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What doctors should be doing as advocates for their patients—as advocates for change—is grading and reviewing the hospitals and insurers, but instead they cower in fear. Doctors get to be doctors by knuckling under, but at some point, for the good of their patients, they should wake up and insist on being in charge.

Both the medical insurers and drug companies make and hold on to as much of the money as they can. They have, to a large extent, subverted the efforts of hospitals and other providers to care for the sick. The sick have been converted into financial instruments whereby large amounts of money are transferred from one corporation to another. The business opportunities presented by sickness and the threat of sickness have cast into outer darkness the opportunity for medical practioners to be of help and service.

A hundred years ago the Flexner Report revolutionized medical education and medical care by emphasizing science and paying attention to what happened to patients. It’s always possible that history will repeat itself. Maybe today’s medical students or the next generation or the next will say, “No. This is how it should be done. First, do no harm, care about what happens to patients, and settle arguments with good science.”

You Can’t Ignore Gravity, 2008

(Painting by Mark Vonnegut)

chapter 13

Short Chapter …

Relationships are absurd spindly contrivances

Of Love Lust + Luck

How sad when we see

Of course

It can’t work

Three years and two more marriage counselors after Honduras, I hadn’t had a drink in five years. I smashed a glass at my wife’s feet and broke an expensive tile. The next day I pushed a chair she was in.

I had to leave.

Whatever peace we had managed to work out couldn’t survive my not drinking.

My wife and I had both come from damaged, damaging childhoods, and both of us desperately wanted to be normal and thought that being married to each other would be a ticket away from where we didn’t want to be. She liked the very un-needy Clint Eastwood–type man I had tried so hard to be. She had bragged to her women’s group about how little trouble I was. Now, suddenly, I was a jumpy mess who needed a drink and couldn’t have one. It was embarrassing for both of us that I had gone nuts and thrown those rocks out of the aquarium at her and been hauled off to the hospital in a straightjacket. You can’t go from being someone who drinks at least a little bit every day to someone who doesn’t drink like it’s wearing different clothes and cutting your hair shorter. She was a perfectly okay woman whom I didn’t feel loved by. I would have done anything except drink to have my own goddamned feelings matter less.

What possibly could happen to a forty-five-year-old man with two kids that would make getting divorced come out okay?

At my most pathetic, when I felt lost and very sorry for myself and was no longer in charge of making breakfast and packing lunches for my boys, I set up a bird feeder on the ledge of my apartment overlooking a parking lot and no birds came.

End of the Lane, 1991

(Painting by Mark Vonnegut)

Use all the armor.

(Photo by Barb Vonnegut)

chapter 14

The Myth of Mental Wellness

Just ’cause there’s nothing wrong with you doesn’t make you right.

Our medical school graduation speaker was a Jesuit psychiatrist who made me laugh and cry at the same time. At least one person in the world understood why I had become a doctor. So I made a mental note, with my two-year-old son, Zach, sitting on my lap, that should I ever need a psychiatrist again, he would be the guy.

I started going to Ned as a patient in the fall of my internship year, right after my sister had a psychotic break that started with voices and not being able to eat or sleep after giving up drinking. At one point she lay down in the aisle of an airplane so that the Black Jesus and White Jesus could talk to each other. I had zero clue drinking was a problem for her. I just thought she was unhappy some of the time because she was married to a