When I was appointed to the NM Medical Board, it was winter and my first attendance was the December meeting. A cold front and an associated early winter snow storm the previous night, caused havoc for my morning 65-mile drive to the state capital for the meeting. I ashamedly arrived an hour late for my first board meeting. To my relief, I learned that two other board members making the same trip had not arrived yet either. This is significant for this article, as the member’s tardiness allowed a lengthy discussion by the members present about a complaint received by the Board on a particular practitioner – apparently well known to them. The entire incident was memorable enough for me to still recall it today.
The particular practitioner – I will call him Dr. T. (for trouble) – became a regular at our Board meetings for the entire seven years, I served on the board. Dr. T. was an intelligent and good medical practitioner. The repeated complaints were not about his knowledge or practice of medicine. Mostly, they were not even from patients, rather, they were from his colleagues or co-workers on his abusive conduct. What made this case particularly difficult for us, was his level of intellect and astute arguments he presented. Of course, he was placed on probation multiple times, even referred for psychiatric evaluation. But even the psychiatrists seem to have trouble identifying his behavior. He was diagnosed with narcissistic vs bipolar vs anger management, etc. type of conduct. Our inability to deal with him adequately, compelled us to ask the governor to appoint a psychiatrist to the board when a vacancy became available.
At one point, we were pleased to hear that he left for a position with the federal government in a neighboring state. But since the federales did not require him to be licensed by that state, he practiced under his NM license. And it wasn’t long before we received a complaint on him, forwarded to us by the Medical Board of our neighboring state.
If there was one thing that I learned about such cases, was how such behaviors were common in highly intelligent, educated practitioners. I also came to appreciate that trying to change such behaviors, seldom works. Sometimes, I feel that a real jolt or as the old saying goes a kick in their attitude works best. There are, of course, other ways to deliver such a jar than an actual physical contact.
A young member of our family got involved with gangs in his school, and a close friend of his was killed in an altercation with the rival gang. The incident had a profound effect on him and as his mother said, “totally messed up his mind.” To a point that the family was worried that he might do something drastic, and asked if he could spend sometime with us and away from his toxic environment. I agreed, but soon after his arrival realized that I had a real problem on my hands, as we were not even on the same level of communication. He looked at me as an older person and repeatedly said: oh, you just can’t understand what is going on these days. All my efforts failed, and I was feeling helpless. Then I noticed a pamphlet I had received in the mail about a medical conference (CME) happening soon, in a resort city of a developing country in Central America. An idea came to me and I told him that I was going to the conference and would like him to come with me, and that it would be a good break from it all. He agreed eagerly.
We flew to the capital city. From there I opted to take the train to the Resort City. I purchased a couple of coach tickets on the overnight train. On the ride, the average citizenry got on and off throughout the night. Often carrying their children, belongings and goods of all kind. Even occasionally their livestock like chickens, goats, sheep, etc. my young relative’s eyes widened and he was totally fascinated by all he witnessed.
At the resort, I checked in at the conference which was held at a 4-star hotel on the beach, but then checked in at a hotel in town, close to the marketplace – making cost, an excuse. The vendors, arrived at five in the morning, carrying their goods for the day. The commotion woke us and despite his objection, I made him get up and go to the market. Again, the seemingly primitive layout of the market engrossed him. Of particular interest was the meat market. We watched with fascination as butchers, expertly cut the meat from the hanging carcasses for the customers, as they swatted the flies (no refrigeration here.) To catch a ride to the conference, we had to walk through the meat market, which added to the effect. When we returned at the end of the day, the marketplace was dark and empty. Even the flies seemed to have gone home.
I can’t believe these people live like this; he commented once. To which I pointed out that I was glad he noticed, as 90% of the world population live thus. As a matter of fact, I said, many places would consider this a luxury.
I was especially pleased when, on the last day of the conference, he decided to remain behind at the hotel and do some souvenir shopping. Later, he couldn’t stop talking about other fascinating discoveries of his. We flew home the next day. His mother could not believe the changes she saw in him.
Now just think of the possibility of our Boards requiring our unruly practitioners to spend a couple of months practicing at a rural clinic or hospital in a Third World country. I am willing to bet that much of such recidivism would resolve.
Oh Great Creator
Whose voice I hear in the wind and running waters
Whose beauty I see in flowers and the setting sun
Whose breath I feel in all living creatures
Whose warmth I sense in the heart of my children
Myself, my parents and their parents before them.
Hear my thankful prayers
Thankful for the nature that keeps me alive
Thankful for the teachings of all your prophets
Thankful for the order of your universe
Thankful for the knowledge of all your creation
That allows me to see beyond what can't be seen.
Oh Great Creator
Give me the wisdom to see my insignificant
Give me the wisdom to realize the fragility of existence
Give me the wisdom to comprehend the balance of nature
Give me the wisdom to discern right from wrong
So that I can add to your blessings and not take away from them.
Oh Great Creator
Guide me toward that which is the right path
Guide me to know my limits
Guide me to not harm all things that I can see and not see
Guide me to rise above my ignorance
And see that all mankind are my kin
That without them I am nothing
My very existence meaningless.
I pray so when I come before you
My hands and heart will be clean
And I can stand tall and without shame.
From the book: Practicing from the Heart in the Age of Technology
Elections are over, some have won
All the changes and nots
Affect many, but none more than us.
In times like these, when uncertainties abound
The nights are long, doubts and fear cry loud
Lying in bed with questions and doubt
Will we ever be homebound?
Sometimes under a crescent moon
The memories of youth and childhood
Nag at our soul, and ask
Whatever was our task?
But here, in this new land of ours
Ideas are paramount
Everyone's voice counts
No matter the reason or cost.
And in this world lies our faith
As it's home now, and we wait
For the call of the day that'll shout
That our votes, too, will now count!
It's Veterans Day. So we salute all veterans.
As a veteran myself, I truly appreciate their service to our country and people. But it is saddening how some of our veterans are treated. In the last twenty years, more than 30,000 active duty personnel and veterans have died by suicide - compared to the 7,057 killed in combat in the same 20 year period. The US is number 22 in the veteran suicide rate in the world - this is appalling and unforgivable.
Throughout history, many nations treated their veterans better than we do today. Persians, Chinese and Romans, for example, had high respect for them. Julius Caesar, for instance, gave land to about 15,000 of his veterans. And it is well known that Emperor Augustus settled more than 300,000 veterans in colonies across the empire. The honorably discharged veterans also received about 3000 to 5000 denarii's depending on their rank. Furthermore, they had certain rights and immunities. They could be a city councilor or serve in their local or regional governments. It seems that our leaders could learn a lesson from the ancients when it comes to caring for our veterans.
Today, many of our veterans are homeless or live below the poverty level. We have the rich spending billions frivolously, like buying a social platform for 44 billion. Just one billion of that could help thousands of veterans out of poverty. There are VA benefits, of course, and I was one of the recipients, but it is hardly enough, these days. Here is an idea; how about interest free mortgages for every veteran who wants to buy his/her first house? How about rent-free dwellings equal to the number of years served, to help them get on their feet in civilian life. Or a guaranteed state or federal government job, or free (really free) education.
There are many ways, our government, organizations, and wealthy citizens can help our veterans further. Let's try!
It was on November 1st 1938, that the racing horse Seabiscuit, made history winning against War Admiral.
Seabiscuit was small and ugly, his legs were crooked, and he injured often. He was named "sea biscuit" a hard bread eaten by sailors, because of his undesirability. It was during the Great Depression, and people needed their spirit lifted by a winner, and Seabiscuit did not seem the one to do it. His trainer had given up on him and he was all but forgotten. Then someone saw potential in him and bought him. A new trainer and jockey also saw prospects and started training him anew. They discovered that if they let him study his opponent, he would feel superior, stare them down and win. So it was that he started winning and on November 1st 1938, a race was set just between him and a younger, attractive horse named War Admiral at Pimlico Race Tracks in Maryland to a sold-out crowd. Millions more listened on the radio. For the first half of the race, they were running evenly, then his jockey eased up on him and let him get a good look at War Admiral, and that did it. As though saying "Oh no, you don't!" he sped off and won the race by four lengths. At one-to-four odds, against him, he not only had a great win, he gave a much-needed boost to a dispirited America during those trying times.
If history has taught us anything, it is that - like Seabiscuit - winners do better if allowed to proceed on their own terms. They cannot be forced to win. Healthcare providers, too, do better without the unnecessary demands of managed care organizations, legislatures, and legal system. Not a single doctor working for an organization has ever won the Nobel Prize. The most unlikely winners in our profession have been solo practitioners serving humanity, often in most dire condition. We salute them all.
This Halloween article has been a favorite of our readers, as many who work the ER, relate to the chaotic nature of such an evening, and so we decided to run it one more year. ENJOY!
Awhile back, I had the fortune or the misfortune of working the ER on Halloween night, which happened to fall on Friday. At the time, I was living in a small but very multicultural town in Northern New Mexico. The night turned to be wackier than any of us expected. Of-course the usual, Friday night crowd kept us busy with drunkenness, bar brawls, car accidents, sniffling noses, and the standard medical incidents. But the unusual was what made it, well, rather memorable.
It started with the usual minor accidents due to drivers watching the trick and treaters rather than the road and running into each other. Kids falling in the dark streets and bruising themselves, and so on. Then closer to midnight, two very striking young ladies showed up in the ER in witch attire. Well the outfits were more risqué than witchy and that attracted some unwanted attention. The ladies were from out of town - California to be exact - visiting friends for Halloween. They were sisters with a long history of asthma - yes, both of them. At the friend’s party, the guests got to drinking and smoking and more smoking and different kinds of smoking, and before long the indoor atmosphere got too polluted and our young ladies found themselves in severe distress. Their inhalers just weren’t doing the job, and they were rushed to the ER by the police - ambulances were busy chasing fender benders. In their haste, they didn’t grab their coats and showed up in revealing witch costumes.
It was particularly cold that evening in the high country of Northern New Mexico. As it was usual for our town, several locals and their homeless friends used to sneak in the waiting area of the hospital to get warm. They were regulars and generally subdued and quiet, if they got rowdy, we would ask them to leave, and they usually quieted down. But that night being Halloween, they had a bit too much to drink and the arrival of two very attractive blond witches - well, just got them too excited. The policeman who brought the witches was known to be a bit rough and, as he too was interested in the ladies, got into an argument with the others in the waiting room. In his roughness, he turned one of the unwelcome visitors to the wall and grabbed his Mace Spray and proceeded to use it on his subject. A scuffle ensued and as the officer pressed the Mace Spray, the man ducked and the officer sprayed himself in the eyes. Well you can guess the chaos that followed.
In the confusion, the uninvited visitors dashed out into the dark night. We covered our ladies with patient gowns and rushed them to the P.T. Department across the hall and locked the door. As it was the standard treatment of the day, we gave them each a shot of epinephrine and started them on a nebulizer. Much to our dismay, they told us that they had been dealing with asthma much of their lives. They were started on a new treatment by their pulmonologist back in California but didn’t know the medication they were given. Fortunately for us, it all turned out well. Our intoxicated friends made it back to the sanctuary of another warm place, we flushed the officer’s eyes and sent him home, dressed, bandaged, and splinted other injured patients, treated the sniffling children and cared for other medical problems. It was a full and eventful night. Our out-of-towners responded well to our treatment and left the next day for California.
We were lucky that night, for our patients were young and did respond to the management of their acute asthmatic attack. Today, of course, better treatments are available and with the help of telecommunication we can access patients’ medical charts from out of town and consult their providers back home - even on Halloween evening. New tools allow us to care for this mobile generation. Still, it helps to remind ourselves of how we dealt with medical urgencies back in the not so distant past.
Come o nature of autumn cool
Rest your head upon the golden leaves
Your fruitful toll of summer, fulfilled
With the sun, soil, and
Water, to the life giving seeds
Grown to nurture man and beast.
Now it's time, rest your weary days
Set for the long nights ahead
Pull the darkness over the naked limbs
Seek a warm abode to hibernate
Blissfully dream among the stars beyond
Of green pastures and berries abound.
Now the cold wind of autumn brings
Nudge of the season to rest and sleep
Nature's promise to revive
And the joy of being alive
Soon to rouse you to the hope
Of all that is so revered.
Reza Ghadimi - Autumn 2022
On a cold and dreary night, long ago in New York, after a long and arduous day of working in the South Bronx, I was going home on the subway. I was surprised, when for the third time, I heard someone say; Hey doc, how is it going?
I was so tired that I had not noticed the pertinence of the question, till the third time. Amazed, I asked the man sitting next to me: How do you know I am a doctor?
"Your stethoscope." He said, pointing to my neck.
I laughed, after touching my neck and noticing that the head of my scope was sticking out of the back of my collar. In my haste and fatigue, I had forgotten to take it off, when I put on my parka, and the head of it was hanging over the hood.
Sheepishly, I removed it and placed it in my pocket. "I am just a PA student." I informed him. Which ended the uncomfortable conversation.
I find it interesting that a simple tool, such as that, clearly identifies one's occupation. Furthermore, I find it amusing that I still remember the incident after fifty years, and often wonder if I would still be greeted, had the tool identified my occupation as something else.
It shows the respect and value, our profession awakens in people. Not many can make such a claim. It also reminds me of the many times we hear on the news of how, some of our colleagues violate this sacred title. I suppose that we are all guilty of taking advantage of our position at some point or another. But when it rises to a criminal level, it tarnishes us all. So who is to blame, is it our responsibility to police each other, are we our brother's keepers, or should we fault the system that, in many cases, has unrealistic demands of us. Maybe it is all of the above. Still, I feel proud to also note that looking comparatively, our group's offenses are relatively small. But, they are there and when they come out, it makes us all wither. Our profession deserves better than that.
October 6 to 12 is International Physician Associates Week. We salute all our brother and sister PAs. Especially all the old timers. Those of us who truly made this profession. Our profession started in the 1960s, so we are celebrating fifty-five years, and we are worldwide, so this is International Physician Associates Week. We have come a long way, still much has to be done.
I was one of the first PAs in the country and am a living history of the many fights we had. Along the way, we gained much and lost a few too. Though AAPA likes to take credit for all the achievements, the practitioners in the field are the ones who deserve credit. For state by state, and country by country, we fought the prejudices of our fellow practitioners, government regulators, legislators, media and the public.
When I first came to New Mexico in 1973, no one knew what a PA was. The secretary of the NM Board of Medical Examiners, told me to my face: "PAs will practice here over my dead body." I am proud to say that not only are we still practicing here, I actually served as the first PA on the NM Medical Board forty years later, and held his job as secretary of NM Medical Board in 2008.
My book Practicing from the Heart in the Age of Technology is all about our experiences and struggles, as a PA, in this country and around the world. Humayun J. Chaudhry, DO, MACP, FRCP, President and CEO of Federation of State Medical Boards wrote the foreword to this book.
Paul B. Roth, MD, MS, F ACEP - Dean of the UNM College of Medicine, Chancellor, UNM Health Sciences Center, CEO, UNM Health System, said: In Practicing from the Heart, Reza Ghadimi has captured the true heart of our healing profession… Every student thinking of entering the health professions should read this book.
Go to the home page of this site and read their endorsements and on the Blog page, the many stories that truly make our history.
Keep up the good work and do not give up the fight.
The UN General Assembly brought hundreds of leaders and policymakers from around the world to New York for a couple of weeks. I found this year's session very disappointing. Many talked, yet little of substance was discussed, as it seemed that blame-placing and finger-pointing was the only thing on the agenda. Although climate change, hunger & famine, and overall health of the world is in dire need of attention, political issues trumped them all. Leaving everyone flabbergasted and at the mercy of uncontrollable circumstances. Interestingly and on cue, several hurricanes have developed and are causing havoc everywhere.
On a positive note, the Nobel Prize Committee is meeting right now and some interesting people are awarded this year's prizes:
Svante Paabo, a Swedish scientist, won the Nobel Prize in medicine for pioneering the use of ancient DNA to unlock secrets about human evolution that provided insights into our immune system.
Alain Aspect, John F. Clauser and Anton Zeilinger are awarded for their achievements in quantum mechanics. As the Committee announced: The trio won for their experiments with what’s known as entanglement – an unimaginable phenomenon of two particles behaving as one and affecting each other, even when they are at vast distances to each other, on opposite sides of the planet or even the solar system. (What?)
Carolyn R. Bertozzi, Morten Meldal and K. Barry Sharpless were awarded the Nobel Prize in Chemistry “for the development of click chemistry and bioorthogonal chemistry.”
The Nobel Peace Prize was awarded Friday to Belarusian human rights advocate Ales Bialiatski and two groups, Memorial, a human rights organization from Russia and the Center for Civil Liberties, which is based in Ukraine.
The Nobel Prize in economics was awarded Monday to Ben Bernanke, Douglas Diamond and Philip Dybvig for their research on banks and financial crises.
When I consider these mind-boggling scientific facts, I am reminded of an astronomer who said: "When you have all the cosmos to think about, who cares about the kind of soup you are served in a restaurant." The total disregard and ignorance of many political leaders, however, reminds me of a cartoon, I once saw, showing: A man standing in front of an observatory, shaking his fist at the cosmos, yelling: "You don't make me feel insignificant."
As these mayhem developing conundrums, sicken the population in many ways, the job of healthcare providers become ever more challenging. If they ever award a prize for patience, I am sure that healthcare providers will be the top recipients of it.