A Closed Mouth Don’t Get Fed
Ypsilanti, Michigan. Tuesday, November 10, 2026. Dictated, then cleaned up.
By Omar Nabil Metwally, MD
This is dedicated, first of all, to the silent but not invisible comrade. The best wife a person could ask for, the smartest person I have known, and a young woman who is a lot stronger than I gave her credit for when we first met and for the first years of our marriage.
She is the one now carrying our daughter on one shoulder and a much older me on the other, with the dog riding piggyback here and there, while dragging a wheelbarrow full of correspondence: insurance letters, bills, debt collectors, appointment reminders, and “global” authorization notices, updates and requests for ten different specialties, with two or three practices or health systems inside each specialty, because each one needs its own “global” referral. Which is really nothing more than a local referral, a hurdle designed by insurance companies to filter out the people who have no other choice but to lie on the floor and ask. Ask their wife, their family, their loved ones, the dogs in their corner, the exes on good terms in distant lands who are busy with their own families.
And it is dedicated to Gedo, God rest his soul, who taught me to answer to my conscience first.
Bulbul and Louly are still working for me. An Hien now is too. All of it payable in love, gratitude, loyalty, respect, and trust. Cảm ơn em nhé.
Thank you all. You have been so good to me, and I love you.
I. Objective
Before I start complaining, an objective. That’s how we were taught to write the note: the complaint goes at the top, but nobody trusts it until they get to the objective.
Objective: I had a lot of pain today. It hurts to stand up. It’s really hard to do anything. I sit down a lot. I walk a little bit, to the ball, to the dog, and back. I used to run. The dog and I would run for hours if left to our own devices. And now.
So I take a step back and keep reminding myself of the big picture. I hope something positive comes from all this in the end. Or not at the total end, but somewhere near it, the second-to-last step, when reality hits and I have to stop laughing for a minute. Hopefully I can pull that off, and we can talk for real, humanoid to humanoid.
Here is how my days go. A little digging around, feeding evidence, MyChart scrapes going into our AI desktops periodically, making sure we’re on the latest model, the one burning the most electricity, with the greatest number of people maxing out the greatest number of usage tokens. All so that the victim’s poor attorney, who definitely can’t afford a data center’s worth of tokens, has some AI-powered legal aid. Until somebody says: okay, fine, you’ve made enough of an annoyance. If I can even get that far.
My wife is extremely doubtful. “So what’s up? You’re not getting anything,” she says. She’s probably right. That’s the reality.
So what do I want from all this? I’m not really sure. I think I need to recover a good deal further before I know exactly, and can state it in the official way, for the day the honorable judge refers the matter to the jury, and the jury refers it to their God, their morals, their faith, whatever guides their decisions on behalf of somebody who can no longer really take care of himself or his family. That is what it is. The judge refers the matter to the great Lord, who takes the shape of a jury, in its perfectly imperfect present-day form. Washtenaw County, Michigan, the United States of America.
For now: to let the truth out. And I’m done paying for healthcare that did not help me. And you should too. I’m not giving you medical or legal advice, and I want that to appear in the same screenshot, that if you too get a wild idea that the time has come to reclaim your humanoid rights by not paying AI generated bills from healthcare factories sent in a provider’s name, then — I don’t disagree with you at all. I think that’s the right and sane thing to do. In many people’s case, the only thing to do. But we are all fighting a difficult fight, and we should give each other a break.
Here’s another secret from the trenches: many of the best clinicians lowball the tremendous value they deliver as professionals when the invoice lands. Those people do not belong in this essay.
Back to Quaternity and Malignant ED: I did not get my money’s worth. They did not meet my expectations. And, here’s the area, they hurt me, physically and mentally. At least Iran settles quickly and fairly when an interrogation goes south. At least they even ask questions. And Iranian food is the best. I’ve already expressed my expectations for what lies ahead for me, and I will give it my best fight regardless of the outcome. It’s for my family at this point.
For years I just opened my wallet and shut my mouth and wrote a check for whatever invoice the robot threw at me the next month, or a couple of years later. I didn’t think much of it, because I thought that’s just the way things are. I used to fear someone knocking on the door and telling me I owe them money. Don’t underestimate the tactical equipment that can be mounted on a wheelchair. If I needed a wheelchair, the first thing I’d do would be to install a projectile defense system with components imported from Dearborn, Michigan. Easy to actuate with a trigger or voice command. I hope it doesn’t come that far, the wheelchair I mean.
When we think of getting hurt in the hospital, we think of the lowest common denominator: the doctor. Yes, doctors make mistakes. They make egregious mistakes. But look at what they’ve become in the grand scheme of the healthcare system. I don’t want to sound like the attendings’ defense attorney. Thankfully I’m not. And I wish nothing bad on anybody.Everyone deserves to live a happy life and learn from inevitable human mistakes. Let’s give each other a break please. This is really just personal accounting. I’m not angry with anyone; I have the Head of Legal on my side, and my own people that are helping me deal with this snowballing series of problems that are not going away on their own.
II. Raw
Let me share something funny and personal, to keep the beat up so I don’t scare people away.
My cousin called from Egypt. Technically she’s my cousin. In my life she plays the role of the older sister I always wanted and needed. She has a beautiful family. I love her husband, I love her kids. And you know how it is when you don’t see somebody often: you remember them at the age they left the deepest impression. For me she is forever about sixteen, very successfully managing a group of very rowdy younger male cousins, like the deputy who shows up to the scene. She had a lot of backup. She never needed it. She’s probably in her forties now. She’s awesome.
She commented that my writing is raw.
I can get mad at her. Tell her if she doesn’t like it she can cut her coaxial cable. Oh wait it’s Egypt. She probably has satellites on the roof. No one runs coaxial in the desert. She’s my sister. Raw? Am I offending you? You have a problem? I didn’t use any bad words on her. Definitely not the B word. I never would. Then I stumbled back and thought: it is. The first thing that came to mind was an operating room. An open wound. And I thought, crap. This is not what I want to be thinking about. This is not what I want my retirement job, my retirement hobby I should say, to be.
I have this image of myself lying in a desert at dusk with an open surgical wound that nobody bothered to come back for.
In an earlier post, ranting about something far funnier, I joked about a patient left in the dark on a stretcher in the emergency room. His name is Mickey, if you want to look it up. Retired owner of a very financially successful home repair and kitchen renovation operation. Mickey lies there forgotten, hip out of its socket. Nobody cares, nobody notices. I laughed so hard at that story. Now I’m laughing even harder, because the joke’s on me. I’m Mickey. I’m the guy left with a damaged spine and a damaged hip, a patient walking from doctor to doctor with a damaged spine, trying to get help from the healthcare system as a fully insured patient, an Internal Medicine doctor and graduate of the University of Michigan Medical School. I have private insurance, in network, continuous coverage. I present to the U of M ED crashing and burning, and nobody even sees the flames, even when UM ED is engulfed in them.
She offered to airlift me to Germany or Switzerland. I said don’t worry, I’m still a doctor. I know my brain’s taking hits right now, but I’m recovering. I think. Thank you, cuz. Thank you for checking in.
III. The Retirement Hobby
The retirement hobby: trying to grow my meds, trying to book doctors’ appointments, manage doctors’ appointments, and help my wife manage me so she can manage the doctors’ appointments.
I learned something funny about global authorization today. Back in my day, on the other side of the desk, it was a non-issue. It was like a tennis ball coming at you. An intermission. Something you just do when a patient needs derm for a concerning skin lesion, rule out melanoma. It was an integral part of good medical practice: utilizing specialists, leveraging their knowledge and skills and experience, looking at problems from different perspectives, care for a patient as a real team of humanoids, not generated text in the EHR. When their joint pain is getting worse. When they’ve had a fever for a couple of weeks and have been bouncing between urgent care and primary care, racking up co-pays if they’re lucky, getting nowhere, wasting their time, being exposed to other sick people, and being subjected to irrelevant diagnostics that cost money and suffering and set the patient backwards with false reassurance. Or radiation.
From down here, the global authorization is really a local authorization, and we have done about ten of them. My wife did most. I asked her to start keeping track of her time, because she needs to value her time a lot more. She came from Vietnam, she’s a permanent U.S. resident currently applying for U.S. Citizenship, after a very long family journey back and forth between America and Vietnam, with a few stops in Egypt. I’m so grateful for our house. Our yard. This is our hustle. This is our company. She takes care of our daughter, and now me, and my medical problems and my legal problems and our bills, et cetera, et cetera, et cetera. There is a lot on her plate. It is definitely too much for one person.
What I need is a social worker at this point. Actually, hopefully I don’t. I have a great family. What I really need is good people in my corner, and I already have a lot of them.
She is always working these days. I pick up the mail on a good day. I bring in the trash bins on trash day. Or, as we call it, abundance day. We are not superstitious, but after a very memorable experience that involved both our laptops and some government documents, we learned not to call it trash day. May that never happen again. I try to be useful here and there. I always forget the laundry. I always forget the dishes.
We are lucky that my parents-in-law are here from Vietnam. They deserve their own compensation, which they will never get, except in the form of a lot of love and precious memories with their bright, bright granddaughter. And I don’t know what I would do without my own parents, who are always a text or a phone call away, who respect my privacy and give me space when I need it, and who step in and fight in my corner when it helps me, even when I’m not expecting two retired adults to do so. Two people who have retired from a lot of hard work that they are still doing, feeding their families the good old-fashioned way, from before the healthcare system became a circus operated by attorneys and hospitals and insurance companies, plus a couple of people here and there who are still technically healthcare providers. The human shields, in other words. The ones who signed up for a job with good benefits and now have to take it for everybody.
Speaking of my parents: Dad is calling me. Always at the worst possible time. He and one of my brothers have a great knack for that. Do not disturb. He goes in the bitch box for a little bit, until I finish and catch my train of thought.
I bought this house as a bachelor, from a pediatric nurse who worked at Mott. I got super lucky. About six months earlier I had started corresponding with a GSI who would eventually become my beloved wife, best buddy, best friend, and number one person in the household, tied with our daughter. She is several years younger than me, much more mature than me, much more grounded than me, and the true G of the relationship, despite technically being the em. I need to save my energy for her, and I mean that in a good way.
IV. Occupation
I think about every time I’ve renewed my passport or my Global Entry, or filled out some form for the federal government, or done my taxes, and reached the line that says occupation. These days my primary occupation is driving to doctors’ appointments and applying hemostasis in the backyard. I wonder if “Victim of the System” would fit on the line. Everyone should be writing that on government forms as their occupation these days. That’s what we’ve become. Victims.
I have never been at the maximum earning potential of an internal medicine physician, because I work for my family, and for my daughter, and for my ideas and my ambitions and my beliefs. I’m an entrepreneurial spirit. I’m a crappy business person, but I’m constantly inventing. The intellectual property I hold, my granted and allowed and pending patents, I value. I intend to keep valuing them, and they are a very important consideration in my decision, so far, to hold on to my US citizenship and my US passport. I have a lot of thoughts about that. Those are their own monologues.
From a financial perspective, medicine was the worst investment of my life, considering how much of my time and my life and my energy and my health I have thrown at it, repeatedly, for so long, until I couldn’t stand up anymore. Literally. I was in school and training forever. Somebody’s legally designated fellow, resident, medical school slave. Exploitee. I mean trainee. That’s most of my adult life so far. Not to mention my parents’ heart blood, which they used to pay my tuition.
And I had ideas. I build software. I design physical things and used to 3D print them myself, on many printers of many types, industrial ones included. I was actually funded for a pretty wild-card idea: a distributed manufacturing system on the blockchain. That was 2019, I think, because Donald Trump was the hot dog ultimately signing the check for the National Science Foundation grant I was busting my butt for. Donald Trump is a hot dog, but that’s the high-water mark. Donald Stump (not a typo) was elected by misled, disillusioned, fed-up and desperate American sadomasochistic people. In 2016. I first said 2020. Amazing how your memory tries to protect you from trauma. In this case, on a national level. Those were better times, when I proudly showed the grant email to everyone I knew, when the NSF still responded to my mail, and when they were still going to pay me the rest of what they promised in the letter. They never did. I self funded part of the grant using income I earned from moonlighting at Highland Hospital. Everyone got paid to the penny, except me. But that’s a French fry of a grievance at this point. I know, the government owes us all. I hope I live to see that day, at least the day when more people wake up and remember the phrase “No Taxation Without Representation.” If you’re lying on your back in the backyard with an injured spinal cord trying to get an airlift to Switzerland, you not only have been taxed without representation, you got robbed. We all did. And I want my money back. Back to the NSF: I was the principal investigator. I worked with very bright engineering students with excellent qualifications, and tried to help launch their careers. I paid myself a little bit. Everybody got a salary. We went by the book, based on the Bureau of Labor Statistics.
I don’t do the printing anymore. I don’t have the time or the space. Our house is small. If I have an hour, I’m going to spend it on CAD design rather than operating the printer, with all due respect to that skill set. It’s not an HP or a Canon where you press print and out comes a paper document. It needs constant maintenance and troubleshooting. You have to be a mechanic of sorts. Kind of like the original cars.
Getting paid. Yeah. Not sure about that. I just keep trying to focus on my spine, my leg, my recovery, and getting the right people in my corner.
V. The Scale
I’m told I have two years to file a malpractice lawsuit. Now that I’m realizing this is much larger than just old fashioned malpractice, I’ll have to read about torture law and civil rights. I’m still trying to find the technical legal terms to describe a patient with a spinal cord injury, asking to be put out of his misery for 6 months, who is left to burn in a wheelchair in the ED and then a hallway stretcher for 16 hours before he begins receiving medical attention, before a physician even stands in front of him. At this point it is becoming a bouquet of claims. Where is the Reverend Dr. Martin Luther King, Jr. when you need him? I wish he was my lawyer. God rest his soul. It started with one thing. I hold on to my dreams.
My original attempt was pro se. Not fighting. Getting my rights. Getting what I deserve, what I paid for and didn’t get, from an academic medical center called Trinity Health. Before this happened I could walk to it. It’s a five-minute drive from here. I’ve biked much further distances along the Finnish-Russian border back when I was a lad. A few years ago, my wife and I biked to campus, our baby in the back seat of my bike.
Then I wanted to talk to somebody who really knows what’s up. Not somebody clocking in and out and billing by the fifteen-minute interval. Somebody who has lost a family member, or has one who lost a great part of their ability to enjoy life, physically and mentally. I should correct myself and say I was looking for an aggressive Arabic woman. A Middle Eastern woman. I wasn’t sure exactly where to start looking, so I thought back to where I have spent the most time drinking alcohol out of red cups, celebrating bros’ and cousins’ birthday parties, and spilling some of the good stuff for the fallen. That was with Chaldeans. We have commemorated a lot together. So that was my pick: the most aggressive Chaldean woman with a law license I could find. I didn’t even look her up. We didn’t make that much progress. Honestly, if it were a date, she’d probably ghost me, in the best-case scenario, and I’m still trying to figure out whether she did, in a very polite, professional way. But I keep confusing her first name and her last name and misspelling both.
I say this from intuition, not extensive experience, as a victim who is not a lawyer but who will continue to call himself a literator [correction: I originally meant “litigator,” but when I sat down after my coffee to edit this essay, I felt that “literator” actually sounds a lot cooler. I’ll have to look that one up — “Healthcare Literator”), because I have a lot to say and I like to say it in a public forum, especially when it comes from the hip. Literally, and as a figure of speech. My intuition is that the best lawyers are the legal equivalent of those private practice Dearborn doctors I used to joke about and rip on, and never gave anywhere near the respect they deserved. Starting with my dad. The dimly lit rented office. The flickering fluorescent lights. The landlord who has been notified many times that the roof is leaking, and the doctor now too old to bother with trivial things like that. The one- and two-star reviews from entitled patients who have been shopping the healthcare system like me, but who started their shopping with those poor, defenseless doctors instead of a big health system, the way I had the misfortune, or fortune, to do.
I try to avoid male attorneys. I did work with one, and he was excellent. Actually I’ve worked with more than one, over the years, and I got lucky: they were all excellent and more than paid for themselves, as good professionals should. But you know the universal saying: too many cocks in the fight. Different technical term. I think of all the cocks that have come and gone in my life. Super annoying. I hate to admit it, but they have their place in the world. Cock a doodle doooo! Wake up bitches! It’s 3am. Time to rise and shine.
Which reminds me of a trip to an agricultural community in central Vietnam called Da Lat with two of my wife’s childhood friends, coffee roasters and cafe owners who get the good stuff straight from the farm. A very significant portion of the country’s produce comes from that region. It’s mountainous and much cooler than an urban areas at sea level getting beamed on all day. Agriculture and natural resources are among Vietnam’s gems, its treasures. The real treasures are its people, which I’ll get to in future monologues. I have a lot to say about them, only good things. I never admitted this in public, but I guess now’s the time: I selfishly just wanted to keep buying those delicious bags of Vietnamese cashews from Costco and the supermarket and Amazon. The nuts grow abundantly there. Nuts of all kinds. I shouldn’t say effortlessly. Farmers work really hard. But they have their rich soil, endless solar energy, so much water, mountains, beaches, basically one long coastline with many communities at elevation, especially in the north. Really, my favorite parts of Vietnam. Mental note: more stories to tell there.
A couple of months ago, the tabs on my computer looked different. I can’t multitask. I do one thing as well and as intensely as I can, then move on to the next in order of priority. That can be a good thing or a bad thing. It got me very far. I had a 3.9 in undergrad. My lowest grade was an A-minus, in Greek archaeology, a first-year elective I really did not want to take. Ancient civilization is a fascinating topic, but no amount of caffeine could keep me awake in that Angell Hall auditorium: 8am, lights off, an elderly female professor with old school slides (those were awesome, I miss those), flipping one image of an ancient rock after another one. I couldn’t tell the difference between them. Even the Greek rocks and the Egyptian and Babylonian ones all looked the same. I mean, they’re actually millions if not billions of years old and originated in a time far before humans and their devices. Michigan is a huge school, and incoming freshmen have the lowest priority. You take whatever meets some broad humanities requirement, something not directly relevant to writing code or being an engineer or even practicing medicine. Something that’s supposed to enrich your character. It doesn’t pay off as an hourly rate. But it enriches you to the point that you can see things for what they are, feel empowered to life with conviction rather than blindly following the ass in front of you, to speak and write for yourself. Advocate for yourself. Fend for yourself. Even when you’ve been fighting your whole life against every injustice in the world, yours and everybody else’s, fighting, fighting, fighting, until now you have a spinal cord injury and you’re on your back in your backyard with electric pain shooting down both your legs.
When this matter was much smaller, in its nascency, I should say its embryo stage, first trimester, maybe second, an AI told me to reach out to a malpractice attorney and ask whether she would take the case on contingency. I was arguing about a much smaller thing then. I didn’t even know what a labral tear felt like. I just had pain in my legs. In retrospect it was clearly a spinal cord screaming very loudly, while I walked around on it for as long as I could, in between the referrals and the referral replies and the global authorizations.
Everybody’s using AI now. And when an attorney answers my email asking about contingency, I can hear them smacking their lips and weighing it, like at a market in Vietnam, on one of those green analog scales, putting the meat on. Vietnamese people don’t waste anything. In my wife’s hometown, there was one supermarket within motorcycle distance that sold beef in a Western-style deli. The quality of the supermarket and its produce far exceeds 99.9% of U.S. supermarkets, by the way. I filled my suitcase with produce and Thai steelware on my return to the U.S. I’m taking a side road to remember the day I wanted to make kofta in my Vietnamese parents’ kitchen. We had to fly to Saigon to get Middle Eastern food. I love Vietnamese food, but the eosinophilic esophagitis was starting to rip me and I missed Arabic food. So I rode down to the supermarket and asked the lady for X kilos of ground beef to make kofta at home. She said it wasn’t enough meat. The supermarket would lose money if they sold meat one kofta at a time because a lot of the ground beef ends up stuck in the grinder, and you need the meat grinder running continuously to prevent that. Kofta is not a Vietnamese invention by the way, and it’s not part of their diet. So ground beef was not the commodity that it is in Western supermarkets. I’m conjuring this scene because it reminds me of malpractice law in the U.S.. Like that meat lady, a malpractice attorney’s first question is probably: is this worth my time? Is this even worth powering a meat grinder? I don’t blame them. That’s the legal system. These people have families to feed. They have people on payroll. They are probably still paying for their education. Definitely their mortgage, unless you are among a minority of lawyers who voluntarily chose to actually help people, contribute positively to society, and live on a trainee’s salary. Attorneys have to make a living like everybody else. Like I managed to do, barely, until this happened.
I’m told malpractice attorneys generally don’t take a case worth less than $1.4 million. That’s the break-even price. It costs a lot of money to pay physicians who have trained most of their lives to help people, who have developed some special superpower within medicine, to do something they are usually not very good at. They can barely talk to the nurses or to their own trainees, and now they have to stand up in a public place in front of very powerful people, several of them carrying firearms, the bailiff by the door, the honorable judge, concealing the biggest weapon in the room (not going there, it was a reference to authority and power), the jury, and people everyone involved wishes never to see or speak to again for the rest of their lives, and try to settle the score.
I hope it doesn’t come to that. I really don’t. I’m just trying to heal. I’m just trying to stand on a ladder without screaming in pain, to walk around without a hunch, and to keep praising the good Lord for my spinal cord and my ability to walk.
The labrum will get repaired eventually. The US healthcare system, probably sooner than my spine. Or I should say: I hope I don’t need surgery on my spine, at least not now. This injury is definitely not going away. It has set me up for a lifetime of friendships with spine surgeons, and with the administrative assistants helping me with local and global referrals. Or, if I can afford it someday, insurance where this nonsense is not a built-in feature and I can opt out of it.
VI. I-94
I conduct my consultations from my back, in the backyard. Formal consultations, I should say, but concierge consultations too, with my go-to neurosurgeons and my go-to pain anesthesiologists, who looked at the MRI that my dad paid for. He took me there and back after a very long day of taking care of other people, as a man in his seventies who should have retired a long time ago. A man with his own, even more serious spine problems, many injections, and spine surgery.
God bless those physicians and their assistants, who spoke to me in a humane way, and who took the time to hear that I have a spinal cord injury, that I have probably been injured for the better part of six months, and that yes, I do have a hip injury, but that’s probably not what has been turning me into the thing I have turned into. Because of them I do not have to wait weeks or a month for an epidural injection to put me out of my misery, or at least dull the pain and hopefully slow down the inflammation.
My dog has become my buddy. Another dog in my corner. He has been there for me from the very beginning. As has his breeder. As have a lot of other people who don’t need to be dragged into the main event at this point.
And yes, I still have my primary care doctor. For the record, she is still my primary care doctor. I never had a problem with her and I still don’t, and I have put that on paper many times, including in my original complaint to Trinity, because I anticipated that the first thing they would do, being a U.S. healthcare system that is actually a legal system with a few white coats, would be to target the weakest chain in the link: the mostly powerless clinician. She is still doing my refills and taking my MyChart messages, and hopefully, at this point, being allowed to exercise her clinical judgment as the outstanding physician she is, without her judgment being denied, clouded, stolen, deleted, or blocked silently, without warning or notice.
So I have an official primary care doctor. And I have probably the best doctor in America in my corner. Pull over a random person on I-94 during morning rush hour, and I would bet you money, and I’m not exaggerating or joking, that my father has taken care of them in the hospital, or in his office back when he had a lot more patients, or delivered them, or delivered someone in their family. Including their parents. He sees patients all throughout Michigan, including rural communities in the middle of the state that are an hour and a half away in good weather. He’s famous in our family for walking into hospitals wearing another health system’s badge. He has so many. He’s been doing this so long and so well that he’s actually become the hospital. The corporate branding that comes on goes is just a formality He used to have dinner, alone in front of the TV, long after everyone else called it a night, wearing whatever badge he was wearing when he stepped out his Honda. May God give him the health and the strength to keep doing what he loves for as long as he is able.
Wow, what a detour. That’s what happens when you spend too much time on the road, in the passenger seat, with your wife or your father driving you to doctors’ appointments.
Except I’m not in the passenger seat. I ride lying down in the cargo area of our Toyota SUV. The makeshift ambulance. I can’t afford a real one. The cargo area is where we used to transport our dog, in better days, when we could take him out more. He always looked forward to riding along. He knew the trails very well. It was a majestic sight, him jumping into the trunk and digging out his place, watching over the vehicle, watching over our daughter, the joy in his eyes as he looked out the window here and there. I hope to have many more of those moments, because it has been far too long.
Yesterday I went to another appointment with my orthopedist, whom I trust, and who I really do feel is in my corner. We are talking about surgery now. I have consulted many people about my hip, so I told him he’s not the one who is going to catch me at the line. I’m not allowing him to. I’m going to throw myself in a different direction. At this point I really just need help getting fixed up, and I mean no harm to anybody. I don’t want to create any problems for him. Thankfully he doesn’t do the procedure I need, but he referred me to the person who can fix me up, someone whom he trusts, and explained the problem and the proposed solution (in hardware store terms, per my request) with patience and competence and empathy. A brother who feels his brother’s pain, and the silent pain in his wife’s eyes, and can remove a lot of that pain and fear by treating me like a fellow human and being a real doctor. Thank you so much.
I-94 is so broken. It’s so bumpy. I know it’s facetious, but I wish I could bill the State of Michigan for the lack of proper infrastructure and for the excruciating trips to doctors’ offices in Dearborn, and now Troy, and who knows where else. Every bump sends high voltage down my legs, and there are a lot of bumps. Maybe even a full airlift, paid on a credit card, to Germany or Switzerland or Vietnam. That would be a really expensive one. I’d be super grateful if I even made it to Canada, across the bridge. I trust the Mexicans too, but I’m not trying to rack up an unnecessarily large bill. I know how defense attorneys are. Like a very seasoned Vietnamese haggler buying kitchenware from a woman with a beautifully laid out DIY shop on a street corner, competing with people left and right doing the same thing in a perfectly organized, efficient, and authorized manner. Quality goods sold fairly by a comrade making pleasant small talk. No collection letters, no threats of canceling my Costco membership, no clowns, no lawyers. Just humans with common sense.
I do wonder whom I would ultimately send the bill to for an airlift to Switzerland. Flu shot, Covid vaccine, neurosurgery consultation, probably more imaging, a comprehensive internal medicine workup, and ongoing excellent emotional support, at the doctor’s, and at home. Friend and family support included.
Wow, I miss civilization. I wish the United States government would send agents and scholars and diplomats to be stationed in Vietnam, far away from wherever I happen to be at the time, to conduct research on how to run a healthcare system, how to take care of your people, how to educate the masses, and how to still keep the ultra-wealthy and ultra-powerful buying in and being valuable to the greater society while they enjoy their hopefully honestly-earned money. There is a ton of room for competent government to step in and set some ground rules. And I’m not referring to IRS fundraising events. Like the German government does, to decompress the pain of its citizens, who honestly live on much less than Americans but without all the same overhead. On paper America has such a high GDP. Then you consider what you’re actually paying for, and how much comes out of your income in taxes that are very ineffectually used. I don’t know what they’re doing with it.
I have actually given up trying to find an American hospital. I am using my personal connections and being grateful for them, because, ironically, they are turning out to be the most valuable thing I have as I crawl, as I roll, away from my work at Corewell. Which I really enjoyed. I look back on it with great gratitude: the privilege of taking care of people and wearing that white coat and fighting against systems that are broken by design. In this country they will be broken forever, or at least for as long as I’m still reading news headlines passed along by relatives in other states and other countries.
VII. Conscience
Back when I was still in the modus of the inventor, after the NSF grant, I was also managing my fatherly responsibilities halfway well. My daughter and I read. We played. We ran around the backyard. A lot of physical education, which for me is a way of conveying what I believe martial arts is. The philosophy. Not throwing punches or kicks, unless you have to.
Of course everyone should be able to defend themselves. I think every young girl should learn how to choke a man much larger than her to the point of unconsciousness. That is a valuable life skill. I’m not your lawyer. I’m just speaking as a dad who keeps a lot of sharp utensils handy for when I start to see red cups at college parties. And this post, by the way, is not coming down. Not today, not in nine million years. I think I speak on behalf of a lot of fathers and brothers out there, and husbands and good boyfriends and partners and friends. And girlfriends.
So. Don’t do that, please. Don’t let it get that far. But I reserve the option to defend myself and my family, and to answer to my own conscience before I answer to whatever laws are in vogue, the ones a particular society is flogging its people with at a particular time. In a very differential manner. The lower you go down the income ladder, the more you feel the flogging. Go above a certain income level, or a certain level of political power, and it’s completely irrelevant. I don’t need to say more about that.
Morals, ethics. That was the most important lesson from my grandfather, God rest his soul. My father’s father was a military general who raised 6 children after his wife passed far too young. He told me he worked twenty jobs in his life before he retired from the military. You never really retire from the military, but he decided it was time to branch out and try different things. I call my wife the smartest person I have known, and I mean it. Gedo is the only one who gives her a run for the title. He does not deserve to be mentioned unnecessarily here, beyond the bare essentials, which is the lesson he taught me.
As I understood his advice, and I’m sorry, Gedo, forgive me if I misunderstood you, a primary goal in a person’s life should be to cultivate a conscience more robust than any law. Any law that any society, in any jurisdiction, at any point in time, happens to be flagellating its taxpayers with. Or its captives. Depending on how you look at it, which part of history you’re looking at, and from which vantage point. This is my editorial, not Gedo’s (he respected the law and taught his children and grandchildren to do the same): only a lowlife uses “the law” as a substitute for a working moral compass, which should be much more sensitive than laws.
I think the founding fathers knew exactly what I’m talking about. The boys from the tea parties on the East Coast. And George Washington, may you be remembered for the person you were and the great things you achieved. I don’t know enough about you to say more. I think of you and I think of wooden teeth, and of people getting their legs sawn off while somebody pours Everclear down their distal esophagus. Now I’m thinking of my fantasy backyard operating theatre again. Redirecting. I can’t say I’m George Washington’s bro, because I really don’t know what kind of person he was. I think of tobacco and the well-to-do, lavish lifestyle. Not sure at what cost, or on whose account. But the capital is named after him, for God’s sake.
So I owe respect to my country and to the people collecting the taxes. They’re the ones with the big guns and the authority, and we need them, in a sane and capable and moral version. It’s just not an excuse for us to surrender our rights, or to pretend that this is civilization, or to keep trying to walk on an exploded lumbar disc until you can’t walk anymore and you’re lying on the floor, blessing the sky, cursing the world.
We can write satire and curse at each other and joke and be silent and ignore our duty and turn a blind eye to our mistakes. We can do that indefinitely, really.
VIII. Counting
Sorry to trouble you. I’m sorry to trouble everyone. Thank you to everybody who has shown me that you’re there for me, especially in the smartest and most unexpected and most effective of ways.
Conflict is a worst-case scenario, but it’s inevitable, and there are rules of engagement for every sort of conflict. They really should begin and end with prevention. Clear systems, protocols, agreements, common sense, humanity. But we’re in the United States. This isn’t Germany or Vietnam. So this is what we come to. This is the trial.
The people in my corner are all playing different roles and helping me in different ways. I can’t ever pay you back. No amount of financial compensation covers what you are giving me, because without you I would not have gotten up. This is just counting, because counting is my habit, and because I don’t want to forget the favors, or the people. The real doctors, whose names and faces I know. The family and friends and lawyers I trust. They’re not always going to do exactly what I want, because what I’m asking for is not always in my best interest. More on that later.
Thank you to the anesthesiologist. This never happens in a pain clinic. I told him what I have been telling every physician I’ve encountered since my Trinity referrals, since the Trinity saga: that this is already a medical-legal matter. Now I tell all my colleagues that right off the bat out of respect and courtesy. I don’t want anyone else to step on a land mine. I just want to heal. I told him I know it’s a pain clinic and there are probably no cancellations on the horizon, and I respect that. Nobody cancels a pain appointment unless they physically cannot be there. I’m sure there are people who have had much worse experiences with far less help. So I did not ask to jump the line. I took the late appointment a couple of weeks out and thanked the staff. Super grateful.
I reached out to more than one pain doctor, and I appreciate all of them. One was just a phone number my dad had forwarded, because they’re both that kind of dinosaur doctor. They practice real medicine. Or at least what I remember medicine to be, from when I was a medical student shadowing in my parents’ clinic, their private practice. Which is a remnant now. A relic. A statement. The last bunker.
I have been thinking about contingency for a long time. I bow to my parents, both of them, and honor and respect them. For their sacrifice and their hard work, for the unspoken sacrifice and suffering, for their forgiveness, for their big hearts, for their endless, endless, endless support and their truly infinite energy. May God give you health and keep you standing and going and happy and fulfilled and bright for a very, very, very, very, very long time.
IX. The Mirror
I guess what I’m trying to say is this. What I need more than anything at this point is somebody who can be nice to me, and who will allow me to be nice to them. Someone to help me heal, someone to laugh with and enjoy meals and the small but very important things. Someone good at enjoying life. Most importantly, my number one girl taking care of my number one baby. She’s great at that. I often wish that I was Eisen. She’s the best. Both of them are.
I’m grateful to the many people along the way who have helped polish my mirror. The same mirror I am constantly trying to remember to polish myself, every day. I know I am asking a lot from a lot of people. I am very needy at this point. I really don’t have any other choice but to ask.
As a medical student I took care of a man in the hospital, on the gastroenterology floor, who told me: a closed mouth don’t get fed. Very wise words. It took me decades to learn what they really meant.
If you are like my older sister and have read this far: thank you. I’m sorry. And thank you. I’m not doing this for attention. I’m trying to heal. This is my medicine. I need it more than anything, and I have to get these words out while I can. To be fair to her, when I asked her if she expected me to stop writing, her answer was: “No, on the contrary.”
I do hope that after all this time in the box I can look back someday and say, wow, that was a close call. Worst spinal cord injury I’ve ever had. But you never really know how things end up until, all of a sudden, they’re done.
Ouch. My left foot is speaking for me. It’s funny, this pain is bilateral. That’s the scary part. But I have concierge neurosurgery, formally consulted, and it is the best care I’ve gotten so far. I’m grateful that it happens in my house, among my family, with people who can help me, and with a beautiful little girl who is a billion trillion gazillion watts of brightness and an endless joy to look at, listen to, speak with, and learn from. God bless you, baby.
May peace prevail on earth. And may healthcare prevail on earth, as the most basic of human rights, tied with accessible, government-paid, quality education. From A to Z.
FIN.