Skate Or Die vs Skate And Die

Originally published on March 29th, 2020

Right about now, three weeks is feeling as if it were a lifetime ago. The year 2012 feels all that much more distant. 2012 was the year I jumped on the blogger bandwagon. It was also the year I started medical school. Back then it was easy to espouse my “man of the people” perspective. If I were to be honest with myself, I would recognize that certain aspects of that persona have fallen by the wayside.

Being a doctor is much different than roasting coffee, cooking in restaurants and working in construction. Duh. Perhaps certains portions of my life view have even become more “bourgeois” than I would have appreciated ten years ago. Perhaps this would have been a natural progression no matter my vocation.

When one’s dawn of adulthood is shaped by a love of skateboarding — all else be damned, certain dynamics come into play. One of them is a rebelliousness and willingness to question authority and challenge the status quo.

Interesting sidenote: (My hometown went from zero public skateparks and skating downtown being a misdemeanor with chance of being charged with criminal vandalism to adopting the most famous DIY skatepark in the world and funding the creation of skateparks citywide. Oh — and official “skateroutes” were even created for the downtown.) Now, decades later, I can see the benefits of efforting for change and appreciate those who operate in a cooperative manor.

The other thing that often comes from being a skateboarder is toughness. Physical, yes, but also mental and emotional. The hardest part of staring down a stair-set is overcoming the fear. These elements, embedded in one’s character, can mature and grow to fuel a mature, well balanced and substantive introspective individual.

I’ve taken pride in the fact (and have written as much) in my ability to specifically connect with disenfranchised men — focusing on disenfranchisement from the medical establishment. Of which, is common due to a myriad of reasons. The most significant barrier being the attitude to authority in the first place.

I’ve molded my burgeoning medical practice to frame “the doctor visit” as a partnership and not just edicts handed down from on high. This seems to work well and when I go to the doctor (hate it!) I desire this approach, too.

Another sidenote: (My approach to patients in the hospital and those in the ambulatory setting has grown to be much different. If you’re sick enough to be in the hospital, the medical management is much more complicated and while I do endeavor to maintain excellent communication, a “you have to do this” type of approach is required, relatively.)

So, when I see skateboarders posting on IG about how this is a conspiracy and that they will fight against what they see as martial law, I’m saddened (kinda angry, too) but I understand. Spending the last fourteen years of my life pursuing gett’n learned (that is learn — ed)my understanding of the world and it’s machinations has also increased.

My best me is someone who maintains the understanding of perspectives borne from a relatively limited perspective all the while working towards a reconciliation of truth and empathy. I often fail at being the ‘best me.’

For instance, I understand why many people believe that a “cure for cancer” exists, but that the people don’t have it because of financial considerations. I easily could have been one of these people, living on or near the peak of the left Dunning-Kruger graph. But now, through much pain and years of study and experience I have learned of the crazy-complicated subtleties of different cancers and the molecular mechanisms powering the malignancies. I have gone from an abstract knowledge of “cancer” to knowing how to diagnose and even manage all types of cancers. In fact, I know so much, I even know that I don’t know much compared to my hem-onc colleagues. I say this not out of pride, but acknowledgment of my decades of dedication to the art of the science of medicine.

However, it is undeniable that there is financial incentives to create and push drugs which either need to be taken everyday for years (or, to the pharmaceutical firm shareholders delight, for the rest of your life) or curative agents for relatively rare conditions. See, the latter is one of the few instances where payers (and I haaaaaate this term “payers” as if they’re not laughing all the way to the bank — how about “takers” as a term for the insurance companies?) will actually pay for a drug that a provider (and if there is a term in medicine I hate more, it’s “provider.”

I am a motherloving doctor.

My colleague is an NP, and that one over there is a PA. They have their place, but if they wanted the title and benefits of being a physician “mid-level providers” should have gone to medical school; and if they want the same pay they need to have the same skin in the game. Jurys see “Physician Assistant” and understandably still believe that the buck should stop with the physician, not his or her assistant. That is a rant for a different time, however.) This blog entry uses a recent drug that actually cures Hepatitis C and shows how the shareholders and investors where not happy.

See, if an infectious disease is cured, than the pool of “customers” shrinks even faster than an organic disease as infected patients stop infecting others and suddenly the market for the drug disappears.

Shareholders prefer a drug that is chronically taken, one that even may make a “customer” dependent on that drug. Sound familiar? And yet the powers that be would have you believe that the only drug dealers to worry about are down on the corner.

Thankfully, there is a push-pull dynamic here. There are still those of us in medicine who are not all in on the Mammon worship and value things other than the dollar.

The people who have the knowledge and capability to develop drugs are generally people who chose this line of work over finance and pursuing an MBA because they genuinely wanted to make a difference in the world. A generalization but one I’m willing to stand by.

It is this barrier against the wickedness of the MBAs that isn’t easy to see if outside the bubble in which I live.

Back to the skater who thinks this is a conspiracy and an “overblown flu.”

I am on the frontlines and seeing firsthand how this particular viral infection is different from other ones, and for the first time, I’m frightened for my own well being just by going to work. Otherwise healthy young people are dying. They are. And it happens fast.

I’m not the mainstream media, I’m a guy who used to love listening to Art Bell and his overnight Coast To Coast radio show exposing alternative explanations to just about everything. I haven’t paid for cable outside of that one year where there was no other way to watch the NBA in all of my adult life. I’m someone who is also wary of our rights and freedoms being taken away in the midst of all this — But it’s not the epidemiologists and the doctors who are after it. Congress trying to erode encryption and the EPA suspending all enforcement (yay pollution!) seems to be much more of a clear and present danger.

Perhaps it is my naivety from which my desire to have a balance between being called a “conspiracy cuck” by those I consider ‘my people’ and being thanked and called a ‘hero’ for going to work and taking care of patients with equipment more akin to one of those “shithole countries.”

If so, I guess I’m naive.

Naive in the good way.

Not in the way where I don’t realize that having our hospitals overwhelmed with COVID patients means that the broken leg or cellulitis from skateboarding will be low priority.

That the skater who needs emergent medical treatment will be in the same room as the COVID patients.

That the same doctors who just ran the code on that COVID patient is now evaluating my sprained ankle.

That while the skater with the fractured clavicle did get COVID turned out okay, but in the process passed it onto their elderly family members. Their chance of being okay is much lower.

I can never go back to being that kind of naive.

So, stay the F home.