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Thomas Merton used a phrase in his classic The Seven Story Mountain that has stuck with me - "mental Pompeii". I think this best describes the content of my blog. It will include the eruptions of thoughts I have during my life as an American, Catholic, conservative, father of two, and physician.

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WHY BLOG?

It goes without saying that every single thought that explodes from my cranium is of such depth and intelligence that it is imperative that I share it with the needy public in order to enrich their lives. My ideas are too important and ground-breaking to keep to myself, so this is a burden that I'm willing to bear by bestowing them upon a society desperate for clarity and truth.

Does this sound too conceited? Of course that's not possible, because conceit is a flaw - as my wife, friends, family and priest can tell you, I have absolutely no flaws.


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Wednesday, April 19, 2006
Not Tonight, Honey - My Sex Hormone Binding Globulin is Elevated

From the Journal of Sexual Medicine (and, no, this isn't the same as Playboy or Penthouse):

Women with sexual dysfunction had higher levels of Sex Hormone-Binding Globulin (SHBG) in their systems in this study of 124 premenopausal women with sexual health complaints. Not only were SHBG levels higher in women who were currently using oral contraceptives (OCs), the levels of SHBG remained significantly higher than "never users" even after discontinuation. These findings led researchers to comment:
"Chronic SHBG elevation would lead to low levels of bioavailable testosterone and chronic androgen deficiency. Androgens affect bone density, muscle mass and strength, adipose tissue distribution, mood, energy, and psychological well-being. As a result, imbalance in androgens in some women could have detrimental effects."
I guess we can add another mechanism of action for oral contraceptives - lack of sexual interest. Is anyone else struck by the irony that the very pill that was supposed to "liberate" women from the threat of pregnancy is the same one that makes them less interested in sex in the first place?

Posted by Clay Randall at 11:33 AM CDT
Updated: Wednesday, April 19, 2006 12:18 PM CDT
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Thursday, April 6, 2006
Did I Say That Out Loud?
Topic: Medicine

Sometimes my inner dialogue reveals itself when I'm talking to patients. Yesterday I actually heard myself saying this:
Patient: "Doctor, my ears are too dry."

Me: "Yeah, but your nose is nice and cold and wet, so you'll be okay."

Posted by Clay Randall at 10:57 AM CDT
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Friday, March 31, 2006
Happy 500th Birthday, St. Francis Xavier!

This week is the 500th birthday of St. Francis Xavier, the namesake of the hospital which was the site of my spiritual awakening. When I was a college student I was introduced to the holy concern and medical expertise of healthcare workers at St. Francis Hospital; as an internal medicine resident I would sit in the chapel at 2 o'clock in the morning and pray for spiritual guidance in my life (even before I was Catholic). St. Francis Xavier is in my Saintly Top Five, along with St. Peter, St. Luke, St. Patrick, and St. Benedict.

Saint Francis Xavier is the patron saint of foreign missions. He was born in 1506 in Javier, a small village in the province of Navarre in the Basque region of Spain. The first and last child of local land-owning nobility, his family home as a castle.

Saint Francis met Ignatius Loyola at the University of Paris. With five companions, they founded the Jesuits to save souls and so serve the Church. The Pope approved the order of the Society of Jesus in 1540.

Saint Francis was gifted with the spiritual vision to build God's kingdom here on earth for the greater glory of God. ("Rejoice, Christians, on hearing and learning how God created all things for the service of men." - Saint Francis Xavier, 1542) Throughout his life, he brought this zeal to distant lands.

Within sight of mainland China, Saint Francis died at age 46 after establishing missions in Indea, Southeast Asia, and Japan. He was beatified, or made Blessed Francis Xavier, and recognized to have lived a life of heroic virtue worth of public acclaim on October 25, 1619 by Pope Paul V. He was canonized together with Saint Ignatius by Pope Gregory XV on March 12, 1622.
Great Saint Francis, well beloved and full of charity, in union with you I reverently adore the Divine Majesty. I give thanks to God for the singular gifts of grace bestowed on you in life and of glory after death, and I beg of you, with all the affection of my heart, by your powerful intercession, obtain for me the grace to live a holy life and die a holy death. I beg you to obtain for me {mention your petition}. But if what I ask is not for the glory of God and for my well-being, obtain for me, I beseech you, what will more certainly attain these ends. Amen.

Posted by Clay Randall at 1:35 PM CST
Updated: Friday, March 31, 2006 1:34 PM CST
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Thursday, March 30, 2006
The Pants Go On One Leg at a Time, It's the Shoes That are Hard to Fill

Today is Doctor's Day. I'm not sure when this became an actual entity, but for the last few years our health system has been making a big deal out of it. This year I got a bottle of wine, 4 movie tickets, a special breakfast in the doctors' lounge, and a free visit with a prostitute. Okay, I'm kidding about the prostitute, but the breakfast was delicious. The lounge was set up with a Playstation2 golf video game on the flatscreen, and there are posters all over the hospital with the phrase I put in the title of this blog entry.

You know that little "feeling" you'd get when working on a project in school that you thought was really, really interesting? You wanted to learn all you could about that particular subject. Well, medicine for me has been like that. Practicing medicine in today's world can be miserable, but the intellectual challenges and the relationships I develop with my patients and their families are what I continue to love. From the CEO of large company to the incontinent, demented, and discarded nursing home patient - I try to see the face of Jesus in all of them and treat them accordingly. I never cease to be humbled when patients ask me to see their mother or father, or when my colleagues come to me or send their wives/husbands, and other family or friends.

To Almighty God, thank you for the opportunity to be a physician. Anyone who doesn't do this for a living will never really know what it's like.

To my patients, thank you for allowing me into your life and accepting me into your family. I pray I will always serve you as best I can:
LORD, Thou Great Physician, I kneel before Thee.
Since every good and perfect gift must come from the, I pray:

Give skill to my hand, clear vision to my mind, kindness and sympathy to my heart.

Give me singleness of purpose, strength to lift at least part of the burden of my suffering fellow man, and a true realization of the rare privilege that is mine.

Take from my heart all guile and worldliness that with the simple faith of a child I may rely on Thee.

Posted by Clay Randall at 8:47 AM CST
Updated: Thursday, March 30, 2006 9:03 AM CST
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Wednesday, March 29, 2006

You Are 30% Weird
Not enough to scare other people...
But sometimes you scare yourself.
How Weird Are You?

Question 6 was confusing - what if you both already are 50 lbs overweight and have genital herpes? Is that too much information, ladies? Just kidding!


Posted by Clay Randall at 12:28 PM CST
Updated: Friday, March 31, 2006 1:29 PM CST
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Wednesday, March 22, 2006
It's Nice to Know I'm Not the Only One
Topic: Medicine

Going through my stacks of old medical journals, I found an article in the Archives of Family Medicine, vol. 9, Feb. 2000. Its title is "Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent". I read the article and will present the findings over the next several posts, but I wanted to share the author's comment first:
"I have prescribed "the Pill" since 1978. My wife and I used the Pill for years, having no moral concerns about it. Then, in 1995 my friend and practice partner John Hartman, MD, showed me a patient information brochure - given to him by a friend - that claimed the Pill had a postfertilization effect causing "...the unrecognized loss of preborn children." John asked me if I had ever heard of such a thing. I had not. I did read the brochure and its claims seemed to be outlandish, excessive, and inaccurate. So, I decided to begin a literature search to disprove these claims to my partner, myself, and any patients who might ask about it. The more research I did, the more concerned I became about my findings. I called researchers around the country and interviewed them. During this process I met Joe Stanford, MD. Joe volunteered to assist in the research that ultimately became this systemic review. We were concerned enough about our findings and about the fact that so many of our colleagues and patients seemed to share our ignorance about this potential effect that we presented the preliminary results of our research at a number of research forums, just to see if we were off base. Most of the reviewers suggested that, although this evidence was new to them (as it was to us), it seemed accurate and not off target. Furthermore, several said that they thought it would change the way family practice physicians informed their patients about the Pill and its potential effects.

The most difficult part of this research was deciding how to apply it to my practice. I discussed it with my partners, my patients, ethicists I know and respect, and pastors in my community. I studied the ethical principle of double effect and discussed the issue with religious physicians of other faiths. Finally, after many months of debate and prayer, I decided in 1998 to no longer prescribe the Pill. As a family physician, my career has been committed to family care from conception to death. Since the evidence indicated to me that the Pill could have a postfertilization effect, I felt I could no longer, in good conscience, prescribe it - especially since viable alternatives are available. The support and encouragement that my partners, staff, and patients have given me has been unexpectedly affirming. It seems that my patients have appreciated the information I have given them. Many have been surprised or even shocked (as I was), to learn about this potential effect. Many of my patients have chosen to continue taking the Pill, and we have physicians in our practice and community who will prescribe it for them. Patients who take the Pill tell me that they are much more careful with their compliance. Others have chosen other birth control options - especially the modern methods of natural family planning. So, this is research that has changed my soul and my practice. It has been an extraordinarily difficult issue with which I have had to wrestle. I suspect it will be so for many who thoughtfully read and consider the evidence contained in this review."

Posted by Clay Randall at 12:15 PM CST
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Thursday, March 16, 2006
In Memory of Robert J. Johnson, M.D.
Mood:  sad

I had the profound privilege of knowing and working with Dr. Johnson (or “Robbie” as he was known to me) for about 10 years. I’d like to thank the Johnson family for giving me the opportunity to share some thoughts on what he meant to me. I met him in 1996 when I was an intern during our residency training at OU. I immediately liked him as a person but, through the many sleepless on-call nights with him taking care of critically ill patients, I grew to respect him for not only his knowledge but also his patience and kindness. He taught me many of the things a young doctor-in-training needs to know, including how to look reasonably intelligent during morning rounds with the attending doctors.

A few years later when I was considering my job offers upon graduating, it came down to the fact that I wanted to work with him, and I have never regretted my decision to join him at Warren Clinic. He had a seemingly endless supply of good humor and an effortless practice style that I could always admire but never fully emulate. I trusted his clinical judgment so much that I asked him to be my wife’s doctor during her frightening cardiac problems and he accepted without a second thought. To this day, when I’m faced with a difficult medical problem, my strategy – as I’ve joked in the past - is to think of what someone smarter than me would do, and then do that. So, naturally, I still find myself asking, "What would Robbie say about this?"

The great Greek physician Galen, writing in the 2rd Century, once said this about doctors: "He cures most in whom most have faith." “He cures most in whom most have faith.” Robbie had a fantastic way of inspiring that kind of confidence and loyalty in his patients almost without exception. In one episode that has stayed with me ever since, I encountered one of the finest testaments to the kind of doctor he was one weekend when I was on rounds for him at the hospital. One of his patients, a frail elderly lady with multiple medical problems, some of which were incurable, was able to summarize what it was that made him an outstanding doctor. She said, "I immediately feel better when he just walks into the room." I can think of no higher praise for a physician than that - to be able to bring comfort to those who are suffering with his mere presence.

Of course, Robbie was good at his job not just because he was smart, he was a great doctor because he was a great person. He was smart and practical. He was funny and loved to laugh. He made people around him automatically feel better about themselves, just as that elderly patient in the hospital said. I think I actually liked myself better when I was around him. I loved playing basketball with him (certainly instead of against him), and I had fun fishing in his ponds, even though I was known to frequently accuse him of not actually have any fish in them. Instead of pointing the obvious – which was the fact that I’m a horrible fisherman – he would just laugh and tell me that maybe I’d have better luck next time.

I always thought that we would always work together, and that I could always sit down in his office and ask him what he thought about various subjects. I enjoyed doing that because of the respect I had for him. I always figured that we had plenty of time to be not just colleagues, but friends as well. Because I still see through the glass darkly, I do not understand why he had to leave us so soon, but I do understand why he was put here – to be a loving husband and father, an honorable son and brother, a good friend, a superbly skilled physician, and the kind of person who inspired both admiration and confidence in everyone around him.

For now, I take comfort in the words of St. Paul to the Romans when he wrote, "Who will separate us from the love of Christ? Will hardship, or distress, or persecution, or famine, or nakedness, or peril, or sword? …No, in all these things we are conquerors through him who loved us. For I am convinced that neither death, nor life, nor angels, nor rulers, nor things present, nor things to come, nor powers, nor height, nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord."

Just as the things of this world are only temporary, I believe that our separation from him is temporary and incomplete. We are still bound together, all of us, in our love and respect for Robbie, just as we are united in One Body, One Spirit, and one hope of eternal glory. Although I miss him, I am grateful for the time I was given to spend with him, and I know that I am a better person and a better doctor because of him. Let us resolve today to honor him by trying to do the things he did so well with such ease – to act thoughtfully, to laugh often, and to care always. Eternal Rest grant unto him, O Lord, and let the perpetual light of your love shine upon him, forever and ever. Amen.

Posted by Clay Randall at 10:53 PM CST
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Monday, February 27, 2006
I Never Knew Dostoevsky Was My Patient
Topic: Medicine

I swear I've heard this from patients before:
"I am a sick man...I am a spiteful man. No, I am not a pleasant man at all. I believe there is something wrong with my liver. However, I don't know a damn thing about my liver; neither do I know whether there is anything really wrong with me. I am not under medical supervision, and never have been, though I do respect medicine and doctors. In addition, I am extremely superstitious, at least sufficiently so to respect medicine. (I am well educated enough not to be superstitious, but I am superstitious for all that.) The truth is, I refuse medical treatment out of spite. I don't suppose you will understand that. Well, I do. I don't expect I shall be able to explain to you who it is I am actually trying to annoy in this case by my spite; I realise full well that I can't 'hurt' the doctors by refusing to be treated by them; I realise better than any one that by all this I am only hurting myself and no one else. Still, the fact remains that if I refuse to be medically treated, it is only out of spite. My liver hurts me - well, let it damn well hurt - the more it hurts the better."
from "Notes from the Underground" in The Great Short Works of Fyodor Dostoevsky

Posted by Clay Randall at 8:15 AM CST
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Thursday, February 16, 2006
It's a Man's World, Baby!
Mood:  incredulous
Topic: Religion

A recent study in the medical journal Lancet (vol. 367, Jan 21, 2006) looks at the declining incidence of baby girls being born in India. In their article "Low male-to-female ratio of children born in Inda: national survey of 1.1 million households", researchers found that there are about 500,000 missing female births yearly, and 10 million missing female births over the last 20 years. The accompanying editorial summed it up best:
"Female infanticide of the past is refined and honed to a fine skill in this modern guise. It is ushered in earlier, more in urban areas and by the more educated, with the help of advanced technologies in the form of selective abortion of the female fetus whether in single or multiple pregnancies. A careful demographic analysis of actual and expected sex ratios shows that about 100 million girls are missing from the world - they are dead." (p. 185)
It's interesting how they're simultaneously referred as infants, fetuses, and girls. I appreciate the author taking what abortion does to its logical conclusion. After all, how can just a bunch of cells be "dead"? The epidemiological ramifications are staggering enough without having to consider the deliberate destruction of 100 million human beings for no other reason that they were created XX instead of XY.

The author points out that daughters are "regarded as a liability" and that a boy is preferred "because he will continue the family name and bloodline, earn money, look after the family, and take care of parents in their old age." When human beings become expendable in any particular society, that society will ultimately collapse. This applies to India, China, and even the United States.

God, have mercy on us all.

Posted by Clay Randall at 12:22 PM CST
Updated: Thursday, February 16, 2006 12:24 PM CST
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Thursday, January 26, 2006
I'm Back
Topic: Miscellaneous

I haven't blogged in almost a year. This is primarily because I can confidently say that 2005 was the worst year of my life for a variety of reasons. I've neither the time nor the inclination to post my thoughts here as I withdrew inside myself for some soul-searching. I will share some (not all) of the things that happened in due course.

The Internet Webring can rejoice - I have returned.

Posted by Clay Randall at 1:39 PM CST
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