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Thomas Jefferson said that given the choice between government without newspapers and newspapers without government, he would choose to have newspapers.

In medicine we have government without newspapers. Patients cannot find out what they need to know to make informed choices. No one in medicine records or reports the information patients need to know the most. So patients will have to.


Rough Draft / Under Construction

Even when everything needed to learn a lesson is present at the beginning, sometimes they take so long to learn.

Bobby Sweet had not been born in this neighborhood. During the first weeks after he had moved in, Aaron climbed over the fence to go to Bobby's house when he saw Bobby behind the carriage house in their backyard. He walked to there and found Bobby digging with a shovel. There was a pit about four feet deep, which was lower than the water table in the area, so the bottom was filled with water. It was next to a pile of discarded telephone poles, some of which had been cut to shorter lengths. Bobby had rolled a few short sections of phone poles over the pit.

"What are you doing?"

"Building a torture chamber."

For the rest of his life there never would be a time when remembering that would not cause him to pause. It caused him to pause that first time too.

Before the Sweets moved into the biggest house in the neighborhood, Aaron's best friend A.K. had lived there. Being around A.K. had made Aaron feel like a hillbilly. Just the fact that his parents called him by his initials had a genteel ring to it. And he was so obedient. One afternoon A.K. said he had to go home and go to bed. Aaron didn't understand. It was only 4:30 in the afternoon. A.K. said his parents were having a party and they wanted him bathed and in bed before it started. Aaron began to express rebellion about parents issuing so an unreasonable edict, but A.K. silenced him saying, "No. It's good. I understand." Even then, Aaron realized that A.K. was a good influence.

When the Thextons, A.K.'s family, lived there the yard and the house were immaculate. The parents themselves always seemed dressed for a wedding. They smiled perpetually. They made people feel welcome. And when they threw a party the people who arrived were like them.

Between when the Thextons moved out and the Sweets moved in there had been city crews digging a storm sewer through backyards. They left construction debris along the back fence, including the pile of telephone poles. If the Thexton's still had lived there, they would have called the city and had it removed. The Sweets never did. Instead, Aaron and Bobby and the other boys in the neighborhood slowly, over a period of about ten years, burned and buried and chopped and hauled away the debris. But first, Bobby built a torture chamber with it. Aaron asked, "What for?"


Jeeps was Bobby's younger brother, nicknamed by his parents when his mother said, "Jeepers" on looking in his diaper once when he was a baby. That in itself was a flash bulb moment for Aaron, the moment when he learned how that nickname was acquired. It was so unseemly. Why would anyone do that?

There were other things about the Sweets that Aaron didn't understand. Their house always needed work. It always needed vacuuming. Its driveway started out as blacktop but over time became gravel colored by the tar that once had held it together. The carriage house behind it was the only available garage, but they never put their cars in it. The driveway leading to it needed weeding. Theirs was the only house in the neighborhood that kept cars in the driveway in front of the house. And they were old cars, rusty and faded. One couldn't help but feel that the house would have become that way too if it were not stone.

Mrs. Sweet's maternal grandmother had died and leaving money to her. The Sweets used their portion of the estate to pay cash for the biggest house they could in the best neighborhood they could. Other than that they didn't put on a lot of airs. They didn't enough money to. Maintenance of that house was beyond their means.

Well, there was the time that Bobby's little sister, Charity, said that they had relatives on the Mayflower. She was a sweet girl and did not seem to be bragging. It merely was family history her father recently had told her. When Aaron was 13 years old and had to write a paper on something from American history with which he had a personal connection, he chose writing it about the Sweet's Mayflower ancestor. It turned out that there were no Sweets on the Mayflower. There were lots of ships called Mayflower during that time, several of which made trips to America, but none of which had any Sweets on board. He asked Charity for more information. She walked with him into the study where her father was reading and asked him the question. It was another facial expression Aaron never would forget as Mr. Sweet said that Mrs. Sweet's grandmother had an ancestor with the same name as someone on the Mayflower.

Other than that sort of thing, the Sweets didn't put on airs. They were just normal people who tortured their little brother.

People intentionally hurting other people is something everyone knows happens, but when they do it, do the people doing it think of themselves as torturers? Calling the hole in the ground a torture chamber was so overt it felt like parody, like a joke to Bobby - even the next day when Aaron heard the hollering and went to see what it was. Jeeps was trapped down in the pit. He couldn't get out because of the splinter filled, creosote-oozing phone poles Bobby had rolled over the top of it. Bobby was shoveling mud on top of that to block light from getting through. It wasn't dry dirt, it was wet mud. He had a hose running slowly on the spot where he was digging the mud. Wet mud was dripping down on Jeeps who was 4 years old, mad and crying. Bobby smirked and shoveled more mud on top and then set the hose on top too. The plops of mud dripping down on Jeeps could be heard hitting the puddle-bottom of the pit.

Bobby was a year older than Aaron and was bigger and stronger and a dominating personality, but they became best friends because of the proximity of their ages and dwellings. Being friends might have been what blinded Aaron. Or it might have been how hard it is to accept that another human being is the kind of a person who intentionally hurts people. Even when it is done to you yourself. Even when it happens repeatedly. Like the time Aaron was underwater in a swimming pool with his feet on the bottom and pushed off the bottom to blast to the surface to get a breath when a blow to his head knocked out of him what air he had left. He dropped back to the bottom. From there, looking up, he saw a piece of plywood on the surface. He swam around it to the surface and got his breath. As he surfaced he heard his mother berating Bobby for slamming a piece of wood down on Aaron's head. Aaron defended his friend by saying, "He didn't mean it." His mother had watched Bobby raise the piece of wood and wait for the moment that Bobby's head would break the surface. His mother watched Bobby time his swing to meet Aaron's head at the surface, like swinging a bat to meet a ball, and then saw all the air in her son's lungs expelled as her son dropped to the bottom in pain. But her son came to Bobby's defense. 

Disciplining another person's child is a dangerous thing. And there was her own son sticking up for the person who had hurt him. It disarmed her, but Aaron saw the look on her face that told the story. He would remember that expression for the rest of his life too. Especially years later when further experience and additional maturity finally brought understanding.

Of course, like all children, he had experienced being intentionally injured by people he trusted. Yet he still trusted them. And he was aware of the cause of the scars on his mother's forehead. But the community shares assumptions that overshadow personal experience. A normal patient doesn't expect a caregiver intentionally to injure him or her, and when one has, doesn't expect another one to. His mother no longer shared that assumption, neither for healthcare nor Bobby. But Aaron was influenced more by his friends and the community and still did.

Summers Bobby and he played in yards and pools a lot - badminton, softball, frozen tag, capture the flag, flag football, soccer, tennis, marco polo, croquet, golf, volleyball, lawn darts, Frisbee, pogo sticks, hoola hoop. .  Whatever came along, they not only tried it but practiced it to see how good they could get at it.

Most of these things they did barefooted. Shoes hurt Aaron's feet from the first time they first crammed his feet into shoes when he was an infant. Everyone assumed he just was a complainer, not that anything was wrong. He took off his shoes whenever he could. No matter what sport they played, if the ground was not frozen, he was barefooted. Sometimes even when it was frozen. Adults treated this as purposeless insanity. His Dad's second cousin, whom Aaron called Uncle Phil, used to scowl at him for it and make snide comments about it and offer dire warnings about the bad things that could result from it. No one ever had a moment when they wondered if there might be an anatomical reason for it.

Some of the kids in the neighborhood followed suit went barefoot too, although not all the time. When they played soccer, Bobby wore shoes. As a result they almost never played soccer without Aaron limping away in pain. In high school Aaron began going to a private school and was playing sports with other people. Between the bus ride and the after school sports, he wasn't part of the neighborhood games during the school year, but some habits from the neighborhood stuck with him. Sometimes at school, during practice, he played barefooted. Once he did that in a match against another school. On the bus someone had taken his equipment. There were no shoes for him. Coach let him play barefooted. He'd done it in practice enough times without it being a problem. Why not?

When summer returned he was playing in a backyard with the neighborhood kids again when he crumpled in pain, only this time with a vision born of a broader experience. In neighborhood games he always felt like a crybaby and a wimp. He always had been the only one limping away. The game would role on without him as people ran past him to chase the ball. It seemed as though it had been a countless number of times that he had hopped off the field in that neighborhood and gone home.

Now he had learned rules and maneuvers and had been coached. He had played against people better than him, older than him, bigger than him, people who ran straight into him knocking to the ground with the wind knocked out of him. He also had played a form of hockey, with a regular puck and ice hockey stick, but on a linoleum floor in a basement hallway at school. It was tight quarters and aggressive. It was against the rules to play hockey in the hall so it was done only when no adults were around. There were bruises and gashes and broken sticks and bleeding. They didn't wear helmets or gloves. The flailing sticks and the flying puck posed serious risks. Even then Aaron did not wear shoes. Everyone else did, but he never got a foot injury even midst the sticks fighting for the puck around their feet. His feet got slapped and stepped on, but never incurred a game ending injury.

Now, back in a neighborhood game, and one in which most of the kids were smaller and younger than him, Aaron had been going for the ball when he crumpled to the ground in pain. This time he had the vision to see that when he had been going for the ball, Bobby had gone for him. The ball wasn't anywhere near Bobby's kick. With shoes on Bobby aimed for Aaron's bare foot and took him out of the game. When Aaron looked up from the ground at Bobby, he saw the same expression he had seen so many times before, the one he had seen for the first time when Bobby had been throwing shovels of mud on top of his little brother in the torture chamber. So it wasn't as though Bobby had had only one experience with people he trusted intentionally injuring him. His best friend had done it many times. It just took a long time to see it.

When you trust someone it can be very hard to see.

Now that he was catching on, Aaron started spending less time with Bobby, but he was spending less time with everyone from the neighborhood and everyone from the public school he used to go to. The long bus ride to the private school and the sports and functions and homework there took all of his time. He used to come home from school with friends, but none of his new friends were within walking distance.

From the public school he used to bring home a black friend named Lyonal whom he had met in second grade when Lyonal used to beat him up everyday. Aaron used to come home crying and bruised and his mother didn't understand how this could keep happening. Finally she drove to where she could watch school let out without Aaron seeing her watching. She saw him get his bike from the rack and get ready to ride home when this black kid stopped him and began punching him.

She drove home and waited for Aaron to arrive. When he limped in on the verge of tears again, she asked him what happened. He repeated his usual story and she said, "You know. You could hit him back."

He did not know what a pacifist was, but the idea of injuring someone else, or even being mean, was not part of him. His father was both proud and worried about this. How would one climb a corporate ladder if one was worried about hurting people.

The next day when Lyonal stopped him after school and hit him, Aaron hit him back. Lyonal hit again and Aaron dropped his bike to the ground and stepped into his next punch. Lyonal ran away and never hit him again. Soon they were going to each other's houses after school playing as friends. They continued to be friends for years. But when Aaron went away to private school, he didn't see Lyonal anymore either.

Then one day in the summertime, Aaron was at home when Bobby called from work. Bobby had gotten a summer job in a slimey, run-down gas station by the railroad tracks that separated Shrumpville and Colorado. Aaron had been down there before and seen a guy walk in and ask to use the restroom. Aaron asked, "He's not buying gas?"


"And you let him use the restroom?"

"He lives in rented room with no plumbing. The owner says it's good community relations."

It was a very different world than Aaron was used to.

Aaron didn't have summer jobs because his father wanted him to be available for travel and golf and other things his father wanted to do with him. Bobby's father thought it would be good for Bobby to work at a job summers. Aaron's father thought it would be good for him to improve his golf game. So Aaron was at home when Bobby called and asked him to get on his high-bike and come down to the gas station.

"What for?"

"Just come down."


"Just get on that high-bike and ride down here."

The high-bike was what Aaron had turned his mother's bicycle into when she was out of town one weekend. He turned the frame upside down so that the pedals were at about waist level. He strapped a piece of plumbing pipe, from Ted's scrap heap, to the frame and on that mounted the seat about six feet above the ground. A similar arrangement held the handlebar at an appropriate height. He did as Bobby had asked and rode it down to the gas station.

Getting on and off of that high-bike was not easy because you could not put a foot on the ground as you sat on it. You had to put a foot up on that pedal and push hard with the other foot to get it rolling as you lifted yourself onto the high seat where you had to start pedaling immediately to maintain balance. Getting on it and getting back off were the most dangerous moments on that bike, and he had fallen enough times to be conservative about getting on and off of it. So when he got to the gas station, he did not jump down, but rather looked for where he could stop and lean on something without getting off of it. The only good place for that was the pole holding Sohio sign at the far corner of the lot.

He leaned on that sign as he shouted from his high perch, "Hey, Bobby." No one was outside. "Bobby." Then Lyonal came out of the gas station. "Lyonal. Hey. What are you doing here?" Lyonal didn't say anything at first as he walked casually across the lot to Aaron. "Where's Bobby?"

When Lyonal got close he said, "Hey, Roark. Why don't you get down off of that bike."


"Just get down."

"Where's Bobby?"

"Just get down off that bike."

"What's going on?"

"Just get down." Aaron sighed and climbed down. He hadn't expected to stay long enough for it to be worth climbing down. But after he leaned the bike on the pole and turned around, Lyonal looked up at him and said, "You've grown."


After a pause Lyonal said "You been working out?"


In the years since they last has seen each other, Aaron had grown five inches and gained sixty pounds. Lyonal hadn't. And it wasn't sixty pounds of fat. He ran and swam and lifted weights. He six four and two hundred and ten pounds and husky. Lyonal said a few more innocuous things and then walked away without saying Bye. Aaron crossed the lot to the office where Bobby was watching from inside and asked what he had wanted Aaron to come there for.

Bobby said that for several years Lyonal had been telling people that the next time he saw Aaron he was going to beat the daylights out of him. It had become his identity in the community. He was the guy who waiting for his shot to tear Aaron limb from limb. He talked about it all the time - how much he hated Aaron and what he was doing to practice for the moment. Bobby had been listening to this for a few years without telling Aaron.

Up on the bike Aaron had not been in a position that would have allowed Lyonal to size up his opponent, and being on such a contraption only made Aaron appear all the more like the kid with whom Lyonal used to play. When Aaron climbed down and stood up, it had been clear to Lyonal that if he touched Aaron he would get knocked on his back so fast and so hard he would not have a chance to defend himself. He left quietly and never mentioned Aaron's name again.

In the gas station, learning that Bobby had set him up for a sucker punch from someone he trusted and thought was his friend, Aaron was dumbfounded. He almost said, "Thanks for the heads up," but was quietly pausing in much the same way that he had the first time he heard "torture chamber." He further understood that the less he had to do with Bobby the better off he would be.

So it was not as though he never before had had someone he trusted arrange for him to meet someone else he trusted when the whole thing only was a setup. But the idea that doctors would do that still took a couple of years of repeatedly going through it before he caught on. Information about healthcare tends to come from people in healthcare and they present themselves as being above the machinations and unfriendly motivations present in any community, whether it is children in a neighborhood, Priests in a parish or surgeons in a surgery. Or even, as it turns out, lawyers sworn to defend you.

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Medical Novel Table of Contents

Persons, places, events, and situations in this story are purely fictional.
Any resemblance to actual persons, living or dead, is coincidental.

Rough Draft / Under Construction


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Silence versus Patient Safety
Loyalty versus Patient Safety
The White Wall of Silence versus Patient Safety
Blacklisting Patients
Freedom of Speech for Patients
Medical Complaints - How to

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It's a path

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