Tides and Transitions: Life and Thoughts 1983-2008

By Dan Stultz

The book is a diary of a physician/father over 25 years of family life and his practice of medicine. The author kept a journal and although this journal reflects his mood and attitude at the time, it is a description about experiences, occurrences and important decisions. These transitions and tides are chronicled whether it be family life, building a practice, or operating a health system. The result is a journal that describes seemingly minor events that directed the author and his family in certain directions and as a result, this story. "Tides and Transitions" describes those people, events, and the stories that helped develop, mature, and challenge the family and medical practice. It is bits and pieces of the life of a young then middle aged physician and father.

• Language: English
• Publisher: AuthorHouse
• Release date: Feb 21, 2011
• ISBN: 9781456701710

Dan Stultz

Dan Stultz, M.D., FACP, FACHE, is the former Pres. and Chief Executive Officer of the Texas Hospital Association where he served from 2007 to 2014. A member of the American College of Healthcare Executives, he earned designation as a fellow in 2006. He was the first physician CEO among the nations 51 hospital associations CEOs. Stultz was President and CEO of Shannon Health System, a three-hospital system associated with a multispecialty clinic, in San Angelo, from 1999 until November 2006. He was a member of the Texas Hospital Association Board of Trustees during that time and served as the THA chairman in 2004 to 2005. Dr. Stultz practice general internal medicine in San Angelo Texas for more than 25 years. He received his bachelors degree from Southwestern University in Georgetown Texas. He attended medical school at the University of Texas Medical School in Houston, and did his internship and residency at the University of Kentucky in Lexington. While in San Angelo, Stultz was a member of the San Angelo Chamber of Commerce, serving as chairman in 2003. He has been honored as a Distinguished Alumni of the University of Texas Medical School in Houston. In May 2016, he was presented with an honorary life membership award by the American Hospital Association for outstanding service. Prior to retirement, Stultz was Associate Professor and Executive in Residence for Leadership at the Texas A&M School of Medicine in Round Rock, 2014-2015. He enjoys welding and metal projects and working in his shop. He and his wife Alice, have 3 grown children and 8 grandchildren. They reside in Georgetown, Texas.

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© 2011 Dan Stultz, MD. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

First published by AuthorHouse 2/16/2011

ISBN: 978-1-4567-0172-7 (dj)

ISBN: 978-1-4567-0173-4 (sc)

ISBN: 978-1-4567-0171-0 (e)

Library of Congress Control Number: 2010917065

Printed in the United States of America

Certain stock imagery © Thinkstock.

Because of the dynamic nature of the Internet, any Web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

To Annie:

To each their comes in their lifetime a special Moment when they are figuratively tapped on the shoulder and offered the chance to do a very special thing, unique to them and fitted to their talents. What a tragedy if that moment finds them unprepared or unqualified for that which could have been their finest hour.

Winston Churchill

Table of Contents

Tides and Transitions:

Life and Thoughts

On Death, Dying, and Electricians

Mysteries, Magic, and Insulin

Waving

CHAPTER 1

Growing Up

Summer 1983

Pee Wee

Sunday Before Labor Day

Thanks Dad

Campfire at Sundown

A Trip Backwards

John

Primary Pulmonary Hypertension

Weddings, Ceilings, and Full Circle

Palm Sunday and Frogs

Lisa’s Nights – Slumber?

Late-Night Thoughts, Friday, the Cross

John

Charlie Trigg

Big Lake Tournament: August 3, 4, 1985

Medicine: Late Night Thoughts

James: July 1985

September 13, 1985

October 15, 1985 Tuesday

October 21, 1985: Eugene Smith

Journal Piece November 1, 1985

November 22, 1985

James

James

A Physician’s Day

James and Biscuits

Spouses with Cancer

John and Women: Summer 1986

CHAPTER 2

Development, New Roles, Teenagers

Journal: Sept 12, 1988

September 14, Wednesday- Diary Entry

Heroes, Advent and Safety: 23 Dec 88

Late Night Collected and Uncontrolled Thoughts:

23 Dec 88

More Childhood Notes: Spring 89

Boy’s Baseball: 6/12/89

Summer Report: Oct. 2, 89

Entry – Fall Report: 10-30-89

Journal: January 1990

Knees

Kids Update

ELECTIONS, ANXIETY AND CHANGE

by Dan Stultz, M.D., Medical Director

Physician Notes – Fall 1993

A WIDER VIEW: MEDICINE AND HEALTH

by Dan Stultz, M.D.

Shannon in Transition and Tom

November 1994

Shannon in Transition III

The Deal News at 10

18 November 1994

27 November 1994: Sunday After Thanksgiving

New Ink, Destination

Wally Chappell in San Angelo and Resultant Thoughts

30 March 1995

Wally: 14 May 1995

Sharing

The Memorial Celebration: July, 1996

Swimming Cats II

Journal Entry 14 March 1998

Palm Sunday: 5 April 1998

Update

Betsy

Spring, James, West Point

History, Documentations, E and M Coding

Decisions /26 April 1998/ May Is a Busy Month

From the VHA SW Meeting

Scottsdale / VHA Camelback April 30-May 2, 1998

Letters, Speeches and the Days After

UMW Day/May 4/ Alice Mae

Entry for the week of May 11, 88

Leadership/Thoughts on Paper/The Moon

May 11 to about June 3 / Family

Discourse and the Meaning of Existance—1998

Patch of Quotes #1

Lisa, June 5, The Woodlands

HGH’s Retirement Party and Small Talk

Journal Entry – 23 June 1998

Patch of Quotes #2

Quote and Betsy Schwening 15 July 1998

There Is Some Stuff I’ve Got To Write Down

Heritage 30 July 1998

Italy—John

Edwin Fleming

Patch of Quotes #3

Leadership Quotes:

CHAPTER 3

CEO: Shannon, THA, Elder

January Report: Diary 24 January 2000

Remembrances 2002—

Uncle Elmer’s and Aunt Minnie Lee’s Dairy Farm

Uncle Gus and Harry Truman

March 29-30, 2003

One Day at a Time

Introduction

SKITERRINKTUM

Morning Prayer

Bookends And In Between

Close to the Earth

Athletes, Pairs, and Colors

Time and Titles, 24 July 2010

Parting thoughts on Tides and Transitions

Appendix

Tide Makers

Homilies

Are We There Yet?

Fleming Reunion Aug 2, 98

Sit at His Feet

Winners and Losers

Samuel 1:17

Eklusis, Four Score, and Paul’s Prayer

Definitions and what people will tell you behind closed doors

DANIEL R. STULTZ, MD, FACP, FACHE

Tides and Transitions:

Life and Thoughts

1983-2008

The title of this collection, this journal-book, may be perplexing at first look; but further explanation should make it both clear and obvious given the nature of this work. Shakespeare’s famous verse from Julius Caesar sets the stage for Tides in the title. It is in this collection more than once.

There is a tide in the affairs of men,

Which, taken at the flood,

Leads on to fortune.

Omitted, all the voyage of their life

Is bound in shallows and miseries.

On such a full sea we are now afloat

And we must take the current when it serves

Or lose our ventures.

Julius Caesar Act IV ii William Shakespeare

This journal and series of stories records over a twenty-five year period a series of rising and ebbing opportunities and stories. We are defined by the decisions we make, the children we bring into the world, our character, and our faithfulness to man and God. No one remembers our free throw percentage or who we took to a dance, unless it affects one of those defining traits. This work is about the times over a period of roughly twenty five years, when I recorded my experiences with family, work, religion, and pieces of life when those decisions were made.

Thus, when a choice was made, or a decision was made by someone else that forced another decision by someone near me, I wrote down the circumstances. The struggle in me, the emotion, and the feelings at the time are recorded in the journal.

This is therefore, no diary, not a collection of daily activity; this is a compilation of events that at the time impressed me as worthy enough to record, to come home and write down. This is fundamentally different from recording daily events, as a diary might reflect. The tides are our opportunities, our choices, and we should take the right ones at the flood. Too often, we choose to wait, or pass altogether, or take the bad choices, at the ebb. Life’s choices come and we make fundamental decisions that affect ourselves, our family and generations. Those are our tides.

The rationale of the second key title word is more evident. This work is about transitions, of all sorts. I did not realize the common theme until I was editing multiple pieces. It became obvious that what I chose to journal about was usually when there was change, or when the kids hit some sort of milestone, however small in the big scheme of things. It is about those life changes, however subtle at the time. This is about transitions and as death is certainly a transition, there is plenty of journaling about death. That transition is fundamental in understanding the life, day in and day out, of an internist. In the prime of a career, an internist is involved in battle every day, with death. I never wanted my children to see that part of my work, but Annie knew it from medical school forward. I don’t know anyone who has the chance to really observe the process and transition surrounding death as well as the physician.

This work is about leadership and change. There are favorite quotes over the years that I liked and I wrote them into the journal, sometimes the same quote years later. There are pieces about my personal heroes, and there is stuff, simply thoughts on paper; all of which does not amount to anything or as Mimmie used to say, Nu-nothin.

I started in 1983, writing down single short events, then short metaphors that popped into my head from cases that occurred at Shannon. I started keeping a journal and over the twenty-five years I managed to fill more than 14 spiral notebooks and blank books; all hand written. Many pages were edits of stories I wanted to refine, many pages were venting from a tough day, and a portion was mental doodling. Late night great thoughts are often badly written and stinky the next morning. Simply put, I have kept the part I liked, and transcribed and edited the various notebooks into this. I squeezed out what I wanted, I saved what I wanted to, and I got rid of the remainder work, don’t look for it.

The journal type pieces decrease around 1998 and a pattern of story narrative, nonfiction type work picks up. This is a reflection of the change in my role at Shannon and at home. As I did less and less clinical practice and more and more administrative work, and as my life and thoughts changed, my exposure and what I wrote about changed. Also, as our children went to college and disappeared from daily encounters, there was less to record of those interactions.

This off to college period started with Waving in 1994 and concludes with West Point entries about 1999. I have included a few stories I put into Turning over in My Mind from 1995, because they fit the bill as transition and rising or ebbing tide stories. They are so noted. I also included an appendix of my curriculum vitae for purposes of chronology if the story’s setting in time is in question. I included several speeches and homilies I wrote during this time frame that were delivered in some worship setting at various places. They are important to me as well.

I am indebted to Annie as she is responsible for the quality, vigor, and happiness of the last forty years. I am indebted to Lisa, John and James, for their inspiration, leadership and character! I am truly privileged to be their father, every day, all the time. When I write about leadership it is more biographical than autobiographical, and they are part of that.

In so many ways our children are leaders and I am very proud of that part of their character. I enjoy watching their leadership still, although long gone are the soccer games, student activities, scouts and swimming events where I saw skills and leadership develop and manifest in them. They inspire me still.

Annie has helped in the transcription, listened to all kinds of stuff, and has encouraged me to write. She has been supportive especially through the edits and time spent on this, given I have a full time job. Finally, I am thankful for my longitudinal family, from Al and Baba and Sara who have blessed me from the beginning; to our three children, and to our grandkids. Included are all the uncles and aunts who are our life journeys and many of our root stories. They are very much a part of our tides and our transitions. I include the Trigg’s and the Dudley’s in our family from west Texas as they were role models and teachers to our kids. Grandkids, like Alexander, John, Liam, and Grace teach as well. They are in continuous transition and change; and their tides will rise and fall. Maybe this will, in some way for the better, guide them to the flood and serve their ventures.

Dan Stultz

26 July 2010

On Death, Dying, and Electricians

Jean was restless when I entered the house. She was lying in a lounge chair in her bedroom with oxygen supplied by a long plastic tubing. Her wig was off, and she had on the same gown I had seen her in so many times before. Jean had that uncomfortable random motion I had seen so often and could not describe. This random motion, an uncomfortable, miserable motion seen in patients with cancer, bleeding ulcers, and ruptured aneurysms. I wanted to do something, apply some tincture of help, provide some care, but I was powerless. I realized I was more uncomfortable than Jean in some ways. I wanted this whole illness to be over — Jean was ready, we all were.

I felt the imagery and could imagine tiny thousands of electricians walking through the billions of cells in Jean’s body, shutting off the current. Jean was shutting down, the machine, the microchemistry was turning off. Nothing was working normally now, just getting her by. There was not one thing I could say was killing her — it was just cancer. I knew the electricians were at work, turning this complicated system off ever so slowly. I could not see the process cell by cell or day by day, but every three or four days it was obvious Jean was slipping away.

Inflammatory breast cancer is, of all breast cancers, the worst. Although Jean had done well for two years, she had finally relapsed. From the relapse until the day I visited the home, not ten months later, she had required various forms of therapy. None of these therapies could really control the tumor, and now she was close to death.

She was dying the way she had wanted to. When I told her of the recurrence, she described the way she wanted to die; a noble woman, a noble death. She was at home, in very little pain as best we could tell, with only her most intimate family and friends present. She still showed her strong spirit. Hairless, oxygen on, crusty blood around her lips, she had refused water and food for several days. I think it was an expression of her readiness to die that made her