Posts Tagged ‘yoyo’

High School Reunion 7: Epilogue

June 6, 2018

I wouldn’t go back if I could

To practice the way that I should

Would the music I write

Bring the world light?

As a doc, I’m doing more good.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, a friend’s funeral, and a British Columbia reprise, I took a break from Sioux City for my 50th High School reunion.  Any identifiable patient information has been included with permission.

 

I left Denver for Boston on a red-eye flight, with a layover about lunchtime in Indianapolis.

I struck up a conversation with a waiter who served me in an airport restaurant. He saw my noise-cancelling headphones and called them “really nice.”

They were an anniversary gift from my wife, I said. To the delight of the children present, I showed off my really nice, spiffy yoyo, also an anniversary gift from my wife.  I didn’t mention the really nice bicycle repair stand she’d bought me for our 10th anniversary.

He asked how Iowa differs from Indiana, and farming popped into my mind first, so I talked about how Iowa might have good ground, but Indiana has better. Then I had to explain that I work as a doctor, not as a farmer.

Because he found himself working on a holiday (Memorial Day), I asked if he were a student.

Working two jobs to save money to further his schooling he found himself in an educational hiatus.

He composes music, and he wants to change the world for the better thereby.

I told him I started my first undergraduate career as a Theory and Composition major. I told the truth, that I hadn’t wanted to do the disciplined work to develop my meager talent, and that I didn’t fit into the dominantly gay subculture of the college music scene.  But I didn’t tell the whole truth, that I had gone to Yale, with one of the best music programs in the world.

I have a high school friend who still qualifies as a musician, I said, and when we play our tunes from the ‘60s I express amazement that I wrote stuff that good.

But I again made the observation that I have done a lot more good as a doctor than I ever would have done as a composer.

I want to tell him that the chances of him actually making enough to pay for housing and food and transportation by playing and composing with artistic integrity come close to the odds of winning the lottery; he faces fierce competition from hoards of those determined to follow their passion, and competition drives down the price.

But I don’t. If he succeeds he can revel in it, and if he doesn’t, his dreams will die a hard death soon enough.  .

 

Raising TV-free Kids

April 12, 2018

The visit finished just swell

Not needed were my tricks than can quell

That interruption

That brings conversation corruption

‘Cause the children were behaving so well

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, and a friend’s funeral, I have returned to British Columbia.  Any identifiable patient information has been included with permission.

A visit with multiple children in the exam room can challenge the most patient of doctors. Those of us with ADHD can find our enjoyment of children threatened by chaos and noise.  I have developed strategies.

I have a yoyo and I know how to use it. I tell any children not involved in the business at hand that I’ll do yoyo tricks if they don’t interrupt; the first trick follows about 45 seconds later, the second one 3 minutes after that, and the interval keeps getting longer.  The strategy works on kids who can’t tell time, and it works better on girls than on boys.

This week I took care of 3 of 4 patients in the room, a mother with her three very young children. The kids sat quietly and didn’t interrupt.  Neither I nor the mother needed to chastise, bribe, or threaten.  I worked through the patients one by one.  While explaining clinical findings, diagnosis and plan to the mother I noticed the middle sibling kiss the older one on the back.  Before I could finish my sentence, the youngest one had kissed the middle one.

When I finished with the heart of the visit, I asked the mother, and found out, that the household had no television.   Then I requested and received permission to write about a family with well-behaved, well-disciplined, loving children raised in a TV-free home.

I congratulated her, and told her my wife and I raised our three daughters with no television. Actually, in the course of time we partly raised 3 others as well, but I didn’t mention them.  We talked about how children love stories and generally prefer them to television.

I didn’t tell her about working in a First Nations community, where I repeatedly saw siblings treat each other with love and respect. Nor did I make the observation that children mirror their parents, and such behavior as I saw spoke well of the way that the parents treated each other and their children.

And I didn’t tell her the real reason that Bethany and I have lived without television: we have a problem with it. If present, we will watch it to the exclusion of eating, sleeping, marital bliss, and parenting.   We are TV addicts, and we do fine if it isn’t available.

 

Yoyo memories at the meat counter

March 21, 2018

For a child hiding under a chair,

A technique that I use with much flair,

With the yoyo, a trick

For the well and the sick

The resistant are ever so rare.

 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, I’m taking a break to welcome a new granddaughter, deal with my wife’s (non-malignant) brain tumor, and attend a friend’s funeral.  Any identifiable patient information has been included with permission.

Bethany and I went grocery shopping and stopped at the meat counter for lamb shanks. The butcher who served us recognized me immediately as his former physician (and gave permission to recount the interaction).  After he took our order he recounted with delight how I could soothe his children with my yoyo tricks.  I reached into my pocket and brought out the toy.

Of course the string had tangled in my pocket, and I had to disassemble the yoyo to straighten things out. To my horror, the bearing dropped off the axle and went rolling across the floor.

Even to the best eyes on the planet, finding an object as small as a yoyo bearing (about 5mm) on a place as big as a grocery store floor come with difficulty, and I don’t have the best eyes on the planet. Bethany and I looked, and then encouraged a couple who just wanted to buy meat to engage the butcher.  When I had given up, I found the shiny metal piece on the linoleum, reassembled the yoyo, and wound the string.  By then my audience included the butcher, my wife, and the other couple.

I chose my single most elaborate (not most difficult) trick: Around the world sideways twice followed by double or nothing.  A great visual but not as hard as it looks, I do it with my eyes closed and invariably draw applause; in this case small applause from a small audience.

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Over the years I developed a system to establish rapport with children, eventually I figured out how to do so even with the sick ones. After 1991, the yoyo found a key place in my armamentarium.

Many children come to me after bad interactions with the health care profession, whether dentists or other docs or nurses, and many of those hide under chairs before I walk in. Generally, I just get out my yoyo and play with it and talk to the parent until the kid gets curious.  Regretfully, once or twice a year a child arrives so traumatized that my best tricks don’t work.

At a funeral I ran into a parent of one of the many children I charmed out from under a chair.

 

Christmas Eve, finishing at noon.

December 26, 2015

I don’t mind that the other docs leave
A balance I hope to achieve
And they’re closing at noon
The time off is a boon,
I’m happy to work Christmas Eve

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. Right now I’m in western Nebraska. Any patient information has been included with permission.

I work the holiday weekend because I don’t celebrate the holiday and I want those who do to have the time with their families. With two exceptions, I’ve done so every Christmas since 1975. Our facility made the decision to close at noon on 12/24/15. One of the permanent docs has already left for vacation.
I came in a bit early to care for a patient admitted yesterday through the ER.
Then I went back to my office to find no one on the schedule until 10:00.
I waded through a backlog of documentation that preceded my entry into the EMR here, NextGen. After two weeks in the system, I got full access this week.
I took the delay with equanimity. If I can’t get a piece of information or do a particular task, then I can’t. Management treats me very, very well here, and hasn’t overloaded me. If I eventually need to stay late to play with the semi-conductors, I get paid.
NextGen has a particular button to push, called PAQ. Because no one seems to know what that stands for, I’ve started calling it Pheasants and Quail, and until Tuesday, every time I clicked it a message appeared saying the provider was disabled, good for a few jokes. Yesterday the button started to function for me, giving me 118 of my own documents, plus x-rays, lab tests, letters, and consultations to approve.
As with most EMRs, NextGen has its share of irrational quirks. I don’t know another system that makes the doctor approve his or her own document twice.
With exactly one patient on my schedule, I cheerfully took another provider’s patient who showed up 45 minutes late. I had a good time talking with the patient and the family; we developed a plan and I completed the electronic paperword about the time the next patient, in the pediatric age range, got through screening.
I carry a yoyo because I take care of children; a really spiffy one because I can. I did a few tricks, involving a couple of mistakes, but impressed the family and the patient. At the end I said, as I usually do, “If you don’t smoke, drink, or use drugs, you can afford any yoyo you want.” I see it as a way to guide concrete-thinking children towards good lifestyle decisions.
A family member held up a thick envelope, expressed frustration that nationally recognized experts hadn’t helped, and requested I take the case.
I said I’d be happy to, but the more doctors that failed before me, the smaller the chance that I would succeed. “Make an appointment,” I said.
That documentation finished at noon, I went back down the hallway to the hospital and conferred with the patient and family. Terms like the 2 midnight rule and the 3 day stay rule flew back and forth. Eventually I said, “I understand the synthesis of porphyrins, but I haven’t been able to grasp the insurance company’s rules. Because they don’t want their rules to be understood. There is no transparency.” And I left the question up to the nurse who would talk to experts working Somewhere Else.
Bethany waited for me in my office when I returned. We sweated in the gym for an hour and went out to lunch.

Enjoying my time on hold: A terrible double murder, a rocky coast, and the US Marshalls

March 7, 2014

Here’s an idea that’s bold:

A thing you can do while on hold

Instead of music to hear

That will bore you to tears

Listen to the story that’s told.

 

SYNOPSIS:  I’m a Family Practitioner from Sioux City, Iowa.  In 2010 I danced back from the brink of burnout, sold my share of a private practice, and, honoring a 1-year non-compete clause, went to have adventures in Alaska, Nebraska, Iowa, and New Zealand.  I returned to take a part-time position with a Community Health Center, now down to 40 hours a week from 54.  Right now I’m in Petersburg, Alaska, on a 1 month working vacation. 

I won’t dwell on the details of the case, or the drama and irony that unfolded as I watched the dancer pay the piper.  The bottom line came when the patient requested a referral to the Native Hospital on Sitka. 

I go out of my way to expedite referrals, consultations, and second opinions; I have never regretted doing so.  In this case, protocol required I call the physician on call at the referral hospital.

I got put on hold.

I have spent a lot of my life on hold; in 1990 my frustration with the insurance companies’ abuse of my time led me to put a yoyo in my pocket (which relieved tension and brought me to a degree of proficiency I could not have imagined).  I now do my best to leave my name and cell phone number rather than wait; I can get work done if not distracted by the hold music or the canned ads that impose on a captive audience.  The phone system at Mount Edgecome didn’t play music or ads. Instead, I listened to a Native story teller.  He had a good story and he told it well, drawing pictures with words, of a terrible double murder and a difficult bureacracy. 

My fascination brought me to another place, a stormy, rocky coast under gloomy skies.  Had I sat in his audience, my legs would have fallen asleep before I noticed.  I really could have listened to him all day.  And just as he got to the part where the US Marshalls discovered the bodies, the other doc picked up the phone. 

Her voice came through, clear and chipper and professional.  We exchanged pleasantries.  I told her about the case, and what we’d done so far.  She asked an incredibly insightful question about substance abuse, and 45 seconds into the conversation we poised ready to ring off.  But I had to tell her how much I had enjoyed the time on hold.  The hospital, she said, had recently changed the tape; I told her it was a great idea.

First night call since December and I had to take it in-house

April 10, 2011

 

The question came up for debate:

To work or not to work late.

       A mistake in the roster

       A dilemma did foster  

In the morning I walked out at eight.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  After a six-week assignment in Barrow, Alaska, the northernmost point in the United States, I’m working on the North Island of New Zealand.  I’ve just finished my first night call since December.

At the end of my clinic day in Snell’s Beach I drove back to Wellsford.  Despite cognitive dissonance about who had call for the evening with my name on the roster and another doc on the computer template, I couldn’t face another forty-minute drive and made it look like I took the night’s assignment graciously. 

The anticipated chickenpox outbreak had arrived, the pharmacy (in Kiwi, the “chemist’s”) had closed, but I rooted through the after-hours drug dispensary and found a surprise supply of acyclovir.

Nitrous oxide and my yoyo tricks convinced a recalcitrant child to hold still to have a cast applied. 

As always, most of the evening’s pathology came from tobacco, alcohol and the immutable law that two objects cannot occupy the same space at the same time.

But I got the chance to quiz the people on life in New Zealand.

Agriculture supports the nation.  Farming divides into dairy and “dry stock” (sheep, cattle and deer).  An average dairy operation runs 300 head.  With one cutting of hay per year most farmers don’t know what grasses nourish their herds.  Deer produce almost as much revenue from antler velvet as they do from meat.  Wapiti (North American for elk) cross readily with English red deer and cannot jump a two meter (six-foot seven-inch) fence.

At eight, the end of the scheduled patients, I got a tour of the clinic’s emergency room, crash cart, defibrillator, lights, locks, dispensary, and alarm system.  The other doc, who had stayed to do documentation, left.  The nurse stayed longer than she had to.

I didn’t ask permission to give clinical information, but from 8:45 till 10:15 I took care of a Maori patient accompanied by family.  I got the gratification of hands-on patient care I usually delegate to the nurse.  I called an expert at a hospital an hour away, who gave me courage to use drugs in doses I’m not used to.  I found more medication in the dispensary, avoiding ambulance and hospitalization. 

I learned that the Maori language has changed in the memory of most Maori.  Some on the Maori channel speak classical Maori, a language richer in nuance than modern Maori, which is losing dialect variation.  The urge to absorb one’s enemies’ life-force and mana (a complex Maori word meaning strength, honor, and social standing) drove Maori head-hunting and cannibalism.  Traditional Maori tattooing was done with a chisel, not a needle, and went deep; any expression of pain would diminish one’s mana.

I finished with a new word in Maori, aye, meaning yes.

By the time I locked the door and turned out the lights I felt rumpled.  I stepped out downstairs into perfect temperature and smelled the early autumn and gazed at the stars. 

Fatigue didn’t slow the bouncing waves of the day’s human tragicomedy, and I didn’t have Bethany’s comfort and listening ear.  In a new bed, alone with my vigilance, shallow sleep danced with the day’s memories.

When the eastern sky lightened I dressed and snacked and read Thursday’s newspaper.  At 8:00 I gave handover (Kiwi for check-out) to the doctor coming on call, and at 8:05 I trundled out of Wellsford and onto the road back to Leigh, winding through hills greener than poetry, listening to the morning news breaking up in the valley’s radio shadows.

Left-sided trauma, skin infections, paperwork for income, and a surgical emergency at the end of the day

March 30, 2011

I will not belittle or curse

Nor whine when it comes to my purse

     I won’t cry or scream

     I work on a team

And I can delegate to the nurse.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, right now I’m in Leigh, New Zealand and working in Wellsford, Matakana, and Snell’s Beach.

Today I attended twenty-seven patients.

Four asked me to fill out paperwork so that they would get an income from the government.  One denied any medical problem so clearly that I suspected some agency had recruited a patient to try to trap me into bad practice, and I refused.  For the others I advised lab investigation, retraining, and lifestyle modification.

Nine patients had superficial skin infections.  I heard the term “school sores” applied to a painless blister that rises, then drains pus, and starts to spread.  I prescribed a lot of mupuricin (Bactroban).  Three patients had fungal skin infections, and I prescribed clotrimazole, available back home over-the-counter as Lotrimin.

The vast majority of the trauma I saw happened to the patients’ left side, and included fracture, sprain, bruise, cut, and contusion.

I learned that cigarettes go for $12 per pack of 30, and that those smokers who protest they can’t afford medical care don’t like me getting out the calculator any more than the smokers at home do.

I calmed three children by playing with my yoyo.

Freezing off warts, a simple operation that requires about fifteen minutes of training, pays obscenely well at home because our system rewards procedures more than cognitive-based actions.  Today I had the delight of sending a patient with warts to the practice nurse, who was happy to apply liquid nitrogen.

I sent two patients to the Ear Clinic for wax removal.  I’ve written other posts about the satisfaction that comes from getting out a really nasty hunk of cerumen, but I never detailed the occasional frustration and back pain that goes along with it.  The frequency of ear wax impaction justifies dedicating a nurse three days a week.

I checked patients’ blood pressures today.  For twenty-three years I could say, “Vital signs?  That’s the nurse’s job,” but I’m in a different framework here.  The nurses have a lot more responsibility and power.  They do a good job and free me up for other things, and I don’t mind if I pay the price of collecting all the vital signs I want.

At five, as I settled down to complete my documentation for the day, a nurse asked me if I’d see a patient.  The doctor on call had stepped out.  Not a problem, I said, and saw an opportunity to demonstrate good team work. 

I can’t write any of the specifics of the case because I didn’t get the patient’s permission. But I can say that the nurse did a good workup and that I had the satisfaction of going one layer deeper to uncover a true surgical emergency.

I had seen a couple similar cases a year ago, and even in my own clinic and zone of comfort, my emotions ran high.

Currently, I have limited access to the Internet. 

You meet the nicest people around a shotgun

October 31, 2010

Found ammo is better than loot

But friends are a much bigger hoot.

     The lesson I got

     For the shotgun I brought

Improved the way that I shoot.

Men like projectile weapons.  If we didn’t have constraints like time and money, most of us would do little else besides practice.  As kids we never got our fill of shooting because our dads had limits like time and money.

Thus men of retirement age gravitate towards sporting clays courses, trap ranges, golf courses, and archery lanes. 

Today I took my shotgun to Grand Island’s Heartland Public Shooting Park. (Explanation: a shotgun cartridge contains multiple pellets.  Today, I used loads of #8 shot, about the size of poppy seeds.  Good for killing clay targets but not for much else; you can buy them in Castro’s Cuba.) 

The facility ranks as the nicest shooting park I’ve been to.  It has up-to-date equipment, well maintained paths, and great habitat.

The sporting clays shotgun course covers seventy-five acres.  A mile-long gravel path encircles it. 

I enjoy a lot of things about shooting sports, among them the camaraderie and socializing.  A stranger here, I had to set out on the course by myself. 

Still, the weather cooperated and at the first of ten stations I hit 7 of the ten electrically thrown targets.  

At the third station I found a whole box of shells.  A brand I’d never heard of, Rio, with bright blue plastic husks, the only words on the box not in Spanish were MADE IN TENNESSEE.

Ammunition constitutes the biggest cost in shooting.  Occasionally one might find a shell that another shooter has dropped; to find an entire box outranks finding five dollars. 

I resisted the temptation to shoot them all right there.  I put them in my backpack, telling myself I’d turn them in at the clubhouse when I was done, then thinking, Yeah, right.  I grinned to myself as I walked away from the station and a button buck deer crossed my path.  

I considered the irony; the deer can’t find a safer place to live than a shooting range.  People who own firearms tend to be law-abiding.  No one would risk getting kicked out of a shooting park for discharging a firearm in the wrong place at the wrong time. 

As I walked up to station #4 I saw two golf carts pulling away with five people.  Even at a walk I caught up with them at station #6.  I pulled my muffs from my ears and asked, “Who’s shooting Blue Rio’s?”

They all were.  I told them I’d picked up a box of their shells, they invited me to shoot with them.

Tim and John were teaching three adolescents.  As I got into position, we saw a rooster pheasant gliding into the thick switchgrass ahead of us.  I had just loaded my 12 gauge when one of the young adults pointed out a deer almost hidden in the tall grass, less than 50 yards in front of us, probably the same button buck I’d seen earlier.  He stared at us for a while, got bored, and browsed off into invisibility. 

I didn’t shoot very well; Tim gave me some pointers, and I smoked two flyers in a row. (When one hits a clay target with enough pellets, it breaks into a cloud of debris, like smoke.)

I had a yoyo in my backpack and I did a minute’s worth of tricks.

“You know,” Tim said, “You meet the nicest people around a shotgun.”

Of chest pain and delusional GPS units

October 30, 2010

The chest pain is the worst part

Though a work-up was done at the start

     I’m out here in rural

     So I got a referral.

The problem, I think, is the heart.

I call my GPS unit Sweetheart.  Most of the time she (she speaks with a feminine voice) reliably gets me from place to place. 

Once in a while she loses contact with reality; while Bethany and I were driving from Anchorage to Fairbanks, north of Denali she became quite confused and wanted us to turn left when all we could see was roadless moose, bear, and wolf habitat.

I drive 1.3 miles from my hotel to the clinic where I work, and most of the time Sweetheart guides me correctly.  About one-third of the time, in one particular segment of the drive coming or going, she gets confused and tries to have me do maneuvers ranging from U-turn to cloverleaf.   I’ll usually say something like, “Are you sure, Sweetheart?  Did you take your medicine today?”  I’ve now learned the route, and the places where she becomes delusional, and I’ve taken to not turning her on to get to work.

Friday afternoon I took care of a third grader, whose mother gave me permission to include the information below.  With a main complaint of cough, he has a long history of chest pain and pallor with exertion.  Sometimes if he plays too hard he has to stop and rest.  His cough started with one of those episodes.

The mother read the alarm on my face, assured me the patient had been to a pediatric cardiologist, and described a thorough work-up.

The mother and I agreed in our lack of comfort with the situation and the desirability of a second opinion.   I called one of my colleagues and friends, a pediatric cardiologist in Sioux City.  I gave him the story and he accepted the referral.  Then I told him why he hadn’t heard from me since May, what I’d been doing and where I’d been going.  I explained that my non-compete clause doesn’t apply thirty miles away from Sioux City.

After we hung up I gave the mother the doctor’s name and phone number so that she can call and schedule an appointment.

Then I did yoyo tricks for the patient.

No doctor practices in a vacuum, all of us depend on a referral network; I’m most comfortable sending patients to doctors I know and trust.  In this case, I didn’t know the pediatric cardiologist the patient had seen, but I knew the history sounded like a heart problem.

There is no substitute for thinking things through.  No matter how good your GPS unit, you still need to watch where you’re going.

Basic economics for fourth graders, yoyos, and life lessons

August 21, 2010

On a beautiful day in the spring

I play with a toy on a string

            I teach kids not to smoke,

            So they will live long and not croak,

And have plenty of money for bling.

 

I am playing with a yoyo in front of a crowd of about fifty fourth graders.  I am teaching them economics, and in the process I hope I am saving lives and stamping out disease. 

I start out by asking if they’ve ever heard the saying, “You can’t have your cake and eat it too.”  They all have heard it, and when I say “Raise your hand if you DON”T know what it means,” all the hands go up. 

The essence of economics, I explain, is that if you choose to do something, you choose not to do something else.  Then I hold up a cheap wooden yoyo, I do a few tricks, and I compare the cost of the yoyo to the cost of a pack of Marlboros.  Currently the smokes run $5.87 a pack, and I paid $3 for the yoyo fifteen years ago.  I pull out a $15 yoyo and I do a few more tricks.  I hand my calculator to a nerdy (I can use that work because I am a nerd) looking kid in the front row and have him calculate the Marlboro equivalency. 

I turn out the lights for the next one, an $18 yoyo.  It is not particularly a good player but the kids love it because it lights up in the dark.

Then the $25 and the $32 yoyos come out one after another.  With each increase in yoyo price comes an increase in yoyo quality.  The kid who is running the calculator gives me the number of packs of Marlboros (much like the number of days of smoking) that could have been bought with the price of a yoyo.  I tell a few stories about the yoyo that I’m using and then I ask the kids which they would rather have, the cigarettes or the yoyo.  Invariably, they choose the yoyo.

I bring my Radian out from the vest pocket of the fishing vest I use for my yoyo shows.  I don’t particularly like the Radian though I can make it sleep for decades; it’s very difficult to make return.  But I do a long, involved series of tricks without rewinding.  I flub the retrieve but the kids don’t notice.  Then I announce the price, $105, and the students gasp.

I now have seven yoyos lined up on the desk at the front of the room.  I open up an octagonal cardboard box just big enough to hold a yoyo.

“This is a Samurai,” I say, “It’s a $200 yoyo.  If you can get one.  My wife bought it for my on our anniversary four years ago.”  Then I do The Matrix.

The Matrix is the hardest trick I do, and it goes flawlessly through two rounds.  I can hear the breathless tension as the children watch the action.  The yoyo thumps firmly back into my hand and the room lets out a sigh of relief.

My calculator crony figures the yoyo would cost the same as 34 days of smoking.  When polled, the class would really much rather have the yoyo than thirty-four ashtrays full of cigarette butts and the health consequences of smoking. 

I explain why teenagers start smoking at age 15 and why they start with Marlboros.  I talk about the animal experiments, which completely grosses them out.

The program is called Tar Wars, and it’s a way of getting doctors and nurses out into the schools to try to get the message out:  DON’T SMOKE.

I have a great time at it.  I think that the teaching tool is concrete enough to be age appropriate.

Afterwards one of the students tells me about an uncle who died of alcoholism at age 36.  He had been dying of liver failure till he got into a fatal car accident.

Drama and irony.

At the end of a very long day I go to one of Sioux City’s best restaurants for a very good piece of beef and a lecture on some of the more esoteric physiologic points of blood pressure control.  I enjoy the science review, but the potatoes are lukewarm, and the propaganda is transparent.  After the internet broadcast a noted endocrinologist from Omaha gets up to speak.  His presentation is redundant, and my words to the fourth graders come back:  If you choose to do something, you choose not to do something else.  I give him ten more minutes and I quietly stand and exit by the back door.  I have a lot of other things I could do with that time.

I am a family practitioner from Sioux City, Iowa.  While my one-year, thirty-mile non-compete clause ticks I’m having adventures.  I wrote and published this post in April; I brought it out for republication while I’m out hunting moose.