By IM Doc, an internal medicine doctor practicing in flyover
Yves had asked me to write something for pledge week and it was my absolute honor to do so. Sites like this one are so rare in our discourse and I feel we should do all we can to maintain them. So please contribute at the Tip Jar!
I have followed this site religiously and daily for more than a decade. I never commented because I am not an expert on much of anything but Internal Medicine, Medical History & Ethics, and Classical History & Languages. CalPERS shenanigans and corporate malfeasance are just not in my wheelhouse. But all through those years, I read the Links and Water Coolers religiously and also the comments.
And what an amazing and rare site this is. Rational discourse between rational actors with respect and admiration for one another. And a fundamental decency when it comes to arguments. I heard Joe Rogan on podcast the other day describe Social Media perfectly. I can attest that he hit it right out of the park – “Twitter and Facebook are nothing more than a mental hospital with the inmates spending all day throwing shit at each other.” Exactly correct. The amount of work to moderate this kind of site and make sure it remains valuable I know is overwhelming and I cannot give Yves and Lambert and Jerri-Lynn and all the others too many kudos for their hard work. So don’t forget to help out via the Tip Jar.
As you can only imagine, the past two years have been incredibly difficult for myself and every health care worker in America. What really bothered me early on was the complete lack of rational discourse and truth-telling that was happening in our media. But I saw both here – and found a place where I could read links and comments and be forced to ponder – often in a manner that was just simply not happening in the medical world. And it just so happened that I am indeed a trained professional in this area and before long I started commenting.
I am not a journalist. Nor an investigative reporter. I am a physician who has done everything I can to strive to do the very best job I could for my patients during this nightmare. I also do everything in my power to be a truth-teller. It is the way I was raised. And what I was seeing on the ground in real life in my world and what was being reported in the news were often completely divergent. More concerning to me was the media and its incessant bathing in histrionics and panic porn. I could see the results of this in the psyche of my patients and felt compelled to do something, anything, about it.
The foundational figure in Internal Medicine is a physician of the early 20th Century by the name of Sir William Osler. One of his seminal works is a piece extolling what he thought was the most important characteristic of any physician – AEQUANIMITAS – which is Equanimity. The ability to stay on an even keel through even the most dire of situations. To be the Rock of Gibraltar for your patients when their world was falling apart. I have spent my life pounding that cardinal concept into the brains of hundreds of students over the years. And what I saw on TV from the likes of all the talking head doctors and our federal health officials was the absolute exact polar opposite.
Sir William Osler. The founder of Internal Medicine. The man who singlehandedly put Johns Hopkins Medicine on the map. One of my foundational heroes in life. I have spent much time the past 18 months on very dark days filling my mind with his exploits, his writing, and what his peers had to say about him. One of the most poignant statements I have found was written by Harvey Cushing MD, the founder of Neurosurgery as a profession in this country. Upon hearing of Sir William’s death, Harvey Cushing wrote the following, paraphrased from the Book of Isaiah -which later became part of Cushing’s masterpiece – Consecatio Medici. I quote:
And that man shall be as a hiding place from the wind, and a covert from the tempest; as rivers of water in a dry place, as the shadow of a rock in a weary land.
That is how Dr. Cushing felt about his mentor Sir William Osler. It also encapsulates how I feel about my mentors of Medicine and how I know they would have responded to this COVID crisis. Nobel Laureates, textbook writers, seminal medical figures of the 20th Century they were – and somehow I know in my heart that they would have been very disappointed in where we are today in Medicine.
A brief story about my very first day of internship all those years ago. My first attending was an Infectious Disease doctor. And my team had just admitted 19 patients the night before. We were slammed. The resident had to go to Morning Report – and the attending looked at me and said “IM Doc will take us to the easy patients first.” And so off we went. In those days, the intern, who had been up all night, stood at the head of the bed with the attending on his immediate left. No notes allowed. The full presentation came from memory. This first patient was a middle aged VietNam veteran with chest pain. I presented the patient in complete detail. The Infectious Disease attending looked at me – “IM Doc, please tell me how the diagnosis of meliodosis would fit in this patient.” “Ummm Sir – I never considered meliodosis in this patient. I am not really sure what that is.” And he looked at the patient and announced – “I sincerely apologize for the complete incompetence from this intern today. Believe me, we will get this straightened out – and he and I will be back later today.”
My very first patient as an intern. I just wanted to go back to the farm. But this attending did not give up. He taught me to be tough under pressure. To be confident and most importantly to tell the truth and admit what you do and do not know. It was intense. It was a trial by fire and it was a frat hazing. But treatment from him and similar treatment all year round during that year made me who I am today. And he and I became fast friends all the rest of the days of his life. He was a mentor in every way to me.
We do not expose medical students to that kind of intensity today. Not even close. Anyone doing that would instantly be branded an evildoer and ridden out of town. But that is the way it has been done for generations – and I fear something has been lost.
And I see the results of this every day in my life now. We were just a generation ago taught to be fierce and independent thinkers. To question everything. To realize that answers were a quest and authority was often the wrong place to look for help. We took the scientific method and applied it to each and every patient decision. We were taught to be comprehensive and unyielding in our advocacy for our patients and their very best outcome. We were taught that our patients were to be treated always with the utmost in care and ethical behavior.
Somehow, my profession has lost its way. We have handed over our autonomy to corporations and hedge funds. We have completely fragmented the care our patients receive. There is often no one “in charge”. We acquiesce like sheep to all kinds of suggestions from our betters no matter how imbecile they are. Doctors come and go from practices as if staying longer than two years was a mortal sin. The vast majority of us are now employees and are completely powerless to effect change no matter how important.
Many are now talking about moral injury among Health Care Workers, and this could not be more true. I hear constantly, and I mean constantly, my colleagues all around the country decrying how this whole COVID situation has gone down. But yet they are up to their eyeballs in debt – either from school loans or their million dollar homes – and can simply not afford to question or make waves. I am absolutely certain a reckoning for my profession is on the way, and it cannot came soon enough.
I however do not feel all that trapped. Because of sites and sources like Naked Capitalism, I long ago realized that personal debt was one of the big sins of the American way. I long ago realized that our current neoliberal and corporate culture was almost in every way driven by motives that were the exact antithesis to ethical behavior. And I planned my life accordingly.
I am in a position where I can speak out, even anonymously, and I have felt morally obligated to do so. I have felt the absolute compulsion to speak for those in medicine like my mentors who have already gone on. And I will be eternally grateful for Yves and Lambert for allowing me to speak freely. There were times this year I was reporting to them things that were completely in a different universe than what the CDC was saying. Even I was beginning to question my sanity. But they never wrote it off. They doubled down on getting accurate information out there. And I can tell you as a member of the COVID brain trust – just how much crazy they sift through every day. They have my undying respect.
Mrs. IM Doc has been very concerned about me lately. I have aged years in just the past 18 months. This entire thing has taken a huge personal toll on me and indeed all of my colleagues. I now understand the mental and spiritual toll that questioning the dictates of authority can cause. I saw this in my attendings during the AIDS crisis – and now it is my turn. Their one overarching lesson – is to not stray from the truth – and when you are wrong immediately admit it.
As is happening all over the country, in my community, two primary care physicians have announced their very early retirements in just the past few weeks. Their thousands of patients will now have to be cared for. There is just simply not enough capacity anymore. I know from talking to others that similar issues are occurring everywhere. This problem has been building for years in my profession. It has taken a crisis to bring it to the fore. I am very concerned about our immediate future.
One thing is for certain – we are not going to hear the true extent of our culture’s problems in medicine from our media and its blind loyalty to Big Pharma, Big Hospital, and Big Insurance. It is going to take sites like Naked Capitalism to fill the gap – and I urge everyone to support this site in any way possible. If you can give, give generously, the Tip Jar tells you how.
You can also contribute by telling your friends and family about Naked Capitalism, sharing posts and comments, and making comments of your own.
And speaking of commenters, my deepest gratitude for all the commenters who have put up with me and corrected me and told me when I am full of crap. The best commenters in the universe.
42 comments
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Dear IM Doc, We are eternally grateful to you for your comments, along with Yves and the group as a whole ( and the person who invented copy and paste so we can pull out your comments to save like a diary of sanity in the madness).
I can’t begin to express my appreciation for this site as a refuge from all the “media” out there that after consuming leaves one with the sinking feeling that all is NOT well, but that things are completely corrupted.
Time to head back to the desk to send a second donation after reading your post today.
May you all be well.
I want to second Randall and thank you for all of the writing you do here IM Doc, your posts and comments are always edifying. You aren’t alone in having questioned your sanity, my wife is a virologist and that was the field my education was in also(although I did not complete), and we have frequently wondered if we were nuts throughout this thing.
I remain hopeful that the truth will win out in the end. Thanks for all you do.
To the above, we can thank a few computing persons at a Xerox facility in Palo Alto. That’s the origination of the word processing steps ( applies to Excel data junkies as well ). Copy paste, I meant to note.
We are better for the comments and anecdotes that IM frequently shares. I know that when he posts or comments, it’s a must read.
Very well said Randall. Thanks to IM Doc for your perspective and all your comments here, as well as everything you do for your patients. We appreciate you greatly!
And Joe Rohan’s description of Social Media is EPIC in its truthfulness. That will certainly be one that stands the test time.
Jaron Lanier’s 2018 book Ten Arguments for Deleting Your Social Media Account Right Now expands the negative consequences of social media participation summarized in Joe Rogan’s description.
http://wisdomofthewest.blogspot.com/2021/11/goodbye-cruel-social-media-world.html
I would argue that a blog with a curated comments column – like this one – is not, or at least not necessarily, a part of the “social media” that is not only showing us our collective flaws, but amplifying them. Staying on the path is hard, and discipline helps us. I am reminded of something from a book by Idries Shah:
Thanks for your service, IM Doc. One recommendation, if I may – high intensity interval training. It may even help elongate your telomeres, but at the least, give you that endorphin rush. :>))
Thanks for having the courage to share your comments. All the ones I’ve read that you have posted are well reasoned, written, and come from the heart. Your contributions keep coming back for my daily dose of NC.
On the misinformation trail: for decades I have supported the CBC Canadian Broadcasting Corp, Donating to Friends of the CBC etc. The comments allowed on some items only, have become so censored that they are either hate for the non vaxxed, (unvaxxed seems silly, you cannot undo a vaccination) or a cheering section for Big Pharma. The deliberate destruction of the low cost effective Ivermectin as only fit for worming horses, and only crazy people would think of ingestion it, along with a total shut out of info on Uttar Pradesh or India in general. Has forced me to block Friends on my e-mail. At the other end the shut out of Israel which is a glowing example of how ineffective the vaccines actually are. The question arises as to who owns the National Broadcaster?
I have seen the same or similar complaints made about the behavior of national broadcasting agencies elsewhere – in the USA, UK, Australia, etc. I am left to wonder why this mindset has taken over in journalism, which was once the bastion of fearless investigation and exposure of corrupt human behavior.
– Is it modern propaganda practice in which governments require broadcasters to parrot the government line to support the electoral prospects of that government?
– Is it government members having sold out the public and any adherence to truth, science, and the public good in return for political contributions and the opportunity to profit from bribes or from insider information from Big Pharma?
– Is it the apparent psychological weakness in the human mind that we seek to conform to the popular opinions of the crowd around us, to join the “consensus” even if we have not considered the issues or even if we think the consensus if mistaken?
– Is it pure self-preservation, saving job, career and family fortune by kowtowing to popular sentiment and stifling any urge to speak out against nonsense?
– Is it the takeover of journalism and the elimination of all contrary voices and investigative journalists by the small cabal of corporate owners who now have oligarchic ownership of US media?
– Is it secretive government agencies such as the CIA, FBI, and MI5 that have taken over editorial offices and now dictate the narrative presented to the public to control or at least distract the public?
-Is it the well-meaning but deluded Social Justice Warriors who suffer from what Alexandr Solhenitzen called “ideological possession” who see society through a “Class Struggle, oppression and exploitation” Marxist lens leading campaigns against capitalism, racism, misogyny, elitism, inequity of wealth and outcomes, preaching inclusion, intersectionality, and rigid conformity to their dogma, threatening to “cancel” and shame-label anyone who dares raise any question about their ideas or endless “isms”?
– Is it the resurrection of Gestapo-like government that is fanatically intolerant of any public dissent or expression of ideas outside their rigid boundaries of “acceptable speech”?
the Ottawa citizen story from sept 27 2021 about the military using propaganda techniques against the canadian people as another experiment in the use of disinformation against populations, seems to be a part of what is going on.
add that to all the disinformation out there from other gov’ts …. in the anglo-american axis of corporatist neoliberals who run things everywhere.
the vaccine machine is surely in that constellation
I have learned from all of you and am grateful. IM Doc, your contributions are sobering, instructive, and grounding. Thank you for setting such a fine example and for making such sacrifices to help us all see more clearly through this crisis and the hysteria. Naked Capitalism is a fine example of naked honesty in the dialogues here, especially when it is uncomfortable and goes against the majority opinion of the day in order to get to the truth of things.
Very well said and thank you IMDoc (and the other Covid brains trust members) for your invaluable contributions here.
Right back at you, sir. Your insight has been much appreciated. Be well.
Thank you for all your work and contributions here. I could tell the level of frustration that you must have been feeling by some of your comments and it would have driven a lesser person nuts. I do wonder how the younger generation of medicos will turn out from what you say when they achieve senior positions eventually. Was reading in “The Making of a Surgeon” by William A. Nolan how they put young doctors under pressure back then to see if they were capable of being under pressure and still being able to function.
Your story of being an intern reminded me of a story from it. Nolan said that he worked with an intern that would make up bs when talking about patient in front of an attending. But he got his one day. He made up some figures which the attendant thought off and so he grabbed an instrument to check the patient’s eyes out. The first eye was OK much to that intern’s relief but when the attendant went to look at the second eye, the patient said: ‘No sense looking at that eye, doc. That one is glass as I lost it years ago.’
I hope you write a book IM Doc! You are a voice for sanity.
Il Tempo is a newspaper aligned with right wing political parties that contain a significant level of Covid denial. I’d take what they say with a grain of salt. The center-left papers (like Repubblica) are no better, in that they never deviate from the “vax is the only solution” line.
Thank you IMDoc! I always look forward to your contributions to NC. I never cease to learn something from your writing and hope to see much more of it here.
Your voice is invaluable. Thank you!
Wow. Stop the presses. People with preexisting conditions are more at risk from Covid-19?? I had no idea. They should have gotten healthy before the pandemic hit – poor planning on their part.
Please don’t neglect self-care. Hopefully the ageing of the last year and half is superficial only, and we will have you hale and vigorous for decades more.
IM Doc, you are an inspiration. As a musician and a public school music educator, your comments are an inspiration for me to continue to “teach” and model good citizenship, honesty, and humility to/with my young students. The adherence to fundamental principals of care, love and humility throughout ones life – regardless of the powers that be over time – is reinforced through your comments and observations. We can’t wait to hear from you again – always a pleasure.
Thank you very much, IM Doc, for your steady hand reporting from the front lines of this situation.
Thank you IM Doc for all of your wisdom, knowledge, and your voice of sanity. You are an invaluable member of NC. I look forward to reading more of your in-the-trenches reporting.
IM Doc, you are one of the shining lights on Naked Capitalism. And I would like to echo what others have said: Write a book!
Thanks, Doc. Your reports are deeply appreciated!
Without a doubt, the combination of (1) policy discourse put through the semi-literate postcard format of twitter, (2) profit-first health care, (3) post-Trump political polarization to the point of intolerance of contrary opinions, and (4) the pressures of the pandemic — all make for pretty heavy cognitive dissonance. Don’t let it get to you!
Best wishes to you, family, and patients, and big thanks to the NC crew.
IM Doc. I always read your analysis. In the beginning of the epidemic I’d sit down at my computer tense and anxious… will I live to see my next birthday? And overtime as I read you I thought, yeah.. I think I will. Because you were, above all, the voice of reason. I decided early on that nobody knows what is going to happen, so be careful who you listen to Susan. I chose you. Thank you. And Yves.
I Personally Identify with your anguish IM Doc, after decades in positions of responsibility, where one can see the rot spreading, destruction of knowledge and ethics in the name of some concocted ideology that seeks domination/dominion over all else.
Watching as those that held the high road were diminished, turfed out, flat out removed, so younger less life experienced malleable sorts could be inserted in their stead, usually at much lower remuneration save for the title – what the game is all really about these days. Hence my currant work allows me to both operate as an ethical person and utilize all the skills I’ve built up during my life time, not to forget all those that are pass on down to me by the old sorts.
The day you stop caring is the day they win …
Apologies for this pedantry, your comment reminds me:
“They also serve who only stand and wait.” -John Milton
https://www.poetryfoundation.org/poems/44750/sonnet-19-when-i-consider-how-my-light-is-spent
Many may doth a garb … yet whom is living it …
I find this so applicable to so much during the neoliberal period e.g. so many that did rail against forces they did not understand and joined groups to find solace in numbers in fighting something, they did not understand, then ultimately find it was just a variation of the thing they were fighting against.
Case in point. Knew a guy that once was a die hard AET libertarian at a state level and did his damnedest to forward that political agenda only to find out after climbing the tree of good boy success [productive(tm)] he was devastated personally to find out it was all a sham concocted by those he thought he was fighting against – hay kid you made it ….
What does that do to someone … what are the long term consequences for a society when its a marry go round and everything you attempt at the individual level just turns out as another scam. Yeah you got sucked in due to your need to find a more symbolic life with your fellows and then given the choice of giving them all the flick so you can have more and when pulled up on it tell them to have a Coke and a Smile …
“I now understand the mental and spiritual toll that questioning the dictates of authority can cause. I saw this in my attendings during the AIDS crisis – and now it is my turn. Their one overarching lesson – is to not stray from the truth – and when you are wrong immediately admit it.”
This triggered a deeply buried memory in me and I searched (NOT GOOGLED) for Fauci AIDS history and found this: https://www.huffpost.com/entry/whitewashing-aids-history_b_4762295
History does not always repeat but it does rhyme and weirdly the same guys with the same MOs keep popping up. On the life saving use of Bactrim as prophylaxis against pneumonia in AIDS patients:
The whole article, written in 2014 and updated in 2017 is like opening a time capsule and discovering that the past is now.
Thanks, IM Doc for all you do and for your words of wisdom. And for NC for giving you a place where your voice can be heard and appreciated.
Thank you IM Doc, Yves, Lambert, J-L, the moderators and the various brains trustees.
Donated.
Thanks IM Doc. It is sad that great people who do great things with the utmost of ethical and moral focus are drowned out by the evil and greed of big medical, big pharma, big tech and big media.
Thank you, IM Doc for this post and for your comments to others – – I always look for them. My oldest daughter is a physical therapist at a major hospital here, thanks to the generosity of her first employers, who financed her education back in the day when such therapists had the advantage of the same rigorous courses physicians experience. This was an enormous gift for which we as a family are forever grateful. And during this crisis, I am so proud of her for being one of the stayers so far, even as short sighted policies cause many to have to leave — for whatever reason. I cannot blame them; in their place I don’t think I would last myself.
But generosity such as that of my daughter’s employers still exists, as a recognition of quality here. All I can do is thank those who contribute to this site — you are the best of the best, as are the hardworking people who give the rest of us this sanctuary in a time of trouble. God bless everyone here.
My brother just finished his residency and is on an army plan. He’s barely started the 4 years he now owes the army & they are so desperate for doctors that he says they’ve already made him an offer for 1 additional year. The offer was big enough he said it would pay for his new born sons college education. He’s struggling with weather to take it or not.
IM Doc,
I think of your wise words in these pages every time I hear the media and especially NPR/MPR (Minnesota) repeat the Nobel Lies of the Medical Elite. When I heard the Dems cut $100 Billion for school improvements from the Infrastructure bill I could hear instantly “All the kids will be vaccinated, it doesn’t matter” in large part because of you and Naked Capitalism speaking truth about such things. I sometimes come here just looking for a word from you, when I need a dose of honesty about what is really going on out there concerning Covid. Thank you, and I hope this works out well for you someday. I wish I could give more.
Thanks Doc. A lot.
Back into the 1970s, I was lucky enough to have a truly impressive IM doctor as a family physician. He would talk endlessly about this and that while asking a few questions. He was never in a rush and never hurried. At the end of which, he’d come to his diagnosis, which was spot on. I never thought I’d meet his likes again for diligence and perceptiveness, until coming across you at Naked Capitalism.
either from school loans or their million dollar homes…
A million dollar home is almost a starter home here in the CA OC.
I wish you could meet my Brother in Law, who was an Early Childhood specialist in the UK. Unfortunately he departed to the hereafter at the turn of the Century.
He and his peers would wholeheartedly support you.
IM Doc,
Thank you for your wisdom. Your comments are always informative and genuine. I sometimes think we’ve forgotten what a human being is supposed to be, but you and the other commentators here remind us of what is important.
I personally know the toll of speaking truth to power. Take care of yourself, and realize that if the world seems to have gone insane, you may be right. Still, your words may be just what are needed to help return the world to sanity.
thank you for sharing your observations and knowledge here. you are a lighthouse that keeps our boats from running aground in the covid night.
if you aren’t already aware, several other sites i frequent for news regularly have commenters that go “IM DOC from NC said…,” so the reach of your wisdom is not limited to this wonderful community. i agree with the others that you should someday write a book about the current fiasco. if i were in charge, i would fire fauci on day one and give you his job, while regretting the fact that i would be most likely taking you away from your lucky patients by doing so.
i cannot express my gratitude for your contributions during these trying times enough. thank you, again, and i am certain your mentors look kindly upon you because of them. you are a real hero.
Thanks all for your kind words –
It made my day today.
I am so lucky to be able to contribute and learn from such awesome people.