L.O.L. et. al.

It’s not what you think. Keep reading. L.O.L. Little Old Lady. You are guaranteed to walk out of the room with a smile. Hardly the perfect patient, they will make you pull your hair out if you have any left. Patient’s blood pressure reading: 170/82, a whole 40 points above the last reading, not good. I questioned, “What happened with your blood pressure?” I didn’t expect to know the answer; I was just throwing it out there just in case. Through her thick glasses and gentle grin, she retorted, “I started taking them every other day.” Obvious reply from any doctor, “Why?” She looked down at her slow swinging feet with curiosity as they were too short to hit the ground from the chair and spoke with soft authority, “It made me gassy.” Although I’ve never heard of such a side effect from her medications, I wasn’t about to argue with her, and I could barely keep a straight face. This is the same woman who at the age 94 years old presented me with a ten step water-tight plan to squeeze another walker out of Medicare (for good reason mind you), informed me that she has already out lived three husbands, was in the process of writing an autobiography, would not let me exam her feet, and with a lean and whisper informed me that she sneaks half of a chocolate candy bar every day despite her diabetes, not that it would be a point of contention in the presence of a doctor. This lady absolutely made my day. She somehow found the spice of life and kept hold with a grip that would make a cliff climber jealous. Her happiness didn’t come from being a millionaire or wearing the latest fashion; it came from staying in the moment and keeping perspective.

In one breath worth of words, a patient can shock you, make you smile, bring tears, or make you walk away in complete disbelief at the potential variables of stupidity. I remember one recent Friday where I had just had enough and was ready to go home. After seeing my last patient before I left for the day, the patient’s roommate, not my patient, called me as I left the room. With a deep breath before I turned around, I went to his roommate’s bedside. An older gentleman who appeared comfortable but very tired in a sickly kind of way, a poster child of the infirm, but just perhaps on his way back from hell. I softly put my hand on his shoulder and asked him how I may help him. He responded, “Bless you. You do for others. Bless you.”

Over my too quiet Thanksgiving holiday with the world in a state of madness brought on by greed and with people still prioritizing the wrong values (one of many examples: the Wal-Mart worker killed via stampede on Black Friday), I have been thinking…a lot. I have a lot of hope for us, but what will it take? How many will have to die? How many will have to suffer? How many good men and women will it take standing tall against the devil? When will we realize happiness exists not in ideals of power and greed? How long until we realize that we don’t need to be under the very worst to see the very best? Or will we ever? Let us take a take a lesson from the two individuals I just spoke of. Let us be thankful for each other. Let us be thankful for that extra piece of pumpkin pie and that extra glass of wine. Here is to peace and happiness. Cheers.

When You Are Neck Deep In It... - DRAFT

I had a bad three weeks. I lost three patients. Death is not pretty; it can be down right ugly if we go the whole nine. In the middle of a working a code, the human aspects of the patient fade way to facts. As doctors (and nurses), we have to set aside any human connection and work the numbers and facts to the best of our abilities. The intensity in the room accelerates to the extent of taking your breath away. "Yes, please" and "No, thank you" abruptly transitions to "get it done" and "we need this yesterday." This is all well and good and should be expected. The part that makes my stomach turn is the family watching the whole process. As a doctor, I can separate myself and move forward through the dramatic process of trying to revive a life quickly fading away. But, what of the husband or wife? Of the son or daughter? What of them? I have seen fear and also looks of horror in their eyes. I dare not imagine the view through their eyes. What horror it must be watching their loved one turn completely unresponsive, and then the intense rush of medical person after medical person into the room as you are slowly squeezed out of the small room as you watch CPR in progress with intubation placement then the central venous access lines and the yells for drugs administration. The process continues to snowball as a hospital representative finally comes up to you and ask you to join them in another room while your loved one's life slowly withers away. I dare not say "I know how you are feeling." They look at you with hopes of a miracle, but all too often the process of dying was already well underway prior to the code, prior to the ER visit. The walk into the room should be one of grace and complete humility. As doctors we are not their to heal in that instant, we are there to carry the truth with soft words and breaths of empathy. The silence is quite uncomfortable; it burns at your lungs. You want to say more; you want to say it will be alright, but again you are there to tell the truth...the truth. In all honesty, the tears upon processing the news compels some sense of odd relief to me, as I know the family understands the news.

Then you have that patient who you have befriended in the hospital. Who has terrorized the poor nurses and staff, only to pick out a few people in the hospital he/she likes and then solely looks to them for assistance. The story underlying such a patient often involves a chronic illness, generally with a very grim prognosis with survival beyond a few months. Watching the suffering can take its toll on the treatment team. Relief to the patient only seems to come with large doses of drugs that dull the patient's spunk and vitality. But moreso, it is hard to listen to such patient ask under grounds of complete sincerity for a lethal dose, and under certain conditions harder to say, "No."

Imagine

Finally, I'm home after a long day at the hospital. Jack Johnson's cover of Lennon's "Imagine" is playing in the background. The song couldn't be more appropriate.

My mother has repeatedly told me over the years of a saying by her mother, my grandmother. In short, my grandmother would say, "We cross back and forth between sanity and insanity every day." It is not that I ever dismissed these words; it is, however, that I never completely understood what they meant. I now do.

Over the last week and half, I have come face to face with horrible illnesses. Most of which there is no cure and the treatment a crude at best in some cases. These patients often struggle to maintain a grip on reality. Before me, the horrors of Schizophrenia / psychosis, Obsessive Compulsive Disorder (OCD), Bipolar Disorder, Major Depression Disorder, and every other mental illness surfaced in the eyes of desperate and almost completely helpless patients.

From the eyes of a schizophrenic, one may find the haunting image of a human being trying to fight off internal voices in a effort to maintain their own sanity and be a functional member of society. Imagine living in a world where one day voices questioned your every thought and slowly through time your thoughts every so slowly twisted with delusions. Imagine knowing you were slowly losing your grip on reality. Imagine trying to fight back...imagine trying to prove to a psychiatrist that you can function by yourself out in this world despite the voices and the deeply seeded beliefs that the president of this country was your friend.

From the eyes of a person with OCD, one may see the confusion and sheer terror of cycling through the same very, very disturbing thoughts without any control over them. Imagine the echoing thought in your every waking moment, and then imagine trying to make sense of why you keeping thinking such horrible thoughts. With such an illness, a person can fall into the trap of depression and slowly give up on life...all because you have these terrifying thoughts that you don't want to be a part of you despite the exhausting struggle to dismiss these thoughts and let alone any compulsions (repeating behaviors that are aimed at calming the obsession).

Imagine knowing that you are now 'crazy' and that at some time in the past you were 'normal' and had a full and wonderful life. The most unfortunate aspect of these illnesses lies in the fact that the patient's prior behavior in life has very little to nothing to do with onset of these severe illnesses. For the majority of cases, people are plucked from reality and left deteriorate before the rest of society. They are trapped in a world they don't deserve and can't escape.

M.

So, after two years of clawing and scratching to make my way through the gauntlet that is medical school I am now "M."  I am halfway there!  Tomorrow, it begins.  Tomorrow, I begin board exam study.  A culmination of years worth of intense education will meet me at the end of June and then for the rest of my life in the eyes of every patient I treat.  It is incredible to believe that life comes at you so fast.  It feels like just yesterday I was trying to claw and scratch my way into medical school.  Then, the wake up call concerning the intensity of medical school came crashing in during the first few months, and yet after every hill, every valley, every mountain, I remained standing.  Despite questioning this journey on many occasions, every struggle ended with me continuing to believe in myself.  I just kept moving forward.   It was just that simple and just that complicated, an everyday question and an everyday answer.

Defining Us - Cliff Note Version

Who are we?  How is that we still live in a world where people are so oppressed that they will risk life itself in an attempt to escape just putting food on the table.  What type of backwards world do we will live in where so many do with too much and then so many more do with not enough?  Why do we allow evil, corrupt men who think nothing of taking lives to walk this Earth?  I ask again: Who are we?

The U.S. is the richest country on terra firma.  With a population of roughly 301,139,947 people (July 07 est), we spend over 1.9 trillion dollars a year in health care.  This is more than any other country on the face of the planet and in many cases quite a few countries put together.  And yet, 43.3 million of us are uninsured of 1/4 are children (9.3 million).  In other words, 15% of our population does not have any health insurance.  Nothing. Nada. Zip.  Where does the 1.9 trillion dollars go?  Surely, we could fund medical care for the entire country off of 1.9 trillion dollars...if we wanted to.  You are probably asking yourself where am I going with this.  And, yes, I'm going there.  Socialized medicine.  Can you hear them?  Those big bad footsteps of socialism and communism creeping up behind me.  Please.  Socialized medicine has nothing to do with government in the sense of ruling the people and everything to do with keeping this nation healthy and right side up.  We have been so inundated with paid-off government officials telling us how big and bad socialized medicine is and why it won't work.  But, hey, I have news for you.  The current system in place is only really being very successful at doing one thing: making a few people very, very, very rich.  Our medicine system is crippled by greed and greed alone.  We as a nation have decided that making money is more important that keeping people healthy.

Question: How do you keep people oppressed?  Answer: You make sure they are uneducated, poor, you keep fear in their hearts, then you send them spirally downward chasing a fanasty without a parachute.  Anybody around here taken notice of our education system issues?  Question: How much do we pay teachers?  I'm not even going to bother answering this one.   We can keep going if you like, as I only covered two of the issues surrounding power, corruption, and greed.

We have allowed our nation to become what it is.  It is what it is, nothing more, nothing less.  We have allowed ourselve to be ruled not by the people but rather by greed of the few.  Where will it stop?  The other day I read that there is pilot project out there to actually pay students to go to school.  I think this is quite the wonderful idea.  Let's just feed right into the greed.  Get them started early on life.  What happen to success in life meaning more than your salary?

Our country is missing idealism.  We are missing the big picture, the goal for all of us and not just some of us.  No matter how much a politician throws it in your face in an effort to strike fear in your heart, evil is not solely found in some far off land, in the mind of some poor excuse for a human being.  Sadly, it unfortunately can be much, much closer.  As much as we should rid the world of those evil men found in lands far, far away, we should also be mind of the potential in each and everyone of us.  It could be argued that the act of not doing could be just as destructive.  So, in closing, I ask: When will it stop?  When will stop not caring about our fellow man?