Over the years, many scenarios have arisen concerning tax problems. When you find yourself in the same situation, there is no need for alarm. For one, there are several available options for dealing with the IRS. There are tax professionals who stand a better chance of arbitrating on your behalf. For this reason, one does not need to be stressed with tax problems, which may cause credit damage. Once you are not able to handle the IRS, seek out a tax professional who will offer impeccable back tax help. For an individual to handle the IRS, they must have knowledge of the law and enough evidence to pin them down. Otherwise, chances of losing a case may be high.
Taxpayers normally have a tough time when dealing with the IRS, as their guidelines are confusing as well as intimidating. This is why, it is important to seek services of someone, who understands the tricks within the IRS game book to counter their strategies. Most of the time, they do not care if your reasons for owing back taxes are valid. Their main interest is the tax you ought to remit. If there is possibility of hiring a professional, so be it. Experienced tax experts will assist you to get back tax help and handle the rigorous exercise for you.
Tax Relief Help Comes With A Compromise
What we can expect from tax relief help is a compromise. This compromise can be arrived at after a close consultation with a company that offers you that help. What they do is sit with you and go over all the receipts and expenses for the year and arrive at a figure that can be payable towards the tax debt. The IRS is not going to wait forever. Sooner or later, you will have to pay up and be cleared of all monies owed towards taxes. At the same time, you do not want to find that what you are asked to pay is more than what you actually owe. This is a critical reason as to why you have to be careful how you go about finding tax relief help.
Invariably, you will find that the compromise is in your favor. The objective is to reduce the burden. This can only happen if the total debt is somehow reduced to an affordable amount. This is what tax relief help is all about. You may find that even the smallest amount is difficult to manage. But, you will have to make the effort especially since you have now engaged the services of a third party. Once they have stepped in, you will be advised on ways to make sure that you do not go back into debt.
RAID 10 is considered an amazing overhead among other layouts of standard RAID. This is having several kinds of breakdowns that include controller failure, operator errors and disk failure. This can be solved by using RAID 10 recovery methods. For recovering the array RAID 10, people need to choose disks that form RAID 0 and after this, people can proceed with recovery methods of RAID 0. There is free software available for array configurations including parameter automatically.
To proceed on the manual techniques of RAID 10 recovery, the RAID 10 parameters are reconstructed. To do this, first of all member disks are excluded that are consisting of similar data. To avoid the excessive disks, software for disk editing can be used that is helpful for comparing content of disks. Recovering RAID 10 with the help of any software is easy and more useful. This method is composed of simple and short steps that are followed. The software of RAID 10 recovery is able of recovering and configuring the automatic systems. To do this in simple way, people must download the software in their systems. After this, the member disks in RAID 10 are selected. After selecting the member disks, the RAID button is selected and the process starts.
Is RAID Always A Good Solution?
RAID has become very popular lately, especially in small businesses where large data amounts should be stored. There are many levels of RAID, but overall, they are created to store data together, and support each other when one RAID fails. This is very reliable tool that lets the user enjoy its performances all the time, and the RAID repair is usually done by professionals. RAID is very efficient in increasing the performance levels, since the data is usually divided in segments, so there is no way for all data to be lost if failure occurs.
Nevertheless, RAID cannot save the data from all damages that can happen. It may be useful when there is a physical damage, but when the virus is a problem, no one can guarantee how much data will be lost. When it comes to RAID repair, it is not much easier, since there may be many individual drives to be repaired. Therefore, it is always recommended to use professional help for more complicated repairs. Some types of RAID only protect against hard drive failure, but they do not really increase the business performances. In addition, RAID is not very convenient to use in different places, since it is too large to carry around, and that can even cause some physical damages. Read more RAID repair tips at http://www.raidrecovery.ws/.
Finally, researchers of snoring problems found a solution for those who suffer from this alarming issue. This Good Morning Snore Solution review affirms that this solution for snore is very easy to use and very comfortable. It is an innovative mouthpiece that can be worn while you sleep. This review finds that this device is non intrusive and very manageable; the final solution to all snoring problems. People with snoring problems who are not comfortable with using other anti snoring products like pillows, spray, head straps and other devices will find this product a very good alternative.
This product is very easy to use. The mouthpiece needs to be placed just right of your tongue’s tip. Once inserted you just move it slightly forward. You will feel that this anti snore mouthpiece will comfortably settle between your bottom and top jaw line. This product will keep your tongue still free to move around without any difficulty. It will not restrict its movements or goes down at the back of your throat. It will not block your airways either. And what’s surprising is, the annoying sound of your snore will be gone for good. What this product does is reverse what happens when you snore which is keeping the air that passes your esophagus from vibrating. The company virtually guarantees that the product will effectively eliminate the noise that your esophagus is making, guaranteeing you a good night of rest.
The Good Morning Snore Solution: Pros And Cons
The Good Morning Snore Solution inventor assures you that this product is Food and Drug Administration (FDA) approved. Another thing is that its effectiveness has been scientifically proven so it means a lot to those who have snoring problems. Dr. Leslie Dort conducted studies which have been published in the Sleep Breathing Journal that show that the snoring problems of patients who used this product have minimized their snores by 70 percent.
It is even recommended highly by many dentists and medical practitioners. This anti snoring product has a very sleek design. It is completely non intrusive, natural, comfortable and an effective mouthpiece roll into one. The manufacturer assured you can be sure of its effectiveness that’s why they offer each customer with a 30 day money back guarantee.
Only two side effects have been noted when using this product. First, the user may experience a tender tongue. It is very common for those who use it for the first few days. But when your tongue gets used to it, the tenderness will be gone automatically. Also, you may salivate or drool when you use this product. This will happen also only during the first few days. But after several days, these symptoms will be gone for good as well as your mouth gets used to it.
For several decades, medical billing was done almost entirely on paper. However, with the advent of medical practice management software, also known as health information systems, it has become possible to efficiently manage large amounts of claims. Many software companies have arisen to provide medical billing software to this particularly lucrative segment of the market. Several companies also offer full portal solutions through their own web-interfaces, which negates the cost of individually licensed software packages. Due to the rapidly changing requirements by U.S. health insurance companies, several aspects of medical billing and medical office management have created the necessity for specialized training. Medical office personnel may obtain certification in the field of medical billing training through various institutions. http://www.medical-billing.net/
The Certified Medical Reimbursement Specialist (CMRS) accreditation by the American Medical Billing Association is one of the most recognized of specialized certification for medical billing professionals. Steps have been taken in recent years to make the billing process clearer for patients. The Healthcare Financial Management Association (HFMA) unveiled a “Patient-Friendly Billing” project to help healthcare providers create more informative and simpler bills for patients. Additionally, as the Consumer-Driven Health movement gains momentum, payers and providers are exploring new ways to integrate patients into the billing process in a clearer, more straightforward manner.
Having been married for a couple of years to a snorer is not a joke. There were times when I got so worried that I chose not to sleep just to make sure he breathes well. He gasped and choked while asleep and having that in sight was just so disturbing. I suffered from hearing that sound, too. For two years, I had to cope up with his startling snores. The first few months were the worst. I couldn’t sleep without taking sleeping pills. That was so stressful that getting pregnant was close to impossible. But surprisingly, my husband has gotten me pregnant. This prompted him that he had to do something about it or our child might be the one to put up with my lack of sleep. He made use of some good anti snoring devices. The first two gadgets that he tried were a failure. But when he tried an item that his doctor recommended to him, and it worked magically. Now, our child is about to be born. My doctor assured me that he’s a healthy baby. If my husband did not address his habitual snoring, my pregnancy would have been unwholesome. It seems like my husband did it not for his own sake, but for the sake of our child.
The Impact of Snoring On One’s Confidence and Social Life
My friends paid me a visit last week. They asked me to go with them as they plan to take a vacation in Hong Kong. They told me that I should not worry about the expenses. The hotel accommodation has been paid and all of us will be housed in the same hotel room for two nights. Although the invitation sounded great, I had to turn it down. It is not actually the expenses that I was worried about. I just did not like the idea that we will all be sleeping in the same room. None of my friends knows about my snoring. I know them too well and they will only tease me if they find out that I snore like a guy. It is sad that just because of my snoring, I cannot join in this fun summer getaway. But at least I have read up on anti snoring pillows to at least reduce the distracting sound that I produce when I am asleep. Maybe I should start locating a doctor that specializes on this medical condition, too. My social life is becoming affected by my snoring. It is also beginning to have negative impact on my confidence that’s why I really have to put an end to it.
The skin tone tags are generally small ample epidermis increase that will cause no hurting as well as is usually harmless. Some individuals adopt information on how to remove skin tags yet medically authorized procedures are typically best applications for handling. You have to distinguish that it happens to be not essential to eliminate epidermis tags other than in cases reveal before. Several people decide to eradicate tags on account of ugly physical emergence. They generally grow in your neck, nasal, eyelids, face along with the armpits although they will grow somewhere in your body part.
The Cauterization is one of the procedures regarding burning the skin cell. It is the most frequent answer to the difficulty with how to remove skin tags. The expansion is burned through apply of a metallic probe that is heated through electric current. Another method is excision, practically, which implies cutting off. It is usually a surgical method the place that the expansion is removed fully through cutting it from the outside of your skin. Some tags are usually unintentionally cut off whilst shaving. Several tags have been traced when bleeders removed. For situation, ensure that the cutting edge you utilize is appropriately sanitized along with the immediate part across the tag to avoid infection.
Advantages Of Learning Traditional Methods Of Removing Skin Tags
Why should you spend your hard-earned money in the hospital on removing skin tags when you can do it by yourself? Skin tags can look like a big issue to any kind of person who has them. Sometimes, their size could be a discouragement especially for you who want to get rid of them. You should not be discouraged anymore. You can learn how to remove skin tags so easily through different means and try them on yourself.
Information is all over presently. In fact, the internet has made it easier for us. You can access information anywhere and at any time. Instead of spending much money going to the hospital to have your skin tag removed, you can simply get to the internet and acquire information that will help you. Learning traditional methods of removing skin tags through the internet will save you a lot of time. This is because you can go on with your work while at the same time dealing with the skin tag. For example, tying a knot on the skin tag using dental floss or a piece of thread will not hinder you from pursuing your daily chores. Going to the hospital to have them removed will cost much of your time since you will have to wait maybe for long queues in the hospital before you are attended to.
It has been discovered that the number of people with snoring problems keep rising every day. In America alone, those with this sleep disorder is approximated to be between 12 to 20 million, and the number is thought to be rising steadily. Meaning that at night, those who have sleep disturbances from snoring partners or siblings is more than triple that figure. This therefore gives a funny trend. Since lack of sleep has lots of demerits, then some causes of poor work and abnormal tempers at the work place is due to fatigue which is common for those who cannot have enough sleep due to snoring problems. The remedy came in the form of a snoring pillow.
The snoring pillows have been developed by medics to help alleviate the problem of snoring. This product was developed specifically to help in keeping open the airwaves which are known to be blocked during sleep thereby causing expulsion of air with difficulty which finally leads to the abnormal sound that a snorer produces. The snoring pillow has a unique shape which promotes healthier side sleeping. It is strong enough to keep the head in the right position that keeps the airwaves open. At the same time, it is soft enough to give the user a comfortable feeling while sleeping. Some manufacturers of the pillow provide a pillowcase as well as an after sales service.
Why Does Snoring Annoy Someone So Much?
Snoring from a roommate can be so annoying when one is struggling to fall asleep. It can get very irritating when someone keeps waking you up every hour from their snoring. Snoring is a problem that should be addressed as it affects a recipient and the victim too. Snoring pillows should be used to support the head and neck for a snore free rest. Repetitive sounds can stress a light sleeper who wakes up at the slightest interruption. Large alcohol intake relaxes the neck muscle obstructing free breathing resulting in loud snores, which can disturb the rest of the residents in a home.
A snoring person looks selfish to the one who is getting disturbed, as they are fast asleep and keeping them awake. A person who snores should agree to use snoring pillows for the benefit of all. There are cases of people who have kicked their roommates to wake them up due to snoring. A married couple may have separate bedrooms when one partner keeps the other awake because of snoring. The snoring partner may be forced to sleep on the couch if another bedroom is not available; snoring may cause reduced intimacy in marriage and hurt it in the process.
The beauty industry is packed with various anti-aging remedies such as anti-wrinkle creams. Many people use anti-wrinkle creams because these products promise to give a youthful-looking skin. But the effectiveness of these products is still being debated. It is hard to measure the effectives of anti-wrinkle creams because there are a number of factors that should be taken into account. Consumers have different skin types so they can have different reactions to anti-wrinkle creams. Usually, the effects of anti-wrinkle creams may be evident after two months or more. It is crucial to consider that type of active ingredients that make up the cream and their concentration can influence the results. If you had been using a particular anti-wrinkle cream for many months already and still cannot find satisfactory results, you should consider switching to another brand. If you had just started using a particular product and you had observed undesirable effects that you were not warned about, you should stop using the product. You can avoid these types of situations by scrutinizing the product before buying it. Find the 10 anti-wrinkle creams with the highest ratings and study each of them. It is better to ask for the professional opinion of a dermatologist before using any cosmetic skin care product. Read more
The Secrets to a Healthy Skin
You may search for the 10 anti-wrinkle creams that are best-rated by consumers but it is better to start the improvements from within. If you really want to have a healthy-looking skin, there is a need for lifestyle modification. These anti-wrinkle creams may reduce the signs of aging on your face but it is better to prevent their premature appearance. There are a number of things that you can do to prevent early onset of wrinkles, pigmentation and discoloration. Wearing sunscreen can be beneficial to your skin. It will protect your skin from the harmful effects of UV rays. It is recommended to use sunscreen with higher SPF if you are staying on a sunny area. You should also drink plenty of water to replenish the moisture that is lost through sweating. You can maintain your skin´s healthy appearance by consuming plenty of fruits and vegetables. These contain vitamins and minerals that are essential for your skin´s health. You should also stay away from smoking and drinking because these can inflict awful effects on to your skin. If you are planning to use any type of cosmetic skin care product, it is encouraged to consult a dermatologist first. The doctor can give a suitable recommendation for your skin type and skin condition.
How Your Lifestyle Can Affect Your Skin
You have to be prepared for the early onset of wrinkles if you are fond of sun bathing without wearing sunscreen. This is because the UV rays can cause wrinkles. And if your skin is constantly exposed to UV rays, it will acquire wrinkles before their due. If your activities require sun exposure for long hours, you should wear sunscreen with higher SPF. Your skin will significantly benefit from this practice. The food that you eat can also affect your skin´ s health. You have to consume fruits and vegetables because they contain essential nutrients that are not only good for your skin but to your overall health as well. It is also encouraged to get enough sleep and learn to relax. You should not smoke if you do not want to have a youthful-looking skin. Cigarette smoking can make wrinkles appear earlier by constricting the blood vessels. If you have visible lines already, you should use a reliable anti-wrinkle cream. There are many options in the market. But you can narrow your options by searching the 10 anti-wrinkle creams with best results according to consumer reviews. You should be careful with any skin care product that you are using. It is crucial to be certain that it is suitable for your skin type and skin condition.
During the first two years of medical school, students intensively study the sciences that form the basis of medical practice. These courses have traditionally been taught through lectures and laboratories and tested by rote recall of literally thousands of pieces of information. This model hearkens back to a previous era when physicians were expected to master all the scientific knowledge that then existed as the foundation of medicine. The explosion of biomedical science over the last several decades has rendered this once challenging task now frankly impossible.
THINK, AS AN EXAMPLE, of our knowledge of infectious diseases over the last 50 years. In 1944 bacteria and viruses had been discovered, but little was known about how they caused disease. The entire antibiotic armamentarium consisted of sulfa and penicillin. Medicine had nothing else to offer for a multitude of fatal infections. Today, we know about many thousands of disease-causing organisms and scientists regularly discover new ones. The hospital where I work routinely stocks 47 antibacterial agents, not counting antiviral and antifungal medications that are in their infancy and just beginning to proliferate. The latest edition of a major pediatric infectious disease textbook runs two volumes and 2,395 pages (and it just covers pediatric diseases). A lifetime of study could easily be spent on this one important but relatively small part of medicine. Yet medical students, with a crash course over a handful ‘of weeks, are presented with a vast portion of the current knowledge. Having had no clinical experience themselves (clinical rotations do not normally begin until the third year of medical school), students cannot separate out of the sea of information what is most critical for them to know. So they try to learn it all. Anywhere from two to four other courses are going on at the same time. Students often feel abject at their inability to master all the material, and these very motivated, intelligent young people flounder at their impossible yet seemingly expected task. It is an understatement to say that student morale is often devastated.
IN ADDITION to the sheer weight of modem medical knowledge, the advent of the molecular age of biomedical science adds further educational challenges. A generation ago, the basic science curriculum of medical school focused on subjects like gross anatomy, physiology and pathology, each of which had a palpable and obvious connection to real patients. The birth of molecular biology has forced these traditional disciplines into smaller segments of the curriculum, while much more abstract studies like cell biology, biochemistry and immunology make up an ever-increasing part of the course load. These newer subjects are indispensable to the modern practice of medicine and no doctor would be considered adequately trained without them, but they bring to medical education a level of abstraction and remoteness from living, breathing, whole patients unprecedented in medical history. Simply put, it was much easier to dissect a diseased lung and imagine, even empathize with, the person to whom it once belonged than it is to study the unseeable molecular mechanisms of lung tissue and feel the same connection.
In no way do I propose that medical students not learn the molecular science that has revolutionized medicine. However, our system of medical education has made no allowances for the new challenge that molecular medicine presents to students. Most who choose medicine as a career do so with the intention of one day caring for sick people, but the heavy emphasis on molecular science from the very outset of medical school without any humanizing patient-care experiences to balance it begins to drive a wedge between the physician-to-be and his or her future patients. The impersonal, sterile, unsatisfying doctor-patient relationship that many of us have experienced has its earliest roots here.
Underlying the first two influences I have discussed–the explosion of medical knowledge and the molecularization of medical science–is a philosophy of scientific materialism that dominates medical school education during the early formative years. The intense study of disease almost exclusively from a molecular, cellular and organ perspective without consideration of the intact patient reduces illness to the level of specific defects. The human being becomes nothing more than a conglomerate of molecular pathways and cellular mechanisms. In principle the whole of the human condition is supposed to be knowable in this way. Illnesses once mysterious and even spiritual, stillbirth or depression for example, are at last giving up their secrets to new technologies and modes of investigation. Why then should not all of human experience–an artist’s genius, a child’s love for her mother, the self-sacrifice of a saint-be a function of programmed molecular processes and no more?
This philosophy of scientific materialism is reinforced by the fact that almost all the first-year courses in medical school are taught by Ph.D. scientists, not physicians. Their perspective differs dramatically from that of practicing doctors and their influence, along with the seeming remoteness of the subject matter from clinical medicine, redefines the self-understanding and goals of many students. Having come to medical school to learn to care for sick people, they begin to see themselves as scientists first and caregivers second, if at all.
The only concession that most medical schools make to the humanistic aspects of the profession is a course in medical ethics taught over a few weeks sometime in the first or second year. A few schools have recently introduced more extensive courses roughly centering on the theme “The Physician and Society,” yet these offerings at most represent isolated and abstract attempts to introduce humanism into the students’ vision, coming as they do buried amid the hard science courses that dominate the students’ time.
PERHAPS EVEN MORE fundamentally, students are subtly but strongly taught in the early years of medical school that the career to which they aspire is foremost about science and only secondarily about people. They lose the sense that while science may be the indispensable foundation of modem medicine, the fundamental goals of science and those of medicine differ. Nowhere in medical school is it stated or even implied that science is about determinism–how process A inevitably leads to result B–while medicine is about freedom–striving to help individuals be as healthy as possible to live out their lives in their essential human freedom.
Much of the depersonalizing approach to patients found in medicine today stems from this early dominance of scientific materialism in medical school. Here are sown the roots of dismissing a man with excruciating pain as “the kidney stone in Room 10″ or seeing a dying woman only as a particularly interesting case of breast cancer. Popular medical dramas always portray interactions with demanding or unsavory patients as the root of doctors’ dissatisfaction with patient care, but nothing could be further from the truth. The clinical encounter between doctor and patient remains the ultimate humanizing and empathizing moment in medicine. Unfortunately, doctors routinely reduce patients to their diagnoses and dismiss their humanity because they have been taught from the most formative beginnings of their medical education to think in strictly scientific and not humanistic terms.
The last sweeping change in American medical education came in the mid-19th century, when Dr. William Osler first brought medical students out of the laboratory and lecture hall to the patient’s bedside. Until then, there had been no hands-on clinical training in American medical schools, and caring for sick patients was learned as an apprentice after medical school had ended. Osler’s revolution in teaching formed the basis for the two-year pre-clinical and two-year clinical curriculum that makes up medical school today. As I have indicated, however, this model has become sorely outdated. A new revolution in medical education is needed that would bring the student to the patient’s bedside from the first moment of medical school to allow the humanizing effect of the clinical encounter to flourish. Immersion in the care of real patients from the outset is the only way to counterbalance the influence of the scientific materialism that now predominates. Students will also much more easily gain a sense of what is clinically relevant in the basic science curriculum and can thus direct their own learning more efficiently to deal with the overwhelming quantity of modem medical knowledge.
Some medical schools, most notably Harvard’s, have begun to move generally in this direction. Harvard’s “New Pathway” program introduces medical students to the clinics and hospitals early in their training, but as yet only in small increments. Other schools have followed suit and some may still introduce more radical changes along the same lines. These moves are encouraging and demonstrate that some influential medical educators have recognized the problem. Yet the steps so far have been modest and change slow, as change in medical education is wont to be.
In the end, though, such fundamental change must come. The vast transformation in medical knowledge since Osler’s day is too overwhelming to be taught by the same system without the inevitability of doctors drifting further and further away from their patients. Early immersion in the clinical setting–interviewing and examining patients, observing and assisting physicians, becoming involved in the lives of real patients–is the only answer to the great challenges of medical education today. Otherwise, the exploding quantity of knowledge, the further molecularization of science and the pull of scientific materialism will only more profoundly alienate doctors-to-be from the very people who seek their help.
Voco, vocare, vocatus–the Latin root of the word “vocation” means to summon, to call, to name, to call upon, to invite, to challenge. The American Heritage Dictionary of the English Language defines the word thus: 1) a regular occupation, especially one for which a person is particularly suited or qualified; 2) an inclination, as if in response to summons, to undertake a certain kind of work, especially a religious career. The phrase, “as if in response to a summons,” introduces a mystical quality. If the word “profession” is brought into the discussion, there is a degree of religious-secular conceptual crossover. One definition of that word, from the same dictionary, is: an occupation requiring considerable training and specialized study. In most religious orders and congregations the taking of final vows is referred to as “making one’s profession.” Profession is a part of vocation, but vocation suggests a higher calling, something requiring time, training and commitment, with an ineffable quality that goes beyond a job.
Vocation in Depth.
Religious have explored and developed the concept of vocation in depth and detail. Consider Your Call, a book by Dom Daniel Rees and a group of English Benedictines that examines the vocation to Benedictine monastic life, supplied much food for thought. Three passages from this book apply also to medical training:
* Vocation also means a call to service of other people at some stage in the unfolding of God’s covenant.
* A human person says yes to God in a matter that seems to affect only himself, but the repercussions of his choices are felt far. beyond his own life. He serves the economy of salvation precisely by being or doing what God is asking him to be or do and on his obedience may hinge the destinies of many in ways entirely unknown to him.
* The greatest of all Old Testament vocations is that of Abram. “Go from your country and kindred and your father’s house and to the land I will show you. These three statements suggest service, influence or role model and faith in God’s presence.
Service is a mandate and the easiest topic to discuss. In the Letter of James we read: “You have faith, and I have works. Is that it? Show me your faith without works, and I will show you the faith that underlies my works.” Service need not be as heroic or exotic as that of Dr. Albert Schweitzer or Dr. Tom Dooley. The potential for service in medicine is enormous: waiving fees, working in an inner-city clinic after hours, short-term work in foreign missions, consulting in an AIDS hospice. Only a little imagination is needed. One of the changes in medical education over the past two decades is an emphasis on community service by medical students. This can range from tutoring reading to work with the homeless or medically indigent.
The impact of the exercise of one’s vocation on the destinies of others is more mysterious. Rarely are we aware of our effect on others’ lives or how others influence our lives. Two personal examples can illustrate this.
My twin brother and I attended a small public high school. Regina Robaczewski, the librarian, was determined that students should become self-sufficient in a library of any kind. About 17 years after finishing high school, while planning the guest list for a party to celebrate his master’s degree, Jim was adamant that Miss Robaczewski, who had been in retirement for over a decade, be invited. He responded to a quizzical look saying, “The only thing I learned in high school was how to use the library, which is how I got through this degree. If it weren’t for her, this party wouldn’t be happening.” The surprise on my face reflected that I had felt something similar years earlier upon first walking into Penn State’s sprawling Pattee Library as a freshman. “Big … but I can handle it.” During the party we were able to thank her for the influence she had on our education. She glowed.
The second passage returns to medicine. After practicing geriatric internal medicine for 10 years, I returned to residency training in psychiatry. In the interim between closing my practice and beginning residency I was able to spend three months working at St. Joseph’s Mercy Hospital in Georgetown, Guyana. Mary Liguori Cantilin, R.S.M., M.D., was one of two surgeons at the 100-plus bed hospital. She made rounds seven days a week and was on duty for stretches of up to two months. Even when she was not officially on duty, she was available to advise me on problems unique to that unfamiliar tropical setting.
Except to attend Mass, Sister Ligouri rarely left the hospital complex in which the convent was located. In her late 60′s, her stamina after two and a half decades as a missionary surgeon in India, Guam and Guyana was incredible, as was her obvious joy in what she did both as a nun and as a surgeon. One evening, a little less than a year later, I received a phone call that she had died suddenly earlier in the day. Looking out over the lights of center-city Philadelphia, where we had hoped to meet during her upcoming from leave, I realized she had, by her dedication and joy in what she did, reminded me of something I was starting to forget: It is a privilege to be a physician.
The lives of both these women, one whose vocation was to teach and the other whose religious and medical vocations were inextricably joined, have had an impact that is probably well beyond anything they could have imagined or realized.
The third text, which promises God’s presence when facing the unknown, is particularly relevant to the physician in training. Abram was asked to leave all that was familiar and trust in God. The limits of his world and existence were to be expanded. Like Abram, the physician is called to go to the limits of his or her world and existence–in this case, the limits of knowledge, ability and physical stamina–and expand them. Becoming and being a physician are not easy. Too little sleep and relaxation, coupled with too much stress and too many deaths, characterize the training of most physicians and the practice of many. Graduation from medical school marks the beginning of more severe challenges and training that continue for three or six or more years. Giving of oneself daily can siphon everything before replenishment is possible. There may be no one to comfort the comforter or heal the healer. Remembering God’s promise to Abram to show the way can take one through some very difficult moments.
A tradition older than Christianity outlined the vocation of medicine in the oath attributed to Hippocrates. The oath set out the relationship between physician and student and proscribed giving deadly medicine to anyone if asked, giving a pessary to produce abortion and seducing patients. Two versions of the oath lie before me as I write. The traditional text, from which this synopsis was made, is in a frame that was propped up, along with a crucifix, inside the lid of my father’s coffin in 1974. He was a 1931 medical graduate whose life and vocation influenced many. The version of the oath administered at my graduation from the same medical school 44 years later deleted references to abortion, ignored the mandate to teach and glossed over administering deadly medicine by suggesting only that criminal considerations should stay the physician’s hand. Many schools have revised the oath and others have ceased administering it, thereby changing the ritual of profession.
Over the past few years much has been written describing changes in the business of medicine. They are too numerous to detail here. Capitated care, in which the cost of lab tests, specialty consultation or imaging studies is essentially deducted from the ordering physician’s salary, is one example. The potential for financial interests taking precedence over patient needs is obvious.
A commitment to residency training and teaching, to passing down the tradition and learning, is being questioned as something that is costly to the physicians who do the teaching. The amount of time spent teaching students and residents at the bedside has diminished over the past two decades. This is tragic. The best way, perhaps the only way, to learn medicine is at the bedside or in the clinic, watching seasoned physicians, not slightly more advanced trainees, interact with patients and having one’s own work as a trainee observed and evaluated by those same experienced practitioners.