The recent headlines about the death of Joan Rivers - in particular the alleged role of her otolaryngologist unauthorized to operate at the GI Endoscopy clinic where Ms. Rivers went into cardiorespiratory arrest - feed the theory that pursuing a career as an MD has transformed dramatically in our lifetimes.
I can remember meeting with many a doctor of my own generation, back in the late 1980s and 1990s, who said, "I'm getting out." Either early retirement because of their unwillingness to participate in the New Paradigm with its curbs on autonomy and excellence, or, perhaps for the less scrupulous, seeking employment/consultant positions with biotech/pharmaceutical companies.
For all the jokes, it may be fair to say that we were better off when, in and of itself, a clinical practice could be as lucrative as an ambitious physician desired. Thus it could attract those who enjoyed clinical work, interacting with people, sleuthing diagnoses, keeping abreast of the latest medical breakthroughs and research, paying careful attention to medications, and supervising assistants and office staff. Medical doctors could look forward to excellent remuneration for the tremendous responsibility.
Today (with third-party-hands on more of that remuneration), if Lucre is still an MD's objective, the name of the Game is: Gimmick.
"Procedurists" (seeing patients on Mondays - routing them into Procedures Tues.-thru-Fri.)
A Little Business On the Side (co-owning ambulatory "procedures" clinics with colleagues)
Competitiveness: "Be The Only One In Town Who..."
Celebrity photos on the wall
Performing procedures "backstage"
Administering anaesthesia at the patients' homes (remember that one?)
Taking unauthorized photos of an unconscious patient, with impunity (Doctor as Paparazza)
Waltzing into a surgery center with NO OPERATING PRIVILEGES and being treated like a star oneself
...Normal medical cautions be damned.
The phenomenon figures into the growing conviction of many that naturopaths and osteopaths, as well as other "alternative" practitioners, are safer to life and limb, which is 180º from the old saw that they were the Snake-Oil salesmen! Among this population, there could be not only increased safety, but greater health and educated participation.
In the PME (Pre-modern Medical Era), I had some very lovely Old School doctors with many famous clients. They were wealthy, but they were humble, careful, and friendly in the examining/consultation room. They were well-informed and gave very considered and conservative counsel to this non-celebrity. If a "procedure" were required, they had attending privileges at reputable hospitals they did not own. Never a soupçon of Conflict of Interest.
As the song said, "Those Were The Days, My Friend".
PS. Interesting: Two days after this blog posts, the following appears in The New York Times:
"The Famous Can Present a Minefield for Doctors: Joan Rivers' Treatment Seen as Possible Example of V.I.P. Syndrome".
Fall-out from some of the Gimmicks I describe.
It has been estimated that the US distribution of blood types is in the neighborhood of 44% O, 42% A, 10% B, and 4% AB. The combination most often paired in couples in my files/ experience is: O with A. I won't speculate as to why that is, but I have found that a brief explanation of the differences in health profile, diet, fitness needs and temperament, go a long way toward piquing O and A interest in Dr. D'Adamo's work. As I did last night, I tell folks:
You're O / Honey is A:
Honey expects you to cut back on your red meat and eat more rice and pasta than you'd care to. Honey might even be a vegetarian and thinks Dean Ornish's or macrobiotic dietary guidelines are Best for Everyone. But A's cooking and choices don't work for you; you feel sluggish after one of A's meals, as if you need higher octane fuel.
Honey's stress threshold might be lower than yours. S/he doesn't seem as hardy a specimen, as if there's something more delicate or high-strung about him or her that requires your protection and sensitivity. Your idea of a fun day together includes far more aerobic exertion than A would like. S/he enjoys golf or yoga - these bore the heck out of you. When you try tennis as your happy compromise, you may find yourself trying to work up a serious sweat while A focuses on perfecting strokes and self-competing, perhaps stressfully. If you two decide on a bike ride, you say, "Cool - Let's ride across the bridge, brunch in Sausalito, and come back," while A would be more comfortable with a leisurely ride around the neighborhood.
Sometimes you feel you're carrying all the weight of the household/family/relationship, but you admit your A is responsible, though not necessarily obviously passionate or energetic.
You're A and your Honey is O:
Honey drives you hard - can even seem a nag or taskmaster, but wears it well, and you're often grateful for the challenges and inspiration. O can give you the "kick in the pants" you need, spurring you to greater career engagement and satisfaction -- or can wear you out trying to reach ever higher, even beyond your capacity.
Honey has a temper. It can shatter your peace, and you just might take to occasionally tuning it out. S/he might appreciate your even keel, but you must consciously explore ways to deal with O intensity.
Honey is more naturally, constitutionally competitive out there in the world; it's more important to O self-esteem to make a splash, and s/he loves knowing the ropes and the right names. You're more comfortable in a somewhat more circumscribed domain, wherein you're happy to keep to your schedule/ routine and work out the fine points. You may be more mental where O is physical. You may fancy chess or puzzles or crafts where O has little patience for these.
Sometimes you may wish your O would relax, act more like a yogi or Buddhist. But if you read Dr. Atkins instead of Dr. Ornish, you'll see what works better for Honey than for you. It's not that s/he really despises Veganism or tofu-eaters; it's just that O can't relate to a way of eating that makes him/her feel unwell. Don't take it personally or ply your O with literature and references versus Meat, or with soyfoods. Rather, read Eat Right 4 Your Type ...and Vive la Différence.
Once O and A understand the intrinsic constitutional differences, this is a complementary pairing that runs the gamut of personality, interest and style, modeling a variety of approaches for any children born to it. And, Good News for the O/A couple: Any biological children will be O or A -- no additional types to consider in the household.
O/A relationship guidelines can be applied to parent-child and sibling-sibling relationships, too.
"Sheesh - you're just like your father!" might find some explanatory foundation in blood type.
Some version of the above Diversity Explanation has interested many I've told in the bloodtype work. It brings a practical, real-life solution directly to points of curiosity and even vexation in the actual day-to-day lives of many couples, and individuals. Where the D'Adamo work is thus brought down to earth for someone, s/he is not likely to easily scorn it where it is derided, but might instead say, "There may be something to it."
Try it out.
Tony Bourdain has a serious bone to pick with this town, characterizing it as a hotbed of veganism rife with "crunchers". This colored his 2009 program with a bitterness I as a carnivore found depressing and hinting of Personal Vendetta. Sure enough, the name Alice Waters was mentioned; there's a feud so wrenching for him that he misses the boat on what makes San Francisco a great place to eat. I generally enjoy Bourdain's programs, although the Pre-No Reservations, younger-Tony shows were more interesting for his being less angry, jaded, self-conscious, and more bright-eyed.
A forty-four minute program is long. To find it wholly devoted to an anti-vegan diatribe was, frankly, boring. It led him to scarf down low-quality meat at greasy dives for a third of the program and to pursue a manic meat-mission at unexciting places for much of the rest. When the San Francisco show was over, I wondered why I was so vexed by it and tried to imagine how he could better have used his time here.
Neighborhoods and ethnicities are the essence of this sprawling, diverse city. For a New Yorker, especially, to devote forty-four minutes to culinary San Francisco and not mention Vietnamese cuisine is downright negligence; the foodiest of New Yorkers are often completely unfamiliar with Vietnamese food, so common here, and truly spectacular examples can be had at all price points.
Another interesting difference between New York and San Francisco is in the Italian cuisine department, New York's tradition being rooted in Naples and Sicily, and San Francisco's in more northerly regions such as Tuscany. As North Beach's former Italian predominance disappears, some focus on the Italian history of culinary San Francisco would have been apt if not important, not to mention colorful and fun.
Views – restaurants with views from decks and heights – of the bay, of the ocean, of the city, would have provided visual excitement for the TV audience and acquainted it with a unique neighborhood or two. Countless visitors to our city are drawn by this very feature, and there's just no denying the romance and thrill of al fresco dining here. Many establishments have charming small patios and gardens. Why not show one? As for our local people, the camera was pointed at a variety of homeless street persons and toothless beggars.
One wondered why Bourdain, in his one foray outside the city, drove all the way to Oakland for a $2 taco from a fast-food truck, and ate it sitting on a parking lot ledge. Was this the (Eureka) clue: Program as dig at nearby Berkeley's "Chez Panisse"?
Sante's Rx: One heck of a delightful, self-ridiculing segment deliberately integrating soy foods into his palate, with his characteristic vulgar humor saying something like, "I've come to San Francisco to lose my soy virginity." This town would have obliged him, sending him to the moon with creativity. There are Thai and Chinese chefs who would have incontrovertibly proved that tempeh and tofu are "Not Just For Yogis" but actually components of an exciting meal. But then he would have had to drop his beat attitude and let himself walk around stunned thereafter, muttering, "I stand corrected."
I agree that the Anti-Meat lobbyists can be annoying, and I personally do not fancy meatless meals. But I also recognize that restaurant patrons are often looking for tasty examples of meatless cookery, and Western chefs are not cooperating. Our culinary schools are not demanding that chefs master soy, for instance, in order to graduate. Over a quarter century ago, I was offering tofu and tempeh dishes to the meat-accustomed palate on a meat-dominant menu at a resort attracting its share of vegetarians and vegans, and this my innovation kept guests on the property for dinner. Omnivores on vacation would experiment at such a place, opting for Tempeh Piccata over Roast Chicken on a given night, to discover its possibilities beyond Asian expressions. Many a customer complimented and thanked me for both accommodating their health needs and inspiring their own experimentation. There are chefs far more talented than I who could expand their clientele catering to this market. Not that Anthony Bourdain need ever be one of them, but the guy's act is just crying for a shattering, silencing sexy night with soy, and I hear him.
Today for breakfast I had one fried egg, over. Served it salted, peppered, flat, and halved on a halved toasted bagel.
Whatever it is about eggs that makes their taste so "complete" for me, so satisfying, I haven't figured it out yet. I suspect it nutritionally has to do with the protein in the yolk, and something about the interaction of salt, butter, and egg-white that just sends me over the top taste-wise.
I marvel at the perfectness of the egg. It's a spiritual experience for me, really humbling me as a cook, because for all my learnedness in the culinary arts, there is nothing I can do to rival (though I can sort of imitate) the flawless dovetailing of nutritive need and gustatory delight so elegantly stated by The Egg.
Food for Thought, indeed.
Last night I was supine on a table, undergoing a medical procedure. Happy Thanksgiving? The light fixture above my head was interesting: A giant photo transparency of a view of the heavens "actually taken from the Hubbel telescope", overlying a large light square that was divided into quarters. Supposed to relax the patient. As I am in the midst of serious personal medical challenges, I'm used to viewing thousands of images of my own and reference innards and organs, and I was struck by the similarity of this slide's appearance to those bio-forms.
"You know," I said to the technologist, "The picture on the ceiling looks like pulmonary parenchyma, dense with miliary nodules, and there's some patchy infiltrate in the left lower quadrant." Needless to say, he was stunned.
As I lay on that table, throughout the next hour or so, I pondered the analogue, remembering some beautiful Nature photographs I've seen that really play up the theme -- flowers and foliage, meteorological patterns, rock formations, speaking a language strangely similar to that spoken by our own histology and gross anatomy.
On my way out of the hospital, I noticed the artwork in the halls and found it very aptly chosen. The themes were similar: Leaves floating on a rippling pond, or swirling in a whirlpool or windstorm; a single flower, a tendril dangling, encircling...
One can "be sick" and see that, exclusively.
Or one can thus gain entrée into yet another wondrous sphere, where even diseased cells can claim their share of beauty.