Essays & Reflections

In fifth or sixth grade, we started the basketball unit in gym class.

I was one of the tallest kids in school, which you'd think would matter in basketball. It did not. By that point, everyone in my elementary school had figured out that I was pretty bad at sports. So when teams were picked, I was chosen next to last. Standard procedure. No hard feelings.

What happened next is the part I keep thinking about.

The game started, five on five, and everyone immediately paired off. Guarding each other, jockeying for position, doing the things you do in basketball when you take it seriously. Nobody guarded me. I was tall and uncoordinated and obviously not a threat, so I was left alone near the basket like a piece of furniture someone had forgotten to move.

Someone threw me the ball. I walked to the basket and put it in.

They still didn't guard me. I did it again.

And again.

Three times before anyone adjusted. And even then, I'm not sure they fully processed what had happened. It was easier to lose the point than to recategorize the kid they'd already decided wasn't worth watching.

I think about this more than I probably should.

✶

I grew up in Kirksville, Missouri. If you've heard of it at all, it's probably because of A.T. Still, the physician who founded the entire profession of Osteopathic Medicine there in 1892. The Osteopathic Medical school is still there. It's the town's identity. And because of that, every doctor I ever saw growing up was a DO. I didn't even know what an MD was. I assumed all doctors were Osteopathic doctors, the way a kid who grows up near the ocean assumes everyone knows how to swim.

My father taught chemistry at Truman State University, the local college. Faculty kid. Which meant I went to college in my own hometown because after my scholarships and the faculty family discount, it was free and I didn't have a better plan. I didn't really know what I wanted to do when I grew up.

I studied physics. And painting. At the same time. This combination made perfect sense to me and almost no sense to anyone else. Physics teaches you how systems work: forces, interactions, the mechanics underneath visible motion. Painting teaches you how to see. Really see, not just look. To notice what's actually in front of you instead of what you expect to be there. I didn't know it at the time, but I was training for a job that didn't exist yet.

I dropped the painting degree. Foreign language requirement. I couldn't get past it. This is the kind of irony that only becomes visible later: the guy who would marry a Japanese woman, build his professional life around immigrants and second-culture people, and find his deepest friendships with people from other countries . . . that guy couldn't clear a language requirement at 20. So I added chemistry instead. My father's subject. Safer. More structured. Less interesting to me, and the path of least resistance.

I graduated with degrees in physics and chemistry and no idea what to do next.

✶

What happened next was the library. Yes, just as glamorous as that sounds.

I needed a job with benefits. That was it. Medical and dental. I was in my late twenties, uninsured, and applying for anything that would cover a trip to the dentist. Most employers didn't respond. The few that did were suspicious. I had too much education for the jobs I was applying for, which is a strange problem to have but a real one. A guy with degrees in physics and chemistry applying for entry-level positions raises questions. What's wrong with him? Why doesn't he have a real job? Fish out of water, in a pool I was born to as a tadpole.

The A.T. Still University library offered the job. It came with benefits. That's the only reason I took it.

But working there, surrounded by the medical school I'd grown up next to without ever really seeing it, something shifted. I started to understand what Osteopathic Medicine actually was. Not the cartoon version, bone crackers, alternative medicine, the thing MDs looked down on. The real version: a philosophy that said the body is a connected system, that structure and function are related, that you treat the whole person and not just the complaint.

This sounded a lot like physics to me. Systems. Forces. The mechanics underneath.

And the painting part, the part about seeing what's actually there, that fit too. Osteopathic medicine cared about observation in a way that felt familiar. Not just running tests and matching results to a chart. Actually looking at the patient. Noticing how they move, how they hold themselves, where the tension lives. This was the thing I'd been trained to do without knowing I was being trained for it.

I applied to medical school at 29. This is late. The typical student arrives at 22 or 23, pre-med since high school, aimed at this since birth. I arrived with a decade of detours, degrees in subjects nobody associates with medicine, and the general demeanor of someone who had wandered in from the parking lot.

✶

But something strange happened in Kirksville. For the first time in my life, I felt like I belonged somewhere.

Not because medical school was easy. It wasn't. And not because I was the smartest person there, I wasn't. Top 40% of the class, which is respectable but not remarkable. Some of my classmates were genuinely brilliant. I had no illusions about where I stood relative to them, and honestly, we'd earned our spot in a more competitive pool than I probably appreciated at the time. Getting into medical school, MD or DO, is a select achievement, and I respected that.

What made it different was the people. A.T. Still drew students from everywhere. Asian, Armenian, French, German, Russian, Ukrainian . . . Mormon. People who'd landed in small-town Missouri from entirely different worlds. Almost all of my closest friends were from somewhere else. More fish out of water.

And there, I learned what kind of fish I actually was.

I just didn't look like one. White guy, American born, faculty kid, grew up right there in Kirksville. On paper I was the default setting. But I had never felt like the default. I'd spent my whole life not connecting to the system I was supposedly native to, going to college but drifting through it, getting good grades on tests but feeling broken because the grades weren't the part that wasn't working. Something about the way I processed the world didn't match the way the world expected to be processed. I could see things, patterns, connections, the simple answer hiding underneath the complicated question, but I couldn't explain why I saw them or convince anyone that seeing them mattered.

And suddenly I was surrounded by people who understood that feeling. Not because we talked about it. Because we didn't have to. They'd spent their whole lives navigating systems that weren't built for them. I'd spent mine feeling like a stranger inside a system that was supposedly built for me. Different versions of the same dislocation. We recognized it in each other the way you recognize a limp. You don't have to ask. You just know.

✶

I chose physiatry, physical medicine and rehabilitation, for reasons that made sense to a physics major and a painter. The body as a system. The patient as a whole person. The diagnosis as an act of seeing, not just testing. Physiatry was the one specialty that seemed to care about what happened between the injury and the outcome, the messy, complicated, human middle where people actually live.

I ended up in the Seattle area. Worked at an orthopedic practice that went bankrupt. Landed at a spine and sports medicine clinic in Lynnwood. Spent the next decade running a satellite office, doing electrodiagnostic studies, and quietly becoming the person who got the cases nobody else had solved. Not because I sought them out. Because they kept arriving.

I'm 55 now. I've spent the last year building my own practice, Sound Injury & Electrodiagnostics, after a decade working for someone else. It's a small operation. One physiatrist, a clinical assistant, a front desk person. We're in a sublease in Lynnwood, a desk away from the practice I used to work for. It's not glamorous. Nobody would mistake it for a medical empire.

But it's mine.

And I'm building it the only way I know how: by finding people who are slightly askew from the culture they inhabit, who arrived at their work from an unexpected direction, and who care more about whether the patient gets better than about whether anyone notices.

I call them my dream team.

Here I am, the overqualified guy who took a library job for the dental insurance. The 29-year-old who wandered into medical school from the stacks. The quiet physiatrist in the sublease, building something small, hoping it's enough.

Now I get to be on the dream team too.

Nobody guards me. I keep walking to the basket.

I keep putting it in.

A family member of mine once got hired to contact every nuclear power plant in America. She's a psychological counselor.

I need to back up.

We were living in Illinois. I was finishing medical residency. T. was between jobs. Her phone rang - a friend back in Japan, in her hometown of Aomori, which was considering building a nuclear power plant. A local TV station wanted to send a crew to the U.S. to visit American plants and show that they weren't scary, that they got along fine with their neighbors. They needed someone stateside to make it happen. Contact the facilities. Pitch the idea. Plan the routes. Book the hotels. Coordinate a cross-country production trip for a group of strangers.

Of all the people on Earth, they called T. The counselor.

She said yes, obviously. She stayed up every night for weeks, cold-calling nuclear facilities, charming her way past media departments, assembling an itinerary that actually worked. By the end, I was driving a van full of Japanese journalists through Minnesota, then flying with them to D.C. for two more sites. T. translated. I drove. I was weeks from finishing residency. The whole thing had a dreamlike quality, like I'd accidentally wandered into someone else's life.

Here's the thing, though. This wasn't a one-off.

A few years later, a mutual friend of ours - a physician named Jason who loves Japan - hired T. as his personal assistant for a trip overseas. Her job was to plan his entire itinerary, set up meetings with interesting people, find the best restaurants, and be on call for whatever came up. She'd never done anything like this before. She handled it like a concierge at a five-star hotel who'd been doing it for twenty years.

These jobs always arrive the same way. A cold call. Out of nowhere. From someone who heard, through some friend of a friend, that T. was the person who could figure it out. Not the person with the relevant experience. Not the person with the right title on their business card. Just the person you call when nobody else knows what to do.

I find this hilarious and also slightly annoying, because I recognize it.

✶

I'm a physiatrist, which is a word most people have never heard. I specialize in physical medicine and rehabilitation. I read electrodiagnostic studies and I treat people recovering from car accidents and work injuries. It's not glamorous work. Nobody makes a TV show about it.

The patients I find most interesting - and I realize "interesting" is a weird word for someone else's suffering, but bear with me - are the ones who've already seen everyone else. Three doctors. Four doctors. Sometimes five. Good doctors, often at big institutions. The imaging has been done. The protocols have been followed. Nothing worked.

Then, for reasons I still don't fully understand, someone sends them to me.

I always have the same experience. I read the chart the night before and think, There is absolutely nothing I can do for this person. Every reasonable thing has been tried. I'm going to walk into that room, shake their hand, and have nothing to offer.

Then I meet them. And I find one or two things nobody thought to check. Not because they're exotic. Because they're boring.

What I keep finding - and this is the part that genuinely puzzles me - is a body that's still bracing for an accident that happened months ago. Muscles locked in a chronic flinch. The tissue has healed, but the nervous system never got the memo. It's still running the emergency protocol. And nobody noticed because the orthopedists were looking at bones, the neurologists were looking at nerves, and everyone was hunting for something dramatic enough to explain why this person still couldn't turn their head.

Meanwhile, the answer was just... tension. Sophisticated, neurologically mediated tension, sure. But tension. The kind of thing that sounds too simple to be the answer, which is precisely why nobody landed on it.

I'm not better than the doctors who came before me. I want to be clear about that. I've just seen this particular pattern so many times that I'd have to be genuinely obtuse to miss it at this point. It's like being the only person at the poker table who's played the same hand four hundred times. You're not smarter. You've just seen the cards before.

My success rate on these "failed" cases in workers' comp is maybe 30 percent. Which sounds terrible until you remember that the previous success rate was zero. In car accident cases, where the psychological piece is more prominent, it's closer to 80 or 90 percent. Which surprises no one more than me.

✶

So here's what I've been thinking about lately.

There's a type of person - I don't have a good word for them - who ends up being the last call. Not the first choice. Not the obvious pick. The person whose phone rings after the obvious picks have come up empty. They tend to share a few traits. They're generalists by temperament even if they're specialists by training. They're more interested in the actual problem than in whether the problem is prestigious enough to be worth their time. And they have a strange inability to overlook the simple answer in favor of the impressive one.

T. is this person. I think I might be this person. And what I've realized, slowly, over the course of building a medical practice, is that the people I most want to work with are also this person.

My dream team isn't the most credentialed group in the room. It's the physical therapist who notices the thing the surgeon missed. The chiropractor who calls me because something doesn't add up in how a patient is moving. The counselor - and yes, I'm biased here - who understands that a car accident doesn't just break your body, it breaks your sense of safety, and that you can't fix one without the other.

These people don't have a professional association. There's no certification for "person who gets the weird call and figures it out." They just tend to recognize each other, the way left-handed people notice other left-handed people, or the way you spot someone at a party who's also secretly wondering why nobody has fixed the obviously broken thing that everyone else has apparently decided to ignore.

I'm lucky enough to have one in my family. I'm trying to build a practice out of people like her. And I still think her version is more interesting than mine. She got to visit nuclear power plants. I just get to tell people their muscles are too tight.

But the principle is the same. Someone, somewhere, has a problem that the obvious candidates couldn't solve. The phone rings. And for reasons nobody can fully explain - least of all the person answering - it rings for you.

It's been roughly ten years since I first drove this road.

Here I am again, traveling between Everett and back to Lynnwood after visiting doctors, chiropractors, and other clinicians I have known for years: people I have worked with across a decade of shared patients, shared questions, shared uncertainty. The highway feels both familiar and slightly altered, the way all things do when enough time has passed.

Ten years ago, I was between practices. I had been working at a place called Premier Orthopedics for nearly a decade, and that practice was winding down. I was worried. I was worried that when the clinic closed and I started at the new practice I was joining (Seattle Spine & Sports Medicine) the patients who had known me for years and the providers who had trusted me with their referrals would simply lose track of me. I imagined disappearing in the shuffle of letterhead and phone numbers.

So I made a list.

I wrote down the names of everyone I could remember: every provider I had worked with, every clinic that had sent patients my way. And I started driving. I traveled to various venues and offices, shaking hands, reconnecting faces with names. It was good to see people in person. Good to be remembered not just as a line on a fax header but as a person who had sat with their patients and tried to do careful work.

Looking back on those travels, I realize it was as much for me as for them. There is something clarifying about showing up. About sitting in someone's office and speaking plainly about what you do.

But I also saw the weakness of that strategy.

People still get lost in transitions. No matter how many times you reach out, communication gets mixed up. People forget what you said. Offices change staff. Referral habits drift. The system absorbs you and re-sorts you according to its own logic.

I'm trying to do it better this time.

Over these ten years, the scale of my world has been changing. I trained in a large hospital system, one that contained every specialty under a single roof. After that, I moved into a multi-specialty group: orthopedic surgeons, physical therapists, myself. An ecosystem with its own weather patterns and food chains. I learned to live within that structure.

Then I moved to Seattle Spine & Sports Medicine, a single-specialty group without all the ancillary services. A crew of people who saw things in roughly the same way, navigating injury and recovery with similar maps.

And now, ten years later, I'm stepping into something smaller still: a single-physician practice. Just me. Bearing the consequences of mistakes. Making the larger decisions, not only about patient care, but about payroll, employment, survival. The scale has narrowed, but the weight has increased.

It changes how you think.

So here I am again, after one o'clock on a weekday, back on the road. Reaching out to people who have known me for years and who, I hope, know my work. Reconnecting with some I haven't seen in a long time. Visiting others who have sent me patients over the years: people who seemed satisfied with what I did, and whose own work I respect.

I'm trying to rebuild bonds or at least keep them intact so I don't get lost in the confusion of separating from my current clinic. I've met a chiropractor I'd never seen face-to-face before, though I'd treated his patients for years. In person, he was even better than I expected: clear communicator, open, generous in spirit. It's reassuring to discover that someone's clinical handwriting matches their character.

I've reached out to a practice that once spun off from Seattle Spine and then went its own direction. I let them know how I might help when they run into a blind alley: when a case gets murky, when a patient doesn't follow the expected script. No flourish. Just what I do and when it might be useful.

I don't know if this approach will work any better than it did ten years ago.

But there's something satisfying about being on the road again. About seeing the world from behind the windshield. Not only revisiting clinicians I've worked with, but noticing towns and buildings I haven't seen in years, or maybe never saw clearly at all.

Larry McMurtry wrote about highways as if they were rivers: long currents connecting distant parts of the country. The interstates become a kind of American bloodstream. You move quickly across them, not stopping everywhere, but the exits and overpasses still imprint themselves in your memory. You come to know the stripes on I-5 or I-90 the way you know the tortuous veins on the back of your own hand.

In a strange way, that's how I think about the clinicians I've known over the years. Some I've stopped with often. Others I've only passed in the professional current: names on referral forms, signatures on notes. I haven't always had the chance to pull off the road and sit with them. But they're imprinted in my mental map nonetheless. They help shape the landscape of how I understand my work.

This drive feels like a reunion: not just with people, but with the idea of motion itself. Of choosing to move toward others rather than waiting to be found.

Ten years ago, I was afraid of disappearing.

Now, I'm less afraid of that. What I'm more aware of is the simple fact that roads require driving. Connections require tending. And sometimes the only way to understand where you stand is to get back behind the wheel and see what's still there.

I want to be clear about something that matters to me. These conclusions do not belong to any one profession or degree.

You do not have to be an osteopath to think this way.
You do not have to be a physiatrist to practice with this lens.

I have met surgeons, internists, nurses, therapists, psychologists, and primary care physicians who arrive at similar truths using entirely different language. Most clinicians I know who are both effective and genuinely content eventually converge on similar understandings. Bodies are complex. Outcomes are nonlinear. Meaning matters.

As an optimist, I believe this happens naturally when people stay close enough to real patients and real outcomes for long enough.

At the same time, I think modern clinical environments often pull people away from these realizations. Reimbursement pressure. Financial anxiety. Productivity targets. The quiet pull of status and external definitions of success. None of these are evil. They are understandable. But they reshape attention.

There is also a structural problem when clinicians become insulated from their own long-term outcomes. A surgeon who never sees follow-up. A provider who does not witness complications. A system where consequences are filtered through others. In those settings, it becomes very hard to learn from failure in the deepest sense.

Many clinicians eventually discover that income does not protect against burnout. Status does not guarantee fulfillment. Titles do not satisfy the deeper hunger for meaning.

When medicine becomes primarily about revenue or reputation, it may still function efficiently, but it often becomes existentially thin. The work can look impressive from the outside and feel strangely empty from the inside.

I remain hopeful that most clinicians, given enough time and honest exposure to outcomes, drift back toward a deeper balance. Relationship over performance. Coherence over conquest. Stewardship over spectacle. Not because it is fashionable, but because it is sustainable.

I do not think fulfillment in medicine comes from winning against disease. I think it comes from participating honestly in the long nonlinear story of adaptation, recovery, limitation, and sometimes loss, and knowing that you remained present for it.

One of the quiet gifts Osteopathic medicine gave me was permission to abandon linear thinking.

Pain is rarely just mechanical.
Emotion is rarely just psychological.
Healing is almost never one-directional.

The nervous system does not respect neat boundaries between thought and tissue, memory and muscle tone, fear and inflammation. These relationships are nonlinear. Small emotional shifts can produce large physical changes. Large injuries can lie quiet for years and then reappear through surprising pathways. The system does not behave like a chain of dominoes. It behaves like a web.

Emotion is not symbolic in the body. It is regulatory. Anger changes breathing. Grief changes posture. Fear reshapes motor control. Love is one of the most powerful modulators of pain I know. These are not poetic statements. They are things you can see. Over time, those emotional states also reshape blood flow, digestion, sleep, and attention in ways that are measurable, not imaginary.

But the system does not stop at the skin.

Every patient lives inside larger human systems: family, history, loss, expectation, devotion, grief. Many people also orient themselves toward something greater than themselves: God, nature, ancestry, duty, purpose. These forces shape nervous systems just as surely as tissue injury does.

From an Osteopathic perspective, none of this is external to health. The body, mind, and environment are not stacked layers. They are a single interwoven system.

Modern medicine is excellent at isolating variables, and that power saves lives. But isolation can also hide the larger field in which healing actually occurs. Structure and function are inseparable across scales: cellular, emotional, relational, and meaningful.

When I treat patients, I am always aware that I am never working on a structure in isolation. My work is kind of like a sandwich. I am working on a living system inside a life instead of another living system.

A young boy drew to pass the time. He drew faces pretty well, and the bodies too. He began to understand how they fit together. As the drawings improved, so did his confidence. It felt to him like there was some kind of order in the world. If he looked closely enough, he could copy a small piece of it onto the page.

With age, drawing was no longer enough. He felt restless. He shifted his interest to computers and began to program them. He set an interesting goal. He wanted to build a working simulation of billiards. He did not know physics yet so his father taught him the basic equations. They described how objects collide. How energy moves. How motion changes when force is added. He wrote the code line by line. He changed it again and again. He wanted the virtual world to behave like the real one.

The program ran, but it did not always behave the way he expected. Simple equations led to quirky results. Small changes led to big differences. Sometimes the movement made sense. Sometimes it did not. He assumed he had made mistakes, and he probably had. But it also felt like he was seeing something hidden. The order he thought was solid seemed more fragile than he had believed.

In school, he studied physics. It promised clear answers. That the world could be described. That motion, structure, and energy could be written in numbers. It felt clean in a way that drawing did not. So, his main interests conflicted. One was about expression. One was about rules. He did not know how to bring them together.

Then he learned about chaos theory. Simple rules birthed unpredictable behavior. Small changes multiplied into large effects in a metaphor called "the butterfly effect". An insignificant flap of the butterfly's wing, in one place, could become a storm on the other side of the world. This idea felt familiar to him. It reminded him of his old program. Chaos found its way into his art. He began to draw in different ways. Less realistic. More abstract. At the same time, his physics moved away from clean systems and toward disorder.

He learned many things. But he still did not feel settled.

Then, he discovered Osteopathic philosophy.

And that is where the story quietly takes a turn and becomes my story. For the first time, it felt like all of these interests came together in one place. Though my directions of interest had shifted in a somewhat roundabout way, in retrospect I realize that I had been circling the same question all along from different directions: how does order persist in a world that is always trying to dissolve it?

Osteopathy gave me a way to think about that question inside a living system. Structure, force, perception, circulation, and adaptation could exist together without contradiction. What I had been sketching in art and modeling in code and studying in equations was now visible in the human body as something alive that constantly adjusts under the loads of stress placed upon it.

In biology, health is not a fixed state. It is not something you simply have. Health is a process that is constantly in flux. Every second, the body is correcting errors, adapting to stresses, reallocating its resources, and spending energy to resist disorder. Even at rest, that system is working. In injury and illness, that work becomes visible and highlighted.

The body has to rebuild itself. Nerves, blood vessels, and muscles have to change to accommodate what is new. Some muscles will atrophy. Some will hypertrophy. On top of this, the brain rewrites its internal maps of all of these structures. In this context, pain often comes not only from the original physical damage, but also from the extreme effort of the system trying to stay organized under strain. Layered over this is the emotional set of consequences of the entire process and how the injured person must now interact with both their body and the world around them.

I have been thinking about this a lot lately as I write this webpage. Something that comes to mind is a dried, dead flower I saw the other day. Visibly, it is brittle. It is finished. But what it actually represents is the endpoint of a long coordinated project. Water transport. Cellular construction. Seasonal growth. A constant striving toward light.

The remaining husk is meaningful, not despite its death, but because of the length and the intelligence of what came before it and created it.

Human bodies are the same. Their death is not the failure of a system. It is the moment when the energetic cost of maintaining that original order finally outweighs what the system can provide. There is dignity in the attempt to hold the system in order.

In Osteopathic philosophy and rehabilitation, this framework matters. We are not here to restore people to some idealized version of what they once were. We are here to help living systems, people, reorganize under new constraints. Recovery is not a return to the past. Recovery is not erasure. It is the search for a new kind of coherence and balance for a system that is constantly changing.

In physics terms, it is the attempt of a body to return from a turbulent state to a stable one. Health is not perfection. Health is how long and how intelligently a system can resist falling out of order and how well it can find new stable states that reflect the new reality of the body.