But I’ll let you decide.

After all, who am I to partake in such matters of vocabulary?

My job is to present the facts.

Thanks to Dos Equis, you are familiar with The Most Interesting Man in the World.

And thanks to me, you will now be familiar with The Quirkiest Man in Upstate New York.

I found this gentleman by chance on Instagram.

Or was it at the doctor’s office he works in—as a doctor?

Regardless, you may know that those of us who don’t live in the grand metropolises of this country take our gas stations seriously.

Buc-ee’s anyone?

But we don’t have those up North.

That’s why The Quirkiest Man in Upstate New York has opted to spend his free time at Speedway.

A quick look suggests the fellow is Indian, perhaps having grown up on the subcontinent.

But his alimentary pursuits have clearly introduced him to the joys of packaged American food—and gas-station beverages.

I once received a DM from the dude admonishing me for not having downloaded the Speedway app. That endeavor, apparently, would have earned me a free six pack of Heineken 0.0.

But I digress—this isn’t about me.

The Indian man, upon inspection of his Instagram account, has taken to posting frequent pictures of himself at Speedway.

The first was on March 9, 2026. There he stood, smiling, in a suit, holding a mug presumably full of gas-station coffee, as suggested by the soundtrack of “Coffee Time” by Natalie Cole.

Whether due to fatigue or genuine love, he appeared to be leaning on a rack of coffee-related paraphernalia.

Behind him were beer, Doritos, and Trolli gummies.

Clearly in his element, he—or his social media manager—wrote in a cursive-like script: @Speedway..Penfield, NY.

View this post on Instagram

The next day, in a similar pose in essentially the same spot, he took to highlighting the $1 ANY Size Hot Refill sign, a reference again to his cup of joe.

Of course, as New York State requires a cut, that translated to $1.08 (including sales tax), indicated in the cursive-like text. But the key element here was the number 108, a multiple of that price, noted at the top.

The Quirkiest Man in Upstate New York went on to list several references to this number, some in sacred Hindu texts, others in Buddhism, and even a couple in the Milky Way. All this was to a soundtrack entitled “Om Chanting 108 Times.”

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In a Taylor Swift-like move, no overt mention was made of what was to come, but fans—in a frenzy of anticipation—knew something big was on the horizon.

Lo and behold, the next day came the much-anticipated answer—a series!

108…Part 2 was shot from a similar location and presented equally interesting 108-based facts, the soundtrack being a possible shout out to Angkor Wat.

View this post on Instagram

Many expected that after Part 2 would come Part 3, but The Quirkiest Man in Upstate New York opted to jump straight to Part 4, where he reminded fellow Speedway enthusiasts that 108 is an emergency telephone number in India.

View this post on Instagram

Next came not Part 5 but Part 6, notable for a 108-centric Irish reference in honor of St. Patrick’s Day, an Irish tune, and a different location within the Speedway (or was it another Speedway altogether?).

View this post on Instagram

The narrative, by this point, should be starting to approximate clarity.

Not one for spoilers, I’ll allow you to explore the rest of the series at your leisure, the actual posts (and tunes) doing far more justice than these CliffsNotes-inspired summaries.

As of this writing, we’re on Part 12.

Will there be a Part 13?

Will there be a part 108?!

Only the Quirkiest Man in Upstate New York knows.

Just please don’t expect to find Part 8.

The post The Quirkiest Man in Upstate New York appeared first on ComposeMD.

It’s been a year full of adventure, starting with exploring abandoned structures in our hometown of Rochester.

From there, our travels took us to Batavia (NY), site of one of the better Pizza Huts in the Rust Belt.

Finally, we were blessed to sample amazing gas station food, from Speedway to Sheetz to Buc-ee’s.

It’s also been a year of milestones.

The older child finally left the house, claiming he is ready to seize the world. From the outside looking in, evidence to support that claim is lacking. When the goal is the music industry and the transcript reads Bible Study, heads will be scratched.

As for the younger child, there have also been many accomplishments, mostly measured in Amazon packages. Between those and dance, she has proven herself quite capable of pushing back retirement dates. There was only one major argument this year, resolved by her recurrent TikTok scrolling.

Of course, no holiday card is complete without talking about the head(s) of household.

In my case, it’s been another year of wheel spinning and questionable decisions, peppered with flashes of irritability, all in the name of growth.*

And then there is the anchor. She continues to wake up every day and thank the Good Lord that Rochester’s healthcare system does not oppress and demoralize physicians.**

To 2026!

*Of my abdominal girth

**DM me for the truth

The post The Shrikhande Family Holiday Card appeared first on ComposeMD.

Case in point: In 1985, as I lay covered with fluid-filled blisters, neighborhood moms sent their kids over to chat, hoping that I would share the love.

As the story went, getting the chickenpox as a kid was the way to go, since infection during adulthood could be more severe and fraught with complications.

Of course, even those who had the good fortune of contracting the virus in childhood could see the dormant virus reactivate later in life—for instance, under stressful circumstances—in the form of shingles, a painful rash that can leave discomfort long after the rash is gone.

All of this, of course, is slowly becoming less relevant since the introduction of the varicella (chickenpox) vaccine in 1995. An entire generation has been able to bypass the right of passage and, as a result, will be much less likely to get shingles.

It turns out, however, that relevance is relative, because on October 19, 2024, I discovered the unexpected: I am the chickenpox of fathers.

The day started with a simple phone call from my wife.

“I hurt myself playing tennis,” she said.

The next thing I knew, she was back home with a splint and crutches. After she not-so-gracefully managed the two stairs into the house, she slowly made her way to the couch.

And there, at that moment, I felt a towering wave of stress.

You see, ever since my sperm donation, my utility around the household had declined precipitously. In fact, much like the varicella vaccine removed the need to tolerate chickenpox, I often wondered whether a sperm bank would have allowed the family to remove the need to tolerate me.

It’s not that I was always so useless.

As an adolescent, I mowed the lawn regularly, and I was a key contributor to yearly leaf removal. I even had a job at a local tennis club taking out the trash, cleaning the bathrooms, and generally being helpful.

As a young adult, prior to discovering the joys of the value meal, I dabbled in cooking, establishing a small but serviceable repertoire of dishes.

But after having been infected with this desire to be of use, those skills went dormant.

I replaced mowing the lawn with writing a check (actually, I asked my wife to write the checks).

I replaced cleaning the bathrooms with sitting on the couch.

And worst of all, I replaced cooking with…blogging.

It was an almost-two-decade run of inutility—the word deadbeat comes to mind.

But on October 19, 2024, as I stared helplessly at the splint, there was a sudden reactivation.

“Make a list!” I barked at my daughter, knowing that a trip to the grocery store was an inevitability.

“Not too long,” I added. “I get uncomfortable when I’m in that place for longer than ten minutes.”

“Why is this here?!” I yelled to no one in particular.

“Dude, you need to empty the dishwasher,” I hinted, perhaps not so subtly, to my son.

“We need to do a better job of staying on top of the dishes.”

“Where the heck is the pasta?!”

“These tortillas are expired. What a waste.”

“You need to get your junk off the table.”

“I don’t understand why you can’t just buy the school lunch.”

“Why do you guys have so many shoes?!”

—

It’s October 23, 2024, and no one has starved.

The house, I must say, looks fantastic.

I am, after all, the chickenpox of fathers.

And as my kids will attest, the pain of shingles is real.

The post I Am the Chickenpox of Fathers appeared first on ComposeMD.

For context, I’ll start with my bio. After graduating high school in 1995, I pursued a four-year undergraduate degree, followed by a four-year medical degree. From there, I required three years of on-the-job training in internal medicine (termed a residency) after which I worked independently for one year as a general practitioner. I subsequently opted to pursue a three-year subspecialty training (termed a fellowship) in nephrology, aka the study of the kidneys.

Along the way, I took a three-step licensing exam, went to various professional meetings, paid all sorts of fees, and so on. One would imagine these activities, along with the 15-year journey after high school, would have mercifully set me free.

The American Board of Internal Medicine (ABIM) does not agree.

The ABIM, you see, is a self-appointed entity that has tasked itself with providing board certification, a sort of seal of approval meant to indicate that a medical practitioner is not a quack. It is not a licensing body, nor is it an educational institution. It is simply…well, many are not sure exactly what it is. That said, one thing is certain—the doctors at the top of the ABIM pyramid make double or triple what practicing physicians make. And given the absence of other certifying entities, the ABIM has had a monopoly. (Thankfully, that could be changing.)

In any event, in my era, board certification has involved paying hundreds of dollars to take a full-day test and repeating the process every 10 years. The process must be duplicated for every specialty—in my case, both internal medicine and nephrology.

In 2006, by paying for and passing an exam, I became board certified in internal medicine. In 2016, I did the same thing again. As for nephrology, it was 2009 followed by 2019. And that’s when the seeds of robbery were planted.

To be more specific, I took the nephrology recertification exam on October 23, 2019. Scored out of 800, a passing score was considered 386 or above. As this report shows, I received an 800. (This is not about boasting—it’s about being genuinely perplexed.)

Thinking I had sufficiently proven my nephrologic competence through 2029, I disengaged from the ABIM for several years (i.e. deleted their periodic emails without necessarily reading them). This naivete made me a perfect candidate for what was to come.

In September 2024, while reapplying for hospital privileges in Rochester, New York, I was told I was no longer certified in nephrology, meaning my privileges could not be renewed.

How could this be?! I thought.

I reintroduced myself to the ABIM website and, after a mild struggle with the password, accessed my personal portal. Immediately, the problem was clear:

Maintenance of Certification (MOC)

Despite having earned myself the aforementioned 10-year pass, I needed to pay an annual fee to maintain my certification.

Making up for lost time, and accounting for late fees, I owed the organization $1,365.

There was, of course, one other factor. I needed to earn so-called MOC points to prove that I was still learning. For that, I had to submit Continuing Medical Education (CME) credits that I earn regularly and receive the necessary MOC conversion.

In other words, without performing a duplicative clerical task and paying the ABIM four figures, the above exam would be rendered irrelevant and I would be out of a job.

Sure, you could call this certification.

But as a budding writer looking to expand his vocabulary, I—like Dr. Glaucomflecken—prefer another word: extortion.

The post The American Board of Internal Medicine Is a Joke appeared first on ComposeMD.

There’s no exact definition, but you know it when you see it—limited muscular definition up top and a healthy dose of flab in the middle.

It turns out that as a man of many talents, I’ve perfected the look, and as a prominent influencer, I feel obligated to share these tips for success.

10

Try not to walk away from the table until you are truly full. Take a TUMS if you need to.

9

Also, remember that dinner is just a crude guideline. Make time before and after to nourish yourself.

8

Lay off the light beer. Stick to the higher-calorie craft stuff.

7

Don’t believe the hype about steps. God invented the automobile for a reason.

6

Use chairs to your advantage. Why stand if you can sit?

5

Support the local economy and/or child development. Outsource all household duties.

4

Remember that the family gym membership was just to save money. You’re under no obligation to actually go.

3

Nachos, nachos, nachos. Oh, and wings.

2

Stay focused on immediate rewards. The long term is overrated.

1

Last but not least, show off the dad bod—if you should wear extra large, go with large. You deserve recognition for your hard work.

A special thank you to Louis De Souza for encouraging me to share my expertise. After spending his early years in Kenya, Portugal, and the United Kingdom, Louis has since gained a genuine appreciation for the American work ethic.

The post 10 Tips for the Perfect Dad Bod appeared first on ComposeMD.

It hadn’t been a great morning at the no-name hospital in Upstate New York.

They were short to begin with, and a nurse had called in sick.

Her staff was used to working with bad ratios, but today was even worse than usual.

Everyone and their mother had decided to come to the ER.

She knew not to bother calling her manager. He was a well-dressed guy, but his ideas were a bit wonky.

His answer had always been to just shorten treatments.

She knew better though—he had never worked in the industry.

A few shortened treatments could fix a day, but the price would be paid in oxygen—as in respiratory distress.

Or cardiac arrest.

Like the one they had that morning.

The lady had been full of fluid for a week, but they hadn’t been able to offer an extra treatment. In fact, per the manager’s advice, they had turned her usual three and a half hours into three flat. That kept the overtime charges down.

When she showed up that morning, she couldn’t breath. Then she lost her pulse.

It never came back.

Just another day in the dialysis unit.

Except for the trainee. It was new to her, and she broke down crying.

The charge nurse tried to comfort her for a minute, but the overtime rules…

Back to work.

The doctor, like he always did, soaked it all in.

He knew what was up, but he had been muzzled long ago.

When things started eroding, he had set up meetings with the manager.

But he kept getting the same word.

Budget.

He would counter with his own word.

Quality.

But his word didn’t carry the same weight.

When he tried a new one—rationing—he was reprimanded.

Human resources came down hard.

They said he was harassing the manager.

He quieted down.

A family. A visa. His options were limited.

It was this or back home.

The manager knew that.

The charge nurse knew it, too. That’s why she had stopped asking the doctor to speak the truth.

They worked together in silence.

Two unsettled souls, just trying to keep things average.

They could sleep with average.

Below that is where insomnia kicked in.

But despite the problems, the charge nurse knew that deep down, the administration cared.

No amount of staffing issues, budgetary constraints, cardiac arrests, or human resource reports could overshadow the love coming from the boardroom.

Because on that day, in the beautiful asphalt parking lot, there was a food truck.

The post How the Food Truck Saved the Hospital appeared first on ComposeMD.

Below are a few highlights, but don’t let this watered-down garbage prevent you from engaging with the highly-readable, immensely-human, and only 234-page book.

What Is It?

Dopamine has numerous roles in the human body, but when it comes to addiction, the focus is on its job as a neurotransmitter. That’s a small molecule that carries a message from one neuron to another. Dopamine is particularly important in the parts of the brain associated with pleasure—the so-called reward pathways.

When we do something pleasurable, dopamine floods these parts of the brain. The human body, in its constant quest to maintain balance (homeostasis), recognizes the excess. To compensate, the production of dopamine and dopamine receptors can decrease. The consequence is that the next time we engage in the pleasurable activity, we need more of it to feel good. In other words, we’ve developed tolerance, and the seeds of addiction have been sown.

This process, left unabated, can lead us to the point of needing a previously pleasurable substance just to exist. That is, the state of dopamine deficit can be so overwhelming that a substance-free existence seems impossible.

What are such “substances”? Drugs like cocaine and amphetamines, which markedly increase the release of dopamine and thus have profound addictive potential, are clearly in the mix. But so are things like cigarettes, alcohol, food, sex, gambling, shopping, video games, and social media. In our world of abundance, we’re surrounded.

The Pleasure-Pain Balance

It turns out that pleasure and pain are processed in overlapping regions of the brain, meaning they are in constant balance.

As above, a pleasurable stimulus results in an opposing reaction in favor of pain. That pain can manifest with cravings. And as mentioned, the balance can ultimately get tipped to a point where fulfilling a craving merely alleviates pain without providing pleasure.

In order to recreate a proper balance, abstinence—or dopamine fasting—is key. Typically, a four-week hiatus is required. At that point, depending on what tipped the scales in the first place, reintroduction can be considered. Achieving moderation, however, may be just as difficult as it was the first time around, leaving abstinence as an easier option for some.

Practical Tips

Don’t start. This is always reasonable advice, even to avoid food addiction, in which non-healthy choices rule the roost. With regards to alcohol, normalization does not equal normal. As a parent, you probably don’t encourage trying cocaine—so why alcohol?

Take a break. If you depend on something to make you feel happy, take a break (as long as the break itself isn’t life-threatening). If the cravings are intense, consider medication. As an example, the opioid receptor blocker naltrexone can blunt the reinforcing effects of rewarding behavior, facilitating moderation and abstinence.

Beware of downtime. Remember that free time isn’t always your friend.

Boost dopamine the natural way. Given the pleasure-pain balance, embracing pain can actually lead to a rebound in pleasure (as is the case the other way around). In other words, a cold shower (i.e. cold-water therapy), fasting, and exercise can lead to a surge in dopamine. Like with anything else, reasonable limits must be applied.

Also, remember that we’re surrounded by benign sources of dopamine: the sunrise, learning, music, the wonders of the natural world, and so on. Know the science, and use it to your advantage.

And finally, be honest. Tell the truth to those around you and, most importantly, yourself.

Now go read the book!

The post Dopamine: How To Get Unhooked appeared first on ComposeMD.

These are the questions I found myself asking as I revisited the music of my youth.

The year: 1992.

The band: Rage Against the Machine.

The album: Rage Against the Machine.

The track listing:

1. “Bombtrack”
2. “Killing in the Name”
3. “Take the Power Back”
4. “Settle for Nothing”
5. “Bullet in the Head”
6. “Know Your Enemy”
7. “Wake Up”
8. “Fistful of Steel”
9. “Township Rebellion”
10. “Freedom”

What was it about this album that resonated?

At the tender age of 15, I had no idea.

Take track 2.

And now you do what they told ya, now you’re under control

And now you do what they told ya!

F*ck you, I won’t do what you tell me!

It was as if frontman Zack de la Rocha was speaking directly to me. Except for one thing—I wasn’t angry. I didn’t feel controlled by anyone, minus the math teacher who gave too much homework. I had two loving parents and lived a standard life in a standard suburb of New Haven, Connecticut.

How about track 3?

Yeah, we gotta take the power back

Come on, come on!

We gotta take the power back

Hell yeah! I remember thinking. But what power? From whom?

Or track 5?

Just victims of the in-house drive-by

They say jump, you say how high

A bullet in ya head

Ya gotta bullet in ya f*uckin’ head!

Jumping meant trying to touch the basketball rim. And I had never handled a firearm (does a BB gun count?), nor did I have a particular interest in heading down that path.

Track 7?

I’ll give ya a dose

But it’ll never come close

To the rage built up inside of me

Fist in the air, in the land of hypocrisy

The reality is that I wasn’t raging against any machine.

To be honest, I could have built the machine myself, i.e. pad the resume for college and pave the way for medical school, a wife, two kids, two cars, and 3,500 square feet.

So what did all of this mean then?

Almost three decades later, I would find out.

Midlife

By this point in my life, I had moved a whopping six hours away, landing in another suburb, this one of Rochester, New York.

The machine was fine-tuned and well-oiled, bringing in six figures and resulting in manicured landscaping.

I was firing on all cylinders.

That is, until The Man descended. If you’re not in health care, that refers to the system—the one that gobbles up small practices, consolidating disparate entities into a dysfunctional whole, all the while funneling funds scraped off the back of medical labor to boardrooms at the top.

By signing on the dotted line, I went from small-business owner to laborer overnight. Soon, representatives from the boardroom began to show up. They generated no revenue themselves, but they knew who did—me.

And I needed to generate more of it. The mandate—see more patients, a euphemism for bill more.

How about quality of care? That shouldn’t get in the way of quantity.

How about quality of life? We’ll get some food trucks and give you a discount voucher.

What if I want to leave the system? There’s a noncompete clause.

Now you’re under control

And now you do what they told ya!

I traveled the halls of the hospital, doing my best to surround myself with doctors who loved their jobs. Or liked their jobs. Or even tolerated their jobs. In the last group, I found a few—they worked part-time.

How did this happen? we asked.

How did all the student loans, years of training, and time sacrificed result in…this?

Yeah, we gotta take the power back

Come on, come on!

We gotta take the power back

But we didn’t.

We didn’t know how.

We did, however, know how the system worked.

They say jump, you say how high

So we resorted to looking for a Plan B.

Why?

Because Plan B could save our lives—literally.

My brother, a doctor himself, lost his burned-out colleague to suicide. A self-inflicted gunshot wound.

A bullet in ya head

You gotta bullet in ya f*ckin head!

Thankfully, in my case, medicine never defined me. It might have defined me in the minds of others, but not my own.

I had dreamed of cutting back and starting a new adventure.

The system helped turn the dream into reality. Each productivity report made me gag. The billboards that feigned an interest in patient care were even worse. And the food trucks meant to appease—they didn’t work.

To the rage built up inside of me

Fist in the air, in the land of hypocrisy

So one day, I told the system my new schedule.

And as I made it through Rage Against the Machine thirty years later, I finally understood what I had been hearing all along.

Track 10

Freedom, yeah

Freedom, yeah right

Freedom, yeah!

All lyrics courtesy azlyrics.com

The post How Rage Against the Machine Rescued Me appeared first on ComposeMD.

Empty storefront.

McDonald’s.

Another empty storefront.

Convenience store.

Dialysis unit.

It was still dark outside. And cold.

There were just a handful of cars in the sea of open asphalt. Most of the patients couldn’t drive. Blind. Weak. Old. Not safe for the roads.

I grabbed my stethoscope and my notebook—the one that helped me keep track of billing.

As the wind whipped my thinning hair, I noted a few snowflakes landing harmlessly on my windshield.

Lake Erie. Nature’s snow machine.

Then I walked in.

No narcotics prescribed here, said the sign on the front door.

Once through, my eyes shifted to the sign offering translation services. Everyone spoke English there.

The carpet looks even older in the winter.

I slowly hung my coat on the coat rack, letting my eyes adjust to the fluorescent lighting before making my way down the hallway into the dialysis unit.

Still haven’t fixed the floor.

The smell was familiar. The patient in Chair 1 had recently had his left leg amputated. Now the right one was being slowly consumed by bacteria, and the antibiotics were fighting a losing battle.

We exchanged pleasantries.

I reviewed his treatment, knowing full well that nothing I did or didn’t do could change the big picture. Transplant was out of the question. The days were numbered.

I checked a box in my notebook and moved on.

As I made my way around the unit, I asked myself if anyone had a light at the end of the tunnel.

Dementia. No.

End-stage multiple myeloma. No.

Advanced COPD. No.

Just high blood pressure. Maybe—but the active cocaine use…

Already had a transplant. Didn’t take the medications.

Each time I remembered the notebook, moving quietly to the next chair.

After completing the loop, I sat down to write my notes.

As I worked, my thoughts shifted to lunch. The highlight of the day, in between shifts.

I scribbled my last note and stepped back out into the elements.

The flakes were a bit bigger, though one flip of the wipers was enough to whisk them away.

I headed to the sandwich shop down the street, the one where I felt like everyone stared at me. Maybe in my head. Maybe not.

But the sandwiches were good.

I felt a transient jolt of energy, ready for the second shift.

Different patients.

Different stories.

The same dead end.

One chair was empty. I asked the charge nurse, expecting one of two responses—the hospital or heaven.

It was the latter.

I indicated that in my notebook.

And I moved on.

I forced a few smiles. Exchanged more pleasantries. Made a handful of minor tweaks. Finished my notes.

I had a fleeting sense of accomplishment, tempered by my dirty little secret—I hadn’t accomplished anything.

I said goodbye to the nurses, hearing the words of Radiohead echo between my ears.

I don’t belong here.

As I turned toward the snow globe outside, I took one more look around, knowing that soon, I would never be back.

The post The Day I Knew I Wasn’t a Doctor Anymore appeared first on ComposeMD.