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?

The Realization

The second year of medical school resembles drown proofing. Drown proofing involves taking someone beyond their fears into the realization of drowning. The 'training' involves many methodologies, but ultimately it involves a 'swimmer' (combat swimmer or rescue swimmer) inhaling water while being forced to perform a series of maneuvers such as treading water with your hands in air or correcting scuba gear while being harrassed. Anybody who as had the pleasure of experiencing drown proofing or has come close to drowning for any number of reasons can tell you that the experience is pretty much a full-up conversion with God. Those who survive such experiences have a will, a desire, a drive to go beyond their fears in the name of something more important than their fears. But, along the way, the individual learns many valuable lessons, to name a few:



1) Life is precious and can be taken away very easily. Therefore, respect life at the highest of all levels.

2) Fear will always be there, but it can be overcome.

3) Believe in yourself.

4) Swim. Sinking is not an option compatible with life.



Although the second year of medical school is riddled with time on the books, my thoughts often drift heavily in the direction of one overriding realization: All this stuff I am learning is not just to be learned; it is to be applied, where mistakes can have ultimate consequences.



I work in the ER/ED from time to time with a physician, a mentor. He will hand me a chart and off I go into the unknown, into the world of patient's complaints, worries, pains, illnesses, and that damn dark shadow breathing down the backs of some patients. Death has a certain way in the Emergency Room. Sometimes, it strikes with such gestalt to the point that there is no arguing with death. But, other times, he rears his ugly head when we are not ready, and in those moments the continuation of life relies heavily on the action of the team, i.e. of those who can. In such times, all that stuff one learns in textbooks, in training, in practice becomes a sobering reality. In the blink of an eye, life can come to a screeching halt, while those who can try their best with focus, hope, and a silent prayer in the middle of a battle.

Thankful for CPs

With every career field, lifestyle, hobby, etc, there exist acronyms, and medicine is no exception. Moreover, every physician, nurse, therapist, or technician at one point or another walks the ever so thin line of the patient versus the illness. The vision of treating the patient becomes fogged by the solving the problem, and so the problem becomes larger than the life before them. "Mr. Smith" is replaced by "Chest pain" in Room 2. It happens. No matter how much you, as a physician, care it will happen at one point or another.

A day and half before Thanksgiving I worked the night shift in the Emergency Dept (ED), a welcomed change of pace from the full up firehose of information being slammed down my throat everyday in lecture. The shift was filled with Chest Pains, moreover, "CPs" as the appeared on the chart. Literally, every single one of my patients had a Chief Complaint of chest pain. Most of the cases were complexed by communication issues such as advanced dementia and short term amnesia. The laundry list of medications and perplexing past medical histories left me scratching my brain on more than a few occasions (ended up with a hole through my calvaria, aka skull). I felt the pull of psychosocial issues from each patient; each patient desperately in need of a loved one and/or friend and perhaps even a restart on life. In ED psychosocial issues can be the most frustrating; it boils to time and priority or lack thereof. Unless the patient is suicidal or homicidal, they are not going to die or become acutely ill. You only have time for a few words, a recommendation, and a referral. This is the sad truth for most occasions.

As I left the ED that night at 2 in the morning, I drove through quiet DC streets with my brain cranked up on one question: why so many CPs? It took me a few minutes and then it hit me. The sad truth sobered me. A while back, I learned about a phenomena, where the number of heart attack / chest pain cases jumped up over the holidays. Many of the cases were genuine heart attacks perhaps precipated by the heightened stress of the holiday season, diet, etc. On a side note, I have always found it quite ironic that the 'holiday' season is such a stressful time. When I started thinking back to every single CP case, of which none were heart attacks, a certain condition seemed to haunt almost every single patient: loneliness. These patients were alone, and nothing reminds an individual more that he or she is alone than perhaps a holiday of togetherness such as Thanksgiving. My realization left me with a chill and more importantly a reason to be thankful for my family and friends.

The Guilt In My Education

I love to run, because it is my time to meditate…just me, the path, a slight breeze, and the faint background noise of my lungs keeping pace with my feet. During a recent run, I had a thought that I haven’t been able to shake, but what is more is that perhaps I should try to shake it and instead just embrace it. I have come to the interesting paradox: my education, my training in the explicit field of healing and doing no harm comes at the price of causing some pain and absorbing emotional distress. In other words, the sad truth of becoming a physician or surgeon comes at the hand of making mistakes, eliciting pain, learning the boundaries of a salvageable situation, and most importantly learning how to put myself in my patient’s position. The patients I come in contact with are already in a great deal of discomfort and pain, and to think I could add to their dilemma kind of scares me a little. I’m okay with the fear. Such a fear is completely natural and expected. I have learned to take my fears in stride and not let them stop me, although I still find it easier to address and overcome fears where the end item only affects me and not others. But then again, I think life should be lived altruistically, at least most of the time. When at all possible, life should be paid forward. This is the philosophy I choose to undertake. Pay everything forward. Do your best for others and only hope they can do the same for someone else. Holding true to this philosophy, I find dealing with the aforementioned paradox and fear to be a little more manageable. But, what about all the stupid people in this world? What about them? Charity. Just realize we are all doing the best we can. Protect those of us who are vulnerable and stricken, then remember, “We are all doing the best we can do.”

On a side note, during the same run, this thought was premised by wonderful realization that I was in medical school and working towards something I full-heartedly believe in. It all still feels like a dream that I am going to wake up from. The truth is I hope I never wake up.

Does Everyone Deserve A Second Chance?

If necessary with no other resolution possible, I could and would pull a trigger. I believe in punishments worse than death. The case found below strikes to the very heart of the matter. Justice for the acts committed by or under the command of the dictator, Manuel Noriega, who claims to be a military general, will not be served until the man has breathed his last breath from behind bars. Soon he will be released from a U.S. federal prison. I have dreaded the day for quite some time, although it is very likely he will be killed by a hitman upon his release onto the streets. Luckily the french government to my astounishment has stepped up to the place and has moved to trial him in french courts for criminal acts committed on french soil. He is a sick, twisted poor excuse of a human being, who does not deserve another chance. I pray he never sees the light of day again.

http://www.cnn.com/2007/US/law/07/26/noriega.parole.ap/index.html#cnnSTCText

Here I Sit

So here I sit. After almost a full year of studying, I have nothing pressing. Right now, my life should be all about fun and relaxing, and I sit here paralyzed. Perhaps this is Murphy's last stand, an effort to thort a chance to breathe and reflect upon the year. When you take a race car to 100 mph and then slam on the breaks, it doesn't just stop. The laws of physic smile down upon you, and the car pushes forward otherwise. Apparently, God intend the law of inertia to perhaps be more broad and resilient than Sir Isaac Newton intended, as my poor brain has a certain affinity for such a law as well.

Youth In The Eyes Of The Dying

Nothing in this life is guaranteed except that we will die. We think we have control, but we really do not for the most part. Our thoughts and perspective we steer but beyond that all else can be striped out of our hands. A youthful, inquisitive, joyful mind slays the demon of this gauntlet. This is the lesson I learned this week. From meeting the real Doc Hollywood, to spending thought provoking conversation with a beautiful woman out to change the world for the better, to the drunk forcing his way into a family’s conversation at a birthday meal, this week I learned the importance of being young at heart.

My friend managed to arrange for Dr. Neil Shulman, professor, medical doctor, author of Doc Hollywood, but more importantly advocate of the being young at heart, to come talk about humor and medicine. I jumped at the occasion…sat front and center and even got up and told a joke myself. His messages were quite simple: 1) Stay young at heart, 2) Mend your passion(s) with medicine when possible, 3) Do not lose your sense of humor, and finally 4) Do not take yourself so seriously. With humor, circumstances become manageable. With being young at heart, life doesn’t shine it sparkles.

Today was a day of polar opposites and as such the message amplified all the more. For a late lunch, I met a very wonderful, beautiful person. She reminded me of the importance of maintaining an inquisitive, child-like perspective of the world we traverse. The good in her radiates in such a way to be contagious in the most epidemic of ways.
Her eyes kindle a fire of hope and prosperity for all. A purpose determined by opening one’s heart and allowing life to take you up. I left this late lunch and conversation with an uplifted feeling. At the moment it still carries me despite the ‘fun’ to follow. For dinner, I met up with a good friend and her parents for her birthday. During the course of an awesome dinner, a rather out-spoken man and his date sat next to us. He quite rudely injected himself into our conversations time after time. At one point he reminded that the NSA (National Security Agency) has ears everywhere. I wanted to tell him, “No shit, perhaps I should drive up the street and knock on their door and ask them,” but I remained in reserve. As if his interruptions weren’t enough, he later went on to insult the truck I drive, my intelligence, my character, etcetera…all except insulting my truck seem to be a going theme in my life right now. I wish I could say I provoked the guy, but I didn’t say a damn thing to him. I guess the child in him was crying out for help as he poured the alcohol down to silence the screams. I pitied the man, and I hope he finds his way back to his childhood.