I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights.   The show stars Clive Owen as the charismatic cocaine-addicted chief of surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop.  The tagline is, as they say, priceless: “Modern medicine had to start somewhere.” On the third episode, last Friday ...

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I’ve always been good at pattern recognition and my visual-spatial orientation is excellent. Photography is my hobby, so it was only natural that as a medical student and internal medicine resident, I loved my dermatology electives.  Each day yielded up a new parade of interesting skin lesions and rashes, and by the end of my rotations I was confident in my diagnoses and recommendations. Contact dermatitis? Steroids!  Eczema? Steroids!  Psoriasis? ...

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to live in this world you must be able to do three things to love what is mortal; to hold it against your bones knowing your own life depends on it; and, when the time comes to let it go, to let it go -Mary Oliver, New and Selected Poems, Vol. 1 As a parent, you are not supposed to have a favorite child, and since some of us physicians feel a strange but kindred protectiveness for our patients, likewise we ...

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A few days ago I decided that since I have been officially retired for two months, it was time to change my profile on the LinkedIn social network.  After all, the purpose of that network is to link business and professional people to potential opportunities and ideas.  I needed to let contacts know that I am no longer with the university where I practiced for the last seven years, while ...

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Heisenberg uncertainty principle:  A principle in quantum mechanics holding that increasing the accuracy of measurement of one observable quantity increases the uncertainty with which another conjugate quantity may be known. Perhaps it is because I just got back from Albuquerque, a city which has become like a second home to me, that I have Heisenberg on my mind. For the one or two of you out there who are not Breaking ...

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When it comes to surgery for cancer, having a “positive margin” is a bad thing.  It means that when the surgeon said he “got it all,” even though he meant it with all of his heart, likely he didn’t.  For a woman undergoing a lumpectomy for breast cancer, that positive margin means a re-excision of the lumpectomy site or alternatively, a mastectomy.  For a woman who has just had a ...

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A couple of weeks ago my nurse came to me with a request for a consultation.  Since our schedule has been packed full lately, she’s been asking me where I can squeeze patients in. She said, “I’m not sure about this one -- he says you treated him twenty years ago and he wants to see you.  But there is no new pathology so I don’t know how urgent it is.” I ...

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Where I come from, when most people refer to the Good Book, they are referring to the Bible.  This is not true for my father, because to him, the Good Books are something else entirely. He describes a scene early in his career as a plastic surgeon, when he had taken his doting mother to see his new office. Coincidentally, a lovely thank you note had just arrived from one of ...

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I don’t have much in the way of eyebrows.  They were victims of too much plucking back in the 1960’s and when you do that, sometimes they don’t grow back.  There’s a very nice woman in Solana Beach who shapes and darkens what I have left, infrequently, when I bother to think about it which isn’t very often. I was in there about a year ago when she told me, “I ...

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Ex-marines are some of the toughest patients I ever see, when it comes to dealing with pain from cancer.  And career ex-Marines have the market cornered on toughness. Take for example, an elderly friend in Kansas who woke up one morning with severe upper back pain, feeling faint, and decided as was his Marine Corps habit that a cold shower would be “just the thing.”   The cold shower likely saved his ...

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