It usually takes me several weeks to write these essays, in part because I am slow, and in part I have more to do in retirement than I ever did when working. But as this goes live, I am recovering from a new knee replacement. As I age I am having everything that fails and either be replaced or removed. Orchiectomy next? Or TMI? Anyhoo, I doubt I will be much in the mood to write for most of September, so a brief hodgepodge at the end of summer.
Critical Thinking is Tough.
I went to use the stove fan and it was dead. Crap. I do not use it often, but I remembered that we recently needed to replace the circuit breaker panel, as the system we had was noted to fail and burn down the house. I think the maker was Talking Heads. I wondered if the circuit breaker was off. I looked at panel and breaker appeared fine, but I flipped it on and off anyway. What do you know? The fan worked. I guessed, as if I know anything about circuit breakers, that maybe it had not been flipped completely to the on position.
A week later, I needed the fan again. It was dead. Crap. I flipped the circuit breaker few times, but this time nothing. It was Saturday, so I made a mental note to call the electrician on Monday.
However, the next day as I walked past the circuit breaker, I flipped the switch off and on and, what do you know, the fan worked. Must be a loose connection or a faulty breaker. So Monday I called the electrician.
She showed up and I told her the story. And? She first went to the stove. We keep the oils and vinegars on a lazy Susan under the stove and over time they had hit the cord to the fan and slowly wiggled out the plug, which was sitting half out. She pushed the plug in and everything was fine.
And I felt the idiot, And over the same weekend my wife had me look at the cable box, which wasn’t working. Because it was unplugged. First thing is to make sure the device is plugged in, I told her.
I will let you list the number and type of cognitive errors I made. Assuming causation and premature closure at a minimum.
Barbie had it easy. Critical thinking is not the default operating mode of the brain, and it annoys me no end with I forget to flip that mental circuit breaker.
Natural History
I have always practiced medicine when there are interventions that alters the course of diseases. Not always altered a lot, as in the beginning of the AIDS epidemic. And sometimes the course of diseases went the wrong direction, as was learned with antiarrhythmics.
But I have always been able to do something to treat diseases. So I rarely had the opportunity to see the natural, untreated, course of diseases. I knew historically what the natural history of some diseases were, such as Tb and syphilis, , but the opportunity was rare as a Coelacanth here in the great Pacific NW.
Disease progression is fascinating. How an infection twists and turns anatomy and physiology is interesting, but most of the time medical interventions modify those findings. And to witness the natural course of disease, people have to suffer and die, so never worth it.
The only people in the industrialized countries who get to see the natural history of disease are TCPM, homeopaths, NDs and other SCAM providers who victims, er, I mean patients rely solely upon them for their health care.
I have told the story before about how I became interested in SCAMs. It has been awhile, but us old folk relish any opportunity to repeat ourselves to captive audiences. Of course you can skip the next paragraph if you have read this one before.
It was early in my career that I was called to see a case of gangrene. What it turned out to be was a young woman who had a sarcoma of her leg that likely would have been cured with amputation. She opted instead to rely on a naturopath who, as I remember it, gave her alkaline therapy, The ‘treatment,’ being 100% useless, did nothing to the tumor, which had taken over her leg and, as big tumors can do, rotted, Quite the smell. But it wasn’t gangrene in the classic sense, just dead meat that putrefied, Nothing for me to do. She had fainted at home, which was why she was in the hospital, and when she woke up, she refused all care, wanting to return to the care of her ND. The rotting flesh was, you see, proof the ‘treatment’ was working. That night the tumor eroded into her femoral artery and she bled out and died.
Denial of massive tumors that went on to putrefy was not that uncommon, although that was the only case I ever saw while the patient was (six feet) under ND care.
But the ND did get to see the natural history of an untreated tumor. And sad to say that tradition of witnessing the natural history of untreated cancer continues, although not by an ND, but a forensic psychiatrist and the patient’s mother, an ex-nurse:
A University of Cambridge graduate who died after refusing chemotherapy was reportedly undergoing “five coffee enemas a day” under her mother’s supervision, according to her brother. Paloma Shemirani, 23, died at Royal Sussex County Hospital on July 24, 2024, having turned down treatment for non-Hodgkin lymphoma.
she also received
cancer treatment revolved largely around a strict diet and “lots of green juices”.
And so they got to watch the natural history of what should have been a curable non-Hogdkin’s lymphoma progress to death.
At an inquest into her death at Kent and Medway Coroner’s Court in Maidstone on Wednesday, pathologist Dr David Wright said Paloma had a large mass, as big as 17cm (6.7 in), in her chest.
“I looked at the tumour and you could see the bulk of it – growing in all directions,” he said.
The tumour had “distorted and displaced” veins and arteries and it caused “major compromise of vessels and airways”, Dr Wright added.
It was growing into the ribs and “replaced most of the upper lobe of the right lung,” he continued.
One of those cases that speaks for itself in its awfulness. Me? I am glad I rarely had to witness the natural history of disease and the inevitable death. I’ll leave that to the SCAM providers.
Uncertain Criteria
I received an email just yesterday from Castle Connelly informing me I was one of the 2025 US best doctors and would I like to purchase a plague? I think my spell checker meant plaque. What makes the designation so impressive is that I have been retired for 2 years and 9 months, also the last time I cut my hair. I am rocking the LBJ look. So either I am a better ID physician than all those who are actually in practice or their “rigorous research process” to identify top doctors isn’t. Probably the latter, even if I prefer the former. But I kind of want a plaque now.
Link to the photo.
