Friday, June 25, 2010

Uncle Jerry: Still Special in Uncle Heaven

Jerry W Hoffman

December 27, 1927 – March 5, 2010

Uncle Jerry was "All Uncle". He ran out of energy finally this year and went to Uncle Heaven. What memories he leaves behind.

First was the classic Liberty EUB wedding to Aunt Joy in December 1949. My brother Mike and I were ring bearers, wearing suits our mom made from scratch. As a three year old, it became the earliest memory remaining in my 64 year old brain. I was married in the same church twenty years later.

Jerry had an awesome convertible car and a catcher's mitt that he used to teach me to be a baseball catcher. I remember catching ball after ball that he threw to me in our side yard, as we broke in the mitt which he eventually gave to me. I was a catcher from 6th grade until finishing high school. I owned catcher's mitts from then til now, sometimes for reasons I couldn't understand, but now I realize that the unique shaped glove is a reminder of the time I spent with Uncle Jerry and a message of persistence and sturdiness.

He and Aunt Joy lived in Greenville for a while, then built a house next door to Grandma and Grandpa Jonas, one yard away from us. He was at all the neighborhood parties (usually receiving gag gifts at the Christmas "Back Street" party) and card games at the family reunion with the Jonas clan (real poker with a ten cent limit on bets and a three bump limit). He was on the committee to pick up beer for Grandpa Art Jonas (it came in bottles by the case back then and the brand depended on which one sponsored his in season sports team and whether he was watching them on TV or listening to radio. Grandpa Jonas had intense brand loyalty).

Grandma (Mary) Jonas often volunteered Jerry (along with my dad, "Scud", and my brother and I) to work at the church for ice cream social set-up and take down. The same for family gatherings at every major holiday which were held at the Jonas grandparent's home next door or the Clayton's (Mom's parents) across the street from our home. We have photos of every Christmas, Easter, and Thanksgiving back to childhood of our family gatherings. We prayed, ate and talked. There were great stories of family member adventures.

A special aspect of Thanksgiving morning was going hunting with Uncle Jerry and Dad. Mike and I helped to scare rabbits and pheasants out of the bushes for Jerry and Dad to shoot with 12 gauge shotguns. We anxiously looked forward to age 13 when we could carry a shotgun and hunt "like a man". Jerry taught us gun safety and hunting etiquette before our hunting inaugural, Mike first, then me two years later. When I could finally hunt for real, I killed a rabbit that was half destroyed by the blast and inedible. I conquered hunting with that rabbit and never went hunting again. I just wasn't a very good hunter. The thrill left me. But I learned a lot from Jerry. He showed Mike and I how to clean a rabbit and a pheasant. He knew a lot about a lot.

He also was the one who taught us to take the feathers off a chicken. For large family gatherings, he took a few live chickens from the pen and hung them upside down on the clothesline and quickly beheaded them. Mike and I used to marvel at how they flopped around with no heads. We were blessed with a chicken foot to play with and learn about pulling tendons to flex chicken toes. These young boy experiences around Uncle Jerry in Liberty were special. (Now that Kroger's does all the work for us, we don't have to apply the chicken killing skills anywhere.)

Jerry played on the church softball team and bowled on the Liberty team in Miamisburg. He went fishing in Canada with both my grandpa's, Dad and Clarence Walters, a neighbor. I always liked the photo of Jerry in baseball cap, with cigarette dangling from his mouth holding one end of a long string of fish, the other end of which was held up by my Grandpa (Bill) Clayton on a fishing trip at Thunder Bay (or Rice Lake?).

Uncle Jerry liked to tease Mike and I, and later, he teased our kids, each of whom he gave a nickname. He worked with the Explorer Scouts based out of Liberty Church. He was often the person asked to pray at the family gatherings. He had many useful talents and applied them wherever he went.

He was an excellent golfer who could hit the ball a mile (he was over six feet tall and had played football at Miami University in Oxford). The man was quite an athlete. In my adult years, I remember a lot of golf outings in which Mike and I were paired against Dad and Uncle Jerry. We had a small bet of one type or another on the outcome. One day in the 1990's, Mike and I were up a stroke or two when we readied to tee off on the tenth hole at the Granville Golf Course when a bee flew into my mouth and stung me. By that time, I was a family doctor and knew too much about what could happen with unusual bee stings. Jerry was obviously not worried a bit as he commented, "I suppose you're going to try to get us to give you a stroke off your score by getting that bee to sting you?" Laughter is a good antidote for bee sting.

Jerry and Joy moved away to Greenville again as jobs changed, or territories for his sales career. Every Christmas, then the whole Liberty Jonas crew traveled to Joy and Jerry's to visit and share and eat. By then, they had Jeff, Jenny and Joe to expand their family and our cousin supply. We played some golf in Greeneville at the country club where Jerry and Joy belonged and socialized. Later they moved a couple more times, finally settling in Hilliard, just west of Columbus. Jerry continued to be a special person as their children grew up and grandchildren arrived from Jenny and Joe. I assume he was as special as a grandpa as he was in the role of uncle. He and Aunt Joy formed a special partnership that could inspire people to energize and to celebrate life. They weathered some tough storms together, including the illness and death of son Jeff, while continuing to serve and help others. Retirement included winters in Florida and more friends for Joy and Jerry, and more golf. Finally, illness called him home to God, after a few years of doctors and decline.

Uncle Jerry was his usual self the last time Mike and I visited he and Joy in Hilliard, to commemorate his 82nd birthday and, more importantly, their 60th wedding anniversary. We got a photo of the four of us who had been in the memorable 1949 Liberty Wedding: Joy and Jerry, Mike and Pat, we had changed a bit in years and wisdom, but the love and caring felt the same. The word uncle was invented to go in front of the name Jerry. We were blessed by God to have had the opportunity to learn from my Uncle Jerry. Uncle Heaven is now strengthened by his special set of uncle skills. Thanks Uncle Jerry.




Sunday, June 20, 2010

Father's Day is 100 Years Old: Imagine 100 Thoughts About Your Dad

My dad died in mid-December, 2001, at age 78.  I remember a particular moment at his Masonic ceremony when the speaker approached my brother, Mike, and I saying, "You who are now fatherless..."  A new feeling came to me, openness to heaven or the hereafter, best describes it.  A thought of "we are next" went through my mind, also (but Mike is older,so it's probably supposed to be him?).  A closeness to God of a new sort started at that moment.  Thank you for focusing the moment, Masons.  I had a new freedom to see Dad so close to God that I knew how safe we all will be.  Dad was also free to be a larger meaning and memory for so many.  He was one of a kind.

At his 65th birthday party, I asked my Grandma what the day of his birth was like, in a house on Oak Street in Dayton, Ohio.  She replied,  "It was the worst day of my life." The doctor had a shocked, depressed look on his face as he did the home delivery (common in 1923) and immediately took the baby from the room without letting my grandma see him.  "Where is my baby?  What's wrong with my baby?", she asked. " There are problems with the baby and he's probably not going to live long, so it's best that you don't see him," was the reply.  Her mother and grandmother sat with her while the baby in the next room was ignored so he could die of multiple congenital anomalies of face, eyes and left upper extremity.  Since he lived til 2001, I guess you know that he made it.  What a heart ripping experience it was, though, for my grandma, until she got her baby and faced the uncertainty of raising an unusual child in a usual world.

He had crossed eyes, a facial droop, a stump where his left hand was supposed to be and a residual, but useless, dangling remnant of the beginnings of his left thumb.  He had eye surgery and they removed the thumb remnant.  He was left with no lateral gaze, resulting in lots of horizontal head movements, and the facial droop.  He opted throughout his life to reject getting a prosthetic left hand.  I remember, as a child, holding onto his stump while we walked to church.  It worked fine.

His parents decided to move to the country where he would be safe and have room to play.  They thought he was going to be "retarded", but were pleasantly surprised.  His deformities didn't escape the medical myth mill in the neighborhood of his birth.  Young pregnant women in that small area of Dayton were advised to avoid certain behaviors, such as twiddling their thumbs (per my grandma), lest their baby turn out like "Baby Arthur".  He most likely was affected by a first trimester intrauterine virus, not aberrant maternal habits.

He played and laughed and taught the adults how to function with a hand missing.  In school, he played sports, including basketball and baseball.  My aunt noted that, if his gym shoe came to be untied, the visiting fans would stare in amazement at him while he quickly retied the strings, enhancing their appreciation of someone with a disability.  He had buddies and played pranks with them.  When World War II came around, all his buddies signed up to serve in the military.  Dad tried to sign up for both Army and Navy (that's all America had at the time) but was rejected.  He felt disappointed and missed his friends.  He went to college for a semester at Miami of Ohio, but felt out of place to the extent that he withdrew.

He got a job working for Monarch Marking Systems, Inc. doing janitorial and "odd job" work.  He played on their softball and basketball teams.  As they noticed his skills, he got promoted.  He worked loyally for "The Monarch" for 43 years, retiring as their Safety Director.

As a father, he showed intense loyalty.  He attended everything we ever did in church, school, sports,  moving (me to Hershey, PA and Mike from FL to Denver to FL to OH or something like that).  He watched TV nightly with us.  He had a great, contagious laugh, which he used liberally watching "The Three Stooges", "Our Gang", "I Love Lucy", Bob Hope, Milton Berle, Red Skelton, and Jackie Gleason on our black and white TV.  He played church softball and bowled on two town teams.  He later took up golf, which he played until he couldn't walk without a cane.

We had a family vacation yearly at a lake front cottage owned by "The Monarch", swimming, reading comic books, playing cards and occasionally fishing.  He taught us to fish (with worms on a hook) and to row a boat at the lake. We fought over who had to sit in the left rear seat on those trips, since Dad had a habit of spitting out the driver's window.  When you heard him snort a couple times, you'd best be rolling up that left rear window as fast as possible (No, we didn't have air conditioning).

He assisted with the boy scouts and explorer scouts at times, going on the longer camp outs with us.  He had an annual fishing trip with his dad and father-in law (one of whom lived next door to us and the other lived across the street- grandchildren were a bit spoiled) and a neighbor or Uncle Jerry.  They went to Canada and caught tons of fish, which I never ate at that time.  They played Euchre on the trips and at neighborhood gatherings.

Dad was a volunteer fire fighter, as were all the men in Liberty, the town of 75-100 people (counting dogs and cats) where we lived.  Every few years the local fireworks plant would have an explosion and the men would go to protect the other buildings while the explosions continued.  (this was before women became firefighters).  The wives would drink coffee together and wait.  Us kids would stand in the back yard and marvel at the free fireworks show.

Dad was a proud father of our accomplishments and forgiving of our shortcomings, sometimes after an angry comment.  He did have some anger, but he had a big heart for helping others. He helped several people in town get jobs at "The Monarch".  He became a great grandfather for Mike's 3 sons and my 3 sons, who turned out to be the only ones left with the last name Jonas.  He helped to raise his great grandson, who lived across the street in Liberty for a while.  The boy who was almost discarded carried through the family name.

Dad became the Lay Leader in Liberty United Methodist Church until he was too ill to do it.  A large group from the family, the church, the Monarch, Jefferson HS, Liberty, the Masons and folks he had helped or befriended attended his viewing or funeral.  He was my Dad.  I actually feel very Fatherful instead of Fatherless.  The memories and meanings are forever.

Wednesday, June 9, 2010

Physician Workforce: Who Will Be the Next Wave of Family Physicians?

This is my response to an excellent blog post on June 4, 2010, by "The Common Sense Family Doctor" about "who will be the next primary care physicians?" He had a nice review of the situation regarding diminishing numbers of medical students selecting primary care for their specialty. Noting that the Patient Protection and Affordable Care Act will result in large numbers of newly insured persons seeking a primary care physician, he commented on primary care work force studies done by the Robert Graham Center and the Association of American Medical Colleges (AAMC).

The AAMC reviewed surveys of medical students from 1997-2006 selecting primary care specialties, concluding that women who intended to serve the underserved are the applicants to select. I know that group will most likely become family physicians (since only 2% of students select primary care internal medicine and pediatric primary care gets very few students) and do quite well in their chosen focus. A much larger group of family physicians is needed to serve the rest of us. My comments to his blog follow:

Being always suspicious of the AAMC, whose members delivered our current specialty maldistribution, I wouldn't tend to align with a direction they recommended. The women who want to serve the underserved should not be the lead category to serve a mostly not-underserved (but maybe soon to be underserved) American middle class. The future of American primary care (which now consists of family medicine and a small potential for primary care pediatrics) may also have to be radically redirected from the business-as-usual humble and compliant employees of misguided powers in the Medical Industrial Complex (MIC).

I wonder about huge numbers of military veterans entering medical school as warriors for their friends and family. Warriors who know the importance of a good story, a friend and a caring God. Warriors who are good at Facebook and Skype, who would love Twitter and comfortably connect to a vast array of professionals on Linkedin. Warriors who hug and cry when appropriate because they are wholehearted and comfortable with who they are.

Warriors who would easily commit to their patient's safety since they already know how to attend to the safety of their friends in hazardous situations. Warriors who understand the stewardship of scarce resources and the importance of citizenship. Warriors who are committed to the freedom of their patients as unique individuals with a singular but connected genome that allows for significant input to become that unique individual.

A Warrior-student will know how to stand up for what they believe while respecting and listening to the opinions of others. They will understand how to say no to illegal orders from a military commander and the same from elements of the MIC that seek to misdirect them toward maximizing profit with overuse of costly, sometimes harmful (e.g., CT scans) resources.

In The Four Fold Way, Angeles Arrien wrote of the Warrior role in each historic global tribe, as well as the Healer, Teacher and Visionary. She noted that, while individuals in each tribe had a major part of their identity in one role, each person has all four roles within. The role of Healer, Teacher and Visionary is within each physician already. The Warrior role may need an upgrade in the individuals who will ultimately be at the front lines of health care. If they have already been trained to function at the front lines in modern military conflict, they will have an advantage in their service to their patients.

(You may notice that I don't equate warrior with killer. There is a huge difference that I hope you can appreciate. I hope you also notice that no gender is exclusive to warriors, nor to military or combat veterans).

I just wonder if we can expand our considerations beyond the narrow perspective of the AAMC to remember the vastness of the populations that we Family Physicians serve. Wholehearted Warriors with recent military service may fit nicely in the future family medicine (and other primary care) team for America.

Wednesday, June 2, 2010

Honoring the Biology in Family Medicine

Our usual patient engagement in the office is scheduled for fifteen minutes.  This involves a facilitated engagement between two or more individuals for the mutual benefit of all.  As a family physician, I sometimes marvel at the relationship between patient and physician, it's simplicity, complexity, humanity, imperfection and beauty.  The biology of what's behind the people in the relationship is phenomenal in a different way.  Each person contains close to 100 trillion somatic (body) cells and a similar number of blood (including immune) cells.  Each somatic cell contains their entire genetic code (back to Adam and Eve or the worm in Africa, depending on your beliefs).

Every day, we humans each get one billion new somatic cells and lose another billion through a process called apoptosis (yes, that will be on the quiz).  Statistically, one of the new cells each day is a malignant mutation.  It has to be eliminated through being defective or the immune system has to find it and destroy it.  A proverbial needle in a haystack!  Somehow, the malignant arrival is usually eliminated. As we age and undergo degenerative processes (starting at about thirty years old) our ability to eliminate the malignant mutation diminishes.  Our genomic predispositions (did we pick the right parents?) may play a large role in the ability of our DNA to ward off the cancer that may eventually arrive.  We are usually powerful protectors of ourselves, up to a point.

As our cells duplicate, they slowly wear out the buffers at the end of DNA strands (telomeres) after which the cell duplications are flawed leading to the eventual demise of the owner.  "Wow, Thelma has aged a lot since I saw her last month.  What happened?"  Maybe Thelma's telomeres aren't protecting her DNA.  She might be nearing the end of her biological life.  In addition to age, radiation may damage telomeres.  Vitamins, such as vitamin D3 may serve as DNA repair agents, extending the number of cell duplications.  Many research studies in recent years address telomeres and telomere repair, hoping to deliver strategies for longer, more healthful lives.

The biology of the body is geared to self repair and healing.  A good example is how the human immune system kills thousands of viral infections,such as the common cold.  This usually results in an assault on the virus by white blood cells, which burst and release their contents including pyrogens that cause fever.  They also release interferon which may cause malaise, fatigue, myalgias (muscle aches), and a desire to be alone (leading to decreased spread of the infection, if heeded).  Time is a key ingredient needed for the body to heal from the infection.

As we learn to recognize and honor how the body heals, we better understand the role of medical care, which often is used to dishonor the natural healing processes.  The misguided sense of urgency that pulsates in American lifestyles and American board rooms drives people, including physicians, to try to artificially impact the natural resolution and recovery from illness.  Too many people are trapped into pushing for unnecessary medical care for self-limited infections or forced to "get a note from a physician" if they miss more than three days work.  The unnecessary exposure to physicians may expose the patient to unnecessary medications or other well intended measures that end in disappointment or extended illness.

The medical profession plays an important role in our society by understanding the natural history of diseases and  knowing when to intervene with reassurance, symptomatic therapy and/ or focused intervention.  Knowledge of the biology of the patient moves the physician to honor it and recommend fewer unneeded medical interventions.  The complexity of the biology helps both patient and physician to remain humble.  As both patient and physician regain their sense of awe about the incredible processes of the human body, their work together will serve more to honor those processes and allow natural healing to occur when possible.