September 22 - Africa Trip - Blog 1

Africa September – October 2014

Blog #1:  September 22

Dear Friends,

Once again I’m off to see the world.  This, my fifth trip to Africa, will be the shortest.  In 2008 I provided medical care in the poor suburbs of Maputo, Mozambique through the Mercy Ships organization.  From 2010 – 2012 I spent about three or four weeks each year in my rural clinic in Keumbu, a village in the western mountains of Kenya, work described in my book, “On a Mission.”  Last year, instead of Africa, I provided medical care in a Leper colony in India.

I arrive tomorrow morning in Amsterdam, Netherlands.  Amsterdam has a well-deserved reputation as a haven of free spirits and individual rights.  Marijuana is sold openly in “coffee shops.”  Women-of-the-Night display their wares in glass walled rooms.  Culture opportunities abound too, though I’ve already thrice toured the most famous, the Van Gogh museum.

After a twenty-four hour stopover, I board on the 24^th for Nairobi.  There I meet with Jared, a fellow who I supported financially through “medical school,” and Francis, an upper level bureaucrat I’ve known for a few years. This latter I met through my brother, Michael, whose career with the US Census Bureau, the United Nations, Harvard, and Hawaii’s East-West Institute, has taken him to over 100 nations around the globe, with resultant friends practically everywhere.   I might also meet with Mishael Oyunge, the head of the HIV program for the country.  A night of dining and stories in Nairobi will follow. 

The next day I fly to Kisumu, a town on Lake Victoria.  There I’ll be met by my friend, Pastor Robert Nyamwange with a rented car and we’ll drive the hour to Keumbu.  When I first arrived in Keumbu, population … oh … 1000, in 2010, I spent three weeks volunteering at their hospital.  I learned a bit of Swahili, studied tropical diseases I’d never before seen, and recognized the needs of a third-world medical system.  In 2011 I returned to begin the water project, bringing with me that year and in 2012 a smattering of supplies and gifts.  Of those, the most important was the water project.  This project alleviated hundreds of deaths due to lack of clean water for drinking, cooking, or medical needs.

When I sell my books at art fairs, showing off my Mission book, sometimes I hear stories of other missionaries or soldiers traveling to Africa and digging wells.  It’s a wonderful and generous action.  Unfortunately, it’s generally more of a gesture.  For once the well is in place, who remains to maintain it?  I paid to have a pump placed in Keumbu in 2011.  In a few months the water supply ran out, and the next year I placed a well.  By 2012 the pump had burnt out.  I paid to have it replaced.  In 2013 the cistern had sprung so many leaks it wouldn’t hold water.  I had to pay for a repair job there.  Earlier this year the septic system needed a rework.  Placing a pump and well is only part of the job, unless those placing the well insure a system to keep it working, it will soon be like an old car on blocks rusting in a backyard. 

So, I will be checking on the water system, and paying for needed repairs.  I’m also bringing gifts for the hospital, over-the-counter medications not available in Africa such as Benadryl and Tylenol, and a pulse ox machine that runs on AA batteries.  The hospital part of this trip will be short, only a few days.  While in Keumbu I stay with the Pastor at his orphanage.  The orphanage began in about 2008 when a homeless girl wandered into Pastor’s church one morning asking if anyone could feed her.  Pastor adopted her, and by my first visit in 2010 he had adopted seven.  By 2012 the residency was ten.  Now he is supporting forty orphans.  When we leave Kisumu we’ll stop first in the county seat of Kisii Town with its three grocery stores and pick up large bags of rice, flour, sugar, salt, and other necessities for the orphanage.  100% of the sales from my Ndovu and Mission books go to my mission trips, and from that I’ve budgeted $1000 for supplies to the orphans. While in Nairobi I will leave in Jared’s care a suitcase stuffed with donations for the orphanage.  Jared will take the suitcase by bus to Keumbu the next day and meet me there.  Let me take this moment to express my thanks to the three nurses at Memorial who donated clothing and toys, and the students under Claudia Parker at Columbus, MS, School of Science who gathered toys as well. 

After my Keumbu visit, I fly to Johannesburg, South Africa.  Here I will be met by Marilyn Bassin.  Marilyn and her husband ran an HIV Orphanage in Sowetto, and, though he passed away last year, she continues to provide care there.  I’ll stay with her and help at the orphanage and see what other medical adventures are available for the next few days.  I have a short tour planned for the end of my stay in South Africa before flying back to the states via Legos, Nigeria.

As I said, it will be a short trip, but a full one.  I’ll send blogs with photos when I can. Some people have asked if I worried about Ebola.  Despite the reality of its rapid spread, it actually isn’t overly contagious if proper precautions are taken, and by that I don’t mean Haz-Mat suits 24/7.  (Anyone ever tried to wear one of those things?  They don’t allow your skin to breathe and within five minutes you’re feeling like you’re in an oven!)  Ebola has its victims in northwest Africa while I’m in the South and Southeast, far away.  My only concern is the airlines might decide to close the Legos airport, requiring a new route home.

So … on to Africa and more adventures.  Feel free to send me feedback, greetings, observations, etc.  It’s always good to hear a few cheerful words from home.

Fondly,

Philip

  

Why Do Writers Write: A four question Blog Hop

 

Why Do Writers Write: A Blog Hop

 

Four questions:

 

INTRODUCTION TO A WRITER’S BLOG HOP 

 

“Writer’s write, that’s what we do. Find out why and how in this new Blog Hop for 2014”

 

Walt Mussell, a wonderful writer I met through the RWA GIAM support group, pinged me asking if I would be interested in participating in a year-long blog hop where writers answer four questions about their writing process. I had no idea what a blog hop was, yet finally figured out I’m supposed to answer four questions, refer back to the writer who pinged me, and then ping on to another writer.

 

To see Walt’s blog please check this link:

http://waltmussell.blogspot.com

 

To read about the writer who pinged him, Sarah Hegger, and her writing process, please check out the link here (but be sure to come back and finish MY post).

 

http://sarahhegger.wordpress.com/2014/02/07/2014-our-writing-process-blog-hop/

 

 

What am I working on?

 

I’m in the finishing stages of my book, “On a Mission,” a 120 page, 200 photo-journal of my three yearly medical mission trips to Kenya.  It should be out in May.  I’m proofing my 65,000 word short story collection “Doctor’s Dreams,” twenty-five short stories based on my thirty-five years of emergency medicine.  I’m organizing my sixth Gulf Coast Writers anthology, this one titled “Mississippi Profiles,” a collection of 25 biographies of Mississippians.  I’m organizing a summer writing conference, the third “Southern Expressions.”  Poetry and contests still find time in my portfolio, and I write non-fiction articles for three local magazines.  As president of GCWA, I organize their meetings and produce their quarterly magazines.  Also, in spare time, besides working, I’ve started selecting photos for my next children’s photobook set in the Galapagos Islands.

 

How does my work differ from others of its genre?

 

   My mission book presents a totally different look and outlook.  It’s a three part piece, the beginning discussing the process of becoming a missionary and my particular preparations.  The middle section deals with the mission itself, an unusual discussion of diseases seen in rural Africa, such as malaria, typhoid, typhus, leprosy, and brucellosis, all illustrated with photos of the diseases.  The final section offers discussions of safaris and national parks in Tanzania and Kenya.

   “Doctor’s Dreams” provides 25 fictional tales based on real E.R. events, each one demonstrating a different disease, many in different genres, including sci fi and mystery.  Though other physicians have written non-fiction accounts of their medical practice, and many physicians write fiction, I know of no other previously published similar work presented as short-stories. Many of these stories have won prizes in contests.

   “Mississippi Profiles” also presents a unique format, twenty-five biographies each written by different authors, presenting a kaleidoscope outlook of favorite personages from all walks of life, with an emphasis on arts.

 

Why do I write what I do?

   I lead an unusual life, medical, missionary, and leadership.  My drive to write stems both from the pleasures of creativity and expression, as well as the belief my writing provides education and inspiration.  Missionary work behooves the giver as well as the receiver, so I hope my work will create the desire to give in my readers.  My doctor stories entertain while informing readers of different types of medical illnesses as well as how medicine has evolved over the past four decades.   By supervising and editing my anthologies, dozens of writers have opportunities to publish, as well as honoring local achievers.

 

How does my writing process work?

   I write at odd times. Whenever I find an opportunity I pull out my laptop and work on one of my many projects.  I try to schedule one evening a week to dedicate exclusively to writing.  For the anthologies, I publicize the opportunity on line and recruit my fellow writers to contribute.

Make Your Writing a Schedule C Business

As we prepare our taxes, many of us will be entering “Writing” as our business, or one of our businesses.  I’ve been filing a Schedule C as a writer for over a dozen years.  Most of those years the sums have been trivial, rarely showing a profit or a significant loss.  With the publication of my first novel in 2007 the situation changed, and as I’ve devoted more time and effort to writing, my income has made the amounts significant.  Starting small helped me learn the techniques of creating a legitimate business with potential for long-term sustainability.

Writing as a business has tremendous tax benefits.  When I took my trip to China in 2007 I took photographs used in publishing my book “Consuto and the Rain God” the following year. Thus the whole trip was tax deductible, as well as my photography expenses.  It is wrongly said you have to show a profit three out of five years.  Below is what the IRS actually says qualifies an activity as a business:

In order to make this determination, taxpayers should consider the following factors:

• Does the time and effort put into the activity indicate an intention to make a profit?

• Does the taxpayer depend on income from the activity?

• If there are losses, are they due to circumstances beyond the taxpayer’s control or did they occur in the start-up phase of the business?

• Has the taxpayer changed methods of operation to improve profitability?

• Does the taxpayer or his/her advisors have the knowledge needed to carry on the activity as a successful business?

• Has the taxpayer made a profit in similar activities in the past?

• Does the activity make a profit in some years?

• Can the taxpayer expect to make a profit in the future from the appreciation of assets used in the activity?

I’m NOT a tax advisor, nowhere NEAR being considered an expert.  Yet it seems to me all of these “considerations” are guidelines open to interpretation.  Many businesses show losses for years before showing a profit … some never do.  One has to be ready to prove the intent and efforts are there.  I keep careful records of my expenses and sales.  I have a P.O. Box, business cards, and a business checking account.  I pay monthly sales taxes to the state.  I paid for a local business license operating out of my home.

Tax benefits include deducting expenses for my home office and an appropriate portion of all the utilities and other house upkeep.  My storage shed, postage, and cable Internet bills are all tax-deductible items.  When I go on a trip and sell some books, pass out cards for publicity, or otherwise do writing business, that portion of the trip is deductible.  When I write articles about restaurants, the cost of the meal becomes another deduction.

Writing is not an easy profession; rejections are many, payment per hour work is low.  I write because it’s my passion.  By making it a legitimate business I can enjoy the benefits of tax deductions for my home and reimbursed travel as well.  And, maybe, yes MAYBE, someday I’ll write that bestseller and, Boy Howdy, I’ll show ‘em then!

Being Your Own Publisher

Questions for a Self Publishing Company

I’ve found success in my writing by being my own publishing house.  It’s easy to do and cuts out the middle man.  There are disadvantages, true, especially limitations distribution.  Recently a friend asked me questions about how my company works.

 

Interviewer:  Are you your own publisher?

    It's easy to be your own publisher -- all you have to do is decide you are one. No registration, training, or fees required. By creating my own publishing house I’ve established a brand.  I started off with a name, “Doctor's Dreams," which reflects that I’m a doctor yet my writing is not necessarily about medical material.  The next step was to create a logo.  Mine is based on a photo taken by a friend (see picture) which I’ve used on my business cards, correspondence, and in my publications. I have a checking account devoted exclusively to writing with my logo on the checks. I have my website www.DoctorsDreams.net. If you plan on putting out more than one book, setting up a brand and a publishing house might be worthwhile, as well as fun. The first step to building your brand is creating one.

   The major disadvantage of being your own publisher is that in order to get your books in major outlets, like Barnes and Nobles for example, you have to go through a distributing house.  It’s not a matter of just contracting with their distributor either, the distributor must agree to handle your book, and to do so, they want to see you have an extensive sales plan (Social media, records of prior sales, or a remarkable book).  Even when Barnes and Nobles agreed to carry my “Rocking Chair” book, I couldn’t get their distributor to carry my book.  If you go with a more traditional publisher, such as Joe Lee’s Dogwood Books, or Create Space by Amazon, they will take care of the distribution for you. 

 

Interviewer:  Did you do an LLC or anything? Business plan? What Mississippi state laws apply, any? Tax ID? ISBN number?

   I'm a solo proprietor. I haven't spent any money on setting up a corporation or anything like that, though it’s not a bad idea.  If you plan to publish non-fiction which might be considered slanderous, such as unauthorized biographies of important figures, setting up an LLC is worthwhile for protection against being sued.  I wouldn’t be surprised if there are tax benefits to being incorporated, but for the amount of money I make, it’s not necessary.  However, it IS important to keep careful books.  I record every one of my sales, run a strict yearly inventory, and document all books I give as gifts, promotions, and donations, for each has a different tax implication.  For example, many of the books I give as gifts have potential to be promotions, however, many do not. 

   I have a MS state tax number and I pay my sales tax monthly.  I also have a license to run a business at my home address.  I use my own social security number. However, it's easy enough to apply for a business tax number, though not necessary.

   Purchase your ISBN numbers from Bowker.com www.isbn.org.  They’re the only registered distributor of ISBN numbers in the country.  ISBN cost $125 for one, $250 for 10, $575 for 100, and $1000 for 1000.  I initially bought a block of 10, but I’ve now used them up (hard back copies, soft covers, e-books, and audiobooks each require a separate ISBN).  This year I’ll buy a block of 1000.  You can buy individual ones cheaper on line, but then the company who sold it to you will be your nominal contact printer.  Most printing companies you contract to will provide you one, because, well, they probably bought a thousand and it only costs them a dollar to give you one.

 

Interviewer: Where did you find your printer? How did you know they were reliable?

   I’ve heard several opinions on this one.  A couple of people in my group have used regional printers with great success.  One told me that there’s one printing company somewhere in the Midwest that does most of the country’s actual printing and he uses them directly.  However, I can’t give you more information on that as I’ve never used them.

   Let me advise to avoid all vanity presses.  They used to be worthwhile as there weren’t better alternatives out there.  Some have terrible reputations.  I’ve known several people who were very disappointed with Publish America and Lulu, though clearly SOMEONE must have been pleased with their work as they’re still in business.  I used iUniverse for my first book, but that was six years ago and though they were good to me, the overhead they charge can be avoided by alternative choices … such as …

    Most beginning writers are using Create Space for self-publishing printing, out of Amazon.com. My-oh-my is it ever cheap and easy! I've used them for my latest book, “Altered Perspectives.” There's no set up costs, you can use your own ISBN or they'll provide one for free (I use my own so I remain the publisher), and they have easy formats for creating the covers. You pay only when you actually have books printed, and they're inexpensive, about $4-$6 each, depending on how big are the books. If you use their ISBN numbers and let them be the printers there are some advantages for distribution rights. If you run off a few copies and then find out there are errors, you can simply load up a revised manuscript and, viola, the problems are fixed!

    An alternative for small runs is to find a local printer. I used one to print my poetry book, $5 each for 200 copies, 80 pages, with glossy color cover.  They sell for $15 each, a good price with a fine profit margin.  For that small project I didn’t even assign an ISBN number. 

   For my biggest projects, BIG runs with hard covers and interior glossy photos, I go out of country to print.  I use Pacom out of South Korea.  I’ll be happy to refer you to my agent if you want further details.  You have to order a minimum of 1000 copies to make this kind of project worthwhile.  But then, it really IS worthwhile.  Libraries, for example, prefer hard cover, and they make a very handsome book.

 

Interviewer:  How many copies did you print of most of your books? How did you set your price? Do you create e-books?

   You have to be able to judge your markets. I printed 2500 copies of my "Ndovu the Elephant" in mid - 2011 and have sold almost 1000. It’s a gorgeous children’s photo book that sells easily, by far my best seller, and I anticipate selling out in another 2 - 3 years.  Ndovu cost $2.50 a copy to print and I sell it for $20.  I printed 1000 copies of my "Rocking Chair" in 2012 and sold 450 in half a year. I anticipate selling it out in 2-3 years as well. The poetry book, 200 copies, is a slow seller. I don't know how long it will take to sell out, probably closer to 5 years. A lot of this depends on your sales plans. I sell mine at various arts and crafts fairs primarily. I'm a good salesman. I have my books at nearly 20 distribution sites; books stores, gift shops, etc, though they rarely sell unless I'm there promoting them. Not never, but rarely. I probably sell about 5 to 8 books a month in these outlets.

   Let me mention, at this point, I have a storage locker.  I used to keep all my books in my garage, but once I reached the 4000 copy level, I couldn’t fit any more in.  I rent a climate controlled locker that keeps the mice and cockroaches out, and, hopefully safe from natural disasters.  Costs about $70 a month.  It also makes yearly inventory a lot easier.

   Setting a price depends on how you plan to distribute your books.  Most bookstores want 40% commission.  So if you’re publishing through Create Space, for example, your books are going to cost about $4.50 each.  If you price them at $12, that means the bookstore will get $4.80, you’ll get the other $7.20, minus your cost, is $2.70 profit.  Not very much out of a $12 sale, but higher prices won’t sell.  In general, hardbacks sell for $16-$25, paperbacks $10 - $15.  Self-publishers tend to try to charge too much, in my experience.  And vanity presses REALLY charge too much.  I typical Lulu publication will run about $25 for soft cover, a very tough sell. Lower prices will reduce your profit per book but significantly increase sales.  By self-publishing and self-selling I’m able to have a MUCH lower cost than going through other publishers.  AWOC.COM out of Texas published my three “Afternoon Tales” anthologies.  He priced them at $11.95 and $14.95 each.  They won’t sell well there.  I sell them at $10 and get reasonably good responses.

   Converting your books to e-book format is not a simple task.  You would think it would be!  It seems that Kindle and Nook would take your word processor files and just have a plug in, like Create Space does.  But, no, you have to go somewhere else.  I have a friend who did mine, but I understand Smashwords is reliable. I'm not good at promoting them on line or in social media. I know of many people who sell them by the thousands. I sell fewer than a dozen a quarter (3 months) on line. I have a business card with them on them that I hand to anyone with a nook or kindle I see. They're cheap, only $3, but I clearly haven’t figured out the e-book business yet.

 

Interviewer:  Did the printer do the specs on your book covers? I know you used your photos? Did you do covers or hire outside help?

   I designed all my own covers, using my own photos as you pointed out, but once they were designed I used a professional graphic artist to format both "Ndovu" and "Rocking Chair" to the printing companies requirement.  On the first three "Afternoon Tales," I sent my printer (AWOC.COM) the desired photo cover and he designed some layouts and we worked together until we settled on what I wanted. I designed my latest, "Altered Perspectives" through the format on Amazon.com ... well, I created it first in Publisher program with help from Photoshop. You should be able to find someone locally who can help you very inexpensively.  Hiring a professional graphic artist might be expensive, though, it might be worth it. After all, THE COVER SELLS THE BOOK.  Really.  It does.  Many publishing companies, if you’re not self-publishing, will provide you with a cover.  iUniverse did a gorgeous one for my murder mystery “Inheritance.”

 

Interviewer:  Do you get an outside editor to look over things or do you do that yourself since you have a lot of experience under your belt?

    EVERYONE needs an outside editor. I'm an excellent writer / editor, but I still miss things. See who you can find to help you. No matter how much you pay, though, they're likely to miss something. Try to get three or four writers you know to give it a good read through.  At this point we’re not talking about major critiquing and editing, but really just proofreading.  GCWA has had several professional editors come through who I can recommend, and also members who will just do proofreading.  This runs anywhere from about $50 minimum for the whole book, to $3 a page medium charge, up to $12 a page for maximum work. 

 

Interviewer:  Did you register your own copyrights or register with Library of Congress? And if so, before, during, or after the publishing process?

   You don't need a copyright. Period. Check out the phraseology in other books and paraphrase or copy it verbatim about “Reserving all rights …” and “No part of this can be copied without express written consent ...” and print that in the opening business page of your book and that's all you need. First off, no one is going to steal your work (people are too busy with their own stuff and, most likely, your stuff isn’t THAT super-fantastic … no offense).  Secondly, if someone DOES steal your ideas or actually whole sections of your work, you can easily prove you wrote it and published it first.  But most importantly, trying to sue someone for stealing your work is a waste of time and money, unless somehow they made several million off your ideas.  Then, of course, they can afford expensive lawyers and you’ll probably lose anyway.   

    The old wives’ tale of mailing yourself a copy and keeping it sealed so you can prove the date in court is total hogwash.  It’d NEVER stand up in court and since you’ll be changing your work over and over until it’s actually in print, you’d have to be sending and saving huge stacks of manuscripts!

   I do get Library of Congress numbers.  There are two levels for this.  So far I’ve ONLY published my own books so only qualify for what they call a Preassigned Control Number.  Look up “Library of Congress” on Google.  You have to register and they’ll provide you an ID and you choose a password.  If you become a more extensive publisher, that is, if you publish at least three different authors and have a wide enough distribution sale of your books, you qualify for the next level and they will classify your books in several categories.  In either case, you have to send them a book as soon as one is ready.  You should get this number BEFORE publication so it can be included on the copyright page of your book.

Interviewer:  Any last words?

Being a self-publisher is surprisingly easy and much more profitable.  I never have to worry about rejections or deadlines or incredible delays or cancellations.  Just be sure your book is REALLY REALLY ready to be published.  Nothing is ever perfect, though, so be sure it’s your best work and then PUBLISH!  You’ll be glad you did. 

 

Foreign Attitudes

I’m finishing up a week’s vacation in Montreal. Every year I take my children on a New Year’s vacation; last year Amsterdam, in other years to such far-flung places as Cancun, London, the Galapagos Islands, and the Amazon jungle. The first few trips the crew consisted of the four of us, that is, my three kids and me.  Soon significant others had to be included, and then close friends.  This trip we’re a group of eleven!  I pay transportation for my family and hotels and meals for all.  We go because, as a father, it’s a duty and privilege to broaden my children’s minds.

So this year we ended up in Montreal in the depths of winter.  It was 10 degrees and snowing the day we arrived, dragging our stuffed suitcases up the steps of the Metro station and down the street towards our hotel on a windswept sidewalk, shivering and wondering if maybe Belize might have been a better choice.  The second day we enjoyed a heat wave, 24 degree high, followed by plummeting temperatures of highs in the low single digits and nighttime depths of well below zero.  Even with two layers each of gloves and socks, our little digits felt frostbit with every outside journey.  In this case, part of the adventure included testing one’s tolerance to environmental extremes.  It’s not often one can enjoy a snowball fight on the Mississippi Coast.

 Montreal has a European feel.  French is the official language; all signs, televisions, and people presume you speak and understand it.  Most everyone is bilingual, and the service people (waiters, hotel clerks, etc.) will accommodate Anglos, except for government people, such as Metro workers, who stubbornly insist they don’t understand English speakers asking for directions, even though they probably do.  But there’s more to the Continental feel than just the language.  Public transportation, little boutiques and restaurants crowded everywhere, and amazing museums.  Well all these are typical of big cities, even in America.  No, the European feel is this city’s attitude; a socialistic, environmentally friendly, athletically oriented, humanistic approach that pervades their lifestyle.  Talk politics with a cabbie.  Read the paper’s editorials.  Saddle up with some locals at a cozy pub and you’ll find people are friendly everywhere, though with different attitudes.

Foreigners wonder why the United States allows regular citizens to have guns, thus having a murder rate thousand times greater than any other industrialized country in the world.  They ask me why United States medicine is run by the insurance industry for profit instead of governmentally socialized, thus providing one of the worst levels of medical care in the industrialized world (despite what Americans are misled to believe).  Citizens of other countries want to know why in the United States do the rich get the largest tax breaks, thus putting the burden of taxation on the middle class and poor. 

There are marvelous aspects of being an American, I tell them.  I have a delightful home, incredible occupation, wonderful friends, and comfortable lifestyle.  I love my freedoms of speech, religion, and peaceful assembly.  However their questions are valid.  I tell them, and I tell you, my readers, I recommend travel to foreign lands to see other possibilities ... even if it means a bit of chilblain on the fingers and toes. 

Changes in E.R. Medicine

One of my E.R. colleagues came up to me yesterday, leaned against the wall, and told me he’s retiring next year. 

“I’m sixty-seven years old; I’ve worked long enough.”

“What will you do?” I asked.

He shrugged, gazing out to the treatment area where a dozen patients waited his care.  “I don’t know.  I feel like I’m falling off a cliff.  How do you give up the only thing you’ve ever done, what you love more than anything in the world?”

It’s true I love being an emergency physician, often proclaiming “I’m saving lives and stamping out disease.”  Though the work isn’t physically taxing, this coming year I’ll turn sixty and I feel my age.  Working three or four consecutive twelve-hour shifts leaves me considerably more exhausted than when I started practicing thirty-five years ago.  Medicine has changed in those years; we used to typically treat five to six patients an hour, now we average about two to three.  Huge changes have occurred in diagnosis, treatment, and testing.  When I was in training, my medical school in the Houston Medical Center had one of the first operational CAT scans.  For the first two decades of my career, one couldn’t order a scan without getting permission from the head radiologist or neurologist.  Now it’s routine to order several CAT scans every shift.  The E.R. chart used to be a single 8 x 11 sheet, a few scribbled notes was all that was needed, now it’s a computer generated book.  When I began, cardiac care units didn’t exist, and ICUs were reserved for the incredibly ill or injured.

I’ve given up doing some procedures; applying casts, draining fluids in joints and bellies, and intra-cardiac injections (medication shot directly into the heart), though as an E.R. doctor I still do intubations, spinal taps, and joint relocations.  Diseases have changed.  Over the past dozen years staph abscesses have bloomed from rarities to everyday occurrences.  Meningitis in infants has almost disappeared.

I doubt I’ll still be working full time as an emergency physician in another eight years.  But I’ll still be a doctor; perhaps more missionary work, or volunteering at a clinic, or doing fill-ins at slower facilities.  Meanwhile, I do have another life.  I write.  I’ll write about medicine, and about life, and how getting older is just a transition, not a cliff.

I’m going to work on my non-fiction book in 2013, “Thirty-five years as an E.R. doctor.”  There’s so much to write, incredible changes, remarkable memories and changes in attitudes and care.  Until then, I’ll continue to work … to save lives and stamp out disease.  It’s what I do.