Saturday, July 29, 2006

Never Quit Quitting

For the book I'm helping to write, 50 Ways to Leave Your 40's, one of my contributions to each chapter is a section entitled "Doc in the Box: Fast (health) Food For Thought."

Here's a sample. This one is for the chapter called "Just Keep Breathing."

My goal for each of these is NOT to repeat the same old messages, but to put a spin on the old or to say something new. Any feedback is welcome.


Just Keep Breathing

I am not going to insult your intelligence by lecturing you about the dangers of smoking. If you don’t know by now that smoking is bad for you, you’re living in a cave. Bad breath, lung disease, ugly teeth, wrinkles, cancer…you’ve heard all that.

Nor am I going to tell you the best way to quit. That is up to you. Different strokes for different folks, and only you know what works best for you. Cold turkey, patch, pills, switching brands, gum…all are equally effective for the dedicated quitter. If you need more information, ask your doctor or go online where there are resources galore.

No, what I’m going to do instead is acknowledge you and salute you, the smoker.You are a functioning human being, and as such, you deserve as much honor and respect as the next person. Just because you made a choice to smoke cigarettes does not mean you are bad, or weak, or a hopeless drug addict. You have included cigarettes in your life for a reason, or reasons, which are your business. People have all kinds of reasons for smoking, and all kinds of reasons for quitting. So cut yourself some slack.

If you have decided you want to quit, I salute you. As a physician, I have to agree that this is a good choice. In fact, it is the single most important move you can make in the direction of health, and will clear up all kinds of current and future ailments, starting just twenty minutes after your last cigarette.

I also understand that quitting will not be easy. In fact, quitting smoking has got to be just about the hardest task a human being can undertake, and I’m including childbirth, which is saying something. I spent 20 years of my life watching my physician father quit. He knew the risks all too well (although, to be fair, he started smoking before the risks were known), and he is a smart guy. If quitting were as easy as “just doing it,” he would have done it on the first try. But I saw him quit, restart, and quit again, repeating the cycle many times. He finally succeeded, after his first grandchild was born. I think that finally got him over the hump. That and a change in office policy that sent smokers outside in the cold like huddled pariahs. He hasn’t smoked in 15 years now (which, by the way, puts him at the same risk of lung cancer as a lifetime nonsmoker) and he still goes skiing at the age of 74 without huffing and puffing. I’m very proud of him, and grateful for the lesson I learned watching his struggle.

Dad’s story is a very common one. I’ve seen it over and over in my medical practice. It’s like the old joke, “I can quit anytime! I’ve done it hundreds of times already!” The important thing to remember is that most successful quitters get a lot of practice first.

There are a few key things that accomplished quitters have in common that I want to share with you.

First and foremost, they are ready. By this I don’t mean they understand the dangers and tell themselves, “I should quit.” That doesn’t count as “ready”. What I mean is that, like my father, their reasons to quit have finally outnumbered their reasons to smoke. The balance has finally tipped and, at that moment, the battle is more than half won.

Second, these smokers have clearly-stated reasons for quitting. It doesn’t matter what the reasons are, but the more specific they are the better. “I want to quit because smoking is bad for my health” is not as effective as “I would like to be able to walk up one flight of stairs to my apartment without stopping” or “I want to live to see my grandchildren grow up” or “I want to smell the flowers in my garden.”

Lastly, good quitters pick a good time to quit. They don’t add “stop smoking” to the end of a long list of New Year’s resolutions, after “lose weight” and “become a better person.” They also don’t try to quit in the middle of a stressful time, like a family holiday or a final exam. They understand that their resolve and their reserves are going to be sorely tested, so they maximize their chances from the get-go. Some choose a weekend when they’ll be alone. If you have quit before, you know how unpleasant you can be. You might want to protect your loved ones from your werewolf self.

Smoking is bad for your health. You know it, I know it. It would be wise to quit when you can. When you are ready, you’ll do it. You’ll tip that scale and finally succeed. I have faith in you. Never quit quitting.

Thursday, July 27, 2006

Crash boy walks out of hospital

I'm thrilled to report that the young man who was involved in the bike crash not only survived, but walked out of the hospital!

He's having post-head injury rehab. That's probably the extent of what I'll ever learn about him, but I thought you all would like to know he did survive.

Saturday, July 22, 2006

4th of July in Small Town, America

The little town near my writing retreat lets it all hang out for their 4th of July parade.

Thursday, July 20, 2006

Child of Misfortune

"Your pregnancy test is positive."

How many times have I said those words? How many different reactions have I seen? Both uncountable. Some women are unsurprised, prepared, resigned. Some are shocked into tears of happiness or fear. And everything in between.

I'm thinking today of a particular woman who was in that first group. I'll call her Sanja. Sanja was from Another Country, here for graduate school. She had fallen for a young American man. They were having sex and had slipped up with their protection. Her period was late. She was pretty sure she was pregnant and had already decided what to do. Although she cared for her lover, she wasn't sure he was It for the long term. He was an unfocused young man, a heavy pot smoker who had since dropped out of school, and she was a scientist in the making, with years of schooling yet to go. She was concerned about the effect of marijuana on the baby, but mostly she didn't want to have a child until she was in a secure, long-term relationship. She was going to terminate the pregnancy.

So, when I told her the news, she nodded, informed me of her plan, and asked for information. I gave her the name and numbers of the local pregnancy termination resources, counseled her briefly, and sent her on her way. One of the easier such sessions I've had.

Two weeks later she was back. "I couldn't do it, Dr. Spencer."

Okay. "Tell me about it."

"Well, I went to the Clinic and they put that jelly stuff on my stomach, you know? And then they did the scan thing to look. When I heard my baby's heartbeat, I just couldn't go through with it."

WHAT?! She heard the HEARTBEAT?!?!?! At a pre-termination visit?

"It surprises me that you heard that." I tried not to show my shock and outrage.

"I think it was a mistake. They turned it off right away. I don't think I was meant to hear it."

No, I don't think you were. "I'm sorry." What else could I say?

I gave her the prenatal resources this time. She carried the pregnancy to term and gave birth to a healthy girl. Because of the child, she stayed with Pothead, in spite of a deterioration in both his functioning and the relationship. He was useful. He could be home, caring for the baby, while she returned to school to finish her degree. She went back to school, determined to complete her education and become a professional, although her love for her child tugged at her constantly. A year went by. One time she came in I saw bruises on her arm. Pothead was beating her. She refused to take any action, asserting that he never hurt the baby and she needed him, and besides, he was the baby's father. Unfortunately, this wasn't the first time. Nor was it the last.

You can't report an abuser if the abused isn't willing. Unless the abused is a kid, or an elder who is non compos mentis. But an adult who is being beaten has to make the decision themselves to call the cops on the person beating them. It's one of the chronic frustrations of the medical profession.

Sanja wouldn't do it. I tried every approach. Sympathy, challenge, outrage--I even played the baby card. Who wouldn't?

Things escalated, of course, and eventually she did end up calling the cops once or twice. But when the incident cooled down, she continued to stay. She worked hard at her schooling. Baby girl blossomed into a delightful and lovely toddler. Pothead was pothead.

Sanja finished her degree, and I was excited. Now she could leave, finally. But she didn't! She thought her daughter should have a dad, so she stayed with that loser, and moved out of state to get a job. I said goodbye with an ache in my heart, for her and for the child. What kind of a home would it be for the little girl, with a father who abused the mother and no love in sight?

I figured I'd heard the last of Sanja. Then one day about a year later, out of the blue, I received a long-distance call. Over the crackling airwaves, her voice was excited, lighter and stronger than I'd ever heard. I held my breath as I listened.

"I did it, Dr. Spencer! I left! He just got worse and worse so one day I just took the baby and a few things and left when he wasn't home. He doesn't know where we are and we'll never go back. I'm so happy!"

I was thrilled to the bone. "Sanja, I'm so proud of you! Thank you so much for calling me with your happy news!" It had taken her almost five years, but she found the strength.

The first part of this story is discouragingly common. Every medical provider (and many regular folks) knows someone who stayed in an abusive relationship. It's heartbreaking.

But this time, this one glorious time, there was a happy ending.

Sanja and your lucky daughter, wherever you are, I wish you a long life and lasting happiness.

Wednesday, July 19, 2006

Calling Again

This is an addendum to the Call for Stories post. If any of you followed the link to the book blog, you found a lo-o-o-ng list of chapters and summaries. In case that was as overwhelming to you as it is to me (!), here are some suggested ideas. If you have anything to share about any of this, please leave a comment here or email me at

We’re seeking true stories from people in midlife, for possible inclusion in our book. What kind of stories? See our 50 suggested themes below. Don’t just tell us what happened; TELL US HOW THE EXPERIENCE CHANGED YOU, as well as any advice you may have for people facing similar situations! Stories should be as brief as possible (and we reserve the right to edit as needed for length and clarity). Don’t worry if it’s well-written; just tell the story in your own words. For more complete information about our book's contents, see the series of posts titled "Call for Stories."

Email your input to Please include your real name, your (real!) age, and the first name (real or not) that you’d like us to use for you in our book and/or blog. DEADLINE:
August 31, 2006 (though sooner is definitely better!)

Fifty Suggested Story Ideas (feel free to think up your own)

1. The Classic Midlife Crisis (whatever that means to you)
2. Near-death experience
3. Mentoring a young person (on the job or Big Brother/Big Sister)
4. “I’m a foster parent"
5. Caring for elderly parents
6. “I became a parent for the first time in midlife”
7. Hypnosis or self-hypnosis for lifestyle change
8. "I got Rolfed!"
9. first-hand experience with the Alexander Method
10. Confronting addiction
11. Junk-food junkie no more!
12. “I lost the weight and kept it off”
13. Reducing dependence on Rx meds through diet, exercise, and/or other natural means
14. Loving your body after disfiguring accident or surgery
15. “I ‘feng-shui’ed my home! (garden, work place, whatever)”
16. “How journaling changed my life”
17. FINANCIAL PLANNER! Help!! What’s your advice for the midlifer who never got around to saving for retirement (yet)??
18. Radical change in your belief system
19. "I truly believe that stranger was an Angel, right here on earth!"
20. "Group meditation can change the world -- I've seen it happen!"
21. Lucid dreaming
22. Solving waking-life problems while you sleep
23. Hey Sailor! Tell us what it really means to "go with the flow."
24. Healing trauma -- even years later
25. Chanting and/or drumming for better wellbeing
26. Howling at the moon
27. How do you feed your Muse?
28. Got a totem animal? How'd you meet? Then what happened?
29. "I was the proverbial 'Little Engine Who Could'!"
30. Road Trip! The long strange trip that changed your life.
31. Adventures in colonics!
32. What would you pack in your Midlife Survival Kit?
33. There are worse things in life than getting a hearing aid.
34. Lasik surgery or first pair of bifocals?
35. Pushing the envelope.
36. Are you a Native American who can tell us about the Seventh Generation concept?
37. "I screwed up my courage and made the call!"
38. Life after divorce.
39. PAR-TAY! Tell us of a big 5-0 celebration for the record books.
40. The gift of my heart attack.
41. Postcards from Nirvana (the serious pursuit of enlightenment or the peak pleasure experience, your choice)
42. Are you a "wild and crazy guy" (still crazy after all these years)?
43. "I am so past caring about keeping up with the Joneses!"
44. New romance in midlife
45. Confessions of a misanthrope: or "How I learned to love the entire human race"
46. Riders on the storm: surviving mental illness
47. There've been WAY too many funerals lately!
48. So what do you want on your gravestone?
49. Forsaking food and sleep: the masterpiece that came through you
50."I love to's getting worse every year!"

Tuesday, July 18, 2006

Daphne's Delight

I do a little e-column once a month at work, spotlighting some good news or a good time in some staff member's life. It's called "Bright Spot" and the idea is to counter, in some small way, all the bad news we get inundated with. With which. Whatever. This month it was about a new pregnancy. Enjoy.

My name is Daphne. I two years old. My Mommy is Sarah and my Daddy is Adrian. Mommy works at a big desk. Every day Daddy and I drive her to work, and she blows a kiss at me in the window and I wave. Sometimes she gets lost and I have to hold her hand and take her to her desk so she can find it.

Then Daddy and I go home so he can help me. I need to draw and paint because I a very good painter. Daddy turns the light on for me to paint and fixes snack for me. He says he is a “SAHD Dad”. Mommy says it’s ‘cause he’s a “Stay At Home Dad” but I think they teasing because Daddy can fly so he must be a Happy Dad. I know he can fly cuz one night I woke up and I heard Mommy and Daddy jumping on the bed and then Daddy asked Mommy if he could “let it fly”. Mommy said “go for it”. Then when he came to check on me he had a big smile. He’s a Happy Dad.

One day after that Mommy dinnint come home for lunch. Every day she comes home and we have peanut butter and jelly, my favorite. But that day Mommy told me she walked to the Fun Deer rest’rant and eated a big giant bunch of enchilalas and then she was still hungry! She said she had a hole in her tummy and she went to the store to buy a little piece of paper. I thought she was gonna put the paper in the hole, but she dinnint. She pee pee’d on the paper! Then she told Daddy it was Posatif. Daddy said no, it was Negatif. They silly.

The next day Mommy pee pee’d on another paper an’ it turned all blue, my favorite color. Mommy said, “I knew it! I could tell by that sick hungry feeling in my tummy. Our first try!” Daddy hugged her and he said, “Now I’m going to have to build on that addition” and Mommy rolled her eyes around and made me laugh. I like her funny faces.

One day Auntie Michelle was babysitting me and Auntie Michelle told me that Mommy and Daddy and me are gonna get a baby! And you know what? The baby is in Mommy’s tummy! Isn’t that funny? Mommy has a baby in her tummy! I guess it went in that hole she got from the Fun Deer res’trant. I told Mommy about the baby in her tummy and she opened her mouth really big and her eyes too. I guess she thought she was just getting a fat tummy, but now she knows about the baby cuz I told her. The baby is growing in Mommy’s tummy and Mommy says it’s gonna come out before Santa Claus gets here.

Mommy went to see her doctor. The doctor sewed up the door to Mommy’s Room in her tummy so the baby can’t fall out. Mommy said when I was in her Room the doctors had to sew the door shut too so I wouldn’t fall out. I glad the doctor sewed the Room shut cuz Mommy forgets things ever since she pee pee’d on that paper, and she might forget to close the door to the Room and then the baby would fall out. I don’t want the baby to fall out cuz she’s gonna be my baby sister and sleep in my room, but not the room in my tummy , the room with my bed in it.

Silly Mommy and Daddy say maaaaaybe the baby is a boy baby, but I know it’s a girl baby. Her name is Apple Mehlela Princess and I her big sister. I a big girl now, and I going to school. I happy I gonna have a sister. I had a brother before, but he went to heaven when he was a very very tiny baby. When my sister Apple Mehlela Princess comes out of Mommy’s Room, she will play with me and we will laugh at our crazy Mommy and Daddy.

If you see my Mommy working on her big desk please give her some food because she always hungry since she got that hole at the Fun Deer rest’rant. But don’t give her animals to eat cuz she never ate a animal her whole life. But ‘cept you can give her choclit if you want cuz she loves choclit, but not as much as she loves me and Daddy and our baby!

Friday, July 14, 2006

Call for Stories

Some of you know of my great good fortune in having been invited to help write a book this Spring. I lucked into it, and am still pinching myself! It's going to be an exciting book. It's called 50 Ways to Leave Your 40's and, as you might guess, it's about midlife.

I'm writing today to make you an offer you can't refuse - a chance to see YOUR stories in print! Please see the Call for Stories below.

Call for Stories!
For more information, email

50 Ways to Leave Your 40s: What to Do When Midlife Crisis Is Not Enough – Sheila Key and Peg Spencer, M.D., co-authors of a book-in-progress, are seeking a broad range of “lived experience” stories to flesh out their funny, soulful collection of essays, stories and informative sidebars, for people in midlife. To be published by New World Library in Fall 2007, this gift/personal-growth book has a mission of inspiring readers to live healthier, more meaningful lives in their “second half.” Please see the chapter lists posted (by section) at or email me at for more information. Please keep your anecdotes as brief as possible and focused on experiences from midlife. Please include your name and age, plus the “name” you’d like us to use in publication. Also welcome: your favorite movies, music, books, pop-cultural references, jokes, one-liners, quotations, websites, and anything else that bears a relationship to any of the chapter concepts. New deadline: 8/31/06. Thank you!

P.S. Just tell us your experience. It doesn't have to be poetic, perfect or even grammatically correct. We'll fix it.

P.P.S. For a great midlife story, please see Kim's post at Scared to Health. Thanks, Kim, for offering us your words and wisdom!

Thursday, July 13, 2006

Awake and Sitting Up!

The latest grapevine report on Bikecrash Kid - he's awake and sitting up. This is wonderful news! His eventual neurological status is as yet unknown, and will probably take a while to establish, but I have whaddyacallit - guarded optimism.

Sunday, July 09, 2006

Update on Crash Victim

Tentative good news on the crash victim from last week. I stopped by the fire station in the little nearby town on my way home yesterday, knowing that they'd have their ear to the grapevine. One of the guys told me that the kid, who had been kept in an induced coma for several days to minimize cerebral swelling, was starting to "come around".

No details as to the extent of his brain damage yet, but I'll post them when I know.

Tuesday, July 04, 2006

Rocky Mountain High

Greetings once again from my mountain hideaway.

I am surrounded by beauty such as most people rar
ely see.

We're working hard on writing, but still have some time to smell the wild roses and take some pictures.

Yes, I was this close.

Sunday, July 02, 2006


This afternoon, as we were banging away on our keyboards, there was a knock on the cabin door. I recognized the woman on the porch from the retreat site office. She knew I was a doctor, and as soon as I saw her face I thought, "Uh, oh. Injury." Sure enough. They had gotten word at the office that someone had taken a bad fall on a mountain bike up the valley. WEnt off the edge of the road. He was unconscious, might have a broken leg...Rescue had been called, but if I wanted to go up ahead of them and see what I could do....

Of course I went. Threw my shoes on, stuffed a pack with what little I had with me, and jumped in the car. Sheila came with me. While I was getting ready, we saw and heard a police SUV go by up the dirt road, sirens echoing in the usually quiet valley. No ambulance yet. The ambulance would have to come from town, 8 miles from us, and 15 miles from the crash site.

I threw the Pathfinder into low and put pedal to the medal. Ten minutes later I was there, at "the bench", a familiar landmark almost all the way to the pass. The road, steep along a rocky ravine, takes a curve and a dive right there. I left it to Sheila to park the car out of the way, and walked down the road heading for the huddled group I could see on the slope below. Just then the ambulance arrived, so I offered my help as a "Family Physician from down there" - vague southward wave. "If you can use an extra pair of hands, I'm glad to help. Just tell me what to do." They accepted, and we trekked down. (I know better than to try to take over a scene from paramedics. They are the experts.)

Turns out it was a 14 year old kid. Tomorrow he turns 15. He had been riding downhill on the dirt mountain road - get this- without his helmet. He missed the turn there at the bench and went right over the edge, where there happens to be about a ten foot cliff. Best I can tell, he endo-ed and landed smack on the crown of his head. Depressed skull fracture as big as your fist. (So I heard - someone had a fat gauze and pressure on it the whole time so I didn't actually lay eyes on it). He rolled down from his impact point at the base of the cliff and lay there unconscious while watchers scrambled to help. I guess his dad was riding with him, and Mom was waiting at the car right nearby. One bystander happened to be a nurse, and had gotten to him, put pressure on the wound, and covered him with a blanket.

When we got down there, he was unconscious, very pale and grey, but breathing. All lung fields clear. Heart steady at a pulse of 80 (surprisingly low). Belly soft. Legs, arms abraded but apparently intact (possibly an ankle fracture, hard to tell). Distal pulses good. Not responsive to voice or painful stimulus. Blood and vomit all around.

When the head paramedic saw his head injury, she got on the radio for a helicopter. The rest of us acted as human splints, holding him in place on his side (how they found him I guess), and then holding him still for O2 and
an IV when he started to come around and get combative (which was reassuring as he moved both arms and both legs). Mom was standing nearby wringing her hands. Dad was helping. The kid came to enough at one point to say a few words ("It hurts!") which I conveyed to Mom as good news. Dad was right next to me. I kept giving him jobs to do - "hold this, Dad." knowing how guys like to be active and figuring it was keeping him sane. I also held the kid's arms away from the oxygen mask and IV needle and spoke to him (more like a mom than a doc) - "I know, sweetheart, I know it hurts. We're going to take care of you." stuff like that.

The EMT or paramedic or whoever who was trying to get an IV line in failed twice. The oxygen mask was somewhere near the kid's mouth. We were working on a rocky slope. I was kneeling on some thick branches, and my back was up against the stump that probably stopped his tumble.

Meanwhile, the weather, which had been cloudy and dark, was getting steadily and rapidly worse. Lightning flashed. Raindrops started to spatter. The helicopter pilots radioed that they wouldn't be able to make it up there in
this weather, so Boss Paramedic said, "Let's get him outta here." My sentiments exactly. So we did the one-two-three heave and lifted him up, slid their inflatable stretcher underneath him, set him down, strapped him in ("tighten that strap, Dad") and did another one-two-three heave to lift him (four handles on each side) and then carried him carefully up the side of the steep and rocky ravine as the drops changed to a downpour. Just as we got to the ambulance, the downpour changed to hail. Jeezus. I gave Mom a hug, (which I don't think she even felt) helped load the stuff up, then went back down the hill with another guy to clean up the garbage and mess we'd left, wrapping bloody gauze, needle caps, alcohol wipe wrappers and trash in a portion of the kid's Tshirt we had cut off him.

Got back up to the car, soaked to the skin
and stinking of vomit, and just sat there breathing for a few minutes until a wave of aftershock hit. Just feel it Peg, it'll pass quicker. So, a few minutes and a few tears later, we were driving slowly down the hill in hail that was literally piling up on the road, a visible quarter mile behind the flashing and creeping ambulance. The plan was for them to get somewhere the copter could land (probably back in town) so the kid could be airlifted to the nearest trauma hospital, over the mountains from here.

I'm hoping his youth and health will get him through and that the damage to his brain isn't too bad, and that they can fix it. I'm thinking of all the positives, to the point of absurdity (well, he's less likely to herniate his brainstem cuz his skull is open and the swelling of his brain can go OUT). I'm hurting for his parents, Jehova's witnesses by the way, who must be kicking themselves over the helmet issue, to put it mildly, and frightened to the core.

I'll probably never know what happens. Maybe the mountain grapevine will get news back to us eventually, maybe not. Maybe not 'til after I'm gone next week.

Sheila and I drove somberly back to the cabin, where I showered and put on dry clothes, and then we opened a bottle of wine. Sounds cold, perhaps, but it was a tough day, and we wanted it. We toasted a prayer for the young man's life.

I keep seeing that kid's pale young face, a kid on the cusp of manhood, so terribly injured. I hope he makes it.
Hold him in the light, as the Quakers say. Pray he sees his 15th birthday.

Writer's Retreat

Greetings from the Colorado Rockies! I am here for a 9 day writer's retreat with my friend and co-author, Sheila Key. She's a brilliant and funny writer who, to my endless amazement and gratitude, invited me to join her in her writing of "50 Ways to Leave Your 40's". Think we might get inspired by this view from our front porch?

Here's where we are staying. I must admit, it hasn't always been easy to stay indoors glued to our laptops, drinking green tea and coffee and being brilliantly creative.

Every so often, though, nature calls, so off we trundle to the outhouse. Kinda hard to leave this place too, though - check out that view!!

Here she is, the erstwhile author, busy at the keyboard. I guess I better get back there and join her! More pics in a few days. (deer, foxes, mountains, mountains, mountains)

The Authors of "50 Ways" Interview on KCHF TV

50 Ways to Leave Your 40s TV interview with Phoenix' Pat McMahon