Just coming out to check on y'all

is America great again yet?

I know I haven’t written much as of late, but hey, that’s a distinct advantage of having a free Substack — I don’t feel much pressure to deliver essays for what you pay me, but I promise I feel the pressure to write some Riveting Politico-Medical Storytelling For All of America. Who hasn’t encountered American medicine to some extent? If we’re to rely on confirmation bias, that audience must be approaching 110%.

Yes, work has been consuming of late. To look at it another way, I’m simply doing research for this Substack.

Here’s a short one I think you’ll enjoy:

One unusually quiet day in the hood I was in the Post Office to mail a package. The postmaster seemed to be having a good day and her greeting matched, but she was not typically one for much more than that. Maybe it was because there were just the two of us that slow afternoon, but she went on to ask me how it was going at the clinic. Like her, living in a small town allows for no anonymity.

I answered, “You know that game, Whac-A-Mole? Lately, every day seems like Whac-A-Mole. For every mole¹ you put back in its hole, another pops up, but your job can’t be much different, is it?”

She laughed, “No, it’s the same.”

“Same here.” Both of us were a little surprised, as I turned around to see one of the High School teachers had just walked in on our conversation and clearly identified enough to chime in.

Then all of us were laughing. As different as you might think our jobs are, they are remarkably similar in some ways.

Whac-A-Mole²

We are not makers of history. We are made by history - MLK Jr.

One of the things I enjoy most about meeting a new patient is asking their occupational history.

Yes, there are the medically important aspects of an occupational history – past and current – which reveal toxic exposures/risks, shift work sleep schedules, hearing damage/risk, protective glasses, job-specific vaccinations, psychological stress loads, repetitive use injuries/risks, etc.

And then there are the anecdotes that transform clients into individuals I would never forget, and could only wish I’d known them many years ago, knowing they had much to tell me and teach me.

Yes, for older generations:

“Housewife.”

“So, the hours are long, and the money isn’t great?”

“Exactly.”

One morning:

“Well, I was a housewife, but during the war I put phones together on the assembly line.”

That afternoon:

“Well, I was a housewife, but during the war I put phones in boxes on the assembly line.”

No, I would not dare kid you.

And yes, many more anecdotes which are so niche you might have known those people too, so I’ll keep them to myself.

Other great reasons to know a person’s occupation? Pointing out the similarities of our jobs takes away some of the mystique of the practice of medicine, makes our relationship more personal and and makes me more relatable. It allows use of more appropriate analogies in our conversations that I know they will identify with and understand.

While we’re all busy drawing needed lines in the sand and shrinking our trust bubble, there are indeed places we can meet and re-learn about each other. I encourage you to look for them.

1. I find the disambiguation of “mole” curious:

1. There are, of course, the numerous little mammals known as moles (Latin: talpa) of the Family Talpidae

2. I happen to make a fabulous mole negro.

3. As an oncologist, I would like to pass on the ABCDE’s of identifying a mole as possible melanoma

4. One mole = 6.02214076×10²³

5. More esoterically, to me at least, is a large man-made structure separating two bodies of water is known as a mole. These were once common in the San Francisco Bay Area, improving navigability for ferries to reach the more shallow, marshy areas found along the eastern shores.

2. Whac-A-Mole was created in 1975 by the amusements manufacturer TOGO in Japan, where it was originally known as Mogura Taiji (モグラ退治, "Mole Buster") or Mogura Tataki (モグラたたき, "Mole Smash"). I’ve looked into buying one of the older models for the clinic staff to work out their frustrations, but I don’t think any of us have $8,000-10,000-worth of frustrations to work out.