Medical Examiner 2-17-23

for a few hours. With assistance from his brother, Jan de Doot was planning to perform surgery on himself. Specifically, a lithotomy (litho- stone; -otomy cutting), removing a calculus or stone from the bladder, kidney, or urinary tract. As the old saying

In observance of our 400th issue, we take a peek at the world of medicine 400 years ago

goes, the definition of minor surgery is surgery performed on someone else. Anything on you is definitely not minor, and when you’re both the surgeon and the patient, well, it doesn’t get more major than that.

His brother’s task was to hold de Doot’s scrotum to one side while he - de Doot - made an incision in his perineum so that... Hey, you know what? Let’s skip the details and just say that when it was all over de Doot had removed a 4 oz. stone the size and shape of a chicken egg that had been obstructing his bladder. We called him unfortunate a few moments ago, but he survived and went on to live a good long life, which back then could have meant 35 years.

That doesn’t necessarily mean people commonly died at that age. It means that so many died in infancy or childhood — as many as 40% never reached adulthood — that average life expectancy was skewed sharply down. Even in the 1600s, if someone could survive child-

hood (and home surgery) they might live into their 50s or 60s.

Along the way, any number of horrific encounters with the “medical” profession might occur, like the one above depicting cataract surgery being performed without anesthesia (other than perhaps brandy or whiskey). The crude procedure would leave the patient unable to see well enough to read a book (if they owned one and weren’t illiterate), but no doubt well enough to plow a field.

MEDICAL MYTHOLOGY

PARENTHOOD

by David W. Proefrock, PhD

Your 4 year-old daughter has absolutely no interest in traditional girl toys. She has dolls and other girl-oriented toys that she never plays with. When she plays inside, she usually plays with her brother’s toys. She loves to ride her bike, skate, and play ball. She seems to be happiest when she is outside running and playing. What do you do?

A. Tell her that girls are supposed to play with girls’ toys. Make her stay inside and play with her dolls.

B. Buy her the most attractive and most popular dolls and accessories you can find. She will then want to play with them instead of toys for boys.

C. Don’t do anything. Let her play the way she wants to.

D. There may be a problem with her gender identification. Take her to a mental health professional for an evaluation.

If you answered:

A. This will cause confusion and make her feel that there is something wrong with her when there isn’t. You will probably end up with a very unhappy child.

B. This probably won’t hurt, but it won’t change her play and it will cost you a lot of wasted money.

C. This is the best choice. There is nothing to worry about in this situation. At this time in her life, she seems to simply be an “outside kid” and there’s nothing wrong with that.

D. These preferences in play are not indications of gender identity problems and do not warrant evaluation by a mental health professional. Hopefully, you won’t be able to find one that would evaluate her for this reason.

Preferring to be outside and active is perfectly normal for both boys and girls. In fact, it is better for both than staying inside all the time.

Dr. Proefrock is a retired local clinical and forensic child psychologist.

MEDICALEXAMINER

BLOOD INSIDE THE BODY IS BLUE

The titles of “Medical Mythology” installments usually describe the myth we’re about to discuss. Not so this time. Blood inside the body actually is blue, although with one important stipulation: for that to be true it has to be the body of a horseshoe crab, an octopus, a squid, or some other crustacean.

But otherwise it’s a no-go on the blue blood — most of the time

For example, skinks have green blood.

Also, as you may have noticed, humans and most other animals have red blood.

We all know this, but the rumor persists that human blood isn’t always red. When it’s hermetically sealed inside the body where it belongs, the tale sometimes told is that our blood is actually blue. “You can see that’s it’s blue, plain as day. Just look at the veins close to the skin’s surface. They’re blue.”

The reason we never see literal blue blood, as the story goes, is because the very instant blood is exposed to air it turns its familiar red color.

To set the record straight, human blood is always red, inside the body or out. There are different shade of

red, however. All the time. In a single circuit through the body, the same measure of blood can go from bright red to maroon and back again. It not only can; it does. Put it this way: it better. And it does so three times a minute on average.

The reason for the color change is that freshly oxygenated blood, having just left the lungs for the heart to be pumped out to every corner of the body, is bright red. That is how the iron in hemoglobin reacts with oxygen: it turns bright red.

As blood makes its way through arteries, it delivers its precious payload, gradually depleting the oxygen it carries. It then circles back to the heart and lungs (not in that order)

through veins for a fresh supply. That blood, the de-oxygenated variety, is no longer bright red, but it’s still definitely red, even if dark red, muddy red, or brick red.

True, there is no denying that veins just beneath the skin look at least bluish, if not downright blue.

The explanation: color is a funny thing. As we all learned in school, an object looks a certain color to us because it reflects back only that color from the visible spectrum of light. Oranges are perceived as orange because they absorb all wavelengths of the entire rainbow of color except orange; that narrow band of color is the only one that bounces off oranges and into our waiting corneas.

Scientists call our blue veins (the ones that aren’t really blue) an optical illusion created by how light is alternately absorbed or reflected by our skin and the underlying vein.

It should be noted in closing that many textbooks, encyclopedias and schoolbooks have diagrams showing red blood leaving the heart and blue blood returning there. Those colors are used simply to illustrate the way blood circulates, not as literal depictions of the color of blood within the human body.

The word “medical” is in quotes because it’s not exactly the appropriate word to describe the healthcare providers of the day.

They were in many cases the most well educated people in a town, city or village, but that education was rarely in medical arts. The village “doctor” was quite often the village priest, and medicine was often administered with a healthy dose of superstition, ignorance, and church dogma.

As the middle ages went on, barbers often doubled as healthcare providers. They were skilled with sharp blades, after all, and that was all that was needed for one of the most popular treatments of the day: bloodletting.

Unlike cars that might be a quart low, the belief persisted for centuries that humans could be a quart over in the blood department. That harkened back to Hippocrates and his teaching that four basic substances or “humors” (one of them being

blood) controlled health. They all needed to be in perfect balance for good health and if they weren’t, let’s draw down a few pints. It always seemed to be only blood that was drained, however, probably because it wasn’t easy to drain black bile.

Another scary practice of the day was trepanation, shown below, named after the type of hole saw used to perforate the

skull in order to — what else?

— cure epilepsy, headaches, and mental disorders, as well as release evil spirits. All without anesthesia.

In addition, all antibiotics and disinfectants — and even the barest acknowledgment of any need for them —were centuries away. The same was true of pain relievers, although various herbal and alcohol-based

concoctions were offered. That was good because there were many treatments that offered no guarantee other than a level of pain far off any chart we could imagine today.

But it wasn’t all bad.

The 1600s saw a first-ever awakening of scientific fact over religious superstition. In fact, the Age of Enlightenment began during the 1600s, paving

the way for such men as Galileo, Isaac Newton, John Locke, René Descartes, and Voltaire to think and act outside a box the church had drawn within very narrow confines and had vigorously protected for centuries. A discovery as basic as the earth circling the sun - the opposite of what the church taughtcould lead to public execution for its proponent.

William Harvey (1578-1657), the discoverer of the circulatory system, had to fight for acceptance of his work against the Catholic Church, which taught that the liver was the seat of life within the body.

Hopefully, people in distant centuries will shake their heads at what passes for the pinnacle of knowledge we claim to stand upon today. In the meantime, reflecting on what people had to endure 400 years ago might help us appreciate the progress we enjoy. We might not even mind sitting in a waiting room for two hours before an appointment.

Who is this?

The question above is probably superfluous. Many readers will immediately know that’s a photo of C. Everett Koop. Next week will mark the 10th anniversary of his death, but somehow he seems to still be with us. During his lifetime he was what is often called a larger-than-life figure.

Two things stand out about Dr. Koop that made him such a memorable figure in the history of medicine and public health, at least in this country.

Perhaps a few words of introduction would be appropriate first, though. If you’re unaquainted with the name C. Everett Koop, he was the Surgeon General of the United States from 1982 through 1989. Therein lies his first claim to fame: not in simply holding that office, but in the way he held that office.

Before Koop, Surgeons General were nameless, faceless bureaucrats. People never knew who the current Surgeon General was. Koop changed that with an administration that was so visible that he became a household name that came up on episodes of Seinfeld, King of the Hill, and The Simpsons

It wasn’t that he was looking for publicity personally. But he sounded the message of public health loud and proud and did so despite political pressure from factions left and right.

For example, the Reagan administration under which he served exerted immense pressure on Koop to condemn abortion. With his Amish preacher looks, he might have been expected to gladly cooperate, but he never did. Although he was opposed to abortion on personal and religious grounds, he viewed the subject as a moral issue rather than a subject for public health legislation.

Similarly, he was Surgeon General when the AIDS crisis first erupted, and although roundly criticized by everyone from conservative religious groups to gay activists, he focused on education and prevention rather than moral judgments.

He famously stated, “I am the Surgeon General of the heterosexuals and the homosexuals, of the young and the old, of the moral or the immoral, the married and the unmarried. I don’t have the luxury of deciding which side I want to be on.”

There is something else about C. Everett Koop that makes it quite likely he would appear in this article series even if he had never been in the Surgeon General limelight: his medical career was nothing short of amazing.

From 1946 to 1981 he was chief surgeon at Children’s Hospital of Philadelphia, where he established the first neonatal surgical intensive care unit in the nation. He invented a number of surgical techniques unique to tiny patients that are still in use today. He tackled difficult cases that at the time no one had ever attempted, and did so with an enviable record of successful outcomes. He performed tens of thousands of operations on pediatric patients, including ten groundbreaking procedures on conjoined twins at a time when such operations were always undertaken with the goal of saving one twin at the expense of the other. Successful separations leaving both twins not just alive but healthy was almost unheard of, but they became Dr. Koop’s trademark.

He died February 25, 2013 at age 96. +

The Technobabble-Free Zone

by Dr. Chuck Cadle CAVEAT EMPTOR

(Buyer Beware)

Hello readers, I took a break from writing this column to teach a doctoral course at the University of Memphis. I was required to design and instruct an online course to teach students how to use the creative process to write the literature review for their dissertations. The university’s course software was new to me, and I must say that the project was a formidable challenge. It was one that I enjoyed, but also required me to set aside other activities, such as writing for the Medical Examiner Now that this course is behind me, I look forward to renewing the Technobabble Free column.

OK, let’s restart this monthly column with how I approach new projects. I always like to ask “why,” especially when it comes to technology. My questioning process is twofold.

First, I want to understand the benefit of taking on a new project. A friend recently gave me a book he had just finished. As I picked up the book (fiction), I asked, “Why do I need to read this since my time is constrained already?” That same day, I received an email with a web link to some technocrat touting some new features of Smart City technology. Again I asked, “Why do I need to study Smart City technology?” I have trained my mind to avoid time-wasting activities so that when a new project opportunity arises where I can learn or add value, I have the time to pursue it.

Technology has evolved to a point where it is less a tool and more of a “boss” of our time and money. I remember when television had only free content, cell phones allowed us to untether our need to be attached to a wall, computers enabled us to write letters, and our home security system was a barking dog. The invasive and subtle technological value changes have mostly gone unnoticed by the consumer. Yet, my questioning technique has alerted my awareness to remember Kodak and Gillette, who firmly set the business model for today’s technology companies. This business strategy, referred to as the “Razor and Blades” model, or in the case of Kodak, the “Camera and the Film” model, is a strategy most MBA students learn in their coursework. Simply put, the business strategy is to sell the hardware cheaply or give it away, but then buying add-on services and products is required. These add-on services become a profit opportunity for companies.

How many of you today pay annual renewals on software or security mon itoring fees?

How many have service contracts covering computers, networks, game consoles, TVs, etc.?

A sizeable portion of our monthly income is now required for technology services and support. Even though your cell phone, computer, or TV is working, corporate marketing and sales strategies are making us feel the need to buy a new device to access new features, which have their associated costs. Let’s take streaming as an example. Many consumers purchase TV and Internet content access from Comcast, WOW, ATT, and other providers. Then we opt to have Prime Video, Netflix, and other streaming services, and then we have to pay for the movie or TV series from these streaming providers. Here are some facts that may surprise you:

• The streaming industry is expected to be worth $330 billion by 2030.

• A staggering 85% of U.S. households have at least one video streaming subscription, and 60% have at least one paid music streaming subscription.

• COVID and general growth have also pushed video streaming services to invest more money into new content, including Please see CAVEAT page 11

Middle Age

BY J.B. COLLUM

Chemical dependency is not a good thing. When I was a teenager back in the Cretaceous period (you probably thought it was the Jurassic period, but I’m not that old), I remember some school acquaintances trying out some illicit drugs, and a couple of those people were good friends. One of them left it at that, just a dalliance, but sadly, the other became an addict. He was never the same again. As sad as it was, it did serve a good purpose: a lesson for me to never even try the stuff, and I didn’t. Well, except for when prescribed by a doctor.

Don’t get me wrong. I’m not talking about those prescriptions you fill at a dispensary where you can get gummies, brownies, etc. I mean things like arthritis medicine, pain medicines, behavioral drugs, etc. All legit and nothing that would see me wearing tie-dye shirts and living in a psychedelically painted van with some other like-minded folk as we share our drugs and our love. No, I’m talking about plain old prescriptions I pick up at my local pharmacy. Of course I know that even legal and traditional prescriptions can still be distributed, used and abused in illegal ways, and I know that some formerly illegal drugs are now legal and are being used for medical purposes. I’m not judging.

What I’m really getting at is that drugs can be a blessing and a curse. I recently switched my arthritis medicine to being filled online, but due to some unknown hang-up my latest prescription was not delivered. I woke up this morning in a lot of pain, so decided to see if I could get a refill at my local pharmacy. I used their online app and it informed me that it would be ready by 2:00 today. I sure hope it is.

The blessing part of medications is obvious, so I won’t belabor it. The curse for me is that I must never be without it. And because of how some people abuse the system, patients like me have to jump through hoops to make sure we can get our medicines. Occasionally, a particularly potent pain medicine is even pulled off the market because it was abused. Its crime? Being really good at eliminating pain while also being addictive. You’d think it would be understandable that anything that eliminates pain would be addictive and maybe this can’t even be separated from its palliative

properties, but as with all things, seemingly, the idiots among us ruin it for the rest of us. By idiots, I mean all of them; the nefarious criminal dealers, the abusers, and the politicians or bureaucrats who make the rules to try to fix things, or more likely, to assuage their bosses, be they voters or the politicians who appointed them. Don’t get me started on that cesspool though. I think the mantra of these folks is secretly the same as that song, “Let’s Do Something (Even If It’s Wrong)” by Vince Gill. I suppose it is inevitable though. As we age, we all need augmentation. I need glasses in order to read without holding the book or newspaper at least three feet away from my eyes. My arms aren’t long enough for that, so I gave in and got glasses. When my gout is acting up, I need a cane to hobble around. Some need a walker or a wheelchair to stay mobile. One thing that I have learned though is that whatever you need to do to stay mobile, do it. I have seen and even helped take care of folks who got more and more sedentary, and it never ended well. If you don’t use it, you lose it. I used to avoid even taking pain medication, but I learned that if, for example, I had a hurt ankle and I didn’t take pain medicine, I walked in an unnatural way to avoid hurting the ankle more and ended up injuring something else. This can turn into an endless cycle that can result in you not moving around at all, and that is definitely not good because the spiral down from there can put you in an early grave. I have seen that happen to friends and family. Don’t let that happen to you.

There isn’t much I can do about being dependent on my medication, but I am constantly trying to make the acquisition of it as friction-less as possible. Though my attempt to use an online pharmacy has currently hit a snag, I am still hopeful that this is the way to go for most medicines. Time will tell. I’m just trying to make sure that I have plenty of that — time, that is — to find out I hope you do too. Take care of yourselves

J.B. Collum is a local novelist, humorist and columnist who wants to be Mark Twain when he grows up. He may be reached at johnbcollum@ gmail.com

MIDNIGHT IN THE GARDEN OF GRIEF

Grief is hard, but it ain’t permanent. We all have it at one time or another. An industrial size case settled onto me yesterday. It started back on Valentine’s Day in 2014 when the Great Ice Storm hit. Power lines down. Wrecks galore. Everybody late to where ever. ERs busy.

The day before, I did the husbandly things to do. Bought my wife some flowers, a box of chocolate candy, and plan to take her to lunch where ever she desired. But when I woke up that morning, it was cold. Real cold. Ice everywhere. Not one of my favorite things. We live in the South. We are supposed to have sunshine and pleasant days. Creeping icebergs are not on my Day Planner.

A strange sound in my garage commanded my attention. Out walked a large, adult, solid black cat, the kind that would appeal to Elvira and her horror movies. Not a white hair anywhere. My wife

BASED ON A TRUE STORY

(most of the time)

A

series

by Bad Billy Laveau

must have seen the gleam in my eye. She said, “You can’t keep the cat. She has a home somewhere.” But sympathy won over and within an hour, my wife opened a can of salmon and fed the cat. I built a warm bed inside our animal crate, complete with blankets, furniture cover wrapped around the crate, and elevate 3 feet. Cats like that. They feel safe.

Midnight Shadow (we later shorten it to Midnight) became an integral part of our family. She was an outside cat. She was a mighty hunter and periodically presented us with evidence of her skill. Mice, small snakes, moles, voles, rabbits,

squirrels, skinks. Midnight did not see us eat and thought we were starving. (That is what cats do that are part of our family. Don’t scold them. Appreciate them.) I would sit on the steps and eat a sandwich. That would be a lull in Midnight’s foraging for us … for a while and then the cycle would repeat. I never figured out the preventive timing for dinning with Midnight on the back steps.

One summer, Midnight began pacing on our front porch, looking intently at the ceiling, her tail in the slow twitch characterizing her hunting mode. Finally, we realized what was up. Midnight sensed, saw, heard, or somehow knew bats had infested our porch ceiling space. An exterminator came and said “wait a couple months to eradicate the bats. They are endangered in Georgia.” I like bats. They eat mosquitoes. We waited. Then the bats were sealed out. They moved on

somewhere else.

A neighbor had attic bats a few years earlier. He did not discover them in time. It cost him $5,000 to get rid of them and repair the damage. Clearly Midnight saved us a ton of money. Her lifetime rent was paid in full, not counting the food she foraged for us.

Midnight was full grown when she came to us, about 4 years old the vet guessed. She aged gracefully. She walked the track each morning with me. She feared men, but allowed women and children to pet her. Midnight had a big following on the track. Most folks were amazed that Midnight faithfully exercised with me. This went on for eight years.

Then one dastardly day that shall dwell in semi-infamy, I noted a lump on her left hip. Long story, short: Sarcoma. An aggressive and deadly cancer. We went full-blown medical intervention. Biopsy. Ultrasound. Chest X-Ray. Specialty referral veterinarian center. All to no avail. The sarcoma went from ping pong ball size to grapefruit size in a matter of weeks. Surgery would require removal of her left back leg and left abdominal wall reconstruction. Pain would be intense. No guarantees. Life expectancy, even with surgery and chemotherapy and/ or radiation: Maybe 6 months. Most likely, less.

Midnight weakened. Lost weight. Never whined. Eating

slowed. I refused to let her suffer any more. My heart could not take it. (I’m selfish like that.) Euthanasia was the only way. We buried Midnight in our back yard, in our pet garden grave yard. We ordered a grave stone. All our past pets have gravestones. It is the least we can do for a family member.

Then came my GRIEF. That is what this column is about. Grief. Medical schools teach Grief has 6 stages. Disbelief/ Shock. Sadness. Guilt. Anger. Fear. Physical Pain. I am now well versed in the first 4. I have no control over those feelings. I have chosen to not indulge in the latter 2. Instead, I substitute: Resolution. My heart is heavy. Tears sting my eyes when I see photos of Midnight … and I have a lot of them. My favorite is when she slept on my feet when I watched TV at night. Hence forth, my feet shall suffer a vacant chill that may last a long time.

Understanding the Steps of Grief helps one mentally adjust to death of a loved one, animal or human. Dwell in the moments of past happiness. Clear you mind of the last moments of terror and hurt. Resolution is the end point for the living. You always decide what resides in your mind. Chose wisely.

And that, I shall do. Midnight is forever gentle on my mind. Otherwise, she would be disappointed in me.

TRYTHISDISH

by Kim Beavers, MS, RDN, CDCES

GREEK POTATO & ARTICHOKE SALAD

Steamed potatoes and green beans are tossed with marinated artichokes, red bell pepper, and capers to give a fresh twist to an old favorite

Ingredients

• 8 ounces red potatoes cut into ½-inch cubes

• 4 ounces fresh green beans, trimmed, cut into ½-inch pieces

• 1 jar (6 ounces) marinated artichoke hearts, drained and coarsely chopped

• ½ medium red bell pepper, finely chopped

• 2 tablespoons finely

chopped sweet onion

• 2 tablespoons cider vinegar

• 2 tablespoons capers

• ¼ cup snipped fresh parsley

• ¾ teaspoons dried oregano, crumbled (or 1½ teaspoons fresh)

• ½ medium garlic clove, minced

• ½ teaspoons Jane’s Krazy

Mixed-Up salt

Instructions

Steam the potatoes and beans for 7 to 8 minutes, or until just tender. Drain in a colander and run under cold water to cool. Drain

well. Meanwhile, in a medium bowl, stir together the remaining ingredients. Add the potatoes and beans. Toss gently. Let stand for 30 minutes to allow the flavors to blend.

Yield: 4 servings (serving size: ½ cup)

Nutrient Breakdown: Calories 82, Fat 3.0g, (0g saturated, 1.5g monounsaturated), Cholesterol 0mg, Sodium 242mg, Carbohydrate 16g, Fiber 3g, Protein 2g

Carbohydrate Choices: 1 carbohydrate, ½ fat

Registered Dietitian Nutritionist, Chef Coach, Author Follow Kim on Facebook: facebook.com/eatingwellwithkimb

GET A LIFE, MOM!

by Ken Wilson Steppingstones to Recovery

“You’ve ruined my life,” screamed a 60 year old woman to her husband of 40 years in my office. “I’ve bailed you out of jail, lied to your boss about your being sick, paid your legal fines, and fed you chicken soup so you could get to work on Mondays and I’m sick and tired of it already. I hate you.” She didn’t realize that her enabling perpetuated his drinking for 40 years.

I felt sad for this woman who said she hadn’t had fun in many years. Her poor life had centered around her husband – no vacations, no nice cars, no perks. Her joy was wrapped up in being a caretaker. Caretakers, you see, are a magnet for “takers,” and vice versa. A caretaker feels loved when caretaking…and a taker feels loved when he/ she is being taken care of! A perfect match. Or so it seems.

Until the day one or the other gets well. Then the equation breaks apart. I’ve seen alcoholics stop drinking, go to AA several nights week-

ly, and adopt great friends in recovery and their wives would tell them “I liked you better when I was pouring your drinks for you every night.” All of a sudden she had nobody to care for and her self-worth plummeted.

In my own home growing up we children didn’t necessarily want my erring father to die – we just wanted him to go away and not come back. We begged our mom to divorce him but she just couldn’t do it. Somehow she seemed to find joy in her misery of being an abused and neglected wife.

Such is the life of one who relies on another person for their joy. Hindsight is 20/20, but dad probably would’ve gotten well sooner had she stopped caretaking him and gotten a life of her own. She never learned to swim, roller skate, drive a car, and never ate at a restaurant until her 70’s because her life was wrapped up in caretaking for pop. She found pleasure in denying herself pleasure in deference to him.

If you or someone you

know is in a similar position, there is hope ahead! Through self-help programs and good counseling out there, a good life can still happen! It’ll feel uncomfortable for awhile though.

It can be unsettling for an alcoholic/addict husband to see his wife come alive and start taking bubble baths with a Do Not Disturb sign on the bathroom door! Candles, music, the works! Each of us is responsible for his or her own happiness. We cannot rely on others to make us happy. That is a precarious position for sure.

If your addicted loved one doesn’t come home in time to go to the concert, go anyway! Take a friend. And to make the move even more powerful, don’t say a thing about it later on. Just that you had a great time.

Be as good to yourself as you have been to him. Bake yourself some cookies, too. Ones that you like. Start spending some of your hardearned money on day trips or hobbies; it makes detaching much easier. In other words,

THIS IS YOUR BRAIN

we can detest diabetes but love the diabetic. We can love the alcoholic but detest his illness. (BTW, when you master this, do write a book on how to do it! You’ll pay off your home mortgage with the profits!)

When you start being responsible for your own joy, do not expect it to feel good overnight. It’ll take months or maybe years. But a journey of a thousand miles begins with a tiny step forward, then a bigger step, then more steps. The point is to not turn 80 years old and regret how you spent your time on this planet. There are no trophies for victims and martyrs, only for those who dare to live well.

So for your sake, and for God’s sake, mom, get a life!

The Money Doctor

RETIREMENT PLAN ROLLOVERS 101

Do you have an old retirement plan? Is it still with your previous employer? Or has your company just been purchased/merged, and the new company has a new plan? Each year many people face this situation. What should you do with your old retirement plan?

You will typically have the option to rollover the old account into your new 401k, 403b, 457 or other retirement plan. Then there is another alternative to consider. Instead of rolling it to the new plan, you can roll it to an IRA or individual retirement account. So, which is better?

Oftentimes you will find that the new plan is very similar to your old plan in terms of options, fees, etc., so it seems like a no-brainer to do the rollover from your old account into the new account. In that meeting, what may not be discussed are the downsides to rolling the old money into the new employer work plan.

Below are some of the key things you should consider when making your decision;

• Flexibility – If you roll your current retirement account to the new company’s plan, your money is often stuck in the new plan until you terminate employment whether its voluntary (retire or take a new job at a new company) or involuntarily (you are terminated or the company shuts down). Unless the plan offers in-service

rollovers, 401k plans usually do not let you move your 401k funds to an IRA until after you terminate employment.

However, most 401k plans allow you to roll your IRA into the 401k at any point. So, by rolling your funds into an IRA you maintain flexibility / options for the future.

With an IRA you keep the key and can unlock the box to move money around when you are ready. With a 401k, your company keeps the key and puts rules around when you can open the box to move money around.

• Investment Options –401ks make you choose from a list of around 20-40 investment options selected by your employer. IRAs allow you to invest in thousands of options that include stocks, bonds, exchange-traded funds, and mutual funds.

• Rules – 401k accounts have lots of rules that must be followed. Your employer can include or not include different options. Can you do in-plan Roth conversions?

Can you take a loan out? Can you do in-service distributions? 401ks are required to withhold 20% from any distributions for federal taxes. IRAs also have rules, but they are not employer dependent. For example, you can always convert your IRA to a Roth IRA, you can’t take loans, and you are not required to withhold 20% in taxes on distributions. It

is important to understand the difference between each option and the rules before rolling your money over.

• Fees – 401k accounts have more layers of fees such as participant account fees, fund fees, admin fees, loan fees, etc. IRAs give you access to low-cost investment options at the major brokerages such as Schwab. Most custodians or places that offer IRAs have $0 account fees and minimums for IRAs.

• Other Differences – did you know that there are differences in many other areas, too, such as creditor protection, minimum distribution requirements, early withdrawal exceptions, fund share classes, withdrawal flexibility, and more?

Deciding what to do with your retirement account is a big decision. This year is a big year for these decisions in the Augusta area. We encourage you to discuss your options with a certified financial planner that will provide unbiased feedback for your situation. You want to consider all the pros and cons to help you make the best decision for your situation.

by Clayton Quamme, CFP® a financial planner with AP Wealth Management, LLC (www.apwealth.com). AP

Wealth is a financial planning and investment advisory firm with offices in Augusta, GA and Columbia, SC.

CRASH COURSE

More Americans have died on US roads since 2006 than in World Wars I & II combined

In the time it takes the average person to read this article, about a dozen people will die in traffic accidents around the world. It would be nice if the deaths stopped as soon as you were done reading, but the accidents and the deaths go on all day and all night, around the clock every day of the year.

Believe it or not, the estimated global highway death toll for 2023 is already well beyond 160,000 (per www.worldometers.info). And it’s only the middle of February. The CDC gives a worldwide highway death toll of nearly 3,700 people every single day.

No community is immune. In the past few days several people have died in traffic mishaps in and around Aiken and Augusta, and the same is true more or less everywhere around the world.

This is probably not the best time to mention that more than two years ago, during 2020, the target completion year for an ambitious worldwide program called Decade of Action for Road Safety came and went. Officially created by the United Nations General Assembly in March 2010 and launched in May of 2011, the Decade was viewed as a historic opportunity to increase action to save millions of lives on roadways over the decade ending in 2020.

“The goal of the Decade is to stabilize and then reduce the number of lives lost. A Global Plan for the Decade of Action for Road Safety outlines a course of action for ensuring that this vision becomes a reality.

“The vision is a world in which mobility is safe for all those who use the world’s roads. The alternative is grim: if no action is taken to address the current crisis, road traffic fatalities are forecast to rise from the current level of nearly 1.3 million deaths annually to more than 1.9 million deaths per year by 2020.”

Maybe the program is working: referencing “nearly 1.3 million deaths annually” at the start of the program along with the stated goal to first stablize and then reduce the death rate,

In a millisecond our lives changed

the data shows 1.35 million highway deaths in 2016 and again in 2018, the latest official data currently available.

That may represent some stabilization — the toll is unchanged since the start of the U.N. program, but at least it isn’t higher — although virtually no one thinks nearly 1,350,000 deaths every year is an acceptable rate. How could they? Globally, crash injuries are the eighth leading cause of death for all age groups, and the #1 cause of death for children and people aged 5 to 29.

A couple of factors make the death toll especially tragic and frustrating.

First, the vast majority of accidents are preventable. They did not have to happen. The cause was speeding, drowsiness, carelessness or some other driver error, not brakes failing or the gas pedal getting stuck. (See story, right.)

Second, more than half of all victims of traffic accidents are so-called vulnerable users, meaning pedestrians, bicyclists, and motorcylists. They too often bear the burden and pay the penalty for the less than cautious habits of car drivers who are encased in a steel cage and may be wearing seat belts and have the benefit of airbags.

Some solutions

The World Health Organization says a number of factors big and small would help lower the worldwide highway death toll. They include improved emergency response time, since minutes and even seconds count in getting the injured to hospitals; also, although none of us like to be on the receiving end of traffic enforcement, WHO cites lax enforcement of traffic laws as a significant contributing factor in reducing road accidents and deaths.

Ultimately, however, putting the brakes on the “it won’t happen to me” mentality might be the greatest single way to bring home the reality that every driver — that includes you and me — is the first line of defense against accidents and all their deadly consequences.

The Christmas holidays were over, and we were on our way home from Atlanta to Daytona Beach. Six hours into our seven-hour drive home, we anticipated sunny, warm weather and days on the beach. And then in a flash, someone failed to pay attention to traffic slowing before him. A speeding pickup truck rammed into the back of the slowing compact car. The impact was brutal, pushing the little car into the next car and the next car. Our nightmare began with a 5-car pileup. We were sandwiched in the middle of the pile. Our cars looked like a mangled accordion.

In a millisecond, metal crunched, windshields cracked, airbags deployed, and our lives instantly morphed into something else. Gone were our dreams of being on the beach the next day. Gone were the plans of celebrating New Years eve. The day turned into a nightmare. My husband lost consciousness. The impact was so hard it knocked the shoes off his feet. An ambulance arrived promptly. My injuries were minor: a broken thumb and some burns from the air bag. My husband had more serious injuries. The EMTs got him on a board and secured his neck. He was having chest pains. We weren’t sure if it was his heart or if it was from the seat belt’s effect from the impact. They monitored him and got us to the ER quickly. A troubling trip through the ER and an overnight stay in the hospital confirmed no immediate, life threatening injuries. But there was more to come.

Further evaluation indicated that he had a concussion. In addition, we both had soft tissue injuries with assorted pains. The concussion caused my husband a lot of trouble. Along with headaches, he had trouble following conversation and remembering things. He went through 8 weeks of speech therapy and physical therapy, but progress was very slow. I wanted my husband back, but unfortunately that was going to take awhile. His progress was slow and his pain continued. He had two more episodes of losing consciousness. Further MRI testing showed a “hot spot” on the brain that could result in a life-threatening seizure. A neurologist prescribed an anti-seizure medication as a precaution, and will re-evaluate the need for the medication over time.

It has been 14 months now, and my husband is just getting back to his old self. We both have PTSD from the accident. Driving in heavy traffic and cars tailgating brings on anxiety and panic. While it has been a challenge, we are determined to stay on track.

He has been frustrated with the pain in his body and the trouble going on in his head, but he kept a positive attitude the whole time. He’s a determined man and never gives up. We keep repeating: We will get back to where we were. Fake it ’til you make it, one mile at a time.

— submitted to the Examiner by Ann Marie Morgan Daytona Beach, Florida

the blog spot

CAVEAT… from page 4

many “originals.”

When I started the TECHNOBABBLE FREE Column, I aimed to introduce new technologies and enhancements to existing technologies that impact the medical community and society. By removing the mysteries around products and services, we, as informed consumers, can discern the wisdom of accepting (or perhaps rejecting) new ways of interacting with technology.

So, before you upgrade or buy the next evolution of technology, make sure you ask, “Why.” Do a cost/benefit analysis that includes the downtime from learning the new system or transferring existing storage to new devices. To highlight this point, I remember an iMac customer who called me to help him transfer saved files to his new iMac computer. He was unaware that he needed to put everything into iCloud because his transfer of files to a USB thumb drive was useless since his new computer now uses Thunderbolt 3 ports. He had shopped to get the best computer deal, unaware that cloud storage and new backup devices would add to the cost of his decision.

I wish you the best for 2023. Hopefully, this monthly column will alert you to the benefits and pitfalls of technological evolution and raise awareness of new technology costs (in both time and money). “Why” may become your essential word as you navigate technological change.

SHORTSTORIES

EXCEPTIONAL KINDNESS I was in the hospital for about two and a half months. My doctor came to see me every day (and sometimes checked on me again if he was in the hospital for something else). At the time I did not have insurance, and it was all quite expensive because I was quarantined and had to have a private room with a changing room for visitors to put on gowns and masks, which were all billed to me. It took me years to pay off the hospital bill, but the doctor told me he wasn’t going to charge me his fees and he was thrilled I was on the road to recovery. I was in disbelief and half expected to eventually get a bill of some sort, but I never did. To top it off he never charged me for any follow-up office calls or regular appointments. I was his patient for many years and he said he would start charging me after I paid off the hospital bill. Sadly, he passed away before I finished paying off the hospital. I will never forget his kindness.

SHORTSTORIES

WHEN THE DOCTOR IS A WOMAN What are your thoughts on being called a doctor or nurse? Do you prefer one over the other? Why or why not?

I wear scrubs to work, and I don’t usually wear a white coat over my scrubs. My badge does not have a big bold “MD” on it. In the ICU, I’m usually mistaken for a nurse or a unit secretary.

When someone asks if I’m a nurse, my response is, “No, sir/ma’am. I’m not qualified to be one. But can I help you?” Usually they need something small like an extra blanket or a glass of water for the patient, something I’m always happy to do.

And I don’t mean to be glib when I say I am unqualified to be a nurse. I truly am. Nursing is hard. I continue to be amazed by what nurses can and must do for their patients. I have tremendous admiration and respect for my nursing colleagues.

Medicine is full of antidotes. Afflicted with this? Take that. Accidentally swallowed that? Now swallow this.

This book is 300+ pages of antidote. For what, you ask?

This book is the antidote to the doctor you barely know; the doctor who rarely spends more than five minutes with you; the doctor who doesn’t really know your name; the doctor whose fees can run into the thousands of dollars.

This book is about the only surgeon on a small island. Timothy Lepore (which rhymes with “peppery”) is that doctor, and the island is Nantucket.

Ah, you say. Nantucket. No wonder he has time for every patient. He’s probably rich No wonder he doesn’t bill some patients, and accepts payment in oatmeal raisin cookies from some others. After all, what does he treat? Sunburn? The occasional fish hook caught in some angler’s finger?

It won’t take you many pages to discover that a lot happens on Nantucket Island that requires every skill the most capable doctor could

bring to the task: “[Over time] hundreds of people would have died if he wasn’t there, if not thousands,” says another doctor who knows Lepore.

Aside from his serious medical skills —you’ll get to know those both on the island and in his preNantucket days — Lepore has what author Pam Belluck calls “his patient-centered approach, once much more the norm, [which] now strains to survive in towns and cities across the country as health care costs skyrocket, medicine becomes more corporatized and monetized, and extended quality time with doctors is an increasingly vanishing

commodity.”

So yes, there is a little bit of sermonizing in this book, but it’s much more like a fast-reading peek into the everyday life of a busy, if somewhat eccentric doctor. Along the way you’ll get to know a number of his more noteworthy patients, from Jimmy Buffet to the titular Underground Tom, and the downright weird Billy Dexter.

Part of Lepore’s duties involve expert testimony in court cases, and being crossexamined by lawyers who know he might have to save their life one day.

There are first-hand accounts of mass casualty fires, open heart surgery, colon obstruction operations, cancer, stabbings, shootings, and ticks, one of the banes of island living.

Yes, Nantucket is just a nice quiet island where nothing ever happens — until it does. All those times are what this book is about.

+

Island Practice: Cobblestone Rash, Underground Tom, and Other Adventures of a Nantucket Doctor, by Pam Belluck, M.D., 304 pages, published in July 2013 by Public Affairs

This Examiner crossword has me stumped.

I’ve got the first three letters of the word that I’m stuck on. What do you have? Yeah, they’re hard sometimes.

THE MYSTERY WORD

Ten letters, and it starts with gas.... Try automobile.

The Mystery Word for this issue: LCUEMS

Simply unscramble the letters, then begin exploring our ads When you find the correctly spelled word HIDDEN in one of our ads — enter at AugustaRx.com

ACROSS

1. Exclamation by Scrooge

4. Worthless person

8. He wrote “Graceland”

DOWN

1. Auditorium name

2. Jessye Norman melody

3. Johnson, former chairman of the Augusta National

4. Prefix meaning lower or below

5. Radio starter

6. Unwarranted

7. Possibly

8. Hang

9. Physician still in training

10. Manner, attitude, look

11. Of the ear

12. Hawaiian goose

13. Hollywood’s Saldana

20. Prefix meaning within

24. Profession of care

25. Inn (in Spain)

26. Decoration; award

27. He wrote and directed Jerry Maguire

28. _____Jackets

30. Seat of Georgia’s Wheeler County

WORDS

DIRECTIONS: Every line, vertical and horizontal, and all nine 9-square boxes must each contain the numbers 1 though 9. Solution on page 14.

31. _____ Building (in downtown Augusta)

32. Expanse of grass 35. It keeps pills in place

Humble dwelling

Black bird

Go back in

Test

Small medicated lozenge; pastille

Augusta’s ______ Market

Noted architect

Capital of South Korea

DIRECTIONS: Recreate a timeless nugget of wisdom by using the letters in each vertical column to fill the boxes above them. Once any letter is used, cross it out in the lower half of the puzzle. Letters may be used only once. Black squares indicate spaces between words, and words may extend onto a second line.

Solution on page 14.

Use the letters provided at bottom to create words to solve the puzzle above. All the listed letters following #1 are the first letters of the various words; the letters following #2 are the second letters of each word, and so on. Try solving words with letter clues or numbers with minimal choices listed. A sample is shown. Solution on page 14.

When it comes to online chats, if a girl says she’s 18, she’s probably 16. If she says she’s 16, she’s probably 14. And if she says she’s 14, she’s probably 52.

Moe: Man, dating in my 30s is like being a Chinese spy balloon.

Joe: How so?

Moe: I’m the size of three school buses and I keep getting shot down.

Moe: What do you call two birds in love?

Joe: Tweethearts.

Moe: What’s the best kind of triangle to ask out on a date?

Joe: Acute triangle.

Moe: If someone who hates Christmas is called a Grinch, what do you call someone who hates Valentines Day?

Joe: Single.

A man from Georgia dies and winds up in hell. The devil greets him with a cruel laugh and gleefully warns him that things are about

to get hot.

“No problem,” the man says. “I’m used to it. I’m from Augusta.”

“We’ll see about that,” says the devil, and walks over to a thermostat and cranks up the temperature to 100° with humidity at 80%.

“How do feel now?” the devil asks the man.

“Love it! Just like a spring day back home.”

So the devil goes back to the thermostat, this time putting the dial at 150° with 90% humidity. “How do like that?” asks the devil.

“Reminds me of summertime in Georgia.”

“I’m through playing with you,” says the devil angrily, jacking up the heat to 200° with 100% humidity. When he goes back to check on the man, he’s sweating and fanning himself but otherwise doesn’t seem to be suffering too much. “I’m fine,” he says.

“That is about to change!” screams the devil, and he goes back to the thermostat and this time turns the temperature to 150 degrees below zero. Icicles are everywhere. The devil’s domain is now a frozen wasteland. He returns to check on the man from Georgia and is shocked to see him jumping up and down in obvious joy. The devil wants to know what’s going on.

“The Falcons won the Super Bowl! The Falcons won the Super Bowl!”

Moe: I predicted the Super Bowl score before the game even started. Accurately too.

Joe: You did?

Moe: I sure did. 0 - 0.

Moe: Why is it impossible to eat baklava underground?

Joe: Because down there it’s bakmagma.

The Advice Doctor

Dear Advice Doctor,

I have two jobs, both of them very physically demanding, while my husband works at home sitting in a chair all day. I come home completely exhausted every day, while he has done nothing, at least physically. But guess who sleeps like a baby? My husband! Advice please.

— Weary of Weariness

Dear Weary,

Thank you so much for entrusting me with the important job of finding a solution to this problem. I am impressed that you care so much about your husband. We have got to get this man some help! The poor guy must be absolutely dragging.

I did some research and found that although newborns may sleep anywhere from 14 to 17 hours in every 24-hour day, they do so only in short segments. They wake up every two to four hours, which from your description is exactly what your husband is doing, to be fed, burped, and have their diapers changed (babies that is, not your husband).

While that might work for newborns, sleeping like a baby is bad news for grown-ups. We need uninterrupted sleep — what experts call sleep continuity. No one fully understands all of the mechanisms behind sleep and brain health, but research strongly suggests that sleep continuity is vital for maintaining proper thinking ability, forming memories, and being able to make sensible decisions. Interrupted sleep is so unsalubrious that in some respects it’s worse than no sleep at all. Researchers found that people whose sleep was interrupted three nights in a row fared worse in mental acuity and were more cranky than people who got less sleep, but what they got was uninterrupted.

Our goal is to stop your husband from waking up every two to four hours. He will feel much better. How can we do it?

Simple things we know but sometimes don’t do: Exercise promotes healthful sleep, but not in the hours before bed. Ditto for drinking coffee or alcohol. Not drinking anything in the last hour or two before bed can prevent sleep interruptions too. Start to wind down into quiet and relaxed mode well before bedtime, which should be the same time 7 days a week. Don’t have screens in your bedroom. Keep the room cool: snuggling under the covers promotes the cozy feeling that promotes sleep.

I hope this answers your question. Thanks for writing!

Do you have a question for The Advice Doctor about health, life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will be provided only in the Examiner.

By popular demand we’re making at-cost subscriptions available for the convenience of our readers. If you live beyond the Aiken-Augusta area, or miss issues between doctor’s appointments — don’t you hate it when that happens? — we’ll command your mail carrier to bring every issue to your house!

I’ve just checked my home insurance policy and apparently if my blanket is stolen in the middle of the night, l’m not covered.

THE MYSTERY SOLVED

The Mystery Word in our last issue was: PILL

...cleverly hidden in the p. 14 ad for SLEEP INSTITUTE

OF

AUGUSTA

THE WINNER: AMANDA GUIDRY!

If that’s your name, congratulations! Send us your mailing address using the email address in the box on page 3. The new Mystery Word is on page 12. Start looking!

The Celebrated

MYSTERY WORD CONTEST

...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then find it concealed within one of our ads. Click in to the contest link at www.AugustaRx.com and enter. If we pick you in our random drawing of correct entries, you’ll score our goodie package!

SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the ads in this issue. 2. Visit the Reader Contests page at www.AugustaRx.com. 3. Tell us what you found and where you found it. 4. If you’re right and you’re the one we pick at random, you win. (Winners within the past six months are ineligible.) 5. Prizes awarded to winners may vary from issue to issue. Limited sizes are available for shirt prize. 6. A photo ID may be required to claim some prizes. 7. Other entrants may win a lesser prize at the sole discretion of the publisher. 8. Deadline to enter is shown on page 12.

PROFESSIONAL DIRECTORY

LONG TERM CARE

Dr. Eric Sherrell, DACM, LAC

Augusta Acupuncture Clinic 4141 Columbia Road 706-888-0707

www.AcuClinicGA.com

3633 Wheeler Rd, Suite 365 Augusta 30909 706-432-6866

www.visitrcp.com

EMF Safe Homes Sheila Reavill Certified Building Biology Specialist 209-625-8382 (landline)

SURVEY•ASSESSMENT•REMEDIATION

IN-HOME CARE

Everyday Elder Care LLC Certified Home Health/Caregiver 706-231-7001 everydayeldercare.com

Zena Home Care

Personal Care|Skilled Nursing|Companion 706-426-5967

www.zenahomecare.com

WOODY MERRY www.woodymerry.com

Long-Term Care Planning I CAN HELP! (706) 733-3190 • 733-5525 (fax)

SLEEP

Sleep Institute of Augusta

Bashir Chaudhary, MD 3685 Wheeler Rd, Suite 101 Augusta 30909 706-868-8555

— posted by Edward Hoffer, MD, on 1/23/2023 (edited)

GUN CRISIS IN AMERICA:

YOUTH FATALITIES ON THE RISE

the blog spot

— posted by Jef Baker, MD, on Feb. 2, 2023 (edited for space)

HOW TO SPEAK SOUTHERN MEDICINE

While one could say I was born in the South, I had to move a lot closer to the Mighty Mississippi to find that my Southern California momma and daddy left certain nuances of expressive gentility untouched in the process of raising me right. Northwest Arkansas, where we’ve come to settle, may not be considered the Deep South, but you certainly can hear it from here.

One good place to do that is the emergency department, a place I’ve worked in and around for 35 years. Eventually, almost everyone has an ER encounter, either as the patient, a family member, or maybe as the friend who carried their neighbor Bobbie Sue into town when she broke her arm falling out of the hayloft that summer.

Remember that? You two were sitting near the top of that ladder making out when … The rest of the family doesn’t know that part, but I do. And I’ve kept your secret nigh up to … well, right now. But this story is just between the two of us, of course.

Anyhoo, the ER is an arena of medicine where you get to see a bit of everything. If all the South’s a stage, the ER certainly is a front-row seat. All too often, the reason for the visitation is unclear at first glance.

Momma might feel poorly, a bit puny, or just laid up. Uncle Enos presents as being plum tuckered, maybe even wore slap out. Whatever it is, it hurts a heap and has most likely totally drained your gumption.

I can’t count the number of middle-aged men who show up in the ER because they were drugged. As in, “my wife drugged me in here.” Getting a Southern man to the hospital when he has four dogs, 20 cattle, and a horse to feed is no small feat. At times, getting him to stay is even harder. As one woman explained when her hard-working husband resisted admission for a heart attack in progress, “He ain’t good looking, but he sure is dumb.” That sentiment ‘taint necessarily a Southern thing.

I’m sure there are women in all 50 states who have had the same thought cross their minds a time or two.

One helpful presenting complaint was, “I just ain’t right,

doc. Sick. You know what I mean, just plain sick! I finally came in ’cause I’m ‘bout fit to be tied.” My diagnosis: he had an inflamed appendix that needed to be done gone and went. A day or two later when he got his first post-op meal, he reported that he was as happy as a tick on a dog.

Usually, we in the ER can fix the hitch in your giddyup and concoct a treatment when y’all have that feeling of being pecked by a hundred chickens, sweating like a sinner in church, or having the bowels done locked up. The panic-producing “can’t get no err” (air) is a bit more complicated, and so is “that boy is acting crazier than a sprayed cockroach.”

As a time-saver, I’ve learned that an extremity wrapped in duct tape might be the best place to start an exam. But Lord knows there’s always more to the story before all is said and done.

Getting the details

Some basics of taking the patient history down South: Recent medical care: such as the cardiology consult the patient with recurring chest pain had scheduled and missed last month. It turns out he was fixin’ to go, or maybe he would get to that directly.

Exercise habits: As one wife of 45 years observed about her husband: “Well, he’ll never drown in his own sweat.”

Stroke history: It’s helpful to have family around so they can identify if that thick accent is a stroke or their normal voice. Maybe they know if the patient is now movin’ slower than a herd of turtles, looking pie-eyed or walkin’ cattywampus. If you trained in Jackson, Atlanta, ‘Narlins, Raleigh or Birmingham, you know that any of these findings can be suspicious for neurological impairment.

Family history: Also known as: how your kinfolk passed. In Meemaw’s case, it was a common case of the dwindles. As in, “She had the dwindles for a good long piece before she went on.” Whereas in Father’s case, it might be an obscure version of uppin. “We don’t quite know what happened to daddy, but one day he just uppin died.”

Mental health history: While it’s true that 45-year-old grown men brought to the ER

by their momma could have organic disease, there’s also fair odds that somethin’ hain’t right in the haid. And when your nephew is nuttier than a port-a-potty at a peanut festival, it might be ’cause sister drove her ducks to a bad pond o’water. Unlike folk north of the Mason-Dixon, people in the South openly recognize that everyone has crazy people in their family. The main point of contention is in deciding what side it comes from. Some general and unofficial psychiatric diagnoses we’ve heard include:

“We’re talkin’ three gallons of crazy in a 2-gallon bucket.”

“That boy’s a half bubble off plumb.”

“Let’s just say if stupid could fly, he’d be a jet airplane.”

“That side of the family don’t have their cornbread done in the middle.”

Bottom line, when EMTs find you in your front yard at 2 a.m. nekked as a jaybird, well … there’s your sign.

Then again, if might be nothing more than an anxiety attack if it puts you in a tizzy. You might even have thrown a hissy fit. If it’s an especially bad day, you might could pitch a fit or go on to have a conniption, bless your heart.

In the “does it hurt here” department:

Neck: “Only when I try to swaller.” If you feel like you swallered a frog, that can’t either feel or taste good.

Abdomen: “Only when you mash on it.” During an abdominal exam, a patient once told me she had the collywobbles. I now know that if they sit upright directly after they say that, you should immediately hand them the nearest round receptacle to heave into, and step aside, post haste.

Wound care: Make sure that you don’t stint on the injectable anesthesia as some of the printable responses could include, “What in tarnation! Lord have mercy! Heavens to Betsy! What in the Sam Hill! I do declare! And my personal favorite: For cryin’ out loud, doc!”

Examining anatomy where the sun don’t shine

At least once or twice a shift, the search for a diagnosis requires a rectal exam. Unfortunately, this is a procedure where neither the patient nor I qualify for much-needed anesthesia. While I’ve received witty and profane commentary from the respondent during this personal procedure, my favorite ice breaker was from the guy who offered, “Why don’t you use two fingers and give me a second opinion?” We had to make do with one, but I concluded by advising him, “If either one of us is enjoying this, you need a new doctor.”

Using common sense with your patients

Just because my people may talk with an accent does not discount a sharp understanding of the obvious. As a 78-year-old gentleman with a terminal lung cancer diagnosis explained about not quitting smoking: “Now that there’s a lost ball in the high weeds.” At other times, a little situational awareness during the exam is helpful. When I asked a patient who was about two sugar cubes short of a diabetic coma about the brown liquid he was drinking, I was informed, “It’s sweet tea, doc. Is there any other kind?”

Is everybody happy here?

Every once in a while, the conversation with a patient’s family member could start with something like: “I’ve got a bone to pick with you.” That would be a good time to pay close attention, especially if it’s the spouse or mother. The added phrase “pray tell” could indicate a degree of skepticism. When that is followed by “that there’s total flumadiddle,” “I don’t give two hoots and a holler,” or the dreaded “with all due respect” (a.k.a. you can kiss my grits), it might just be time to back it up a bit and make sure we are all communicating in a clear and friendly manner. Just remember that when all’s said and done, if momma’s not happy…

Regarding the discussion of surgical options

As a patient with Crohn’s disease and an inflamed but not quite yet obstructed colon and I discussed his options, including seeing a surgeon at some point, I was advised, “My mama didn’t raise no fool. You never ask a barber if you need a haircut.” As we concluded a discussion of hospital admission and the ensuing diagnostic process, he added, “So if we don’t get it in the wash, we’ll get it in the rinse?” Yup, that about sums it up. As it turns out, he did just fine without seeing the barber, but he couldn’t avoid an encounter with that “durn butt scope guy.”

When people feel

recovery coming on

Before leaving the ER on her way to a surgical admission, one dear lady whose gallstone pain was obliviated by an opiate-induced bliss professed, “there’s nothing like lah-teedah!” I had never heard the potent pain reliever Dilaudid pronounced that way, but she had the right idea. Earlier in the evening, she reported, “My husband thinks it’s my gallbladder, but I think he’s barking up the wrong tree.” Actually, nope. Maybe I’ll join that guy on his next raccoon hunt.

Living in or near the South is more than a lesson in euphemisms and pronunciation. It is a recognition of a way of life that emphasizes faith, family, and an uncommon grasp of the nuances of relationship. I’ve found that in the South, the language and the culture, just like old married couples, go together like moonshine in a mason jar.

Keep in mind, friend, that you can say what you want about the South, but last I heard, no one ever moves North when they retire

Jeff Baker is an emergency physician.