Commencement

8 Replies

June is the month for graduations and commencement speeches. I accomplished the former in 1979 and it’s unlikely I’ll ever be asked to do the latter. I wrote this in 1998 in response to a long-forgotten question my sister-in-law asked and revised it for this blog post.

To all graduates, family members and faculty, welcome. It’s my honor to be here today. I might not be if it was not for persistence, determination, and the fear of being stuck with loans I couldn’t repay if I was unemployed.

First, to the esteemed faculty:

When I applied to medical school, admissions committees wanted applicants who looked good on paper: science degrees, high test scores, ambitious undergraduate years, and largely male. They frequently weeded out those with the characteristics patients wanted in their own doctors, replacing them with what they were most familiar – future Great White Fathers.  If those anomalies survived medical school and residency, they were often ostracized and driven out once in practice because they refused to follow the herd and questioned what we did. The heretics among you kept you honest; you needed them to grow. And you have made progress.

Medical school classes have become more diverse. Women made up slightly more than half of applicants and new students in 2017. The FlexMed program at Mt. Sinai’s Icahn School of Medicine in New York has admitted nontraditional students for thirty years. There are fewer white and more Asian-American students admitted, but the percentage of African-American and Hispanic students remains low.  A lot of work remains.

There are many different ways to teach and to learn.  The creation of medical schools was done, in part, to standardize what was taught and to ensure some semblance of consistency in medical training.  But much has been lost confining students to classrooms and expecting them to read volumes of medical literature taken out of context.  The old guys used to say, “Look at the patient, not just at the lab tests!”  Teaching at the bedside still has a place and cannot be replaced by expensive computer-controlled models or simulations.  It can be done with integrity and respect for the patient — and for the student.

Be careful what you say, for the damage might be permanent.

I did a month rotation with a faculty urologist during my junior year of medical school. At the end he wrote “He does not have what it takes to be a physician,” on my evaluation. I should not have been surprised; his over-achieving son, a year ahead of me, had highlighted the entirety of Harrison’s Principles of Internal Medicine – a 1200-page tome – in four colors, and he had purchased his own indirect ophthalmoscope. I was stunned, humiliated, and spent the next six months wondering if he was right, if I should drop out and career for which I was better suited.

Remember the golden rule.  Do not “teach” medical students with sarcasm, derision or humiliation. Bitter, cynical students and residents become bitter and cynical physicians. We all suffer for it – patient and physician.  If you can’t say something nice, don’t say anything.  But it is not that hard to find something good in someone.

Always teach the art along with the science.  Teach students and residents to laugh and cry with their patients, to rejoice in the little accomplishments and grieve for the losses.

Above all, teach them the grave responsibility that comes with the profession. This is not shift work; a job to endure until retirement. It should still be viewed as a calling.

To the new graduates:

Even though William Hurt’s movie The Doctor is dated, all beginning medical students should be required to watch.  Your patients will be people with weaknesses and vulnerabilities hidden behind their strengths. You share those same weaknesses and vulnerabilities although you are loath to admit that to yourselves, your colleagues and your families.  Walk many miles in your patients’ shoes; you will be a better physician for it.  Accept that you are not perfect and never will be; your patients already have.

Long gone are the days when a physician hung out a shingle and practiced the way he wanted in an office he owned, before he retired after forty years. I say “he” because back then women physicians were few (and resented). Many, if not all, of you will be employed by a corporation.  Be careful and realistic.  The perceived security of a steady salary, liberal vacation and “avoiding the business hassles” comes with a hefty price tag.  When we trade autonomy for financial security, we end up with neither.  Some of my colleagues regretted selling their souls.  You will be judged on how much you cost the company, not on how compassionately you treat patients, which may adversely affect the care you provide your patients.  You will also be judged on your loyalty to those who sign your paycheck. They expect you to be a “team player,” even when the team bus is headed for a cliff. Or, as one of my former partners asked me, “Why can’t you just take the money and shut up?” Don’t leave your conscience at home.

Managed care is not intrinsically evil, but its implementation has been fouled by greed, callousness and stupidity.  It is an imperfect response to the rising cost of health care, an event which has largely been ignored by the medical profession.  My predecessors robbed the candy store and left all of us with the aftermath.

People do not trust the health care system; you can help restore that trust.  But don’t make promises you can’t keep.  Properly managed, there will be care for all.  But health care dollars are not infinite. You must choose between want and need; what is desirable and what is necessary.  As the Rolling Stones sang, “You can’t always get what you want, but if you try sometime, you just might find, you get what you need.”

Beware of the Golden Handcuffs. Avoid conspicuous consumption and remember money cannot buy happiness.  You can’t spend it if you are 6 by 6 in the dirt, and you can’t take it with you.  He who dies with the most toys still dies.  Keep in mind you will still be making more than 99% of the population.  Also remember you told the admissions committee some ridiculous story about going into medicine to help people, not to make a lot of money.  If you tell a lie long enough, it becomes the truth, so make it true.

Be kind to nurses, because they can make your life easy or a living hell. They also have your back and may one day prevent you from doing something completely stupid.  You owe them far more than those in the administrative suite who often have no idea what you really do.

Be grateful and acknowledge the other people that help you do your job: unit secretaries, housekeeping, maintenance, phlebotomists, transporters, techs. It won’t kill you to smile and say hi. Trust me, they will notice.

Find other things to do with your life.  Medicine cannot be your entire universe; you need to strike a balance in your personal life.  If not, your spouse may leave you, your kids may hate you or, worse yet, not know you.  You will be tempted to ease the pain with drugs and alcohol.  Some of you may be driven to suicide–a waste of a good doctor and the taxpayers’ money.  You won’t be much good to your patients–and yourself.

Don’t be afraid to pick up a colleague who has fallen.  Someday, the favor may be returned.  Don’t compete, keep score, or ostracize each other.  There isn’t any point.

If you find yourself wondering why you go to work in the morning, it is time to pick another profession.  If you never question why you go to work, you made the right choice.  This has been an honorable profession.  Let’s keep it that way.

Thank you and good luck.

Stop Whining

5 Replies

I came across the plaintive tale of a young OB/GYN physician, Dr. W, who decided to bail out of practice after less than a decade. She gave several reasons: falling asleep while driving home and wrecking her car; missing out on birthdays and weddings; sticking herself with a needle while drawing blood from the umbilical cord of an HIV positive patient and felling like crap while taking prophylactic antiretroviral drugs. Worst of all, she discovered health care wasn’t what she thought it was when she started residency, and that physicians are “only pawn in game of life,” albeit very well-paid pawns.

I can hear the ghosts of the old timers saying, “See, we told you women had no place in medicine!” I can also hear the voices of the women with whom I went through medical school four decades ago yelling, “Shut the fuck up! Do you have any idea what we had to endure so that no one now thinks twice about women in health care?”

Being a physician isn’t a nine to five job unless you’re a dermatologist. Obstetrics is a grueling, physically demanding profession and four years of residency should have made that intuitively obvious. Babies arrive at all hours. So do emergencies like ectopic pregnancies and twisted ovaries. Someone has to take care of those patients and sometimes we must go above and beyond the call of duty in the name of patient care.  Good labor nurses frequently stay past the end of their shifts to follow through on pending deliveries.

My first post-residency job was in rural Michigan with a former fellow resident. We did every other night call which turned into solo call when one of us took vacation. Two years later I joined three ob/gyns at a staff-model HMO, doing call every fourth night and every fourth weekend. I did 250 deliveries a year, four years in a row. Sometimes it was so exhausting – I didn’t know my own name after doing thirteen deliveries one weekend – but it was nowhere near as bad as residency.

Those of us who’ve been in this biz for a while aren’t oblivious to the dangers of sleep deprivation. The Institutes of Medicine, the Joint Commission, and even The American College of Obstetricians and Gynecologists (ACOG) recognize the problem. But you made one choice when you entered residency and another choice when you started practice. There’s a middle ground between working yourself into an early grave and quitting altogether. You just have to find it.

I’m a hospitalist in a town with about forty OB/GYN physicians, mostly women, in groups of six to ten. Most of them are mothers; one of them has six kids! They take call a few times a month. Yeah, sometimes staying up all night gets old, but they are making far more money than I could ever fathom and it’s hard to walk away from those golden handcuffs. Working part-time is one possibility but you can’t expect a full-time salary.

Dr. W. said, “no one wants to hear a doctor complaining about their job.” No shit, Sherlock. What makes you think physicians are the only people who work odd hours, miss out on family events and suffer from sleep deprivation? Municipal workers where I live (the Midwest) stay out all night plowing and salting snow-covered roads in the winter. Many sales reps spend a lot of time driving or flying to clients and living out of suitcases. Store managers are the first to get called in if there’s trouble – a fire, a water main break, a burglary – and they fill in on the floor when someone doesn’t show up for work. My brother-in-law calls his Asian-Pacific vendors in the dead of night because that is when they are doing business. Many of those people make a lot less money than you, but it’s part of the job and they don’t whine about it.

I had joint custody of three kids and worked full time. I picked them up from daycare and/or school, cooked dinner, bathed them and read them stories before tucking them in. I made them breakfast the next morning before getting them dressed and dropping them off. I did laundry, housekeeping and grocery shopping with no help. I missed some things, but my life was far easier than someone on active duty spending fifteen months in a war zone, just hoping to come home alive.

(c) Can Stock Photo / zabelin

I’ve never worried about acquiring HIV from a needlestick because the chances are about 3 in 1000. I don’t double-glove when I do surgery because I can stick a needle through two pairs of gloves just as easily as one. I worried more about acquiring influenza from women who came to my OB Emergency Department hawking up hairballs this past flu season.

Health care started changing in the 1970s, not the mid-aughts of the 21st century. I came of age between the Great White Fathers who could do no wrong (and who had easy access to amphetamines, so they could function like superhuman gods), and the employed physicians of today who ceded autonomy for financial security and lost both. Administrators, insurance companies and the government started telling us what to do in the mid-1980s when the money got tight. Capitation, diagnosis-related groups (DRGs), relative value units (RVUs), and the overly complicated ICD-9 coding system (now the hilariously overly complicated ICD-10 system) made unending paperwork an integral part of practice. Medical coding and billing is a multibillion-dollar industry.

I left the rat race over twenty years ago, largely because I got tired of the people who signed my paycheck lying to me. I became a locum tenens physician and traveled around the country. I made a quarter of what I could have made in private practice, but I could just do my job, get paid and go home. No meetings. No hospital politics. No turf wars. If the situation became untenable, I could give thirty days’ notice and walk, something I did only twice. And, I didn’t have to pay a $150,000 tail for liability insurance.

What troubles me now is seeing a generation of physicians for whom practice appears to be just a job to endure until they make enough money to retire. I can honestly say that for me medicine was a calling (I was thirteen when I decided to go to medical school). Now I’m just praying for a quick and painless death in lieu of spending my golden years beholden to some baby doctor who doesn’t listen, can’t think and is just going through the motions.

Crying Girl: (c) Can Stock Photo / jirousova

Unrequited Love

8 Replies

In the Spring a young man’s fancy lightly turns to thoughts of love.
From “Locksley Hall” by Alfred, Lord Tennyson

And when very young, to that which cannot nor should ever be.
Dr. Dave

When I was in the fourth grade I had a terrible crush on Jeannie, a blond, blue-eyed girl to whom I pledged my eternal undying love. Her twin sister, Carolyn, was a gangly brunette with glasses and braces. She was in that awkward stage through which some girls are destined to suffer and just didn’t hold the same fascination. As a callous and superficial nine-year-old kid, I saw Jeannie as beauty idealized – a living Barbie doll. Which, as most of us learn as we get older, is one of the worst criteria on which to base a relationship.

In my mind I would walk her home, hand in hand, and gently brush her lips with mine before she disappeared into her house. I would protect her from the slings and arrows of playground torment. I would be hers forever, and she, mine.

The only problem was she had no idea any of this was supposed to happen. We’d never had even a brief conversation in passing because I was too terrified to say anything. The best I could hope for was catching a glimpse of her as I rode my bike past her house, which worked out only once in two years.

Donna, the only girl I ever talked to, was more like a sister to me. We’d walk the block or so to her house and talk of simple things, much like two very good friends. Many of my adult relationships with women would follow the same two separate tracks of friend or love interest, something I’ve recognized only as I write this.

I continued to pine for Jeannie during fifth grade. She liked to play jacks with the other girls (go look it up, kids) so I bought her a set for Christmas – ten little metal spikes and a small rubber ball attached to a cheap piece of cardboard. I wrapped it and the next day unceremoniously shoved the package into her hands. “Here,” I said before turning away, avoiding the inevitable rejection.

My infatuation with Jeannie was potentially far more dangerous. I knew racial differences existed in the mid-1960s – when I was five years old a playmate’s grandmother called me a “little black liar” after a minor skirmish – but I was blissfully unaware that a poor Puerto Rican kid with kinky hair had no business being even remotely interested in a nice, middle-class white girl. I did not know that less than ten years previously a young African-American boy named Emmitt Till was savagely beaten to death in Mississippi for allegedly whistling at a white woman. I might have become St. David the Naïve, martyred for stupidity, were it not for being tragically socially inept. We moved to another school district two months into sixth grade and I never saw Jeannie again.

Make me feel the wild pulsation that I felt before the strife,
When I heard my days before me, and the tumult of my life;
Tennyson

Love may be deaf, dumb and blind, but karma has a wry sense of humor.
Dr. Dave

There was another blond girl in my new class. Anita was, as older folks would say, cute as a button: short hair; small, upturned nose; fair skin and bright, smiling eyes. Had I been paying attention I might have noticed, but avoiding further humiliation took priority.

A few days before school let out for the summer, our sixth-grade teacher, Mrs. Jackson, organized a class trip to the Chiricahua National Monument, a “Wonderland of Rocks,” about two hours from Bisbee. That morning we gathered at the playground with our sack lunches where Mrs. Jackson and a few volunteer moms herded us into their cars. I felt honored to be invited into the back seat of Mrs. Jackson’s station wagon.

We headed out Route 80 to Double Adobe Road, memorable for the frequent, gut-dropping dips in the otherwise straight and boring black top. My family had made the drive a couple of times in our navy blue ’60 Chevy Biscayne, with the wide flat fins and the trunk that could hold at least a couple of bodies. My stepfather loved to take those dips at speeds far greater than the snail’s pace I was used to in town. From there we picked up US 191 North, passing through McNeal and Elfrida, then east on Arizona SR 181 until we turned on to Bonita Canyon Road and into the park.

The road rises gently for a few miles and Bonita Creek flows past the roadside picnic area where we stopped. We ate lunch, waded through the icy water and explored some of the trails. One girl cut her foot on a sharp rock in the creek and I cleaned it with alcohol I’d brought, figuring it might come in handy.

As we were getting ready to leave, Anita came up to me and, out of the blue, said, “You know, I really like you.”  As with Jeannie, we’d never spoken a word to each other (or at least that is what I remember), but now the shoe was on the other foot and I was stunned. Any flattery I might have felt was completely overwhelmed by sheer terror and I said nothing.  It’s only now that I realize my lack of response probably hurt her feelings, and for that I’m sorry.

Truly, youth is wasted on the young.

I acquired a Bisbee High School yearbook during a trip back to Arizona in 1972. Carolyn, Donna and Anita had become lovely young women. Jeannie was the All-American girl; I would not have been surprised if she’d been elected Prom Queen. Some of the guys I’d known in grade school, on the other hand, hadn’t quite gotten their edges smoothed out. Ricky, the class clown whose twin sister once yelled, “Sit down, Junior!” in class, wore sunglasses for his yearbook picture; he might have had a future in stand-up comedy.

Knowledge comes, but wisdom lingers, and he bears a laden breast,
Full of sad experience, moving toward the stillness of his rest.
Tennyson

What he said.
Dr. Dave

More than half a century later I can only imagine what happened to them. Maybe they all got married, had kids and grandkids, and lived happily ever after. Or maybe, like most of us, the joys were enough to withstand the inevitable pain and sadness that occasionally tests even the best relationships. I’ll never know, and some things are best left undisturbed.

But wherever you are, thanks for the memories.

Spring flowers © Can Stock Photo / sborisov

 

Christmas Blues

15 Replies

Some of us really hate “the most wonderful time of the year.”

It is difficult, no, it is impossible to explain our aversion to Christmas to anyone who hasn’t struggled during the holidays. We are likely to hear, “Whassamatta wit’ you? It’s Chris’mas, fer Chrissake! Stop being such a downer and get into the spirit!”

“…Crappy toys flying off the shelves
Midgets dressed up to look like elves
Spread good cheer or burn in hell…”
Denis Leary (1)

It wasn’t always this way for me. I looked forward to Christmas when I was a kid, especially the smell of a fresh-cut tree permeating the house with a scent that we enjoyed but once a year. We’d buy a tree from the stand some local fraternal organization had erected in a parking lot, then haul it back home. My parents struggled to get it into that rusting metal tree stand without losing too many needles, and then adjust the crooked trunk until the tree was as straight as possible.  We’d untangle the lights and clip them to the tree branches, sometimes swapping screw-in bulbs to balance the colors. Finally, we’d take those fragile glass ornaments from their thin cardboard boxes, shake a wire hanger loose from the pile and carefully put them on the tree, hoping they would all survive until January.

But things changed. The details aren’t important; let’s just say I cringe when I hear John Denver singing Please Daddy Don’t Get Drunk This Christmas.  It got worse after we moved from Arizona, where everyone was pretty much on the same socioeconomic plane, to the Midwest where I discovered the haves and have nots. That the sun disappeared behind endless grey skies between November and April exacerbated my own depression.

One dismal winter day in 1974 I found “The Death of Christmas: Interviews with forty-three survivors,” in the bargain bin at Follett’s Bookstore, across the street the University of Illinois Urbana-Champaign.  The proceeds from this 1971 book raised funds for the Neediest Children’s Christmas Fund in Chicago. On the cover a sad black Santa with an empty toy sack stood in the snow before three poor urban kids, a heartbreaking sight. The title page featured this illustration (2) by John Fischetti, an editorial cartoonist for the now-defunct Chicago Daily News.

A quote from one of the “survivors” summed up my feelings: “Christmas is for the rich to enjoy, the middle-class to imitate, and the poor to watch.”

A few years later I was walking down Michigan Avenue in Chicago one miserable December evening for reasons I’ve long forgotten, as I certainly didn’t have the kind of cash one needs to shop there. People hurried along the sidewalks like salmon rushing upstream to spawn. Women in furs. Businessmen in overcoats and severe looks. All the stores windows were brimming with faux Christmas cheer—the kinds of decorations no ordinary family would even think of buying—enticing the wealthy with diamonds and furs. “If you have to ask, you can’t afford it.”

A young woman sat on the cold concrete, leaning up against the marble front of a jewelry store, eerily illuminated by a light above the display window. She was rocking a young child wrapped in a thin blanket. The child’s mouth was open in a silent cry – I suspect the little girl may have suffered from cerebral palsy. A small container with a few meager coins lay at their feet. People passed them by without a glance and my heart ached at the wretched scene. I stood looking at them for a few moments, feeling helpless and confused. I don’t remember giving her any money; I think I was too shocked and ashamed. I’ve never forgotten that little scene from more than forty years ago.

The approaching holiday season triggers a predictable emotional sequence: annoyance; irritation giving way to righteous anger; resignation, relief when it’s all over followed by the post-holiday despondency. I’m annoyed when Home Depot and Costco start stocking Christmas decorations and crap in September. At least they have the decency to not play Christmas music until a week or so before Thanksgiving.

Then there’s Black Friday. The day after professing gratitude for friends and family, a roof over one’s head, and more than enough to eat, people get into fistfights over crap that will lose its appeal a few weeks into the New Year. I detest the term “Doorbusters,” which conjures a stampede of desperate peasants trying to buy their way to happiness, unaware they are being shamelessly manipulated by corporate overlords with far more money than they will ever have.

My irritation grows in direct proportion to the frequency of overly precious Christmas advertising on television and blossoms into righteous anger by late November when car commercials outnumber all others by about ten to one. Nothing captures the true meaning of Christmas like buying your spouse a luxury SUV wrapped in a gigantic red bow and telling your Yuppie kids some bullshit story about how Santa delivered it.

The post-Christmas crash follows the buildup to Christmas Day. It’s the hangover from the night before, except that night was six weeks in the making. Dried-up trees litter the curbs and dumpsters overflow with cardboard boxes and torn wrapping paper. Stores fire sale their Christmas crap up to 90% off, which gives one an idea how much it was worth in the first place. Wal-Mart starts stocking Valentine’s Day cards before New Year’s Eve. The college bowl games and the Superbowl are often anti-climactic, and I never liked basketball. Football pre-season is eight long months away.

I made a conscious effort to suppress my inner Grinch when I became a father. I didn’t want my kids to have the same dismal holiday memories I had, and I think it worked out reasonably well. (One year the oldest got a pair of pliers to pull the bug out of his pre-teen butt.) Still, the first time I read them The Polar Express I lost it at the end when Billy reflects: “At one time, most of my friends could hear the bell, but as years passed, it fell silent for all of them. Even Sarah found one Christmas that she could no longer hear its sweet sound.” (3)

My son asked, “Why are you crying, Daddy?”  You’ll figure it out in about twenty years.

I’ve made my peace with Christmas. I take delight in the little things. Classic Christmas albums by Andy Williams, Nat King Cole, Johnny Mathis and the incongruous duet with Bing Crosby and David Bowie. Christmas movies like White Christmas, Miracle on 34th Street, and Die Hard.
The guy in the neighborhood who spells BAH HUMBUG on his roof in rope lights. (I wanted to put an inflatable Grinch on the roof, but Peg promised to shoot it full of holes). The look on the Chreasters’(4) faces when they show up at 12:15 a.m. for the Christmas Eve “midnight mass” that’s been starting at 11p.m. for at least thirty years.

Christmas Day is becoming more like Thanksgiving – dinner with family and friends, wishing all peace and good will, and trying not to be a dick in the coming year. Getting stuff isn’t important; being with those you love is the best gift.

Many still find very little to celebrate around the holidays, but some churches have stepped in to fill the void.  During the 1980’s the British Columbia hospice community started “Blue Christmas” services which have since spread to churches.

“…The idea of Blue Christmas is to acknowledge the darkness, and let it be dark. That is a quietly revolutionary act in an optimism-obsessed culture that would pressure even the Little Match Girl to look on the bright side. Some churches refer to the event as the “Longest Night,” because many services take place on December 21, the winter solstice, when the sun stays hidden longer than it does on any other night of the year. The structure varies widely, but common motifs include candles, music in minor keys, periods of silence, and time to privately share specific sadnesses and fears (say, by writing them down and placing them on a “tree.”). …” (5)

If you can still hear the bell, you are indeed blessed. Please say a prayer for those for whom hope remains elusive.

  1. It’s a Merry F@#%in’ Christmas (C) 2004 Denis Leary
  2. “The Outsiders” (C) 1971, John Fischetti. Used with permission.
  3. Text from The Polar Express (C) 1985 Chris Van Allsburg.
  4. Chreasters: occasional Catholics who show up only on Christmas Eve and Easter, largely out of some subconscious obligation to the memory of long dead relatives who will chew their asses once they reach Heaven.
  5. Graham, R. “Blue Christmas Services Honor the Dark Side of the Season“. Slate, December 21, 2016. Accessed on December 7, 2017.

Baxter

8 Replies

She dropped them off at the shelter; Baxter, the five-year-old Shih-Tzu, and the puppy. It was a difficult decision—they were her family—but she couldn’t care for them anymore. She was going into hospice and her time was drawing near.

Peg, and I had been looking for another dog ever since we’d lost Goldie, our petulant Pekingese. We’d gotten her and Gus, a 13-year-old Shih-Tzu with several health problems, from a foster family for the same shelter. They were life-long companions and the shelter didn’t want them separated. Gus was with us for two years; Goldie died five years later at the ripe old age of 18. We mourned their passing but eventually decided it was time to welcome another shelter dog into our home.

Peg periodically browsed the shelter’s website for dogs and found Boo-Boo, a mischievous-looking little dog. We thought this was a sign because Boo-Boo was our favorite nickname for Goldie, but we discovered he’d already been promised to someone. So, one afternoon we went to the shelter and spent time with several dogs. It was almost heartbreaking; they were all eager to find someone to love them. Most were bigger dogs or came as a set of two or three, more than we could handle.

We left and returned a week or so later. Peg went with one of the staff to check out another dog she’d found on the website. The woman at the desk said to me, “We have a pair that just came in. The woman who cared for them just entered hospice. Why don’t I introduce you?”

I met Baxter and his puppy companion in the enclosure—a jail cell with two diminutive convicts. The shelter people were more concerned about Baxter’s chances of adoption. “Everyone wants a puppy. Few people want an old dog.”  Old? He was only five! That’s middle age in dog years and he had far more energy than I did.

She suggested I take him for a walk, so I put a leash on his collar and we went outside. Baxter wandered along the sidewalk in front of the shelter, an inmate on parole. He sniffed at the shrubs, surveyed the parking lot and turned back.  By that time Peg had joined us. I knelt down and looked into his eyes. He appeared confused, wondering why he’d been left here with strangers.  I imagined him saying, “Please take me home with you.”

I looked at her and said, without hesitation, “He’s the one.”

In retrospect, I think he said, “What took you so long? Let’s get out of here.”

Baxter’s biography said he was “active,” “crate-trained” and “loves to play with balls,” so we went shopping. Peg insisted on buying a crate, which I thought was silly since neither Gus nor Goldie stayed in one. We also got a nice pad, a few soft blankets, food and water bowls, three miniature tennis balls and a couple of squeaky toys.

A few days later we signed all the paperwork, made a generous donation to the shelter, and walked Baxter out to the car. On the way home he sat very silently in Peg’s lap, leading us to surmise his bio had been embellished. Well, that was the LAST time he would sit quietly in a car, let alone on someone’s lap. Now he bounces around like a Superball when we’re on the road.

Baxter wandered about the house after we arrived. He ignored the crate in the family room, sniffed around the kitchen, then made his way upstairs to the bedrooms. He devoured his dinner right away; the shelter feeds the dogs twice a day and takes it away after 30 minutes, so you snooze, you lose. We went for a walk and then sat on the couch until bedtime, getting to know our new family member.

Peg insisted on having him sleep in the crate in our room, so we hauled it upstairs. I still thought this idiotic since our other dogs always slept with us. Baxter walked into the crate, turned around and then stared at me, imploring.

“He’s fine. He’s used to being crated,” Peg said.

“Yeah, well how would you like to sleep in one?”

She relented and open the crate door. Baxter immediately ran out, jumped the 30 inches to the top of our bed, curled up and went to sleep. The crate now houses his toys when he’s not flinging them around the family room.

He is my faithful companion and my muse, and we have our routines. I tried to have morning coffee and then take him for a walk, but he has trained me. Walk first; coffee later. You know how this works! He then stands guard on the bed in our guest room, staring out the window and barking at trespassers on the sidewalk: other dogs; people walking; kids riding their bicycles, delivery people and the mail carriers.

We sometimes go for a cappuccino around 2 o’clock. I swear he can tell time; he becomes impatient if I’m not ready. I switch to mocha in the winter, sharing the whipped cream with him. On Sunday mornings we go to McDonald’s for breakfast. (Walk first, remember??? Damn, it’s so hard to find good help.) At bedtime he reminds me I need a protein snack to stabilize my blood sugar. And, of course, he’s available for quality control.

Baxter is just as persistent when he’s in the mood for dessert. He’ll jump on the couch, paw my leg and grumble under his breath if I don’t respond.  His ears pick up and that little puppy smile crosses his face if I suggest going to Culver’s for a sundae.

Baxter is like a perpetual toddler. He delights in little things like car rides, treats, dinner and naps. His occasional snits blow over in a few minutes. Best of all, he doesn’t ask for car keys or money.

I travel a lot for my job and I usually leave a T-shirt on the couch while I’m gone. One day he dropped one of his toys in my suitcase while I was packing and now it’s a ritual. Bat, Spider, Crab, Taz and Mouse have all spent time on hotel nightstands. I take pictures with my phone and send them to Peg, but he isn’t at all interested. He is ecstatic when I return home. He does his little happy dance while looking at Peg. He’s back, he’s back! Let the rejoicing begin!  Lately he’s been bringing one of his minions to the airport to greet my arrival.

I had a dog when I was nine, but no one taught me how to care for him. My mother didn’t like dogs and my stepfather saw dogs as just part of the all-American home. In retrospect, I/we neglected that dog. Baxter’s entry into my life allowed me to atone.

At this Thanksgiving, I’m thankful for our time together. We’re both getting older and slowing down – well, I’m slowing down. I try not to think about the inevitable parting, but who knows? At my age, we might just both ride into the sunset together.