Posts Tagged ‘tesosterone deficiency’

Testosterone deficiency, exit strategies, excellent lunch, saxophone lessons, the VA, and previous careers

February 26, 2010


In any human environment

There is a final  requirement

            Wherever you go

            Whomever you know

You face an eventual retirement


A very long time ago I had a career in radio.  At the time it seemed a long career, now, from the perspective of 23 years at one gig, it seems very brief indeed.  I learned an immense amount about human communication and those lessons have helped ever since. 

I start Thursdays with a brief radio segment.  On the way to the station I drop a friend at Same Day Surgery, then I drive through the darkness and the ice in unforgiving frigid temperatures, the city just starting to wake up.  In the four-minute wind up, Sean, the DJ and I talk about what we’re going to talk about.

I had intended to speak about skin cancer, Sean would prefer to talk about rapid weight loss.

Sean is a real pro.  The control boards bear a superficial resemblance to the analog stuff I used to work with, but there are no turntables or tape decks.  There are computers with digital music, spots, and features.  News and weather are still read live.

On the air, I launch into my spiel about not losing more than a kilo a week if you really want the pounds to leave and not come back.  Sean notes that I’ve been losing weight, I admit I’ve been hitting the gym pretty hard, and he says that he’s been losing six pounds a week.  I finish with my tag line, “Nicotine, caffeine, alcohol, diet, exercise, sleep, and seatbelts.”

It’s the seven word distillation of the good advice I give out through most of my day.  I probably reach more people and do more good in the five minutes a week of my radio spot than in the rest of my work week.

Then into the cold and a sixteen block drive up the street to St. Luke’s.  My OB patient’s anemia reached an equilibrium at Bad but not Critical.  She won’t need transfusion.  I examine the baby, I give advice about iron intake, and I hang on the verge of giving a discharge order when the nurse notes a fever.  We’ll wait another eight hours to see how she does.

I’ll be giving advice on anemia for the rest of the day.

In the doctor’s lounge I eat an orange and I read the funnies, and one of the subspecialists walks in. 

He’s heard about my career move, and we sit and we talk. 

Bad sleep has battered his face, but I don’t say anything.  I have been sleeping poorly for the last fifty years or so and it’s been worse for the last four weeks.  Doctors don’t mention the bad sleep that they see on a colleague’s faces because it’s less interesting than the weather.  It is always there, a feature of the landscape like the sidewalks, taken for granted.  Occasionally I’ll see a doc who slept well the night before and I’ll mention it as a compliment.

We discuss retirement in general.  I say I know I’ve got to slow down, and slowing down is going to be easier and less of a shock to my system when at sixty than at sixty-five.  He tells me he’s stuck in a rut.  Certainly, in terms of his situation and specialty he can’t slow down.  Not on a personal basis and not in terms of the critical place he has in Sioux City medicine.  We agree that slowing down is a good and desirable goal, and we agree that it can be very difficult.

No two doctors have exactly the same job, even in the same specialty or lack of specialty, even if they work side by side in the same office.  Each one has a unique situation.  In our discussions I take care to make statements about my place in the grand scheme of things. 

We also talk about how Ken Tjeerdsma’s death affected the entire medical community.

He was a very good, very warm cardiologist.  He died suddenly in October at the age of 53 and his passing left a palpable void in the Sioux City medical community.  Every doctor in town knew him and enjoyed him and the tragedy made a lot of us reassess our personal direction in life.  I talk about how it played a large factor in my decision.

At the house I start making calls, talking to recruiters, trying to line up work for the coming year.  I leave some voice mails.

At 9:30 I go for my annual VA appointment with Dr. Sly

Dave Sly has been in town for more than fifteen years.  He joined the VA about 8 years ago.  I talk about my career move.  He’s very supportive.  We talk about what is sustainable in a medical career and what isn’t.  He really enjoys his position and doesn’t have plans to change at all.  We agree we have the best job in the world, but we have problems setting limits on it.

Last year he talked about his move to the VA and how he made the pleasant transition to not carrying a beeper.  That conversation left its impression on me. 

I’ve been thinking about exit strategies for years, especially when things don’t go quite right or when things go too long.  We talk about how much we love the work and how medicine can frequently be too much of a good thing.  Dr. Sly has a career that’s sustainable for a very long time. 

Sioux City has sent a large number of really good FP’s into the VA system.  Enthusiastic about their work, they do reasonable hours at a reasonable pace for a reasonable wage with great benefits.

I’ve considered the option, but I think I’ll do my best for society in a spot where I can use my Spanish.

He examines me.  We go over my lab work.

Niacin and fish oil control my cholesterol, my thyroid words well, and my kidney function continues to improve.

My low testosterone explains the hot flashes, sleep disturbance, and the tendency to tendonitis with resistance exercise.  I’m hoping it helps with my cold intolerance.

In the late morning Bethany and I go down to the bicycle shop.

My career in bike repair ran longer than my career in radio, and the two overlapped.  We look over the bikes in the shop, Bethany picks one out, we talk about modifications and we negotiate a price.

The owner of the bike shop looks like he’s enjoying business so much he doesn’t want to retire.

Prices of bicycles in absolute terms have not gone up much but the quality has spiraled upwards. A 21 pound machine would have cost upwards of a thousand dollars back then, today a 20 pound cycle is available for $450.

We lunch across town at the new restaurant, Eldon’s.  We run into friends, and an acquaintance introduces the owner himself, Eldon.

He is much more down to earth and accessible than I thought possible.  He has done well for himself in the food industry with some brilliant patents.  He looks like he’s enjoying himself in this next part in his career.

We lunch on rib eye sandwiches and fingerling potatoes.  The attention to the science of cooking astounds me.

The food is fabulous, the décor is excellent, and the service extraordinary.  The prices are reasonable.  If this place reflects Eldon, I’d like to get to know Eldon better.  And in a town like Sioux City, it’s very possible to do so.

Bethany drops me at my saxophone lesson. 

I had a very short career as a professional musician.  I wasn’t very good at it, and I didn’t retire gracefully.  That was before I thought about medicine.  I still love music and I still love playing the sax, but I hold no illusions about reinventing myself into the industry.

My teacher loves music, teaching, and teaching music too much to stop teaching music, and does a good slow-down business in the private lesson sector.  She has been a friend of the family for years. 

I bring a gift, a jar of home-made peach jam.

It’s good to play the saxophone again.  It’s good to have formal music teaching now. I like learning some of the fine points that I was never taught, because I was self-taught.  I run through scales and I don’t resent them. 

I have neglected my drive for music, and I look forward to nurturing it again.  I don’t care if I lack the talent to get paid for it.