I still hear my ventilator alarms in my sleep. But what stays with me is the silence.
For a long time, our ICU felt sealed off. No families. No clergy. No one at the bedside except us. When someone was dying at 2 a.m., it was machines, medication drips, and a screen propped up so a family could say goodbye from somewhere else.
We filled in the gaps. We had to. We …
ICU nursing did not return to normal after COVID
When the American Psychiatric Association formalized Section 7.3 of its Principles of Medical Ethics in 1973, it acted with a clear sense of urgency. Nine years earlier, the psychiatric profession had profoundly embarrassed itself in a partisan poll published by Fact magazine, where 1,189 psychiatrists, without any clinical examinations, labeled Republican presidential nominee Barry Goldwater “psychologically unfit.” The diagnoses were sloppy, weaponized, and defamatory.
The decayed fortress of silence
In response, the …
The Goldwater Rule and the cost of psychiatric silence
As a former Team USA figure skater with my own Olympic dreams, I couldn’t help but reflect on my own experience as an elite athlete while watching the Winter Olympics this year. With Match Day behind me and medical school graduation approaching, it is also time to dream of the future again.
In March, I matched into orthopedic surgery for residency, and I hope to complete a sports medicine fellowship to …
A letter to my future self, the team physician
If you work in medicine long enough, you learn that science moves slowly. Regulation moves slower. And social media moves at the speed of caffeine and bad decisions. That collision is exactly what is happening right now in the peptide world.
One week the FDA tightens restrictions. The next week state medical boards issue warnings. Then telehealth companies pivot. Then compounding pharmacies change formulations. Then another peptide disappears from the market. …
Peptide regulation: 4 lanes every physician must know
The announcement landed the way tech announcements usually do: bold claims, a glossy render, the implication that health care’s problems are basically engineering problems that nobody competent had gotten around to solving.
Elon Musk envisions Optimus, his humanoid AI robot, stepping into medical care. Surgical precision. Universal access. Automation of the tasks that slow medicine down. He has gone so far as to claim Optimus could one day perform “any medical …
What AI in medicine can and cannot do
I am a geriatrics and hospice and palliative medicine physician with over 20 years of experience. Over the years, I have seen how cannabis has helped my patients, and I am very comfortable with my patients using cannabis.
But like many physicians, I was not formally trained in cannabis medicine. In fact, for the longest time I thought people smoked the leaves. It was only much later that I learned that …
Why physicians need to learn cannabis medicine now
For most of my career I was an unlikely candidate to build software. I am a consultant cardiac anesthesiologist. My world was the operating room, the bypass machine, the bleeding patient, the next case.
What changed wasn’t ambition. It was a quiet realization: Life had become loud and fast, and I no longer had time to sit down, open a textbook, and read the way I once did. And I started …
I built clinical decision-support tools at the bedside
Fifty million Americans wake up in chronic pain every day. Not soreness. Not the dull ache of a hard week. Pain that has dismantled careers, ended marriages, and driven people, my patients, over 25 years, to suicide, overdose, and a slow erasure of self. I trained at USC and UCLA, spent three decades in interventional pain management, and I can tell you with clinical certainty: the system we built to …
GLP-1s and neurotech are colliding over chronic pain
She had already signed the lease.
A friend of ours, a hospitalist, had accepted an attending position in the Chicago area. The contract stated she could be assigned to work at any of the practice’s contracted hospitals. She read it carefully. She asked which hospital she’d be based at. They told her. She found an apartment nearby, signed a lease, and started planning her life around a commute she could live …
Physician contract review is about what is missing
You might recall the 2002 film John Q., in which a desperate father takes a hospital emergency room hostage because his insurance company refuses to cover his son’s heart transplant. It is a gut-wrenching depiction of medical rage. But now looking back at that scenario from the vantage point of 2026, the moral direction of that anger feels fundamentally different from what physicians face today. John Q. was furious at …
Violence against doctors: 5 forces that ignite it
I have noticed something interesting. Most patients become obsessed with how much protein they eat. They track every gram. They compare protein shakes. They know their daily target by heart. But very few pay attention to when they are eating that protein.
This creates a problem I see regularly in practice. Patients come into my office convinced they are doing everything right because they reached their daily protein goal. Yet they …
Why protein timing after bariatric surgery matters
I still remember the moment clearly. A patient stood in front of me, frustrated and exhausted. She had been prescribed medication for her diabetes months ago, yet her condition was worsening. As I reviewed her profile, everything seemed “correct.” The prescriptions were filled. The claims were processed. The system showed adherence.
But she looked at me and said something I couldn’t ignore: “I never really understood why I needed to take …
Medication adherence is a communication problem
I spent four years as an Air Force flight surgeon before I finished surgery residency, and the safety culture I learned on the flight line still shapes how I run an operating room. Aviation learned long ago that the smartest person in the room is sometimes the most dangerous one. Surgery is learning the same lesson, but we are not there yet.
My path to becoming a surgeon was unusual. I …
What aviation safety can teach surgery about culture
For many years, peer review has been an expected but largely invisible part of academic life, undertaken quietly, without compensation, and often without formal recognition. In my experience, peer review requests now arrive almost weekly, often competing with teaching, mentoring, and administrative responsibilities. While not all are accepted, many are taken on out of a sense of professional obligation, even when time is limited. This work has been sustained by …
Paid peer review is overdue in academic publishing
Physicians need to demand a seat at the table in deciding how artificial intelligence is integrated into medicine. This is not a luxury or a branding slogan; it is a necessity. If physicians remain engaged, AI can become a powerful tool. If we disengage, we risk allowing others to define medicine on our behalf.
AI is already here. It is being used in documentation, diagnostics, risk prediction, imaging, scheduling, prior authorization, …
Physicians must shape AI in medicine, not watch it
Cardiovascular disease remains the leading cause of death in the United States, yet its burden is not evenly distributed. Black Americans experience higher rates of hypertension, heart failure, and premature cardiovascular mortality. These patterns are often called “health disparities,” but that language risks understating a central reality. Cardiovascular risk does not arise in isolation. It accumulates along lines of social and structural inequality.
The relationship between social conditions and cardiovascular health …
Cardiovascular disease in Black Americans is structural
After sharing numerous thoughts on pain management and the health care system, which are topics I am deeply passionate about, I decided for a moment to step out of my role as a physician and share some personal insights I encounter regularly as a parent raising teenagers. At times, this journey can feel even more challenging than practicing medicine.
Raising a teenager today feels like navigating a beautiful storm. One moment, …
How to raise teenagers ready for the real world
At 10 p.m., the phone rings. A patient discharged three days ago is back in the emergency department. The care plan was clear. The medications were correct. The follow-up was scheduled. Nothing was missed, on paper. And yet, here we are again.
The uncomfortable truth
Health care does not have a planning problem. It has an execution problem.
We design excellent care inside the hospital, then we quietly hope it continues outside of …
Why does post-discharge care keep breaking down?
A patient entering a cosmetic surgeon’s office may remove her clothing, disclose fears she has not told her family, submit to anesthesia, reveal pain, expose scars, ask embarrassing questions, or place her body in the hands of strangers. When her privacy is violated, psychological and lasting harm may ensue.
That is why the recent judgment from the Superior Court of Justice in Ontario against Toronto plastic surgeon Dr. …
Medical trauma and the betrayal of patient trust
As a doctor, I often explain to patients how long recovery is likely to take. We offer timelines because uncertainty is often the hardest symptom to bear.
I know this from the other side too. Four weeks after giving birth, I found myself jogging outside at 11 p.m., with an app counting my steps. I was 12 kilograms heavier than before pregnancy and could barely look at myself in the mirror. …
The recovery no one schedules after maternity leave
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