was no label, it didn't smell like gasoline, gunpowder, or anything obviously lethal. I hadn't dallied with anyone's girlfriend, wife, or ex, and besides, the local boys wouldn't use a tape; they'd run me down with a really big truck and then shoot me for good measure. Thinking I was fairly safe, I inserted it into the player -- with my hand on the door latch, just in case. 

A dispassionate male voice I might have accused of belonging to Lawrence Fishburne under other circumstances, said, "Good Evening, Mr. Beggar. Your mission, should you choose to accept it, is to answer the question, 'What is a D.O.?' in 140 typed characters or less. Whether you include spaces is entirely up to you. For what it’s worth, your team suggested we do something physiologically impossible with this, so you're on your own. This message will self-destruct in 5, 4, 3, 2...hiss, whirrrr, click."

Acrid grey-black smoke billowed from the CD/cassette player and I swung the door wide, leaning out into the rain and coughing like Doc Holiday in Tombstone (1993) or Wyatt Earp (1994). Somebody from the AOA with a taste for cloak and dagger, I thought, who else? Talk about Mission Impossible. Wait a minute, isn't there supposed to be theme music playing? Where's the thump-thump, thumptha thump-thump signaling I'm about to do something really cool? Mmph. Budget cuts.

What made my task resemble Tom Cruise leaping from a speeding train was the subject matter. It's hard enough to express meaningfully when you've got all night. My "assignment" -- in reality, a sort of contest, but it's more fun this way -- was going to present a challenge. How can we explain the "DO essentials" to the average person for whom "doctor," often as not, refers to an MD? It's like trying to fit an elephant comfortably into a box designed for an engagement ring and expecting it to be recognizable as an elephant when the box is opened. At this point, 140 characters started to resemble the penance given a petulant soul doing time in Purgatory. And then it got worse.

Pretty much everyone agrees, the care and feeding of both types of medical doctor is virtually identical, with the exception that DOs are also trained in the delivery of Osteopathic Manipulative Medicine. On that basis, the question might be raised, why not have the same degree? By itself, is OMM sufficient reason to warrant separate licensing, specialty boards, and so forth? In other words, why not just make all physicians DOs and be done with it? I have a sneaking suspicion the American Medical Association might have something to say about that. Not to mention my best friend who is an MD and one of the most osteopathic of physicians I've ever known. Yet, even he will admit that he and I, MD and DO, are better together than we are separately, and that is due to the differences in our training, not the similarities.

Our training is the overall critical factor and if the training received by DO and MD physicians were truly mirror images, an identical designation would make lexicographic sense. Despite appearances, they are not, however, and not merely because of OMM. Osteopathic medicine is oriented differently and this takes us to the heart of the matter.

Hippocrates said, "It's more important to know what sort of person has a disease than which disease a person has." He could have been speaking as a DO because osteopathic medicine focuses on persons, both as individuals and as members of a community. It conceives of them as complex entities who experience themselves and their environment in ways inclusive of cognition, emotion, and physical embodiment. Their behavior is goal-directed and they are prone to regard the search for meaning as a sublime pursuit. Their bodies are a model of integration in which the part affects the whole and nothing affects the whole without also affecting the person whom it visually represents. Ultimately, the person is everything.

Person-centered care has become a hot topic lately, especially at medical conferences. For osteopathic physicians, however, person-centered is far more than a hot topic, it is a pervasive and all-inclusive, soul-deep conviction that conditions every aspect of the doctor-patient relationship. It isn't a practice emphasis, it is our defining feature. It isn't something we do, it is who we are.

I'm way beyond 140 characters and we haven't even hinted at the role played by OMM or the osteopathic preference for finding and treating the cause of disease rather than symptoms alone, whenever possible. See what I mean? The elephant is so big and the box so very small.

Still, I did accept this mission, so I'd better get cracking. You'll forgive me if I keep one hand on the door latch. Maybe the tape wasn't a "bomb," but that doesn't guarantee my solution won't be. A D.O. is a medical doctor, dedicated to the care and treatment of persons, in sickness and health, of all that they are and wish to become, and a great deal more, besides. 140 characters without spaces. You know, I think I'm starting to hear music.

Thump thump, thumptha, thump thump...

(Creative Commons Image by Baptigrou via Flickr) 
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