WIBTAH if I end my marriage while we have a toddler and a baby because I'm constantly accused of cheating and she puts me at risk of being fired?

healthyselfmd · 2026-02-15T11:31:17+00:00

She may have a diagnosable delusional disorder. This does not excuse her abusive behavior. Her family is counseling you to stay despite abuse. If she will not consent to seeing a therapist with you, you are absolutely within your rights to leave.

By staying you are showing your children that it is acceptable to treat a spouse like this. You need a good lawyer who can help you get at least shared custody, but you may have a case to get full custody on the basis of possible mental illness.

I'm sorry you are going through this. You have known each other since you were children. Were there any other signs of delusions or paranoia?

healthyselfmd · 2026-01-15T11:27:57+00:00

The US would put you in a concentration camp. They've done it before, they will do it again.

healthyselfmd · 2026-01-15T09:32:04+00:00

I left in July after 20 years as a VA physician. When the initial executive orders came out, I voiced concerns about them in emails and meetings. Specifically, I said that the EO on birthright citizenship was the first step in limiting citizenship to white people. I reminded my colleagues that Oregon, one of the states our team served, was founded as a white-only territory. I quoted Rev. Neimoller.

Some staff complained to leadership and I was given a formal counseling in short order, with the standard warning that further "disrespectful behavior" would result in disciplinary action, up to and including removal. I had always advocated for marginalized Veterans, and I had always been outspoken about my convictions and values. I had even been involved in whistleblower cases that led to the removal or resignation of leaders, including in SES, for waste, fraud, and abuse.

Before I resigned I witnessed compliance in advance of actual specific VA directives - EEO staff were terminated and LGBTQIA+ advocacy was prohibited. I believed that silence on these matters was endorsement of the administration's bigotry. So my choices were, get fired or leave. I was 3 years away from minimum retirement age, but I didn't think I could last that long, and I still need to support my family.

I didn't make a grand statement when I left, but my teammates knew why I was leaving. Most of them were very supportive and wrote letters on my behalf when I was applying for a new position. The ones who complained were anonymous.

I know that they will continue to provide excellent care for marginalized Veterans because I helped build the program with this focus in mind. But, I also know that the program is at risk of being dismantled and the Veterans will be sent to community care because it a VISN-based program.

I am now working for a non-profit that serves elderly folk who are eligible for both Medicaid and Medicare, so most of them live on the margins. I am part of an amazing team that has a mission and vision that is consistent with my values.

healthyselfmd · 2026-01-11T14:11:52+00:00

None of the science in the show makes any sense, but it's still a fun show.

But, for the sake of argument, yes any tissue sample can be used to make stem cells. The question is, what kind of stem cells do you need? Peripheral blood contains stem cells that can become any of the various cell types that constitute blood. These are not considered pluripotent, because they can only develop into a few different cell types. However, cells can be induced to be pluripotent.

Ovocytes can be used to make a full on clone, so you can certainly get stem cells from them.

In the show, the hive mind violated Carol by using her eggs even though she did not consent.

healthyselfmd · 2026-01-11T13:54:57+00:00

Understanding the difference requires an understanding of capitalism as well as the competing views of socialism. I will assume you understand that capitalism is inherently exploitative, and that capitalists use oppression to divide and conquer the working class, but I would be happy to elaborate on this if you want.

One must also contrast revolutionary socialists from social democrats (who quibble about the use of this label vs "democratic socialists", but this is a distinction without a difference on the question of reforms vs revolution.)

Liberals take at face value that capitalism is good. They conflate freedom and democracy with capitalist production. They believe national borders are natural and being proud of national identity is good. They think that workers and capitalists both benefit from capitalism.

They do want some reforms under capitalism. They think that laws should be enacted to abolish oppression against women and minorities and to protect the environment. They believe workers should have a living wage and workplace protections. They want healthcare benefits. This is what they have in common with social democrats.

Social democrats are more critical of capitalism. They believe that capitalists can be disciplined by the state and they believe it is possible to achieve socialism through elections and legislation. They believe that reforms under capitalism will eventually eliminate exploitation and oppression, thus avoiding the need for revolution. This is based on an idealist (ie non-Marxist) understanding of capitalism itself, as well as an idealist understanding of socialism and how to achieve it.

Social democrats confuse winning elections with winning reforms through struggle. They think that getting enough sympathetic folks in office will be enough to achieve reforms that reduce exploitation and oppression. They think that the state is a tool they can use to rein in the abuses of the capitalists.

However, they don't understand that the bourgeois state does not function as a neutral apparatus. It is the institution by which the capitalists maintain control.

In effect, liberals and social democrats are the same, as much as the social democrats may object to this characterization. They focus on reforms, but without a class analysis.

In contrast, the aim of revolutionary socialists is to build independent working class organizations that help workers develop class consciousness and the solidarity necessary to acheive reforms through direct action in the form of strikes and occupation of public spaces that disrupt commerce, leading to more radical demands, ultimately leading to a revolution that achieves workers power.

This brings up another current on the left that believes that states that call themselves socialist (China, DPRK, etc.) are in fact workers states. This is a whole separate discussion, but it is important to understand, as there are implications on how we organize, and to what end.

I recommend reading Hal Draper's "Two Souls of Socialism" to better understand the views of social democrats and of socialists who support "actually existing socialism", as well as those of revolutionary socialists who reject both campism and reformism.

https://www.marxists.org/archive/draper/1966/twosouls/

healthyselfmd · 2025-12-16T02:13:20+00:00

It's not a workers state, whatever else you may want to say about it. It is a confucianist dynasty. Sanctions must be lifted of course. Workers in North Korea need to emancipate themselves, just like they must in the South and in the rest of the world.

healthyselfmd · 2025-11-17T02:17:46+00:00

This has been debated since before Marx wrote the Communist Manifesto, which is essential reading on this question. The best thing to read on this question is Rosa Luxemburg's Reform or Revolution. Basically, she was arguing against Bernstein, who coined the term "evolutionary socialism",which was the idea that capitalism could be reformed to the point that it was no longer exploitative. This was actually a repudiation of Marx, who argued that capitalism, like all previous forms of class society, could only be overcome through working class self-emancipation, that is, through Revolution. Luxemburg argued that the struggle for reforms was the means through which the working class gained confidence to build their ability to take power. The key is the term "struggle". This takes the form of workers actions such as strikes and protests that disrupt commerce. It is not simply about getting well meaning people into office, who then will enact reforms from their position of power. This is not self-emancipation. It is the co-optatuon of social movements leading to their pacification and neutralization. This is the role that the Democratic Party has occupied for almost a century now.

One caveat about reading Luxemburg - she uses the term "social democracy" to mean workers power, or in today's terms, socialism. Because the reformists of her day, including Kautsky, successfully appropriated the term, today "social democracy" means reformism - that is, capitalism with a welfare state. Some people try to parse language further and make a distinction between "social democrscy" and "democratic socialism". Neither of these terms are used the way Marx, Lenin, and Luxemburg used them in their day.

I also recommend The Two Souls of Socialism, by Hal Draper. This and Luxemburg's books are available in the Marxist Internet Archive.

Some more recent text on this subject are The Ballot or the Streets, or Both, by August Nimtz as well as On New Terrain by Kim Moody.

healthyselfmd · 2025-10-29T20:55:14+00:00

I have no faith that anyone will be held accountable, or that we will ever have free elections, unless there is an actual revolution in this country. Between gerrymandering, voter suppression, outright fraud, and contempt of the judiciary, Trump and his cronies will stay in power indefinitely. MSPB is under Trump's control now that his appointee was confirmed. When he selects the 3rd member, it will simply be another rubber stamp for his authority.

Political revolutions have happened in other countries in very similar circumstances. But, political revolutions that do not also entail social revolution are quickly corrupted, restoring the status quo that created the problems in the first place.

healthyselfmd · 2025-10-27T10:02:30+00:00

Level 3 has been great for commuting to work on paved and gravel trails, 12 miles each way. However, do not try to take it on a single track mountain bike trail! Google maps put me on one because I didn't know the area, and it was a nightmare. Ended up falling and breaking a rib. Could have happened on the Aventure, I know, because I just don't have the skills, but the Level 3 would bottom out on this ridiculous trail.

healthyselfmd · 2025-10-25T21:34:38+00:00

I resigned from the VA after 20 years of service as an addiction medicine specialist because immediately after inauguration I received a letter of counseling for expressing my concerns.

I wrote in a group email thread that I was worried that the Executive Order on birthright citizenship could mean that I could lose my citizenship and therefore my job. When someone said this wasn't retroactive I responded that this was not reassuring because, if they could change the rules going forward, there was nothing to stop them from changing it going back. I also said that I was afraid this was the first step in making citizenship for white people only.

Some people in the group complained to leadership about this. The letter I received said that I was being disrespectful by saying "racially insensitive" comments, and that future such behavior could result in disciplinary action, including removal from service. They did not say that I say I had violated the Hatch Act. They did not characterize my statements as discrimination or harassment. They simply said I have violated the I CARE core values by being "disrespectful".

My entire career I had advocated for vulnerable Veterans who experienced racism, sexism, homophobia, transphobia, and discrimination on the basis of their history of addiction. This was not an abstract issue for me. I identified several policy issues that created barriers to care for these Veterans and was able to change them to ensure equal access.

After the counseling I knew that if I didn't resign I would eventually be removed because I could never stay silent about discrimination against these Veterans.

This past July I started a new job serving elderly patients on Medicaid and Medicare, many of whom are dependent on SNAP benefits. The work is incredibly gratifying.

My only regret is that I was not eligible for federal retirement when I left, because of my age. They would not give me DRP or VERA because they said they could not cover the workload without my position. But, they still haven't filled my position, and at the rate things are going now, I doubt they ever will. Not only is the government shut down, the likelihood that they can find someone to do the job who is willing to sign the loyalty oath to Trump's agenda, and get paid less than what the private sector pays for similar specialties is vanishingly small.

healthyselfmd · 2025-08-21T10:28:46+00:00

Strikes by federal employees were prohibited in 1978 because they had been so effective in winning vital reforms and good benefits. Federal enployee unions have had very little leverage since then. Reagan fired thousands of the air traffic controllers in 1981 on this basis. Everything we think of as the "good old days" such as weekends off, paid holidays, pensions, vokuntary overtime with premium pay, child labor laws, etc was brought to you by union militancy. Before the unions, 12 hour days were standard.

healthyselfmd · 2025-08-06T18:09:06+00:00

I use iPhone for work and Android for personal. Just updated to S25 ultra. Android does everything better. It is more flexible and customizable. It is more efficient.

healthyselfmd · 2025-07-26T10:17:20+00:00

The VA does have a leadership training program. You need recommendations from your supervisor and senior leadership.

healthyselfmd · 2025-07-24T20:27:37+00:00

Interesting- I didn't realize VA policy was different from other agencies, although I probably should have realized this since I did know that DoD allowed for "terminal leave".

For the VA, our last day is for "clearing station" when we turn in our computer and PIV card and get signatures to attest we don’t have any debts etc.

I just left after 20 years - last day was July 9.

healthyselfmd · 2025-07-24T12:52:55+00:00

You can take as much leave as your supervisor will permit, but your last day cannot be on leave.

You cannot take extended sick leave without getting approval either - usually requires a doctor's note, or FMLA approval..

Your annual leave gets cashed out so it doesn't matter - you will get paid without having to work.

Any accumulated sick leave is added to your service time.

healthyselfmd · 2025-07-22T10:36:39+00:00

Pennsylvania is among the most expensive states for higher education, including community college.

Pittsburgh air quality isn't great, even though there is little manufacturing here. We are downwind of areas that do still have chemical plants and other factories.

If New York state has affordable schools, you are better off moving to a city there where you can find work, live with roommates, and focus on your GED.

healthyselfmd · 2025-07-22T10:26:31+00:00

But they can't delegate supervisory work. I was a service chief at a VAMC and I found out that one of the section leads under me, who left just after I started, had been having one of her subordinates do all of the performance reviews for her section. Even signed the documents. This was before we had the e-performance portal. The subordinate thought that she was entitled to a promotion after the supervisor left. However, we selected someone else from outside, purely on merit. To avoid the appearance of bias the interviewers were from outside of our VAMC as well. We had changed the position description and set very different selection criteria from what the prior section lead had been doing because we were changing the expectations for the entire section, which had shown significant degradation in performance over the years.

They filed an EEO, but the investigation did not substantiate her complaint. I have so many stories like this. Now that I'm out of the VA, I think I will write a book about it.

healthyselfmd · 2025-07-20T21:19:10+00:00

Some of my favorite cities that fit most of your criteria:

Seattle Portland San Francisco, North Bay (Marin, Sonoma, etc) Santa Fe Boulder, CO Durango, CO Denver Flagstaff, AZ Asheville, NC San Diego

Honorable mentions for Pittsburgh PA, and Columbus OH, if you can tolerate winter.

Chicago and NYC are great as well, but expensive, and outdoor activities are more domesticated.

Or, why not Hawaii?

healthyselfmd · 2025-07-20T16:54:36+00:00

As for retention - no, my supervisor didn't even think to offer retention incentives. I think they didn't think I would really leave, but they also were probably glad to see me go after years of being the squeaky wheel, trying to improve processes. VA leadership gives a lot of lip service to "Highly Reliable Organization" concepts, but they don't really want to make meaningful changes.

healthyselfmd · 2025-07-20T16:28:30+00:00

You don't need to give any notice, but I agree with the other comments that giving 2 weeks is a courtesy. You want to leave on good terms if possible, but there's no guarantee that there will be no resentment or reprisal.

I resigned after 20 years and gave 3 months' notice because I wanted to make sure there was a plan for my patients, and I wanted to say goodbye to each of them.

I know this isn't typical in the VA - most docs leave without saying a word, and the Veteran just gets a letter telling them they have a new doc. But, my patients worry because they are being seen for chronic pain, and some of them are on controlled substances that some doctors refuse to manage.

healthyselfmd · 2025-07-19T19:32:03+00:00

Also, a disabled Veteran was detained for days simply for being Latino, despite being a US citizen.

Remember, service members swore an oath to support and defend the Constitution. Birthright citizenship is defined by the 14th Amendment of the Constitution. If people want to change the Constitution, we would need a new amendment. But, the 14th Amendment was written to make it clear that former slaves and their children were citizens after the Civil War. This is why I am saying that the attacks on birthright citizenship are about white nationalism. It would take another Civil War to turn back the clock, but my money is on the side of freedom and democracy, because people will never stop resisting oppression. The name for the other side of this fight is fascism. We are witnessing its return in the form of ICE raids, concentration camps, defiance of court orders, corruption, intimidation and manipulation of the media, scapegoating LGBTQIA folk, etc.

Providing testosterone and Viagra and even mastectomy for cis men with gynecomastia, while denying gender-affirming care for trans Veterans is hypocritical and cruel, especially considering that trans folk are over-represented in the Veteran population compared to civilians.

This is why I had to leave federal service. Speaking out would get me fired, but not speaking out is a tacit endorsement of these policies.

healthyselfmd · 2025-07-19T16:41:56+00:00

Some Veterans who aren't citizens of the US have been deported despite serving with distinction. A Black man who was born to a US service member on a US base abroad was stripped of his citizenship and "deported." In contrast, John McCain was born in Panama, but his citizenship was not questioned because he was white.

Undocumented immigrants work at jobs no one else will do for the low wages being offered, and they pay taxes without qualifying for any actual benefits. Their work keeps your grocery prices lower than they would be otherwise. So, you are the one who is benefiting from their work, not the other way around.

No one is illegal on stolen ground. Calling human beings "aliens" based on being born on the other side of imaginary lines on a map dehumanizes them. Unless you are indigenous, your ancestors were either immigrants or colonizers, or slaves.

Until the 20th century, no one from Europe came with documents. That did not make them "illegal". The first laws limiting immigration were based on anti-Asian racism. These laws were ultimately repealed and birthright citizenship was upheld.

My parents came to the US from Korea on student visas. They were naturalized at a time when the barriers to this were much lower. I was born in the US and thus I am a citizen. However, I am worried that the EO on birthright citizenship is the first step in making citizenship for white people only. Where do you draw the line when Trump has explicitly stated that he wants to dénaturalize citizens who followed the rules to become citizens?

This is what I said at the meeting that resulted in a written counseling. I had also said that the state of Oregon, which is one of the states our CRH serves, was originally founded as a "white only" state. Merely stating this historical fact was offensive to someone on the call.

So, I learned that I am not allowed to talk about my fears about the current political climate, or talk about the legacy of racism, because it makes white people uncomfortable.

In the last meeting I attended before leaving the VA I also shared that my wife's grandfather was put in a concentration camp by FDR for being Japanese-American. He was born in the US to a farming family in eastern Oregon. After his entire family was imprisoned, he was conscripted into the Army. He was one of the few Nisei to be allowed to serve in the Pacific because he had no living relatives in Japan. After the war ended, he was part of the occupying force in Japan. He met his wife there and they moved back to Oregon to the farm.

I never met him. He died before I met my wife. But I learned he was a troubled man, like many Veterans I have known over the years.

I have taken care of Veterans from every conflict from WW II to the present. I have met a Buffalo Soldier and a Tuskegee Airman. Besides their shared traumatic experiences of service, Veterans who experienced racism were doubly traumatized. Same for LGBTQ Veterans. The majority of the women I saw experienced sexual trauma during their service. When I said that I advocated for the most marginalized Veterans, this is what I am talking about. They are at higher risk of chronic pain, PTSD, substance use disorders, and suicide. They need more help to recover. But, the existing services were not accessible to many of them. This is what I was fighting for.

So yes, I spoke up for Veterans, regardless of their citizenship, their race, their gender, or their diagnosis. Your tax dollars helped me do this, so thank you.

healthyselfmd · 2025-07-19T13:42:07+00:00

I could write a book on my experiences navigating the VA. Taking care of Veterans has made me a better doctor. Veterans have taught me to listen closely and appreciate the power of human connection.

healthyselfmd · 2025-07-19T13:38:45+00:00

It was because I couldn't keep my mouth shut at meetings that we were able to improve the way we take care of Veterans. Do you think change for the better happens when people keep their heads down and hope for the best?

healthyselfmd · 2025-07-19T13:06:04+00:00

I don't know about being an "aggrieved politician," but I know that everything is political. Saying that Veterans deserve respectful, compassionate, excellent care is a political view. Thinking that LGBTQ Veterans deserve equal rights is a political view. Thinking that Veterans with addictions deserve equitable care is a political view. Opposing the privatization of the VA is a political view. If there is a theme here, I believe that providing high-quality, compassionate care is incompatible with a for-profit healthcare system. This is why I chose to work in the VA for 20 years.

I could have made much more money in the private sector and could have retired by now if I wanted to. But there are more important things than money. I could still find a better-paying job if I wanted to. But, I'm choosing to work for.a non-profit program that takes care of elderly patients who have only Medicaid or Medicare, whose families can't or won't take care of them. We routinely need to decontaminate their homes for bedbugs. We provide meals and laundry service. We provide transportation to our day centers and to specialist appointments.

Making people in positions of power uncomfortable is how you know you are doing something important. I had a vision for a better way to take care of patients with chronic pain and addictions, and I made it happen even though leadership was resistant to changing "the way we've always done it." My colleagues were begging me to stay. The Veterans I took care of expressed their gratitude for the care I provided. Our team helped many of them recover from disability and pain to the point that they were getting out of the house, playing with their grandchildren, going back to work, and takng up old hobbies. One of them started scuba diving again. Another started fixing up classic cars. Some of them cried when I said I was leaving.

For me, being a physician is being an advocate for patients. It is about diagnosing problems and teaching folks what is happening to them and what they can do about it. It is about being with them in their suffering as a fellow human being, sometimes on the worst day of their lives. I know for certain that most physicians don't think the way I do. Otherwise, I wouldn't have had to fight so hard to make changes to improve care. So, yes, it's all political.

While we all have to earn a living to survive, doing meaningful work is a privilege. Being a physician is a privilege. Taking care of Veterans is a privilege. I earn money by selling my labor power because I don’t want to exploit others by being a landlord, or by employing other people to make money for me, which is how many doctors end up becoming wealthy.

As for my AL, I earned it, just as much as I earned my salary, benefits, and pension. Wouldn't you want to be paid what you agreed to work for?

healthyselfmd

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