Woody Allen is quoted to have said “Eighty percent of success is showing up”.  In Medicine I suspect the other twenty percent of success is ten percent decent documentation and the other ten percent is not being a jerk.

From time to time I review medical cases consisting of complaints against doctors. These originate from patients or clinics remonstrating their (now former) physician failed to follow standard of care, usually written in some sort of formal fiddle-faddle. But the gist is always the same. The doctor has pissed them off and their feelings are hurt.

I may not be the most brilliant of physicians but I connected the dots early if I did the following things I would look brilliant:

Explain things

Document what I am doing – and why

Actually listen to patients

and (most important)

Don’t be an asshole. 

The case I just finished (and what a job that was!)  made my eyes cross how awful was the physician. The clinic where he worked created a catalog of complaints against him. Reading between the lines I daresay most of their kvetches were spot-on valid.  However, the clinic notes and EHR are so bad there is no way to support any of their allegations against the man.   Dr. Demento is going to get off thanks to poor documentation.

I’m convinced if doctors acknowledged their blunders and were less patronizing  this would eliminate most lawsuits and medical board investigations.  I’ve had a few cases when I could have been easily cleaned out by a lawsuit but I had the balls to say I’m sorry and/or hear the patient vociferate without becoming defensive.

Along with a much-earned consultation fee I receive ‘free advice’ from each case I review on how NOT to be a bad doctor.

I may not have élan but I am not as a schmuck.

*Beim schlafengehen – German for ‘at the time of falling/going to sleep.’

I thank all of you for your comments of concern and encouragement. To clarify: I am not burned out from work; I like my job and I am proud of my profession. My dissatisfactions lie elsewhere.  I will post on these matters anon.

Meanwhile there is beef broth.

It’s getting down into the 40s at night and for the first time in many months it is cold enough to keep the windows closed. I am wrapped in my white terry bathrobe for the first time since January.  I am drinking beef broth. Broth – whether beef, chicken or vegetable – is a lovely beverage for late November nights. The steamy salty hot toddy runs down the throat and warms my innards.  The sodium content is not good; it is best not to think about it. All the same, it soothes the mind and makes the evening lovely.

I will unpack the gym bag and repack it for the morrow. I need to lay out tomorrow’s clothing; I need to pack Tuesday’s lunch. This concludes the day. I will go to bed (probably with a good read) and pull up the covers. Harper makes a good hot water bottle.  Hot broth within me; warm furry hound without.

My hibernaculum is complete; please don’t wake me until March.  Sleep dreams to Spo-fans near and far.


SideviewYesterday while walking on top of the mountain that overlooks Palm Springs I felt a black mood come over me. All the open Windows in my brain, which I had counted on this morning to create a splendid blog entry, all shut down leaving me dull and stupid. I suppose it was the altitude. It was well above 8,000 ft; the temperature was in the lower 40s and the wind howled like it was early spring in Michigan. Instant seasonal affective disorder.

It annoys me the-weekend-is-over-I-have-to-go-back-home blues likes to kick in while having the holiday; it ought to wait until we get on the road, but there it is.

Having a break from the mundane gave me pause to consider Life, the Universe, and Everything. I need to get more vivacity back into my life. Taken further, the many dissatisfactions in my daily deeds need doing. There’s got to be a shakeup.

While Someone drives home today, engrossed in Sirius broadway tunes, I will look out the window and start to solidify what I want to improve. Where this is going I am uncertain. I hope by day’s end I have some concrete goals established and the initial steps necessary to inchoate them.  I don’t think I will blog about this much. Self improvement entries make dull reading.  And The Board of Directors Here at Spo-Reflections won’t have it.  Perhaps I will sneak in an improvement update when they occur.

Yesterday instead of buying oh-so-practical boxer underwear I bought some bright and bold ‘Colt” shorts to replace my worn out nether drawers. Now I am off to brunch. For breakfast I am having oatmeal and fruit, not eggs Benedict. These are small steps I suppose but satisfying nevertheless.


Greetings from Palm Springs.

How I’ve longed to be here! There is nothing specific about the place which makes it so seraphic, other than I feel good to be here. Perhaps it is the cleaner air; my allergies have already cleared up. Maybe it’s the company of fine fellows – Fearsome Beard came to town (the dear!).  Being surrounded by handsome hirsute hombres (in various stages of dress) probably has something to do with the sense of eudaimonia.  Sometimes it is best not to analyze things, especially when things are well.  Sit back, have a cool drink, gab with buddies and gap at the lovelies.

Someone and I drove into town last night to meet friends who have been here on holiday. They are all well over four feet.  Shawn drove in from San Diego. This morning we had a lovely breakfast consisting of more calories than I consume in a day. Now it is poolside sitting and not more else. I have no sense of having to go out and see the sights or be enlightened by some sort of lecture.  As a boy I was flabbergasted Mother didn’t want to do anything but sit poolside and read a book; I now know precisely what this means.

The only impediment to this otherwise zen-like weekend is the distraction. Surrounded by men who are ‘sky clad’ makes it difficult for me to focus on my Balzac novel. 19th century novels haven’t a prayer when directly across from me on the other side of the pool reclines a chorus line of bare backsides. Happily, I am wearing a dark set of glasses to avoid my obvious staring although I must remember to turn the page from time to time for appearance’s sake.

Some of us will go into town to do some shopping while some of us will take the tram up the mountain to see other sorts of spectacular views.  This evening is ‘show tunes’. Gin and tonics are probable.

Ah, but this is pleasant. Why on earth I don’t do this more often is a mystery.

popcorn-kid-bagSomeone is in charge of picking up the post, but he doesn’t do it on a regular basis. Sometimes like today there is a quite a barrage, an accumulation of several day’s deliveries. Today I received a few packages: medication (from Express Rx), a package of fabric from Jeffrey Ravenwing. These were expected. However, there was a surprise.  In a box labeled ‘Your cheese snacks have arrived!” there were three bags of gourmet-style popcorn. Someone questioned the purchase; a mild interrogation  got me to remember I had indeed ordered this.  A while ago an industrial boy scout was going door-to door selling popcorn; I was in a charitable mood at the time (dammit, I was a boy scout once).  I had completely forgotten this event until now.

The arrival of several large bags of popcorn into a house with two dieters is about as welcome as a delivery of “stash” to a sobriety house. Bad timing indeed. I thought of packing it up and returning it but this seemed indiscreet. We made a vow not to open the damn things but to bring them this weekend to Palm Springs for munching during discussions of recondite matters.  It was only two hours before two of the three bags were opened ‘just to see’.  Great. I am going to appear in CA looking lumpish and no nibbles to pass.

Once upon a time “Just Say No” was recommended as as the panacea to drug abuse; it was laughable then as it is now – especially when there is Halloween candy in the freezer. I foolishly thought putting the sweeties into a cryogenic state would dissuade their consumption. Alas no such luck.

I recently reheard the Genesis story and I wonder about the logic of Elohim for putting the tree of knowledge smack-dab into the middle of Eden and then telling A&E not to touch it. Anyone whose ever placed a bag of cookies onto the kitchen counter knows how feckless and futile it is to tell people ‘Don’t touch’.

If you lack willpower the best you can do is rid the house of all temptations. I should thaw out the candy bars and bring them to work,  or pass them along like runes. I hope the boy scout who sold me the popcorn revisits soon. I plan on giving him a bucket of frozen skittles and tell him never darken my doorstep again.


Word has come to us The Board of Directors Here at Spo-Reflections of certain characters of ill repute who are running around blogland surmounted by atrocious Viking horns in gauche imitations of ourselves. Although we acknowledge imitation is a sort of flattery we must remonstrate using the strongest possible terms there are copyright laws that clearly forbid the use of trappings and handbags reserved for the use of Board Members and/or their delegates without written permission. The Board of Directors has asked loyal readers of this blog to be on the lookout for the following reprobates:



Exhibit A.

He is well over four feet and in his spare time he is prima donna of the San Diego Opera Company.

Best lured by hair tonic.

Reward:  500 pieces of Danegeld with beard;  600 pieces without.



Exhibit B.

He is well over four feet. While Freya’ chariot is pulled by two cats and Thor’s chariot is pulled by two goats, this scurrilous intransigent has a chariot pulled by two lapdogs.

Best lured by a pitcher of cosmos.
Reward:  500 pieces of Dangeld with clothes;  850mg pieces without.

* Apparently the writer of this blog has graciously offered a bonus, provided he gets to deliver B’s punishment.




Exhibit C.

She is well over four feet. If spotted do not dare to approach without group assistance and back up drugs.

Best lured by philly cheessteak sandwiches

Reward: 600 pieces of Danegeld with wand; 700 pieces with soundtrack.


Viking Horns 2

Exhibit D.

He is well over four feet.  He is the writer of the blog; there is nothing noteworthy about him.

Best lured by comments.

Reward: 200 pieces of Danegeld if someone  would please take him off our hands even if only for a little while but he has to be home by Monday we really could use a break just don’t give him buns and things.

imagesI’m worried about the mesquite trees; they are up to no good that’s for certain. The one in the backyard has three or four primary trunks, one of them is leaning over the top of the house as if it is thinking of spreading its branches and lifting off the roof in order to have a look-see. Someone has called the groundskeeper several times but there’s been no action and the menacing foliage leans closer with each passing week. I fear the next bout of wind or rain will be its downfall.  Its brother in the front yard is no less sinister.  Mesquites don’t have a deep root system and the ground turns to mud pretty quickly in a downpour. I am guessing it has a fifty percent chance of falling forward into the street (preferable) or back onto the front of the house.  I’m all for chopping both of them to smithereens.  Mesquite trees are a nuisance: in summer they shed small, black legumes, which resemble desiccated dog droppings.  In the spring their chartreuse pollen dusts everything and makes pool maintenance a 24/7 job (and my allergies hellish). Nasty things.  People pay big money to have mesquite wood for their yuppie BBQs. I see profit and safe sleeping with the demise of each branch and twig.

Nature is attacking from within as well. Unlike Napoleon, Mother Nature’s two front assault is succeeding at driving Urs Truly to distraction. A legion of flies and small biting gnats seem to be getting through the screens via osmosis or teleportation.  It is hard to concentrate at night knowing some small buzzing bastard is hell-bent at sucking my blood and giving me at least an itch and at worst the mosquito-borne illness de jour.  I don’t recall having flies and gnats this far into the year, but there they are.  I would attribute this to climate change but most folks here in AZ poo-poo this notion along with evolution, global warning,  gun control, and allowing Hispanic people the right to vote.

Et alors, as mon ami from Ottawa recently taught me to say.

This Friday Someone and I will get the heck out of Dodge and leave the trees and bugs all to themselves, for we are going to Palm Springs to see Mr. Fearsome Beard et. al. and get some roses in our cheeks (or at least a decent drink). Meanwhile I must get through a busy week and try not to have falling branches cancel the whole caboodle.


Spo-fans know when I complete a shirt I like to post its photo; I like to display my industry.

This ‘retro-style’ colorful cloth made a nifty shirt indeed. In it, I have a fancy to smoke a pipe, grill red meat, and vote for Eisenhower.

I was going to make it for “somebody” –  I didn’t know who, but (alas) it has a few errors.  One was blatant enough (to me anyway) I don’t want to give it to anyone, lest they spot the blemishes – and there goes my good Henley Street name.  So I will keep it myself, although it is a tad too big in the shoulders.
I am relieved to have a new frock for Someone reminds me  we go to Palm Springs this Friday.

Imagine showing up in PS in last year’s outfits?  How gauche.



I have just returned from a walk with Harper. It is still warm enough to wear short trousers and a T-shirt out of doors even at 730PM.  I wish this town would cool down.

Harper didn’t mind. Unless it is raining she is glad to go out anytime.

This weekend has been rather a bust. Last night we walked out of a local theatre production for we were both tired and not enjoying the show. Normally we don’t do such a thing, but to sit there out of Midwest guilt, bored and wishing to go home and to go to sleep, did not make sense. We were both asleep by 930PM.

Saturday morning was spent sitting in a medical conference.** The subject was Valley Fever, which is a nasty fungus that lies dormant in the desert dirt here in the Southwest (60% of cases are in Arizona).  Most people who move here get exposed; it is a sort of microbial welcome wagon.

I spent the afternoon dictating charts.

I decided I needed to do something other than Medicine, so I worked on a shirt while Someone played a “Dr. Who” episode in the background. I didn’t well follow the plot for I was engrossed in my sewing. Apparently the Earth was (once again) being invaded by Daleks and/or Cybermen. The Daleks are getting on my nerves with their plainsong of “Exterminate!” which they shriek at regular basis. I blame them for my bungling of the button holes, which came out all mish-mashed and had to be exterminated themselves. It is a terrible tedium to rip up newly-sewn button holes. Stinko. I need to get this shirt done by next weekend but in my state of solicitude it is a bust for now.

Gads, but there is work to be done. Speaking of deadlines I need to finish reviewing a medical case as soon as possible. If I read the notes properly, the clinic in question uses electronic health records which changes Rx prescriptions in retrograde. Example: a note dated June 2013 reflects Rx which are dated December 2013?! In notes from December 2013 the prescriber actually initiates the mentioned medicine. Dr. Who and his Tardis should have such time travel. If this is correct then the clinic doesn’t have a leg to stand on in their complaint about the physician for there are no notes to support their allegations.

The remainder of this degenerate and debauched day will be spent reading blogs and doing more homework. If I am really depraved I may start Sunday’s laundry early. Oh what reprobate living.  It is small wonder my existence is a threat to national stability.

** Other than doing paperwork, isn’t this what Saturdays are for?

I have a rule not to write a blog entry when I am a) tipsy b) depressed or c) in the bathtub.

I am certainly not a) or c), but I am a bit b).  It comes from the combination of today’s 6th court decision, the election, my inability to shake a cough, and a disappointing work out. These things are probably temporary, although I have some doubts about the first two items. I lack equanimity; I will defer matters to those with clearer heads.

keep-calm-and-stay-at-home-4My work is asking me if I am planning a February holiday for patients are already getting booked. The usual travel companions are going to Central America. Someone doesn’t have much interest in revisiting PV.  We could go on a cruise I suppose. Or we could visit somebody.  We’ve had lovely invites from folks all over: Portland, Albany, New Hampshire, Ottawa, Arkansas – the list is a long one. Alas, none of these places sound too jolly to visit in February.

We have a lot of house projects and repairs; perhaps I should stay home for a week in order to save money and work on the house.  This is not a bad idea.  Taking a week off and sitting still (more or less) sounds rather attractive.  I wonder if I would survive. I could lead a dull life: go to the gym, do crosswords, and be a flaneur.  I could  eat some nice meals and drink tasty bourbons and whiskies (no rubbish) every day as if I on holiday.  This sounds more delicious with every tap of the keyboard.

I suppose I could do something on my bucket list. Example: I want to see a tea plantation. Amazingly South Carolina has one – and it is one of the remaining states yet to be visited.  This would be killing two birds with one stone.  I wonder how cold is SC in February?

I must ask Someone what he thinks of this modest proposal of a week of stay-at-home idleness. He will probably insist we ‘go somewhere’ as I will need the break and need to get the heck out of AZ. He has a point.

If any Spo-fans have working proper fireplaces I would be tempted to visit even in the gloom of February.  Just let me curl up on the floor in front of a fire with a good book and a snort and I’d be most grateful.


A yellow labrador retriever puppy sleeping in front of a roaring fire.

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November 2014
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Spo-Reflections Years 1&2


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