Umami

Life is so very precious. We take it for grant. We squander our lives in chasing after, for a lack of better terms, materialistic crap. Never mind personal responsibility. Let’s also not bother in bettering the world. We are completely caught up in chasing after some kind of ridiculous status on par with the flavor celebrity of the week. (Did you know there is a fifth ‘flavor’ we taste? Sweet, Sour, Bitter, Salty, and…Umami!) Then, we allow those crooks on the hill to take from us, and in effect we have allowed them to further divide this country. We are running our health care system and our economy into the ground, because we refuse to take responsibility for our actions.

Okay by now perhaps you are wondering why I keep using “We.” The etiology, the cause, lies in all of us, thus it is and will always be “We.” All the same, the answers rest in our appropriate and decisive action. This week I have spent some time reflecting on our Greatest Generation. Look around you, we exist because of their blood, sweat, and toil. Yes, you can dissect this generation and find fault as you can do any point with any one person or people, but as a whole, they were amazing! We have wandered far from them. Ultimately, I fear for the worse. No amount of technology will correct this fundamental problem nor will empty promises without action.

So I have quite the rant going here. What to do? To quote the famous Yoda (little green guy from Star Wars), “Do or do not. There is no try.” He is right! I believe we should not hang our hat on just trying to do right when it comes to noble and just causes. We must do. We must not accept an attempt. We must demand better from ourselves and responsibility for our actions. We must remember that we are all connected to each other and that we must educate, inspire, and nurture our youth.

Umami is a taste that is generally not directly perceived. However, the aforementioned taste revels with a pleasant savory characteristic. In essence, umami could be described as the glue of our fondest flavors. In “All I Need to Learn, I Learned in Kindergarten,” Robert Fulghum reminded us to revisit the Golden Rule, share, respect, take naps, wonder, question, have fun, laugh. I think he is right…well with a touch of umami sprinkled into our lives to help us along.
So, this holiday season I leave you with a final thought. A child name Mischa was battling with a brain tumor in a New York hospital. Unable to walk, from a wheelchair, this child would wheel around the hospital to see other children who had survived brain operations to remove their tumors. From the wheelchair she would offer words of encourage and hand them a tricycle to ride, a goal to achieve. The surgeon of this child wrote in reflection of observing this brave child:

“It’s how you behave in a ****-storm that shows what you’re made of. ‘Commit Random Acts of Kindness.’ There is NOTHING random about acts of kindness. Compassion is an active verb with moral consequences.” – If I Get to Five by Fred Epstein, M.D.

Merry Christmas! Happy Holidays! Peace. Peace be with you.

Acceptable - Draft

"Acceptable," Merriam-Webster, definition #2, section b: barely satisfactory or adequate

Is this our expectation? Should I look no deeper for a fund of knowledge in our youth? Is Plutarch wrong? Forget this mind as a fire to be kindled. Leave it to mindless button pushing, locked into a television set. Let our bodies rot under their own weight. Out, out brief candle without a moment of spark.

No more is there pride. Long since been replaced by acceptable. We have lost sight of our past. Much of this country has forgotten, never learned, or never fully grasped the blood, sweat, and tears of our 'Greatest Generation' and those who came before. We have become soft, weak, full of blame, and completely lacking responsibility.

In essence, without a clear understanding of our past, without true leadership, without a protected family nucleus, without respect, without sympathy, without empathy, without responsibility, the future is lost. America is at risk. We are at risk of the ultimate of all risks, extinction.

The Rant

(This is the short version without any stories…more to come later.)

Enough. I have had it with people not taking responsibility for their actions. There is no place in the Emergency Department (E.D.) for the drunken patient who was brought in by Emergency Medical Services (EMS, aka ambulance) and needs to “sleep it off.” I am tired of his / her (most often a male) belligerent behavior, physical and/or verbal harassment of nurses and staff. I am beyond pissed off at the potential needle stick that comes with a staff member trying to place an intravenous line on these belligerent patients. As it goes, chances are this is a person who doesn’t make good decisions from the get go, and thus he/she is at a higher risk of having a virus that could cause problems for the person stuck by the needle. Furthermore, these individuals clog the E.D., as the “sleeping it off period” takes hours. And finally, the overall healthcare cost of these patients presenting to the E.D. is astronomical. And guess who takes on the bill…you and I. It is completely and utterly ridiculous. Quite frankly, I am disgusted at not only these patients but also at our leadership for not taking on what has been an obvious problem for a very long time. We need a strong voice. We need legislature that will take a stern, no exception approach to dealing with people who present to the Emergency Department secondary to alcohol and/or other drug abuse. My solution is as follows:

1) Any patient who presents to the E.D. for medical care directly related to alcohol / illicit drug use MUST pay back society no matter the ability of the patient to pay for the ambulance ride and E.D. visit. It should be considered a misdemeanor under the strict sense of public intoxication. Repayment to society, i.e. punishment, should be in the form of public service, perhaps cleaning the ambulance used to bring the person to the E.D among many, many other options.
2) With regard to the same person in #1, any level of physical or verbal abuse to a staff member in the E.D. should result in an automatic charge of assault, battery, and/or equivalent against the person.

This is the short and sweet version. This is a serious issue, and ‘We’ should not allow this to happen any more. By establishing consequences, we are placing the responsibility back to the individual and away from our current lackluster approach of societal responsibility, which was put in place by our ever so wonderful ‘leaders’ on the Hill.

Teachers...

The life of a young doctor is riddled to the brim with ups and downs. I spend most of my time thinking, worrying, fighting with an internal dialogue over my next question, my next exam, my next order, my next anything. It is not so much that I am frozen by fear although I hold my fears close and allow them to help guide me through the valley of death. This internal dialogue rests in the realm of polar opposites. In life there are fundamentally two kinds of people: those who do and those who do not. Inherently, we slide back and forth between these two kinds of people throughout each day, a continuum of doing and not doing. Each decision between these two end points carries consequence and responsibility. So what does this all have to do with teachers? In the emergency room, there is a lot of doing especially from the young doctors who are still treading through that soupy matrix of residency. Young doctors mainly learn from three people: the patient, the nurse, and finally senior doctors. We learn the most from the patient, who trusts us to do no harm and find a way to the right decision, albeit stumbling at times. Above all, however, it is the nurse who carries my utmost respect and admiration. A nurse carries the weight of the patient care and advocacy, of teaching, and of keeping the physician out of trouble. To the resident who is about to make a mistake in ordering a drug or laboratory study, one might hear from an experience emergency department nurse to the new intern, “Doctor are you sure you want to order that lab?” There is a method in their ways. They come at you with the respect of a colleague but also with deep down seeded confidence in knowing the right answer and still offering the student, the young doctor, a chance to learn. The nurse could easily pass on the opportunity to teach and continue to go about his/her duties, but he or she doesn’t. The nurse cares not only about the patient of which he or she is responsible for but also for the young doctor. Tonight, with my glass of gentle red wine, I toast the nurse from which I will learn more than I may ever realize.

18YO M, Near Drowning

“Come with me.” I sat there for a second as the words sunk in. Then, boom back to reality. I grabbed my stethoscope off the computer station. In stride, I joined my attending physician en route to the resuscitation bay. “Your patient” echoed as we entered the room. A medic was in the room, tablet computer in hand. No pleasantries, just the facts, one after another. Mental checklist lit up like the edge of a wildfire. An 18 year old kid was rolled up in the surf, panicked, and inhaled a bunch of water. Lifeguard rescue. Okay, he’s awake. That’s a good start. He’s talking that’s even better. No distress. Why isn’t he on a backboard? Where is his neck stabilization? “Hey bud, were you awake the whole time? …Did you hit your head?” As I reached to feel his pulse, I asked “Does anything hurt?” Normal radial pulse, a little tachycardic, I’ll take it. I turned to the medic, “How was he at the scene?” Okay so his oxygen saturation was a little low at the scene, let’s see what we get here. As I inspected and palpated his body for tenderness and listened to all vital organs, I asked, “Any breathing problems right now? Any numbness, tingling, weakness? Any history of lung problems, asthma, heart problems, seizures? Can you tell me where you are? What is your name? Who is the president?” I ask again, “any pain?” No signs of trauma. Lungs actually sound clear. Oxygen saturation is normal. Patient appears to be stable. Okay, let’s slow this down. I turned to the medic, “Anything else to add?” “Thank you for your work. You all did a good job.” The attending broke the brief silence as I finished up my initial checklist, “What do you want to do for him?” “Nothing besides a little oxygen. He needs a chest x-ray and basic labs.” “Okay, fine with me. Are you going to admit him?” “Not at this time. We’ll watch him. If he stays stable and nothing turns up in any of the studies, then we can send him home.” “Fair enough.” Okay, I have to remember to add him to my patient roster. Now, what in the hell was I doing before this?

Tailgating Coffee

She embodies every quality I have ever looked for in a woman. She is amazing to watch. She is so beautiful. Her smile, a contagious wonderment, warms my heart. Next to me on the tailgate of my truck in the middle of a D.C. neighborhood, we sip coffee together. We speak of our love and of our dreams together. The sun paints the ground, while the birds give us harmony. I find myself lost in our conversation. I love this woman before me. My life is with her. Blessed am I. Loved am I. When I am alone the mere thought of Elizabeth and how happy she makes me brings a joyful tear. I admit on quiet nights alone in my room of falling to my knees and praying that this is all not a dream.

So, here I am...

So, here I am seven days away from completing my last rotation in the hospital as medical student. After the seventh day, my next walk down a hospital corridor while wearing a white coat will be as a physician. And although I now carry the weight of medical decisions only authorized by a physician, I do not carry the same burden. I still have that safety net in place. I am not quite yet on my own. I would be lying if I said I didn’t have fears of this impending day. There is much fear in knowing I am human and fully capable of making mistakes that may in error takes someone’s life away or hurt them. Such fear will always be a component of my life. I wear this badge; I will always wear this badge.

I am fortunate in more ways than I could ever describe within the content of this manuscript. Blessed am I. Every day on the wards of Georgetown University Hospital I am reminded. This month I have seen my fair share of death and suffering. Every little bit of it takes something from you, but if you are careful, then you realize the return has a magnitude far and above what you lose. Death has a face, an air, an ambiance. Foremost it is scary to the observer although not always to the bearer: ashen, either deafening quiet or piercingly loud, time stops, cold, completely sterile or completely messy, alone despite company. You never forget them. You learn from them. You become a better doctor because of them.

In the last week, I have taken care of four dying patients. All of which are at different stages in the process of dying let alone grieving. There is cancer. In the body’s worst way, it turns on itself, the irony of immortal cells. The body dies from its own cells. There is unrelenting infection. As physicians, we are masters of chemicals. We find a problem and throw laced candy at it. We laugh at bacteria. We laugh at fungi. We laugh at parasites. We stare hard at viruses. But, in this laugh and stare, we hide. For, it is these tiniest of organisms that we never turn our backs. Death comes by sea, a flood of overwhelming inflammatory chemicals produced by the body itself, again the irony. At times, the body is stripped of its armor. With battle, the rage of both exotic and commonplace infections easily overwhelm the defenseless body. Slowly, by means of drowning or starving, the body slides away to that deep undiscovered country of which no traveler returns.

There are those patients; the kind you know are not going to leave the hospital with a heart beat. They are prisoners to the hospital bed for months. You keep track of their stay in terms of weeks and not days or hours. They weep tearless cries. Barely able to move despite physical therapy, they rot, nearly catatonic, in an endless state suffering with emotions of frustration and anger. They are held together by a mere single remaining fiber of dwindling hope. They demand an end to the countless questions every morning before the sun comes up. They glare at the same damn ceiling, day in and day out. They have given up on fighting the needle sticks every day for the countless blood drawls only truly taken so that the doctor can check the mental box for the day. Yes, I have tried to help this patient today. In their indolent course, they lose the ability to make decisions. They fall victim to the choice of another, a surrogate, a hopeful ill-informed guardian. One day after months, their last fiber breaks, and they die. It is for these patients that today I weep in silence and solitude. It is for these patients that doctors and nurses must maintain due diligence in doing what is right and best for the patient. To the contrary of what most believe, the easiest thing to do is to throttle up and allow the system to keep these dying patients alive in a state of morbid suffering with no hope of recovery. We must always be cognizant of patient despite our own fears.