He pulled into the driveway and sat in the car for several minutes, the radio off, just thinking. Arnie Levine quietly surveyed the yard and outside of the house. He could see dozens of things that needed to be cleaned, fixed, organized, painted or torn down. But he was just plain tired. After 26 years of chiropractic practice, he recognized that he did not have the energy to " do it all" anymore – and today had been especially chaotic at the office.
As he came into the house through the garage, Arnie passed his kayak, dirt bike, golf clubs and woodworking lathe table. He couldn't remember when he had last used any of them. He opened the back door quickly to keep the cats "outside," but was immediately attacked by the shih tzu puppy. His wife, Toni, had the architectural plans for the remodeling of their kitchen, spread out on the cooking island.
"Sweetie, I think granite kitchen counters still make more sense than the laminate," she said. Arnie had promised Toni that he would remodel the kitchen himself, since he thought he had the skills to do it. But he was no longer looking forward to it.
"That sounds expensive," he answered as he slumped down in his recliner chair. Toni got it ... this moment was not the best time to talk about kitchen counters.
Arnie was working four-and-a-half days a week and two Saturday mornings a month. He had a long commute from his rural home to his practice in the heart of the city, and usually left in the morning at 6:30, getting home five nights a week at about 7:30 p.m. Then he watched TV, ate dinner, and went to bed – a typical evening.
It must have been about 2 a.m. when he woke up and couldn't go back to sleep. Arnie knew he was working too hard, but had to do it. Income was good, but not close to the reimbursement of years ago. Their two kids were young adults, fortunately on their own and surviving somehow. Toni was back in school, a student again, trying a new career. All this was manageable, but something was not in focus, and in the middle of this night, he figured out what it was.
About 5:30 a.m., he woke Toni up. "Dear, I have an important favor to ask." Toni was bleary-eyed. "Sure", she mumbled, "What is it?"
Arnie said, "I want you spend the afternoon with me in the office."
Toni sat up. "Is Doris sick again? Do you need help at the front desk or something?"
"No", he replied, "I want you to be with me while I treat patients." What could have been a very long conversation began, but Arnie cut it short. "We'll talk later, I'm sure. I'll see you right after lunch then, OK?"
Toni sensed this was very important to him, but she wasn't sure why.
She got to the office right at 2 p.m. "How are you going to pull this off?"she whispered to him. "Won't patients be uncomfortable with me in the room?"
Arnie replied, "Some will, and you can excuse yourself. But I'm going to introduce you as my wife and as a student, which is true. It's a big town and almost no one will know you, anyway. Let them imagine why you're with me."
The odd circumstance of Toni in the treatment room worked surprisingly well. Most patients thought she was either a chiropractic student intern or was going to be working with her husband in the office soon. With the exception of Shelly, their veterinarian, Toni did not know any of the 16 patients Arnie treated that afternoon; but she did learn a lot from them.
Louise told her that without Dr. Levine, she wouldn't be breathing, her asthma was so bad. Ahmed related how he had been unable to work at the warehouse until Arnie fixed his "slipped disc." Elderly Francis explained that Dr. Levine had counseled her about getting surgery for her spinal stenosis when it was clear he had done as much as he could for her.
All afternoon, Toni heard tales of people with health challenges, the successful recoveries, the tragedies of decaying health, the appreciation of even the smallest relief from pain. She met people who had been Arnie's patients for more than 20 years.
"I first came to see your husband when he was in that little office above the barbershop," said Miguel. "The facepiece on that old treatment table he was using felt like it had no padding on it! His new one is much better."
When the workday finally came to a close, Arnie and Toni decided to go out for dinner. "I never really knew you had studied so many different techniques until I watched you use them!" Toni exclaimed as she finished her wine. "I guess I thought you did mostly that cracking method on everybody."
Arnie was pensive as he responded: "That's why I needed you to come in today, honey. I needed you to understand what happens in my world every day; the things I can't quite communicate to you when I come home at night. ... It's probably my fault. When we were first married, I couldn't wait to share with you. I don't know what happened. Too often, I feel I'm alone in the office."
As they drove home, both were quiet. Then Arnie said, "You know, I'm going to call Matt Whitt, the contractor, to finish the kitchen remodeling." He looked over at Toni, whose eyes had become moist. She didn't need to say anything to him now. Those teary eyes said it all.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
