Dec 31

The year is over. We are still alive in spite of Obama. Life goes on. The end of the year gives us pause to reflect on where we’ve been and where we’re heading for the year to come.

2011 has been a good year. My surgical practice has slowed down a bit, and I am giving Obama just a little less support than in years past. I have not done as many bicycle rides as I wished. Betsy and I have been able to spend more time together, and that has been most enjoyable. One particular highlight of the year has been our trip to Europe, having Betsy meet Katja und Hannes for the first time, and getting to see Italy. It’s always a treat to touch base with Onkel Herbert. Russ Anderson has been very special this year in providing a real friend to go bicycling with. The elaboration of those trips last year can be found on the various blog posts in feuchtblog.net.

Betsy and I are thinking about next year. I will be going to about four surgical conferences, including the Miami Breast conference with Betsy and Society of Surgical Oncology meeting with Dr. Tate in Orlando, both in March. I’d like to go to the American Society of Breast Surgeons meeting in Phoenix in late April. Betsy and I also plan to go to the American College of Surgeons meeting in Chicago in October.  We anticipate a trip to Germany and Switzerland in early June, hopefully where I could do some bicycle riding with Russ and Carsten (and maybe Peter?), as well as seeing Katja and Hannes, Herbert, Hille (Herbert’s sister), Marike (student in Bonn whom we met in Cameroon, Udo Middelmann in Switzerland (Francis Schaeffer’s son-in-law) and our good friends Mike (and Carolyn) who is doing a year teaching Sabbatical in Lausanne, Switzerland. That might be a little too packed of an agenda, but… In November, Betsy and I are seriously planning a trip to Egypt, Jordan and Israel. We’ll do the tour sort of thing. I’ve never been to the Holy Land, but have always wished to go. If you are interested, come along with. We will be going with the Rev. Dr. John (http://www.biblicalisraeltours.com/), who I found after a long internet search.

I continue to ride my bike. Yesterday was enjoyable in taking Patrick for his first long bicycle ride. He did about 8 miles. Not bad for an 8 yo kid on a 20 inch bicycle. It got rather cold at the end, the sun going down about 15 minutes before the end of our ride. Typically, I’ll ride the trainer. It’s one of my bicycles hooked up to a virtual reality trainer (Tacx). I’ll usually have iTunes going. This last year, I’ve been working through the series on Romans by Martyn Lloyd-Jones while training. I am now down to about 97 more 50 minute sermons out of 353 sermons. That’s a lot of sermons on Romans, and tends to be repetitive. You’ll get a review on that series once I’m done with it.

While sitting at my computer, I listen to music. My iTunes has a total of 721 gBytes of music and lectures, etc. One may wonder what I do with so much music. Well, I listen to it. It’s mostly classical, a total of 359 gBytes, or 175 days of constant listening. Making a smart playlist, I started working through everything a little over a year ago. I’m now down to 94 days, or 196 gBytes of classical music left. Right now, I’m listening to a little known piano concerto by Mendelssohn, which is actually quite good and doesn’t deserve obscurity — a trait true of much of classical music.

I continue to read every moment possible. Currently I am working through Gregg Allison’s Historical Theology, and am about 1/2 way through. I am reading Crime and Punishment by Dostoyevski on the Kindle. I have a massive lineup of books remaining on my shelves and in the Kindle store that I must read. I’ll need to quit medicine just to get my reading done. For time with Betsy, we’ll usually watch things like Teaching Company series together, and are currently working on a series about Oceanography. We are becoming adept at speaking about the pelagic vs. neridic realms of the ocean, knowing the difference between plankton and nekton, etc., etc., as well as understanding the various forces that make the ocean a wonderful world. For a lighter note, Betsy and I will watch movies. We have just started the films of Clint Eastwood, a total of about 40 that we’ll be seeing. Reviews for those films will have to wait! We still don’t have television, and I refuse to pay for cable. When we must watch something, we’ll watch it over the internet if it’s available.

I will be turning 58 in 2012. I’m not sure how much longer I will want to continue practicing medicine. It’s a serious love-hate relationship. I love the practice of surgery, but it’s everything else that one needs to put up with. Government has taken complete control of medicine, and turned it into an uncaring prohibitively expensive beast. Desperately needed tort reform is now a long-gone wish. As one pundit commented, “America is no longer governed by the rule of law, but by the rule of lawyers”. Such a statement could not be closer to the truth. Political processes are always preempted by court decisions. Democratic or Republic behavior no longer exists in the USA. We are governed by the tyranny of the courts. It wouldn’t be so bad if lawyers were behaved. Unfortunately, lawyers have devolved into a subhuman species. It’s hard to know what to compare them to, but the cyclops  is most fitting. Cyclops have only one eye, are monsters seeking to destroy anything alive that is not one of their own, will act even more intentionally and violently when their one eye is put out, a threat to anything else in existence. That’s the good part about what I have to say about lawyers. Don’t get me going on their bad side.

Those of us that work in the public realm have occasions from time to time with lawyers. Much of this we are not allowed to openly discuss for privacy concerns, and so will discretely tailor my statements. Physicians are advised to avoid a jury trial as much as possible, as juries tend to ignore the facts and are easily swayed by emotion. There is no rule of law in the courtroom. The selection of juries has become a joke. It used to be a trial by your peers or neighbors. Now, it is a trial before the a highly selected group of individuals based on the bias of the judge, people who would rather be anywhere than setting on a jury or people who are so worthless in society they have nothing better in life to do. The instructions to the jury often counter the constitution, which is why I will not set on a jury. I’ve written more on this elsewhere. The prevailing consensus among Joe Public is that justice no longer exists, and that is for the most part true. Why do we do everything to avoid the courts? If our neighbor sues us for using the wrong type of fertilizer that gives him asthma attacks, the costs in court will be prohibitive, it will be unbearable stress, and a flip of the coin will determine which way the judge may lean, even after hours of defending your case. It’s too easy to create a case, as you have little to loose in the process. Lawyers will determine the case based on their merit, which means, if it is possible for the lawyer to make a good profit off of a case. In the end, the plaintiff and defendant lawyers win, and the plaintiff and defendant loose. I’ve seen so many people destroy their lives by taking someone else to court, get lost in a long court trial, and even if they win the trial, much of the money ends up squandered or in the hands of the lawyers. Nobody but the lawyers win. We were taught well as kids to never sue, and for the most part, that remains true. There are three prongs to the solution. 1. Go back to the European court process where the looser pays all court costs. 2. Use Biblical law, which truly punishes offenses to others and demands restitution or death penalty in serious cases. There is no prison term in Biblical law. If you are a violent murderer, you die. If you stole, you repay. If your debt is too great, you become an indentured servant (slave) for 7 years to the person you owe to. Bankruptcy would not be tolerated, and Donald Trump would be picking cotton for the next 30 years. 3. Return to a Christian society that thinks in a Judeo-Christian fashion and holds Christian morality as the highest of all possible goods. Unfortunately, this isn’t going to happen, even if every non-Christian were immediately terminated. So, we tolerate matters, try to keep our nose clean by living morally, and if one must suffer for doing good, they will get their blessing and reward in the end. It is good that for a Christian, this short life is not the totality of existence.

So, I wish you all a happy New Year.  Keep looking up, and keep  your stick on the ice.

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Dec 30

It has been uncommon for me to write commentaries of late, in part because there seems to be minimal feedback from the internet community. In my earlier years of web blogging, I used iWeb and it facilitated readers adding comments for feedback. I would never wish to go to a social networking type style, such as with FaceBook, in that it tends to breed short, abrupt thought processes that do not have premises, reasoning, and conclusions demonstrated. It is meaningless prattle. No, even if I love you, I’m not interested in your kid graduating from pre-school, or where you went out to eat last night, that is, unless these events have a significant meaning in your life, and you offer explanation as to how these events were significant life-events.

Hope. It is one of the three Christian virtues. Faith, hope, and love. Just as we don’t wish to ever cause another person to loose love or faith (in Christ), we never wish to cause a person to lose hope. But, hope in what? I am on rare occasion accused of causing my patients to lose hope. Generally, I try to tell the patient the exact truth. If I don’t, they’ll get it over the internet. I feel that integrity is a foremost virtue for a physician. I have heard many doctors argue otherwise. Dr. Lauren Pancratz argues vehemently that if a lie (deviation from the whole truth) contributes to the betterment of a patient, then we should lie to our patient. I disagree entirely. Truth must be presented graciously and skillfully, but it must be presented all the same.

I see many patients that come from other doctors, mostly medical oncologists, who were never told the significance of their cancer. For many medical oncologists, hope  in “the system” must be preserved. Perhaps much of this is self-serving. I find that only 5% of patients do not wish to know the truth of their condition. Most patients welcome it, often are relieved and are happy that they can better understand their condition and make long-term plans with better knowledge of their condition.

There is a balance that physicians struggle with. If there is a reasonable expectation that the health care system can significantly improve their condition, then I will strive to be positive, even if the short term outcome is expected to be dismal. In one sense, there is always hope, but that hope depends on the objectives of the physician/patient encounter. If the expectation is to prolong life no matter how miserable that life might be, the treatment options are going to be different than if the objective is to simply offer comfort measures. Both contain hope that the therapy will work, but the outcome expectations are different. Thus, in a real sense, hope is never lost.

The source for hope is my greatest concern. Patients usually do well or do poorly in spite of me. Health care professionals have less control of a situation than they would like to believe. To trust that the health care profession will provide health is a mis-direction of one’s trust. It is always a pleasure when a patient comes to me, realizing that only God can give them hope, and trust in Him is of greatest value. It is a pity that so many devout Christians have a seriously displaced hope, trusting entirely in the physician, and not seeing that even the best physicians have feet of clay. Balance is important. To ignore the physicians that God provides is unwise. To expect that physicians always know best is also unwise. Many Christians run to Hookey-Pookey medicine (Chiropractors/Naturopaths) feeling that they are more “natural” or “christian” than mainline medical practice — that is also highly unwise.

We don’t want our patients to loose hope. We wish for them to have the correct source for their hope. We wish them to have realistic expectations. We wish them never to give up. We wish them to be able to change expectations when the facts suggest it. Mostly we wish them to maintain the three Christian virtues, faith, hope and love, up to the very last breath that they take.

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