Magical Thinking


Photo: Bohman

One of my patients suffers from chronic constipation due to irritable bowel syndrome.  During the literally twenty years since she was first diagnosed, her symptom pattern has remained remarkably consistent: she has perhaps 1-2 bowel movements per week, occasionally accompanied by some mild cramping. Even she admits the symptoms are more a bother than a worry. And yet, every time I prescribe a new medicine for one of her other ailments, within a day or two she calls me up complaining that it’s causing her to become constipated. When I ask if she means that while on the new medicine she has fewer bowel movements or more abdominal pain, her answer is always no. Continue reading…

The Good Guy Contract


Photo: tosaytheleast

Twenty years ago, the first woman I ever loved broke my heart.  Like many break ups, the end came in stutters and sine waves rather than as an abrupt but mercifully irreversible amputation.  However, for reasons I couldn’t understand yet quickly began to resent, my ex-girlfriend continued to ask favors of me.  And I continued to grant them.

Then one morning while chanting I found myself ruminating about how inappropriate it was of her to keep asking, and the more I thought about it, the more irritated I became.  My indignation continued to intensify after I’d finished chanting and began showering, finally reaching a peak as I rinsed the shampoo from my hair, causing me to make a sudden and angry determination that the next time she asked me for a favor, I’d refuse. Continue reading…

What Compassion Is


Photo: pedrosimones7

The other day I was out walking my son in his stroller (my now constant occupation) when a homeless woman approached me asking for money.  I’d seen her before in the neighborhood many times, including behind our condominium using drugs.  I turned down her request and continued walking, to my chagrin, as if the wind had blown a newspaper against my leg and I’d kicked it away without any thought.

I used to get angry at strangers who asked me for money, projecting onto to them a rage I actually felt toward myself for having such a difficult time turning them down.  Then I learned to set boundaries comfortably and my anger gave way to inconsistency:  I’d sometimes acquiesce to requests for money and sometimes not, the likelihood of one or the other depending randomly on my mood, how much I believed their story or how much it entertained me, or my belief about what it meant to be compassionate at the time. Continue reading…

Your Neighbor Is An Alcoholic


Photo: peteSwede

My patient smiled a toothless grin and told me, “I feel fine, doc.”  But he was far from it.  His liver enzymes had risen into the thousands, his skin was a pasty yellow I didn’t need the benefit of sunlight to see, and his albumin (a protein whose level indicates the liver’s functional capacity as well as a patient’s degree of malnutrition) had fallen far too low.  Further, he’d been admitted to the hospital with a chief complaint of vomiting blood, which turned out to have been caused by esophageal varices, a potentially life-threatening condition seen in end-stage alcoholics. Continue reading…

Marriage As A Business Proposal


Photo: SimonShaw

People marry for all sorts of reasons.  People enjoy being married and stay married for reasons that evolve over time.  Though studies have shown being married is associated with a longer life span (for men, at least), I don’t believe—nor is there evidence—that a married life necessarily results in more happiness in the long run than a life lived singly.   However, marriage is challenging in ways that living singly is not.  Because viewing the challenges of a given situation in the context of a parallel situation can generate a fresh perspective and energy for problem solving, I thought I’d describe an analogy that—while not able to encompass or explain every aspect of married life, including the wonderful and necessary dimension of love—has nevertheless served my wife and me well:  marriage as a business proposal. Continue reading…