When despair for the world grows in me and I wake in the night at the least sound in fear of what my life and my children’s lives may be, I go and lie down where the wood drake rests in his beauty on the water, and the great heron feeds. I come into the peace of wild things who do not tax their lives with forethought of grief. I come into the presence of still water. And I feel above me the day-blind stars waiting with their light. For a time I rest in the grace of the world, and am free. ~ Wendell Berry: The Peace of Wild Things Dear Reader, I have so many wonderful updates to tell you and it has taken me awhile to sit down and piece it all together to turn into a blog post. The reason most people would assume for this is that it has become busy in my practice, which is somewhat true. But that isn’t the main reason. The real reason is that I don’t want to write my thoughts down in the blog just for it to be stolen by people and machines. Not that there’s anything spectacular or original about the blog so hopefully only the nice people in my little town, my family and friends pay attention to it. Thus, I have procrastinated delayed posting a blog while I re-evaluated what I really want to do about my writings and what this blog should be about. I would say that it has accomplished what I wanted it to do - which is to introduce who I am in an authentic way and provide updates about my practice. For now, here are some updates: Beginning with thankfulness: I would like to send my eternal gratitude to the people who have supported me since the very beginning of my journey into physician entrepreneurship: my husband and sons, my mom and my dad (even though he passed away 3 years ago today, he would have loved that I have my very own clinic), my brother Lloyd, my mother-in-law who made the beautiful and very comfortable exam gowns and of course, my friends who are my adopted family. There are no words to describe how infinitely grateful I am to be married to my best friend - cheesy, I know - but it is true. My husband is the CEO (chief encouragement officer), janitor, and all around handyman for Lupine. In the internet/AI universe, this is very old news now but Lupine did win the Supernova Business Launch Competition 2023! Thus, I encourage those of you who need some camaraderie, encouragement and guidance on how to start a small business to join this competition! I will help you win, or at least, cheer you on :) https://ncwedd.com/supernova-business-launch-competition/ Lupine Lottery starts - we have several patients who have started working on their healthy habits and I am very excited to choose the winner on Dec. 22nd. Stay tuned! Growing membership: I can now say definitively say that I will start being able to privately contract with Medicare and Medicare-eligible patients starting January 1st because I will be opted out of Medicare. It’s unnecessarily very confusing but basically, anyone over age 65 can now be my patient and pay me privately via the monthly membership and receive all the Lupine services and I will NOT bill Medicare/submit a claim. There are no copays or surprise bills - it’s just the monthly membership of $95 starting January. On a related note to update#4, I’d like to raise awareness on how shockingly “scammy” Medicare Advantage plans are (why in the world are they even legal) - please read this report from the Physicians for a National Health Program: https://pnhp.org/system/assets/uploads/2023/09/MAOverpaymentReport_Final.pdf To end it on a good note because the beginning poem is about peace, I have been working on partnerships with private and non-profit organizations in the community and it has been slow going but it is finally starting to progress and I am very excited to be able to announce those partnerships in the next year! As usual, it is always thrilling to get responses from people about my blog. Thank you to those who have sent responses and encouragement. Send all correspondence to hello@lupinemd.com . Sincerely, Dr. Hendrick © 2023 Angela C. Hendrick

Though joy is better than sorrow, joy is not great; Peace is great, strength is great. Not for joy the stars burn, not for joy the vulture Spreads her gray sails on the air Over the mountain; not for joy the worn mountain Stands, while years like water Trench his long sides. “I am neither mountain nor bird Nor star; and I seek joy.” The weakness of your breed: yet at length quietness Will cover those wistful eyes. ~Robinson Jeffers: Joy Dear Reader, There are so many things to report about the Lupine clinic. (TL:DR - things are going well, but even when they are not, there is joy in a quotidian life, even without certainty). I have over 30 member patients since opening March 1, 2023. I started with ZERO patients, very minimal marketing and all while homeschooling and participating in a business competition. I say all this to encourage my fellow physicians that having a solo practice is NOT impossible. It is definitely hard work but very doable. In comparison, going to medical school and residency is at least 10 times harder. Being a parent in the 21st century - also at least 10 times harder. I have found that it is not so scary, after all, to own a small practice and practice solo. It’s still scary - but maybe just squirrel-sized scary, not elephant-sized. I was able to turn in all of my homework for the Supernova Business competition and am in the final 5. The winner will be announced next month - it is so exciting!!! Although, of course, I would like to win - it is just so wonderful to have been part of this process. I got so many things out of this competition: a mini-business course for free, learned from and hung out with other small business owners, and a really organized business plan. And a chance at winning $10,000! What’s not to like? And there are so many wonderful conversations going on in my little clinic. I try to savor them and write about them in my little journal but there are so many, I can’t keep up. Most of these are from patients but also from fellow health professionals, other businesses who want to partner together and during meetings/phone calls with prospective patients. And I have successfully hired Lupine’s first assistant and he will introduce himself soon. After all of the updates, I wanted to write about joy this month. And it ought to be easy, right? Because it seems like everything is going well, blogging about joy should just roll right off the keyboard. I wish that were true. I had a hard time writing this blog post even though I just really felt compelled to write it. The reason I wanted to write about joy is not because my circumstances are going so well right now. At this moment, I truly believe that there was a 50/50 chance that something could have gone horribly wrong and I would not be so excited about anything at all. Not because I think I am bad at what I do or that I don’t think good things can happen if you work hard- but because I really do not think we can control our circumstances no matter how good or even extraordinary we are at anything. And even if we could control our circumstances, it never lasts. Something will always break. Just the fact that you are a live human being means that your mortality rate is eventually 100%. However, social media/the information age/corporations/marketing giants would have us believe that we can control everything in our lives so that our everyday can be tailored to anything we want. As long as we work hard enough, earn enough money, act/say the right things, exercise, be attractive enough, buy the right product, make the right connections, follow the right Facebook group, take the right supplements, read enough reviews, heck, in the case of health care - have the right health insurance and have the best doctor who does everything you want (or at least ask the Dr. Google rabbithole enough questions), we can arrive at a definitive diagnosis and treatment and prevent all the bad things in life. SATISFACTION GUARANTEED. And once we tailor everything in our lives to whatever we want, our everyday will always be extraordinary. Just look at all the things that are posted in the media - EVERYTHING is extremely extraordinary all the time. And we all know, intuitively, that there is NOTHING further from the truth. But we will all buy into this giant lie, in some form or another, because it’s nice and comfortable to have a feeling of control, of certainty and of being extraordinary. Just imagine all the things we have sacrificed, mainly time, to have this nice and comfortable feeling. And boy, how amazing it is to believe that everyday can be extraordinary. Not only have we sacrificed a lot for it, we then make the most erroneous assumption: that this nice and comfortable feeling of control and certainty is the same thing as joy. On some deep level in our souls, I think we all know it is not the same. It is hard to sustain this awareness when we have so much information to process - from the news, social media, amazon reviews, TV, Google, TikTok, blogs, vlogs, SO MANY life coaches and gurus. (And a lot of this information will increase even more and will be mostly synthesized by AI…except this blog). Never for this blog. :) Do we even have any idea what joy is and why we would want it? Who’s to say that it’s any better than certainty and insurance against everything bad and guaranteed satisfaction with a side of an extraordinary social media post? Can’t we have our cake and eat it, too? I am writing about joy because I want to define it for myself so that I am more aware of it. And encourage everyone else to somehow figure out what joy is all about and where is it in their lives. Somehow I feel compelled to be more aware of this state of being and experience it in my everyday life. I think it is an important part of being alive. I would like for us to think of joy as a well-tended, vegetable garden. It takes a lot of work and thought and it will not make us millionaires nor celebrities but it will give us fresh air, exercise and healthy foods to eat. Cultivating and sustaining joy and living it is essential for survival, essential for our health. I think it is essential to resilience. I think it’s a very important antidote to our greed for comfort and extraordinary things, which have taken away our collective courage and resilience as a society. What I have gleaned from being more acutely aware of joy is that it is a deep experience of having meaning and purpose, of belonging, and of the full knowledge of being loved. All of these things can happen at the same time even though one is in the midst of terrible suffering and uncertainty. It is having an awareness of our mortality and eternity while maintaining gratefulness and humility. Joy can be painful and beautiful all at once. What I have also learned is that it is actually very difficult to experience joy when things are going really well in our lives or when we are getting everything we want. Because once we have what we think we want, it is very hard to seek joy. We do not feel the need for it; although it is one of the most essential part of being be truly alive. In contrast, we seek happiness in our everyday and I think of being happy as a feeling in response to favorable circumstances. It does not last and it loses its meaning once circumstances change. Although I love being happy, like everyone else, I just don’t think it’s a good life goal. I don’t think it’s enough. In summary, what I really think we all need a prescription of is this: a very large dose of a plain, quotidian life with a garden of joy within us, un-wanting absolute certainty and comfort. Is this possible? Yes, for sure. It does not come as a pill or a life coach or a Facebook post or some innovative/progressive hyped-up thing. Joy is mostly quiet. It requires paying attention to one thing or one moment at a time, and having the courage to let certainty go in favor of love, time, faith and meaning, and accepting that happiness is a temporary emotion. I choose joy and I urge you to do so as well - for your own health. It is always thrilling to get responses from people about my blog. Thank you to those who have sent responses and encouragement. Send all correspondence to hello@lupinemd.com . Sincerely, Dr. Hendrick © 2023 Angela C. Hendrick

The waiting is the hardest part Every day you see one more card You take it on faith, you take it to the heart The waiting is the hardest part ~Tom Petty “The Waiting” Dear Reader, This post is about courage part II. It is one of my favorite topics to think about. If you would like to read courage part I, please click here . I was unable to post a blog in June or July - mainly because there were many things to juggle: finishing the Supernova business competition, my sons’ soccer schedules, homeschooling, after school activities, music recitals, my youngest turning 9 years old, family camping, etc. And on top of all of that - maintaining my new practice and working for telemedicine. And since I promise to never use AI for my blog, there never will be a hurried post that is written by a machine and supposedly looked over by a human at Lupine blog. So it was very helpful that business slowed down because I needed the time for family and friends. Still, it brought a lot of feelings of self-doubts and worries that I am not getting a barrage of patients that I normally would in a traditional practice. But then in a large clinic, they have unlimited resources to market their people and do all kinds of publicity. Also they bill insurance so they have a whole pool of patients that various stakeholders have negotiated pricing for and are assigned to that practice. In stepping out into the world on my own with my profession, I am granted the daily opportunity to fully take care of my patients in a way that makes sense and at the same time, practice the courage that it takes to continue to be when things are not going smoothly, such as a slow month or not fulfilling the high expectations that I often have, or succumb to my very strong urge to perform for other people, no matter how unreasonable they are. But there are still times when I start to feel that it would be so much easier to do the traditional practice of being an employed physician, wherein it would be so easy to hide behind a dysfunctional system and never truly show myself and be vulnerable. Not that all physicians do that - it just becomes sort of the default. I picture myself doing that when self-doubts appear about my private practice. Then I think about all the things I would have to give up in order NOT to have that vulnerability: independence/complete autonomy as a physician homeschooling my kids spontaneous dates with my husband caring for my patients in a way that makes sense for their lives honesty and integrity And when this happens, I come to the conclusion that even though things are not going my way ALL THE TIME, I am absolutely certain that I cannot give these things up and continue to be content with my profession. Hence, I really have no choice - I have to make it work because the other way just really does not work for me. Going through the local small business competition, I was able to get to know other small business owners and it has really helped to know that people go through the same things since it is absolutely terrifying to put yourself out there. And to get the reward takes time, patience and grit, and quite a bit of luck. And a supportive family and community. And when I picture the worst thing that can happen - if I am unable to sustain the business and continue private practice, if I absolutely make a complete fool of myself over this venture, and if I am able to rewind time, would I still start the practice anyway? And the answer is a resounding YES! And so I will need to teach myself to wait and do my work as best as I can and follow the usual adage that a lot of physicians live by when dealing with difficult things: hope for the best and prepare for the worst. And while I feel as prepared as I am going to get, I just need to learn to hope and to wait. Most humans are terrible at hoping and waiting. If we look at what I think are truly the chronic illnesses in our modern society - overconsumption, isolation, discontentment - they are all the consequences of all the things that we are VERY good at: expecting rapid gratification, avoiding discomfort, remembering negative things and forgetting gratefulness. On the other hand, hoping and waiting takes a lot of courage and it is VERY uncomfortable. Upon grappling with this on a regular basis, I have realized that there is a structure to courage in every situation - as if it has its own anatomy and each part has a function. Right now for me, necessity is its head - I need to do this because this is what works for me. Its heart is made of my family, friends and community. Its limbs are made of love of medicine and of my patients. And so onward to the rest of the summer where I hope and wait to grow my practice and to find the right patients I can truly help and guide to optimal health. Sincerely, Dr. Hendrick © 2023 Angela C. Hendrick

I measure every Grief I meet With narrow, probing, eyes – I wonder if It weighs like Mine – Or has an Easier size. ~Emily Dickinson Dear Reader, Some of my favorite words in the English language are reading, grit and resilience. And since I was too busy opening up the practice, I was unable to write a blog for National Reading Month - which was in March. (Why March? Supposedly because it was Dr. Seuss’s birthday month). I have decided to write about reading this month because one of my two brothers was born on May 6th and he and I loved to exchange book recommendations and discuss them. His name was Mark and he died at the age of 35 of complications of COVID and end stage kidney disease at the end of 2021. I write this post to honor and grieve him. I was separated from my brothers when I was 10 years old. I lived thousands of miles away but Mark and I were able to foster love of reading even as time and family life increased the distance between us. Even when we exchanged harsh words and fought bitterly - we would come together over a book recommendation. We did not have many books growing up. We really got into reading during our teen years. I would say it was out of necessity that we read books. No one else understood us - we knew we were very awkward, lonely and misunderstood. But with reading books, we somehow felt understood. And I think that’s why despite the many traumatic events in our childhood and the chronic feelings of isolation and self-doubts, and despite how much it has affected our health (his kidneys, my breast), we were able to sustain resilience and managed to have families and give love to those around us - basically overcome many terrible traumas against all odds. I disclose this because after all these challenges, I didn’t think I had it in me to be a parent. But now that I have my two boys and have homeschooled them for 6 years, I realized that the part of me that was saved - the girl who somehow found joy reading classical books, starting with the Bible - that girl continues to survive and thrive and even became a mother of two boys! What a miracle that is. I am extremely grateful for this opportunity. And of course this is not to say that I do parenting perfectly - no one does - although a lot of books would tell you there is a perfect way. I am pretty sure that there is no perfect way to do this and even if somehow one achieves it, the outcomes are not guaranteed anyway. But I do think that fostering the love of reading in children - regardless of whether you are a parent or not, is a necessary part of helping them develop resilience and grit for the struggles and trials of life. And of course I would argue that the quality of the books matter. I subscribe to the Charlotte Mason way of teaching and she definitely had opinions on good literature and what she called “twaddle” - poorly-written books that do NOT provide quality reading material. Read real, living books - books that have stood the test of time. Books that are beautifully written. Point to the words and recite them with emotion and passion to your kids. Boy, I could go on and on about how fun it has been to read with my boys. Here are some articles that support the idea that reading increases resilience in kids - especially boys. And there are a lot of concerns that kids are falling behind in reading nowadays, especially boys. So hopefully these articles will convince some people to read to the kids around them as often as possible - even if the kids are struggling with reading. Read to them instead - beautifully written poetry, novels, newspaper articles, etc. I have plenty of advice/recommendations but the best source is your school's English/Language Arts teacher. IMO, they are the family physician equivalent of teachers. Another good discussion for another blog post. https://www.sciencedaily.com/releases/2022/03/220308102826.htm https://www.sciencedirect.com/science/article/abs/pii/S0145213421003707?via=ihub https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8898035/ My other goal for this blog post was going to highlight the services I do for my patients and as usual, extol the virtues of being a family physician - the jack-of-all-trades physician - the best kind :). One of the main services I can offer patients is PRIMARY CARE. This means that you can come to me for advise on a myriad of things like rashes, (I love diagnosing rashes) and at the same time talk about how you can incorporate an evidence-based, healthy lifestyle into your daily routine while also reviewing what can be done about your anxiety and depression, back pain and type 2 diabetes and high blood pressure and I could even do some in-office procedures like wart removal, skin biopsies and pap smears, even laceration repair. I do my best to partner with patients so we can avoid medications, expensive tests and gimmicks, i.e. seemingly “healthy” fads that are just really trying to get your money but you may as well sprinkle fairy dust all over yourself. We can do this at one visit or spread it out as you wish or check periodically with each other so that we are on the same page about your health goals. All of this at a very low price of $85 per month for adults, $50 for kids. And once I have achieved my goal number of “founder patients”, the price per month for primary care for adults will increase to $95 (which is still quite a deal). I can also provide specialty types of services at a higher monthly price but it also includes primary care. I will give more information about these for those who are interested - the best way is to have a free, 15-minute non-medical appointment with me to discuss. A bit of a disjointed post - I have been waffling at making all of these posts “perfect” but to round back into the idea that there is a perfect way to parent or a perfect way to be a sister to brothers thousands of miles away - I am going to let that all go and encourage myself and others to just do our best to love and read to our children. And there is no perfect way to blog. I am trying to be lupine - and that does not mean perfect. As usual, if you have any comments or feedback or blog post ideas, please email them to hello @lupinemd.com . Sincerely, Dr. Hendrick © 2023 Angela C. Hendrick

Off in the woods in the quiet morning a redbird is singing and his song goes out around him greater than its purpose, a welcoming room of song in which the trees stand, through which the creek flows. ~ From Sabbaths by Wendell Berry Dear Reader, (For millennials - TLDR: growth => change => action). Advance happy Earth day, everyone! I believe I am at week 7 of solo practice and things are getting settled in at Lupine Family Medicine. I have a little pharmacy. I have 10 established patients! Six of them are brand new to me and the other four I have known before my business. I have 9 more who have registered to be my patients but have not had their first appointment yet. I am hoping to have them all scheduled by next week. Something that has been surprising with starting my practice/business: I have had 3 very nice people apply to work with me - and I have NOT posted for any position yet! And they are extremely wonderful human beings. I am looking forward to being able to afford hiring them - so the sooner I have 60-100 patients, the sooner I can hire these wonderful people. I am hoping to hire an office assistant by summer to help me with clerical work. Then eventually add a care coordination nurse once I am at 200 patients. One announcement that potential patients may want to know: my first 100 patients - my “founder” patients - will have the current pricing of $85 for adults and $50 for kids. After my first 100 patients have established, pricing will change to $90 for adults and $55 for kids while my founder pricing will stay the same because these patients took a chance on me and I greatly appreciate it! I will soon start marketing my practice in a more systematic manner. I apparently made mistakes with my first two weeks’ attempt at Facebook ads because I had unknowingly been advertising to the ENTIRE United States. Thank you to the very kind and tech savvy people Wenatchee Insurance Agency ; they helped me figure this out. If anyone wants to help me with marketing in Facebook and Instagram - for free - please let me know. I have attempted a couple of times and felt like I wasted 2 hours of my life so I have not wanted to attempt again. Thus, I’ve decided to try the old-fashioned way of advertising. Two days ago, I sent in a press release that a couple of friends helped me write to local news people and have not heard anything back. If anyone knows anyone at our local news, I would appreciate your help! As for my clinic itself, there are only very few things left to do such as move in my giant ficus plant that I bought when I started my family medicine residency in 2007. I had just graduated from medical school and was 25 years old. The plant was about 6 inches tall then. Now it is probably 9 feet tall! It is the photo for this blog post with my medical school diploma in the background. It’s currently taking up room in our tiny home office that doubles as a closet for boys’ toys and stuff that doesn’t belong anywhere. And speaking of diplomas, I had copies sent from my university and I had it professionally framed but it is still being worked on. I did not know it would take this long. Hence, my clinic walls are still bare. But the good news is because it has taken so long to get these diplomas framed, I am being given a huge discount for them. (There are lots of bills when you are a business owner; any discount is appreciated.) When I look at my ficus plant and its growth, I think of my own growth as a person since being a student for what seemed like a very brief time though it took 11 years from college to the end of residency to be a family physician. Through that timeframe until now, there’s been an amazing amount of changes in myself - similar, seemingly seismic changes in the world - an example below: me: approval addiction (college and med school) => imposter syndrome (life as an attending/mom/wife) => cultural humility (summer of life) world communications: AOL => texting/cell phones => social media/smartphones to Chatgpt - whatever that is and whatever it is going to do to the world. The practice of medicine has completely changed as well - the electronic medical record is ubiquitous and data mining from this is becoming the goal of pretty much everyone in the medical industry; except for the patient and the doctor. For me, and for a lot of physicians, the goal is still to take care of another human being by using the science and art of medicine. And by starting my own practice, I hope to keep it that way. Now that I’ve updated about where I’m at and where I was before I started, I’d like to announce what my next few blogs and FB posts will be to keep myself accountable to keep writing blogs/posts because they still will not write themselves for me. And I promise this: this blog will always be written by a human! The next blog posts will be about my services at Lupine, something about what philosophies/art influence how I practice as a physician, and why is it called Lupine part II. And as always, dear reader, if you have any blog post ideas or feedback about all the stuff I am writing here or just let me know that someone else is actually reading these posts other than my husband, please send me a message at hello@lupinemd.com . Sincerely, Dr. Hendrick © 2023 Angela C. Hendrick

Do not dread the disease that stalks in the darkness . Psalm 91:6 NLT Dear Readers, There are no words for the excitement (and terror) on this day: Lupine Family Medicine's opening day and my commencement as a solo practice physician. So I will turn to Latin and Dr. John Stone - one of my most favorite physician poets. This is one of the poems he wrote for a medical school graduating class years ago at Emory University. The poem is called Gaudeamus igitur which means “therefore let us rejoice”. According to Wikipedia , it was the title of a popular song for university ceremonies during the Middle Ages. It was also known as De Brevitate Vitae, “on the shortness of life”. I feel Dr. Stone’s rendition really captures the joy, the pain and the beauty of becoming and being a physician. Gaudeamus Igitur For this is the day of joy which has been fourteen hundred and sixty days in coming and fourteen hundred and fifty-nine nights For today in the breathing name of Brahms and the cat of Christopher Smart through the unbroken line of language and all the nouns stored in the angular gyrus today is a commencing For this is the day you know too little against the day when you will know too much For you will be invincible and vulnerable in the same breath which is the breath of your patients For their breath is our breathing and our reason For the patient will know the answer and you will ask him ask her For the family may know the answer For there may be no answer and you will know too little again or there will be an answer and you will know too much forever For you will look smart and feel ignorant and the patient will not know which day it is for you and you will pretend to be smart out of ignorance For you must fear ignorance more than cyanosis For whole days will move in the direction of rain For you will cry and there will be no one to talk to or no one but yourself For you will be lonely For you will be alone For there is a difference For there is no seriousness like joy For there is no joy like seriousness For the days will run together in gallops and the years go by as fast as the speed of thought which is faster than the speed of light or Superman or Superwoman For you will not be Superman For you will not be Superwoman For you will not be Solomon but you will be asked the question nevertheless For after you learn what to do, how and when to do it the question will be whether For there will be addictions: whiskey, tobacco, love For they will be difficult to cure For you yourself will pass the kidney stone of pain and be joyful For this is the end of examinations For this is the beginning of testing For Death will give the final examination and everyone will pass For the sun is always right on time and even that may be reason for a kind of joy For there are all kinds of all degrees of joy For love is the highest joy For which reason the best hospital is a house of joy even with rooms of pain and loss exits of misunderstanding For there is the mortar of faith For it helps to believe For Mozart can heal and no one knows where he is buried For penicillin can heal and the word and the knife For the placebo will work and you will think you know why For the placebo will have side effects and you will know you do not know why For none of these may heal For joy is nothing if not mysterious For your patients will test you for spleen and for the four humors For they will know the answer For they have the disease For disease will peer up over the hedge of health, with only its eyes showing For the T waves will be peaked and you will not know why For there will be computers For there will be hard data and they will be hard to understand For the trivial will trap you and the important escape you For the Committee will be unable to resolve the question For there will be the arts and some will call them soft data whereas in fact they are the hard data by which our lives are lived For everyone comes to the arts too late For you can be trained to listen only for the oboe out of the whole orchestra For you may need to strain to hear the voice of the patient in the thin reed of his crying For you will learn to see most acutely out of the corner of your eye to hear best with your inner ear For there are late signs and early signs For the patient's story will come to you like hunger, like thirst For you will know the answer like second nature, like first For the patient will live and you will try to understand For you will be amazed or the patient will not live and you will try to understand For you will be baffled For you will try to explain both, either, to the family For there will be laying on of hands and the letting go For love is what death would always intend if it had the choice For the fever will drop, the bone remold along its lines of force the speech return the mind remember itself For there will be days of joy For there will be elevators of elation and you will walk triumphantly in purest joy along the halls of the hospital and say Yes to all the dark corners where no one is listening For the heart will lead For the head will explain but the final common pathway is the heart whatever kingdom may come For what matters finally is how the human spirit is spent For this is the day of joy For this is the morning to rejoice For this is the beginning Therefore, let us rejoice Gaudeamus igitur. I would love to hear responses about any of the posts here, so please email me comments and also send blog post ideas to hello@lupinemd.com . Sincerely, Dr. Hendrick

Above all else, guard your heart, for everything you do flows from it. Proverbs 4:23 Dear Reader, I am ALMOST ready and it is unnerving that I chose February as the month before opening when it’s the shortest month of the year and we are officially halfway through it. The good thing is that I anticipated and planned to start slowly. Make sure all the small and big details are accounted for so I can for sure see patients starting March 1st - in 14 days! I have had a run of patients I am treating on my telemedicine job for panic attacks and each time I think about having one of my own, it doesn’t come. I think my anxiety manifests a little differently. I think I end up distracting myself with other things like the water leak that happened in our laundry room. Thankfully that happened two weeks ago and I fixated on that. Also, I am homeschooling my children so that also keeps me busy. Then there has been a lot of sunshine in Wenatchee so I dream of seedlings and gardening. Then I realize, oh dear…I have 14 days to open my clinic. I thank God everyday for my husband - he is the calm antidote to my anxiety. Aside from a glimpse into how I deal with anxiety, this post is mainly an update. I have finally secured the discounted pricing I wanted for my patients for send out lab tests. I have been waiting to post the pricing to make sure it’s right - there are 293 pages of labs to sort through! But basically, I am able to offer around $5 per test for the most common lab tests if patients do not want to use their insurance, or they don’t have insurance, or their insurance will make them pay for most of it anyway. I’ll post it once I have it all organized into a page. I have also been trying to figure out how much test tubes to order and other lab draw supplies. I even got my very own centrifuge and autoclave - for FREE! I am waiting to see how much of a discount I can get patients for common medications. I am very enthralled that supposedly, I can get pricing even lower than Walmart’s! We shall see after my meeting with the vendors. My hope is that my patients will find value in not having to go to the pharmacy for common medications - I can just dispense to them directly. For example, you have a UTI or your child has a bacterial ear infection - do you really want the hassle of having to wait at the pharmacy to get these dispensed? And sometimes the patients get to the pharmacy and find out the prescription did not get sent there or it’s the wrong dosing, etc. How annoying right? You can just see me, your physician, and if I think you need a medication, I just hand it to you during the visit. I talked a lot about health insurance last blog and how it looks from a doctor’s side of things. The past 3 months I have slowly been learning about other insurances: business/liability, medical malpractice and umbrella. So many things that I have never really thought about. There is insurance for every situation! In any case, I finally secured my medical malpractice insurance. I thought it was going to take a long time and that it would be excruciating - like buying a car or trying to sort out mobile phone plans (some of the things that I highly avoid like the plague). After 15 years as a doctor, I have never had to pay for malpractice insurance so I was nervous that it was going to cost me a lot or be complicated to get. I found out that it’s actually pretty cheap - compared to the other stuff I’ve had to pay for to get started. And all I had to do was send in some information about me and my previous practices and voila - I am covered and can see patients on my own - without any employer hanging over me. It’s very liberating! I can quit my job now and just rely on hiring my own self. If you are a medical student or a resident or a fellow doctor who is thinking of starting their own practice, I am happy to walk you through my business plan anytime and let you know about sorting through all this insurance stuff. As for the quote from the Bible above - I thought it fitting because February is American Heart awareness month. This is when everyone from the CDC to the American Heart Association and your local doctors urge you to pay attention to your heart and do all the things to prevent heart disease. Hopefully you end up doing it for the rest of your life, not just for the month. https://www.heart.org/en/around-the-aha/reclaim-your-health-during-american-heart-month-in-february Even though it’s such a short month, and again - we are halfway through it, it is overloaded as an awareness month. There are also a lot of notable birthdays in it so I presume that’s why a lot of “awareness” stuff happens this month. For example, it is also Black History month. My boys and I often read or watch a biography about black historical figures for our social studies class. Last year, we read a lot about George Washington Carver. I think this year we may read some Maya Angelou poems. Here are the notable birthdays in February: (disclaimer - I got this info from google). Frederick Douglas – February 1 Langston Hughes – February 1 Elizabeth Blackwell – February 3 Rosa Parks – February 4 Thomas Edison – February 11 Abraham Lincoln – February 12 Susan B. Anthony – February 15 Audre Lorde – February 20 Sidney Poitier – February 20 John Lewis – February 21 Nina Simone – February 21 Steve Irwin – February 22 W.E.B. Du Bois – February 23 So then here are some other holidays/awareness days celebrated during February: National Women Physicians day Feb 3rd World Cancer Day Feb 4 Valentine’s Day Feb 14 President’s Day Feb 20 World Bonobo Day – February 14 World Hippopotamus Day – February 15 International Childhood Cancer Day – February 15 Random Acts of Kindness Day – February 17 World Pangolin Day – Third Saturday in February The Great Backyard Bird Count – Third Sunday in February World Whale Day – Third Sunday in February World Day of Social Justice – February 20 International Polar Bear Day – February 27 Rare Disease Day – February 28 World Encephalitis Day – The last day of February The part where it’s Valentine’s day has again escaped our household because to be perfectly honest, I am in the camp where I think it’s a day that causes heartache and tooth decay for a lot of people. I rather like all the other stuff that is being celebrated in this overloaded month. How do you celebrate February? I would love to hear responses about any of the posts here, so please email me comments and also send blog post ideas to hello@lupinemd.com . Sincerely, Dr. Hendrick

Light cannot see inside things. That is what the dark is for: Minding the interior, Nurturing the draw of growth Through places where death In its own way turns into life. ~John O’Donohue - To Bless the Space Between Us Dear Reader, Based on my last blog post, that is if you read it, it may seem that I am anti-insurance. That is not true, though. As someone who has gone through breast cancer treatment (surprise diagnosis 2019 while I was training for my first marathon), I am deeply appreciative of the health insurance we have through my husband’s work. (TL:DR - paying for health insurance to pay for mundane health issues is causing a HUGE problem! No surprise - antidote?) I definitely recommend having health insurance! Just like our home and car insurances, it’s obviously helpful in case there are emergencies or life-threatening illnesses like cancer or cardiac arrhythmia. Apart from that, most people are probably like me - we avoid going to the doctor unless we absolutely have to, or if we take our responsibility to our health seriously, we go when we need to have health maintenance checks, preventative screening and minor symptoms that may eventually become a problem. Much like a car, we need a regular check up. Some cars chronically leak oil like some people have chronic diseases like high blood pressure or diabetes or chronic pain. So a lot of times, some cars need to see their mechanic at least 2-5x a year for these things along with maintenance checks and we all pay the mechanic directly and we do not ask our car insurance to get involved. (And this is where we end the car metaphor because unlike my husband, I have no idea what fixing a car entails). But unlike a car, when we need a doctor’s visit for minor dings like a laceration or a wart or routine maintenance and check ups for chronic diseases (non-emergency type health care), it has been ingrained in our health care system that we ask our health insurance companies as a third party payer for these types of visits. Why is this a rule? And is it beneficial? To whom? Does it make sense? Does it cause enough problems that perhaps we should rethink it? What I have experienced as a family physician in this system is this: health insurance companies basically tell patients which clinic/doctor to go to, what pharmacy and what medication they should have and which specialist they can go to IF approved. They also tell physicians that patients need such and such a medication before another medication is covered or must do this thing first before another test can be ordered. Health insurance companies also dictate how much they will pay for each visit, each medication or procedure. None of the doctors dictate this. In fact, when I was at my regular job, I never had any idea how much any of the visits, tests I ordered or procedures I have done. No doctor has ever said: hey, let’s charge this patient a $20 copay each time they are seen, and oh, please send them a bill 3 months later for the 20% that they owed plus the deductible and make it so that it’s hard to figure out what all the charges are for. If lucky, the patient will have a nice health insurance through their work and their maximum out of pocket expenses will be affordable enough. But because we depend on third party payers for primary care, costs have gone up to a range that is both illogical, complicated and unaffordable. For example, a regular 15- minute doctor’s visit is averaging $100-400 without insurance. If you want to discuss your back pain along with your high blood pressure, weight and depression, it may go upwards to $400-500 for a 45 minute visit if your doctor can spare the time. Why are prices going up? The answer is another long blog post but a sort of snarky but probably true answer is this: insurance companies and hospital administrators need more administrators to keep billing each other and more administrators to tell patients and doctors what to do to keep the process standardized and streamlined with the aim of reducing costs and making a profit! Because clinics have had to battle insurance companies on being paid for these visits, they’ve had to raise the price or cut lose the insurance company and so then patients are left scrambling because their health plan no longer contracts with that clinic and thus are told their doctor no longer accepts their insurance. What is the solution? At a minimum, what going through a pandemic as a society should have taught us is that there are never standardized, simplistic solutions to challenges that arise in which the outcome is greatly tied to personal responsibility, luck and privilege. When I was a young, idealistic medical student - I would say - yes, universal health care will fix ALL the problems. What I can say now is that I do not think it is that simple. What I would say is we ought to have universal coverage for emergencies/life-sustaining specialty care, much like we have an awesome fire department if our house is ever on fire. (Holy smokes, this happens a lot in Wenatchee!) But for the everyday, mundane things (PRIMARY CARE) - like an oil change for a car - should we rely fully on third party payers? I don’t think it’s working that well for the patient or the primary care doctor (unless they have really good boundaries or don’t care much). It just doesn’t seem right to collectively rely on corporations for issues that require personal responsibility, honesty and autonomy: health care. Right now, what’s become glaringly obvious is there are not enough primary care doctors to go around so they are basically being replaced by NPs/PAs who are also getting burned out. Meanwhile, patients are unable to get their health maintenance visits and are scrambling to get their refills or just get checked for minor ailments before they become life-threatening. Or they end up doing DIY medicine and gimmicks from Dr. TikTok. At the same time, many companies and private equity funds are mining the chaos this causes with millions of dollars because a broken system causes a LOT of profit. And no way they will want this fixed. For more info - see the Shkreli Awards from the Lown Institute - the top ten list of the worst examples of profiteering and dysfunction in healthcare. Is there a solution? There are tiny solutions that all need to happen and it begins with the patient and behavioral change. (We are all patients and the best offense is a good defense). Some of this: eat right, reduce intake of processed foods, exercise, reduce nicotine, alcohol and other substance use, exercise more. Be civil and respectful to each other (it causes a lot of unnecessary stress not to be). Make sure you have adequate health maintenance visits with your primary care doctor and avoid gimmicks and misinformation. Consider a high deductible health plan and health savings accounts to manage your health care bills. Disclaimer: I barely know anything about business, accounting or health economics. Please don’t take financial advice from me. There are other solutions - probably right under our noses. Right now, I truly think independent medical practices that nearly went instinct are making a come back because I think they are part of the solution. In any case, that is why I am here. I had the choice to return to this disarray and actually have a very profitable, comfortable career and retire at 50 with loads of money. It is extremely easy for physicians to make money - just keep the current system going. But instead, I am choosing to start my own practice that does not depend on health insurance companies: direct primary care. Not because I am overflowing in virtue. See my previous blog posts as to the big reasons why. I thank you for your consideration of this letter. I would love to hear responses about any of the posts here, so please email me comments and also send blog post ideas to hello@lupinemd.com . Sincerely, Dr. Hendrick

Disclaimer /disˈklāmər/ noun: disclaimer; plural noun: disclaimers a statement that denies something, especially responsibility. All generalizations are false; including this one. ~Anonymous Dear Reader, I hope you are enjoying your holiday season and staying healthy! With all the stuff that goes with the holidays, I am sure you have seen disclaimers everywhere, especially when signing up for something new or purchasing things and signing up for protection/insurances for those items. I avoid doing these like the plague. Like most people, I deeply dislike disclaimers. For example, see the quote above. But then it is also one of my favorites. I would like to end the year with my own disclaimer for the blog: Never think that this blog is meant to answer your specific medical questions. It will not, I promise you. Instead, go to a trusted physician to discuss them. And as for Drs. Google or Tiktok - they are mostly for entertainment; maybe helpful in some circumstances where patients find what things they want to be reassured about. But remember, when the excrement hits the proverbial fan, they will not be around to help you. That should be their disclaimer. This blog is simply what I hope to be a record of my adventures as a physician at Lupine Family Medicine while being a mom and homeschooling two boys, a wife to a firefighter and a citizen in this wonderful place called Earth! I have been learning what it means to be lupine in the current health care environment now that I have endeavored to start my own practice. An update on my start up progress: my office is now looking presentable and I am able to give tours to prospective patients. The only things left to do to open are to finish purchasing office supplies and equipment plus getting my patient agreements set up with a lawyer and paying for my own malpractice insurance. I hope I get all of these done before March 1st - projected opening day. And lastly, because many people are going through this month figuring out what is best coverage for their health insurance, check out the generic disclaimer from health insurance companies: Insurance Disclaimer: “A quote of benefits and/or authorization does not guarantee payment or verify eligibility. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member's contract at time of service.” In the meantime, we are supposed to pay the monthly premium of $560 - average cost. Much higher if you want a lower deductible. (What the heck is a deductible. It took me a year after I graduated from medical school to understand this concept. I'd like to think it's because it's conniving and doesn't make sense). And what does that get us? If it’s a “good” insurance company, it will cover our basic health care costs and emergencies. But wait, we need to pay the out-of-pocket maximum first which includes copays and the deductible. And then no worries, we are now completely covered. Also, we can only go to the doctors that the insurance company is contracted with. Oh and also the pharmacy that they are contracted with. Oh and also the formulary. Oh and also, who is a good insurance company? Is there one that is local and not owned by a faceless private equity firm? And is not taking millions of dollars of taxes we have paid to the federal government and turned it into a private companies that administer Medicare Advantage plans that over-code and make their members look sicker so they can collect more money and drive up costs of insurance? Who came up with this stuff? It is a genius money-making machine - and it is completely legal? So taking the data from Dr. Google below, and we want to pay for the BEST insurance company - the GOLD plan - for an individual person - we have to pay $10,000 per year to have full insurance coverage. So, now that we are covered - shall we make an appointment with the doctor? How long does it take you to see your doctor? Once you see your doctor after the 6 weeks you waited for the appointment, how long do they spend time with you? What are they doing outside of the 15 minutes they are allotted to see you, in addition to the other 20+ patients in the ir schedule ? $6,921 for Bronze plans, $4,816 for Silver plans, $1,641 for Gold plans, and $0 for Platinum plans 2023 out-of-pocket maximum cannot exceed $9,1000 for an individual plan and $18,200 for a family plan Just a plug for my little clinic: it will cost a family of 4 (2 kids and 2 adults) $3,240 per year to have a guaranteed physician taking care of them directly - in the way that makes sense and is clinically indicated. There are no surprise bills - that is it. And this physician is not a faceless entity. She is a regular, tax-paying citizen of Wenatchee, WA who is fully invested in her community - which means she has NO disclaimers. To be lupine, she cannot disclaim the inherent responsibility in being a part of a community, in being a human. I would love to hear responses about any of the posts here, so please email me comments and also send blog post ideas to hello@lupinemd.com . Sincerely, Dr. Hendrick

Dear Reader, For the past two weeks, winter has come early and fully at our quirky, wooden house in the mountains. It is 5 am and like everyone who has been pummeled by snowfall, my husband is plowing so he can go to work and I listen to his labor as I type. I have been waffling between which blog posts I should complete and which to publish and in what order. I have had a lot of time on my hands yet am unable to work on the business start up due to ongoing challenges with recovering from surgery. The office itself has been fully remodeled, my exam table has been installed and the many supplies and equipment that have arrived need to be unwrapped and put away. For this post, I did not have the poetry nor a quote to go with it because this is the first post in which I did not know my destination before I finished. I feel a prompting to communicate an underlying story or concept and it has something to do with disclosure, empathy, the Thanksgiving aftermath, and the interim time that has been imposed upon the schedule of the business startup. Thus, even if I can’t fully wrap my head around it, I chase it and perhaps I will catch it and if not, I hope the chase goes well. (TL:DR - doctor thinks about disclosure while convalescing from surgery). I titled this post disclosure because I have been wanting to carefully incorporate the three main purposes of this blog which are: -record of my journey in solo practice -authenticity -encouragement to myself and readers And to set clear limits for myself against abject self-indulgence and unhelpful self-disclosure. Physician self-disclosure is an extremely under-studied subject. And I suspect it affects patient care more than most doctors would care to admit. A lot of what I have disclosed so far in this blog has come from intuition of how much to disclose to fulfill its motivation. Time will tell whether it was either useful or horrible. I have approached it in a way that is compassionate for myself. I think that physician self-disclosure is a way to communicate empathy and establish rapport that is clinically useful for the patient. At its worst, it has been used for injurious intimacy on both sides and unhelpful, self-indulgent narrative. It seems that there can be a very thin line between empathy and injury. I would like to “disclose” a very common patient interaction that is occurring by the millions right now in America after the many Thanksgiving dinners held across the country. But you MUST see it from two perspectives, dear Reader. The first is from a 25 year old newly-graduated physician who had no plans to marry nor have children and has spent the last 8 years of her life reading a lot of books and taking difficult exams. The second perspective is from a mom of 2 boys who has worked 20-80 hours a week taking care of patients, even during her pregnancy and weeks after postpartum, for 15 years. Picture this scenario: there is a patient scheduled for a 15 minute visit. It is about a child with an exhausted parent who tells the story that for the past 3 days, the child has been very congested and coughing, and can’t sleep at night and can’t eat much during the day because of this. The child is very irritable due to the hunger, thirst and fever that would come and go. And they sit across from me expectant, that I somehow had the power to rid them of this misery with just a stroke of a pen or, now that we’re in the 21st century, a click of a mouse. In the first perspective, you can imagine the awkward, clunky conversation that the physician will attempt: that this is a self-limited viral illness. And based on exam and history (fully vaccinated, no chronic medical problems, no signs of toxicity on exam, etc), that the child will eventually get better in 2-3 days. The treatment is continued monitoring and copious saline irrigation and suctioning of the nose, and as needed ibuprofen or acetaminophen for discomfort as well as plenty of fluid intake. There is no magic wand but time and close observation. In the second perspective, I can establish rapport in the space of less than 2 minutes by self-disclosure: I have had to wrestle my boys down with saline spray and suction their noses, too, and it is very scary to watch when their fever is so high and they look like they are having trouble breathing. And I can communicate with empathy and affirm the parent’s exhaustion and frustration due to missed work or holiday stress and expectations; and give them the prescription that this is the time for slowness, of letting productivity go in place of cuddles and close awareness of their sick child. There is a sense of kinship that can happen at this visit that is very powerful and I often can feel it when trust is established and the parent feels understood and is empowered and reassured. I will often call the parent myself in 1-2 days or have the staff do it to see how they are both doing. Of course there are variations that play out through all of these conversations depending on the patient’s background and medical history. But I have learned that establishing rapport effectively requires experience and disclosure. And I hope that in my solo practice at Lupine Family Medicine, I will be able to use my experiences as a mom and physician to guide my patients in their journey through health and illness and also to provide them evidenced-based care while affirming their difficult experiences. Thinking about what we do with the urge to communicate about our personal experiences and what we think we know leads me to think about the many subtleties in how disclosure is used in our society - in public and private spaces, and our expectations on what it should accomplish. In the case of physician self-disclosure, I don’t think it’s ever clinically useful to divulge anything that may make one seem exceptional or superior or different. And none of us are immune to this so we need to have awareness. I wonder if that is also true outside of the exam room, in public fora and social media, if the goal is truly to bridge divisiveness and curtail violence. I wonder what is lupine about all of this. I hope you all had a wonderful Thanksgiving, and that whatever sniffles and bugs that you caught after that will prime your immune system in the most awesome way possible and you get better quickly! Sincerely, Dr. Hendrick

Wisdom tells me I am nothing. Love tells me I am everything. Between the two my life flows. ~Nisargadatta Maharaj Dear Reader, Now that I have written about some of the main reasons/cascade of decisions that has led me to starting my own practice (whew), I would like to officially welcome you to my website and Lupine Family Medicine! I want to thank the handful of people who have read my blog posts! (This includes my husband) It is thrilling. I've had two "non-friend" folks reach out to me on the Lupine FB page asking when I will open. Again, thrilling. And that is projected to be March 1, 2023. Equal parts thrill and terror at that. Will I actually make overhead on this Lupine practice? I wish I could see the future. Right now I am just concentrating on recovering from a surgery where I had my other boob removed to make sure it doesn't try to kill me in the future as well. That is another blog post. For this post, I give the mundane details on how to be my patient. I hope there are at least 200 of you, somehow, in the next year or so. Schedule a free 15 minute non-medical visit with me to learn more about my practice and see if it’s a good fit for both of us. Email me at hello@lupinemd.com to schedule or call the office at 509.888.2200. I will even give you a tour of the clinic if time permits. This starts next month! Once you’ve decided to be my patient, pre-register and click on this link: lupine patient registration . This will take you to Atlas - my secure electronic medical record - where you can start filling out patient information forms. You will NOT be charged for anything until I see you for your first medical visit. Patients who pre-register will be given priority to be able to schedule their first appointment with me once the clinic officially opens. Why pre-register? I am only taking 3-5 new patients/families per week and planning a total of maybe 200-300 patients so there is very limited number of patients I will take. Medicare patients: if you have Medicare or will soon be getting Medicare insurance by 2023, you can establish care as my patient once I am able to opt out of Medicare (I will explain this at the free, non-medical visit and try to make a useful blog post about it). The only way I can opt out is IF I already have at least 50 patients registered. The more patients pre-register, the sooner I can opt out of Medicare so I can take care of you and your family! I hope to see you soon! I am working on my next blog posts which will talk about what services will be offered at Lupine Family medicine. I would love to hear responses about any of the posts here, so please email me comments and also send blog post ideas to hello@lupinemd.com . Sincerely, Dr. Hendrick

To see a world in a grain of sand And a heaven in a wild flower, Hold infinity in the palm of your hand, and eternity in an hour. ~William Blake: Auguries of Innocence Dear Reader, You might be wondering this: why would a doctor name her practice after the wildflower lupine? (Millennials: TL,DR - doctor names it lupine = wolfish or wolf-like => makes ecosystems that are struggling actually thrive, not the other way around). Lupine is a native and common wild flower in the western US. It is named after wolves; the scientific name for wolves is Canis lupus . Why would a physician name her practice after a plant named after a wolf? People used to think that lupine overpowered other plants; that they robbed the soil of nutrients so they were thought of as “voracious” like wolves. Now, it is known that lupine is a type of legume. This plant can grow on very poor soil and actually fix nitrogen to the soil and make it healthier for other plants to grow! Wolves have traditionally had negative representation in literature and agriculture, i.e. the big, bad wolf. However, a lot of scientific data has emerged that wolves are a “keystone” species. A specific example is when gray wolves were re-introduced into Yellowstone National Park in 1995 after being almost extinct. It resulted in a cascade of well-being for the overall ecosystem, some of which are: healthier elk herd, more berries for bears, more trees for songbirds, more beavers to build dams for fish, amphibians and otters to swim in, and cleaner water for all; plus money for the tourism industry. So, how does this somehow connect with health care? Because of the prevailing thought that health insurance means you have health care, a lot of people’s first reaction is WITW?! (what in the world) What in the world is direct primary care and why would I pay a monthly fee to see my doctor when I already have health insurance for that? Because health insurance is NOT health care. But if you google health care, what does Dr. Google say? It gives you a concantenation of results about health insurance companies… Where are the nurses, doctors and health care team? Hence, like the re-introduction of the nearly extinct gray wolf to a national park, a re-introduction of the old school way of practicing medicine has to happen in order to enrich this wasteland we call our health care system. The old school way was this: doctors saw their patients and took as much time as was needed to take care of them and patients paid their doctors directly for their services. The prices of services were completely transparent and there were no surprise bills. This old school way is now being called an “innovative” way to practice medicine - Direct Primary Care. In this way, patients and physicians are un-shackled from the time constraints and paperwork that is produced by corporations and administrators. The visits become only about medical care, period. This also simplifies the payment system and creates an honest and transparent way to practice medicine. There will be many more posts about DPC. And you can also read about it in the FAQ in Lupine’s website. And IMO, there is a place for health insurance in health care - i.e. catastrophic illnesses and expensive but necessary specialty care. Just like we all pay our taxes to have our fire department, police department and military to all protect us during a fire, a riot, foreign invasion, we should have a national, fully funded catastrophic health care insurance for when there is a major health emergency and a public health department to be fully funded during major pandemic emergencies. It is our right as tax-paying citizens. Obviously, I digress to another blog topic. Two things I would really like to end with is this - would you like to know what Dr. Google is especially good for? Googling the meanings of flowers. And here is one of the results for lupine that you must read: https://flowerfabulous.com/meanings/lupine-flower-meaning/ The second thing is for you to watch this beautiful video about the wolves of Yellowstone: https://education.nationalgeographic.org/resource/wolves-yellowstone I hope you are having a wonderful day! I would love to hear responses about any of the posts here, so please email me comments and also send blog post ideas to hello@lupinemd.com . Sincerely, Dr. Hendrick © 2023 Angela C. Hendrick

We see you, see ourselves and know That we must take the utmost care And kindness in all things. Breathe in, knowing we are made of All this, and breathe, knowing We are truly blessed because we Were born, and die soon within a True circle of motion, Like eagle rounding out the morning Inside us. We pray that it will be done In beauty. In beauty. ~Joy Harjo: Eagle Poem Dear Reader, In the first blog post, I hope I was able to clearly communicate why I wanted to be a physician. In this second post, I will share why I wanted to start my own practice. (For millennial readers: TL,DR - doctor undergoes cancer treatment during the COVID pandemic and finally has time to re-evaluate her life goals). Like most people, I’ve dreamed of doing brave things. And there are people who have the privilege to do it but take it for granted. Or more often, we just do not have the courage nor the time nor the opportunity, or all three. But strangely, the years 2019-2022 happened to me and I was granted all of these. I had heard about direct primary care (DPC) in 2012. Occasionally, I would let myself dream of starting my own practice. It’s what a lot of people would think is the “old school” way of practicing: the patient pays the doctor directly for services provided and there is no insurance involved. It is truly just between the patient and the physician. I thought it was a very beautiful and honest yet practical way to practice medicine. It made a lot of sense to me. (More on this on my next post.) But I never thought having my own practice would actually happen because of several reasons: Most doctors are like me. We know NOTHING about running a business. I loved my current patients and liked working where I was, and was secure in making a good salary with a great retirement program and other benefits. I was too busy balancing being a mom and working, who has time to figure this out? I still struggle with self-confidence on a regular basis. Basically, I didn’t think I had the guts. During the first COVID quarantine on March 2020, I had just started my second month of one of the most intense chemotherapy regimens in medicine for my surprise breast cancer diagnosis of 2019. I was also grieving the loss of my adoptive dad - a painful death from esophageal cancer. I had been working about 2 days a week throughout my treatment until my boss told me it’s probably unsafe for me to keep seeing my patients, especially with the shortage of protective equipment once the pandemic started. My work accommodated for me to do online tasks for them. I then found out a few days later that I also had to homeschool my children. Thus began the year of staying home 24/7 with my boys, except for my chemo days when I went to the cancer clinic to get my bloodstream infused with extremely toxic medications that would hopefully help the cancer stay away so I would live longer than 38 years old. It would also make me more prone to severe COVID, neuropathy, leukemia, heart disease, etc. It was a year of very tough decisions, to put it mildly. It would seem that this time of toxic medications and isolation should just be full of pain and despair. Yes, there was so much pain. But I also found this time of my life to be one of the most blessed, beautiful and peaceful. It was truly the height of privilege. I took daily walks with my boys in our little mountain. I actually slept at the same time and woke up with my husband daily. I read a lot of wonderful literature that I have been putting off. I read the Bible and poetry. I made fresh bread regularly. There was silence, fresh air, gardening and so much love. I breathed and breathed and breathed - It was wonderful. I started to see what I had kept buried under all the busy work of medicine and mothering. There was so much pent up resentment and ugliness within me that would emerge as I dealt with all the unnecessary tasks that were connected with my work as a physician. I finally admitted to myself that I did not love my work anymore. That it no longer provided the meaning and the beauty that my idealistic self had envisioned many years ago. Even though I knew a lot of people were experiencing the same thing - especially fellow health professionals, it took me some months to get through the shame of admitting this. Each day I had to work, I would feel rage build up when I would see how much was left in my “inbox” - a conglomeration of tasks that are sent to the physician in the computer on a daily basis. Some tasks were meaningful and helpful for patients and I got those done quickly. But a lot of the tasks were commands from insurance companies: put this patient in a cholesterol medication (even though it’s not indicated based on patient’s history/preference), switch this patient’s medication to something else because the formulary was changed for no reason all of a sudden, sign this extra document with lots of verbiage for unknown reasons when the order for service has already been signed, etc, etc, etc. All health professionals know about this refrain. All of the these tasks, on average, multiplied x 100 on a daily basis amongst lab results, consults and other paperwork that come across our screens. And it’s not just the tasks in the “inbox”. In primary care, we are supposed to get to know 1500-2500 patients and see 18-25 of them per day and incorporate all of this into the complex interplay of the patient-physician relationship and provide medical care that is compassionate and evidence-based in a span of 15 minutes per patient. In each of these visits, doctors are expected to also enter data so that insurance companies can be billed and data could be analyzed by administrators. This often reduced the 15 minutes allotted for a typical primary care visit to 7 minutes with the patient. Our charting was no longer about the patient’s story; and our time with them was also no longer theirs. None of this is an exaggeration. You may ask all health professionals and they will tell you the same thing. And yet I kept doing it. Why? The pandemic and cancer allowed me to have the time to say to myself: the job of a family physician in the context of the current health care system no longer makes sense. I have to stop making excuses, feeling afraid and ashamed, and do something about it! This painful time of my life ultimately gave me the permission and the pathway to do what I really wanted to do: start my own practice. I had the time to read about the business of direct primary care. In between the hours when I was not homeschooling my kids, I could work online and see patients on my own schedule. I then could raise the money for my business. And going through the diagnosis and treatment of breast cancer, the profound grief I experienced in the possibility of not seeing my children grow up, and facing the heartbreak of the deaths of my dad and then my brother - how much more courage could I possibly need to stand up to this system that is broken and is continuously causing more brokenness in my patients and fellow physicians? How much more courage do I need not to return to the current system of health care and finally give myself the chance to be the physician I have written about in my application to medical school? And that is how I decided. I do have the courage to start a new adventure called Lupine Family Medicine. Health care that makes sense. I would love to hear responses about any of the posts here, so please email me comments and also send blog post ideas to hello@lupinemd.com . Sincerely, Dr. Hendrick © 2023 Angela C. Hendrick