Timothy H. Cook's Blog, page 13

The Edmond Book Club

This week has been kind of special for me, and it was capped off Thursday evening by my attending the Edmond Book Club.

Now, I was asked last year if I would  speak to them about my book, which, at that time consisted of only one volume of The Book of Drachma. My first volume (Laminar Flow) had been released, and the other two were still being edited. I readily agreed to do this, as I was eager to get the word out.

Since that time, of course, my second volume (Coaptation) has since been released, and my third volume has become available (though not released until March 12th). And as the time came for me to be the speaker, what I found out was that the folks at the Edmond Book Club really just wanted me to talk about my first book. In essence, to give a verbal summary of the plot, and then open it up for a question and answer period.

Do you know how hard that is for me to do? To talk about just the first volume, and not to give the readers even so much as a hint of what was to come? Let me tell you this was very hard for me. In part because the first volume is something of an introduction to the characters, the scenes and the action. The second volume starts off the real action of the story, and the third volume is both the conflagration and the resolution of the whole mess.

But I did just what I promised I'd do, though my talk was spiced up a bit by my telling of how I got started with my writing, and how it went into deep hibernation, only to be revived again in later years. And I also mentioned how, as a physician, I had been disillusioned by the portrayal of medicine in the lay media. And I did manage to keep the persons in attendance (all 75 or so persons) awake, despite this being after a fine meal. In any event, the whole thing turned out to be something of a success, and I'm glad I did it.

Somehow, I thought that I could hear old Paracelsus smiling his encouragement, realizing that I was not going to jail over any of this.

And for any of you who might be wondering, I'm still actively working on the sequel(s). You may catch a glimpse of the sequel at Authonomy.com.

Great reading, my friends!

Paracelsus, and The Book of Drachma

Well, now that I've completed the task of writing The Book of Drachma, I think it would be safe to let all of you in on a little secret - namely the origin of some of the characters in my story.

In either November or December, 1493 a certain person was born to a german physician and housemaid, whose given name was (I am not making this up) Theophrastus Philippus Aureolus Bombastus von Hohenheim. Well, as you may well imagine, he changed his name, and became known to the world as Paracelsus, which is Latin and means "beside Celsus", an ancient Roman physician.

Now Paracelsus was taught the arts of medicine, alchemy, mathematics and music in a number of universities across Europe, including universities in Germany, Hungary, the Netherlands, Denmark and Sweden, and though the records from the time are sketchy, it would appear that young Paracelsus had to leave several of those universities under cover of darkness. It seems that his own persona was not one to be held down in any debate, and his temperament was a bit too abrasive to be handled.

So, the young Paracelsus roamed about Europe, lecturing at universities, being sent to prison, or nearly so for a number of years, and working alternately as an itinerant physician, astrologer and a journeyman miner, with stops in Germany, France, Spain, Hungary, Denmark, Sweden and Russia.

It also turns out that Paracelsus was passionately fond of learning from any and all, from whatever source the person came from, and sought out healers from Spain, Africa, Asia Minor, including the Holy Land. Now he is said to have gathered and translated manuscripts as he went along. But his greatest surviving work is one called Die Grosse Wundartznei (the Great Surgery Book).

One of the things that kept Paracelsus on the "hot seat" at the universities was his disdain for the teachings of Galen, which were considered by physicians to be absolute and unchallengeable. The main thrust of Galen's teaching was that there are four "humors" in the body (blood, phlegm, yellow bile and black bile), and that disease was caused by imbalance of one of these "humors." This did not appear, to Paracelsus, to have any validity, and he prized observation, experience, experimentation, and intuition over any attempt at "correcting" the humors. He was also known as a chemist, and developed the notion that mercury could cure syphilis (which held up until Penicillin came along). He is said to have developed the chemical laudanum, as the first truly good analgesic, and he coined the term "alcohol."

As to wound healing he was quick to note that "if you prevent infection, nature will heal the wound all by herself."

And then, his ideas on the nature of physicians and healers resound to this day, including such notions that the practice of healing was a sacred and noble profession, and the qualities of a true physician include wisdom, empathy, purity and singleness of purpose. And further, a true physician must be physically pure, intellectually honest, and a person of true integrity.

Well, you may wonder, "who is this character in The Book of Drachma?" Let me just say that there are multiple persons in my story, who exemplify the features of Paracelsus. If you look, you will find him in the characters of Robert Gilsen, Drachma, Falma, and, yes, Judy Morrison.

It's all there!

This is just a quick note to let you know that the entire Book of Drachma is now available on e-book at Amazon.com.

Just go to Amazon.com, and type in Laminar Flow, Timothy Cook  -  or Coaptation, Timothy Cook  -  or Turbulence and Restoration, Timothy Cook.  The e-books are cheaper, and you can get them right away.

The official release date for Turbulence and Restoration is still 2 1/2 months away - March 13th. So if you don't want to wait that long, you may get the e-book format, or find me at one of my book signings (I've got one tomorrow, Dec 27th, at Select Specialty Hospital, Oklahoma City).

Good readings!

Kind of an eventful week...

This has been a week to remember, as far as my efforts at becoming a "well-known-author" are concerned. Now, last week I got the first copies of the third book of my trilogy. This was the culmination of my years of effort in the world of writing. And now here it was, the completion of The Book of Drachma, in three volumes (Laminar Flow, Coaptation, Turbulence and Restoration). Even though I had written the whole trilogy by 2011, I had the process of publishing to keep me humble. But in the span of a year, the three books were published, and now here they were.

So, I kind of took a deep breath, and looked toward a week of some adventure, with three book signings in the works, as well as preparations for upcoming events which included presentations to the Edmond Book Club, my wife's book club, and my own senior physician's (old fart's) book club. Then, I was on call Wednesday, which meant that I would have Thursday as my post call day, which can be at least as brutal as call days. And this Thursday was every bit as brutal as expected. So, I was busy sorting through the medical problems of of my admissions from the night before, trying desperately to get ready for the book signing event that afternoon, when I got a call from one of the TV stations, saying that they were expecting me there by 1:20 PM. What???

I was not even aware that a TV appearance was in the works. It turns out that said TV time was arranged by my publisher's director of marketing, but I was not, unfortunately, kept in the loop. So, now I really had to hustle. I had to call and reschedule my book signing (easier, and less painful to do than rescheduling TV time). I had to email some talking points to the people at the TV station, as well as call my publisher and have them email copies of my book covers to the station. And what about my patients? As it turns out, I've got some wonderful partners who agreed to look after my patients, and to keep things going at another of the hospitals I serve, so that I could go be "a TV star."

As it turned out, my brief TV appearance turned out OK, according those who watched it. (If you want to see it, you may go to my facebook page, or just type in , then look up Oklahoma Live, and then under "snippets" go to Medical Fantasy Trilogy) And I made it back to the hospitals, got my patients sorted out, and went home exhausted.

Well, then, I posted my little bit of TV exposure on facebook, and things started happening. I started getting texts from friends and relatives, who had seen my snippet. And then I went back to work, had my book signing today, and came home to a fine meal with my wife. And when I looked at my statistics on amazon.com, I noticed that, instead of being in the 4 - 6 millionth on amazon's list, my two books were suddenly in the 100 - 200 thousand bracket. Hmm... I really don't know what to make of all this yet, but it's at least a very promising sign.

I was just thinking about medicine... dangerous!

The climate of medicine is definitely changing, and not for the better. Just today, our small group of hospitalists (those who just take care of patients in hospitals), met with our CEO, to discuss ways to bring down our lengths of stay for patients in our hospital. Now this discussion came about because our hospital, in November, lost money - the total for the hospital was over 1 million dollars in the red. Now,  I do not pretend to understand all the whys and wherefores of how this came about, but I will tell you that medicare payments to hospitals look like they will take a major nosedive (to the tune of 25%) in 2013. That is enough to make any hospital CEO have indigestion, angina or worse.

And so, why am I writing this?

It is because I really used to love this avocation. I truly loved taking care of sick patients - those who needed my expertise, who looked to me for answers, and for help. But it is hard to love a job in which your working long hours, taking care that your very ill patients are properly cared for, is summarized on a sheet of paper in which your length of stay, your case-mix index, and your standing compared to "the national average" means so much more than your skills and compassion.

Now, when I got out of training, I was really ready to do whatever needed to be done, to go that extra mile, for my patients. And I was looked up to, was sought after, and was highly regarded for my efforts. These efforts have not changed, however, their significance has been trivialized, to the point where I have been considering that this might just not be worth it after all.

How and why have we gone so far off that formerly sacred path; you know the one with the doctor and the patient being the important ones in this mix? It is economics, purely and simply economics. It has to do with the invention of the DRG (Diagnosis Related Group), and with the influx of the overseers who have come to recoup the revenues that were considered wasteful.

This was made even more poignant when I was listening to a discussion about the current state of medicine, and one of my colleagues said that a prominent cardiovascular surgeon became discouraged, when he found out that it would cost more to have his dog operated upon, than he would get from doing a heart transplant! Yes, that's right.

So, do I plan to put up with this nit-picking, mind-bending and basically made-up trivia? Well, for the present time, yes. Though I tell you, it takes the joy out of this season of joy to read that your length of stay, factored in with your case-mix-index just doesn't seem to be measuring up to standards.

Across from the mall

I just finished having my book signing in downtown Oklahoma City at the Full Circle Bookstore, and I thought about things outside. The bookstore is one of those wonderful places that sells books - lots of them, and that's really all they do, besides having a wonderful little coffee shop. Now this is an independent bookstore -  not part of a chain of book-vending behemoths. It sits across the highway from one of the large malls in OKC, which you can see out the door or windows. It was reasonably busy by its own standards, but if one were to look out across the road to the mall - there one could really see what busy meant.

Now, it turns out that this large mall has no bookstores in it at all. Yet at this time, less than two weeks from Christmas, it was seething with people, mostly doing their Christmas shopping. Yet none of those thousands of persons were buying books! There are numerous, and I mean NUMEROUS, places to buy clothes, accessories, audio and other high-tech devices. There are movie theaters, and innumerable restaurants. But no where in that teeming city-within-a-city could you buy a book.

All this began to make me feel really old-fashioned. As an author, and purveyor of the written word, was this turning me into a trilobite or some ossified toe bone of an antiquated carnivore? Well, not quite. For I realized something about what we are reading these days, and where we get our written material. What we are reading is turning out to be either the texting of our friends, the latest stories of whatever is currently making the news, and is available without the distraction of having to actually sit down and turn pages.

I realize that this is a lot of generalization, but the thought of sitting down, by the fireplace with a book, and getting lost in the world opening up before you, is getting to be a rarer and rarer form of pleasure. It is one pleasant diversion that I have indulged in, and has brought me numerous hours of of insight, experiences that could not be portrayed on the screen, and has brought me closer to many people whom I never had the chance to meet.

Perhaps, as a Christmas wish, you would indulge me this moment of nostalgia, and for a present just think about what pleasure a book - I mean a real book, with pages - that you can carry around, could mean to someone.

Turbulence and Restoration - where you can get it now

Just to let all of you know, Turbulence and Restoration, The Book of Drachma, Book Three, is now available from the publisher, both as a paperback, and also as an e-book.

Here is the address where you can scope it out, or buy it if you choose:
http://www.tatepublishing.com/booksto...

Also, if you wanted you could go to my website (http://timothyhcook.tateauthor.com/) and find the books (all three).

And remember, if you're in the Oklahoma City area, I'll be having a book signing event at the Full Circle Bookstore, this Saturday, Dec 15th, from 3:00 - 6:00. This is one fine, independent, old - style book store, which is worth visiting anyway.

It's here!

This is just a quick post to let you know that Turbulence and Restoration, The Book of Drachma, Book Three is now available at the Tate Publishing site:  http://www.tatepublishing.com/booksto...

It will be released internationally the first week of March, 2013. I'll let you know more as I find out more.

Soon to come - Turbulence and Restoration

Now it is done. It is complete...

And tell me. How does that make you feel?

Well, this whole journey has been a real experience - a real piece of me. So, let me begin at the beginning. It was at a medical conference, one where we went to get our requisite hours of CME (continuing medical education). We came from around the region, and descended on the city to go to lectures by experts in the various fields of medicine. And about the only thing I remember of the lectures was the dimming of the lights, and the phrase, "if I can have the first slide." But, for some reason, at this particular conference, my lunchtime conversation with my new-found colleagues was indelibly burned in my memory. What we had to say revolved around the state of medicine as it was portrayed in the lay media. And to a person, our gripe was the same - that in none of the TV shows or the printed material out there did the "authors" get it anywhere near right. It seemed to us that our own lives and experiences stood in contrast to how we as medical people were being portrayed in what was presented to the public.

Next, we got to talking about what it was that made a doctor. It was not, in my own mind, the technology, not the rigorous scientific training, nor even the back-breaking hours of study. It was (and still is) my belief that there is something innate in some of us which makes the study of medicine, and the practice of medicine a formal need, and that no amount of money, or lack of money can replace or repay that which is in us, probably from birth.

On the short trip back home, I pondered these things, and then I had an idea. It was an idea for a novel, a general "outline" of which rapidly formed in my brain. It would be a novel in which the protagonist would be one of us. A real, living, breathing person to whom we could, as medical people, truly relate. He or she would be out there in the trenches, fighting disease and death. And then, in contrast, there was the story of a physician in an age long past, who was fighting for and against these same things. Then, somehow, I would bring these stories together...

By the time I got home, I had the concept of my novel firmly in place, and I started writing, mainly late in the night, when no one would be bothering me. It took me the better part of a year to write what became the first book. Then, with what I have come to regard as my own magnificent naivete, I sent my manuscript to a number of publishers, none of whom even acknowledged receipt of my manuscript. And so, I became somewhat discouraged, and my attention wandered. I did write a few more chapters, which eventually became the start of my second book. Then things really spun out of control, as I went through a divorce, got remarried, moved out of state, then moved again, eventually landing in Oklahoma. All this time, my old manuscript stayed with me, as it gathered dust in my office.

Things were now, at least in my life, a bit more calm and even, and then I made the fatal mistake to casually mention to some of the people in my office that I had written at least the beginning of a novel.
As I recall, this was at the time that I also inquired about what a blog was. Well, let me tell you that things have never been the same since. As I discovered what a blog was, Michelle Ogle began transcribing my manuscript onto a word-compatible format, and I began my blog, posting a  chapter per week, and The Book of Drachma was reborn. First came Laminar Flow, The Book of Drachma, Book One. Then came Coaptation, The Book of Drachma, Book Two. By this time, my novel was now running on its own energy, and the third book, Turbulence and Restoration was soon written. And now, with a completed trilogy, I had some success finding a publisher.

So much had changed in the world of publishing, which I was to discover as I began the process of working with a professional publisher to put out my printed manuscript into the world out there. But also, so much of the world of medicine had also changed. But my major discoveries about how the media still very inaccurately portray medicine and those whose lives are devoted to it are still very valid.

So, now, what of these books? Do they still tell the truth about medicine and medical people? Well, the books are fiction, but I do believe that beneath the veneer of fantasy you can still see what I have to say about what makes a real doctor or nurse, even through these troubled times.

And, yes, The Book of Drachma is now complete with the third book (Turbulence and Restoration) now being printed. I'm hoping that it will be available for Christmas.

After this week...

This was just one of those weeks when my efforts at blogging, writing and posting definitely took second place to family matters. By that, I mean that we took off for Kansas City, where we could gather for our annual four-day weekend of relaxing, swimming, reacquainting, chasing children and, of course, EATING. All of which was done with abandon by the fourteen of us. I think we got better gas mileage going up to KC than we did coming back, because of all the eating that we had done. Hmm...

And so tomorrow it is with some definite lack of enthusiasm that I throw myself back into work. And, as some of you know, that work for me involves taking care of the desperately ill of Oklahoma City. And many of those are just as lacking in enthusiasm about being ill, injured or recovering as I am to be there among them. Now, I am not normally so underenthusiastic about my work. I can typically produce some level of umph to get it going, and to make a showing of being there for the downtrodden.

But this week has got me thinking seriously about just what it is that I do, and why. This business of medicine, in particular, has taken turns most assuredly for the worse. Now, I know that many of you have gotten to feel that there is now a growing distance between you, as the patient, and your doctor. And let me expound upon that just a bit. When I began my medical training, as a first-year medical student, just looking around at the upper-class medical students with some envy, with their short white coats, their own stethoscopes, bulging from their pockets (not hung draped about their necks in the current fashion), I couldn't help but think that they were becoming privy to those marvelous traditions of actually taking care of real patients - out there on the "wards." That there was something very special - almost blessed - about the whole scenario.

And then I got my chance. My very first patient was an old, shriveled-up shell of a man, who had deep, necrotic bedsores, which smelled just awful, and whose only communication with me were simple grunts and moans of pain. But here he was, my very first patient, for whom I had some real responsibility, and for whom I dedicated hours of caring, and continued study. My very young and enthusiastic medical self was being nurtured by years of tradition. And let me skip ahead a few more years to my first day as an intern, at the VA Hospital in Ann Arbor, Michigan, where I picked up a service of eight patients, and I was also on call that night (we were on call every third night - meaning we were expected to stay all night, and take care of those admitted to us, and to have their COMPLETE history and physical exams written down on the chart by the next morning). And besides that I was the MOD (medical officer of the day), which meant that I was responsible to be the voice of the VA to those within the hospital, as well as physicians on the outside who wanted to send their sick veterans our way. Well, let me tell you that I did it, and I survived it all, including the three years of internal medicine training, as dished out by The University of Michigan. And I did it all with the knowledge that, by the time my training period was done, I could handle almost anything that the world threw my way. I was ready, willing, and (yes) enthusiastic to begin my real practice of medicine.

But then something happened, something that ate at the core of medicine, something pernicious and pervasive. It began, simply enough, with a clerk in New Jersey, inventing the DRG (Diagnosis-Related Group), which was immediately and fully taken up and greatly expanded by Medicare, then by the state's Medicaid systems, and then by the insurance companies. This was a means of forcing physicians to cut back their expensive medical care provided to the sickest of patients (those in the hospital).

If you want to look at what has happened since then, you need only observe what has happened to the doctor (health care provider) - patient (client) relationship, and the training that a new physician gets. Believe me, there is no comparison. A new physician is very well-versed in the computer, and its intricate composites of what patients look and act like, and what their laboratory tests, their vital signs, their intake and output look like "on paper" (though that, too is going the way of the dinosaur). But just bring in a live patient, with real pain, real dyspnea, real emesis, real and acute neurological changes - and suddenly those are all symptoms which are deferred to all those others who are "taking care" of the patient. Their own doctor jobs are at the computer! But to actually "get your hands dirty" with the ill human being presented before you in agony - well that just doesn't show on my computer screen.

Well, this has been kind of a roundabout way to tell you that my own novel (in three parts) is, in many ways, a tale of my own frustration with what medicine has become. It is no longer the respected trade taught by those who have themselves been through the trenches. It has become something else entirely, and I'm just not sure that I am equipped to take it on. Not tomorrow, at any rate.