New blog on Physicians Practice:
http://www.physicianspractice.com/blog/when-war-and-medicine-combine-physician-reflects
Thursday, July 31, 2014
Thursday, July 24, 2014
Misdiagnosis
Just had another blog published:
http://www.physicianspractice.com/blog/a-physicians-recommendations-for-avoiding-misdiagnosing-patients
http://www.physicianspractice.com/blog/a-physicians-recommendations-for-avoiding-misdiagnosing-patients
Thursday, July 17, 2014
New post On Physicians Practice
Here's a link to another blog, where I hope to be regularly posting:
http://www.physicianspractice.com/blog/after-serious-illness-a-physician-faces-questions-about-the-future
http://www.physicianspractice.com/blog/after-serious-illness-a-physician-faces-questions-about-the-future
Monday, June 2, 2014
Survivors Day
Yesterday was National Cancer Survivors Day. There were activities nearby. But, the whole idea of survivorship is not to have disease overwhelm humaness. The person is more than the disease.
Organized activites are great to see old friends who have also made the journey, but it is also a time to celebrate life, spend time with children, in nature, reading, or whatever one's pleasures are. As it turned out, an RSVP was required and I had failed to call. The office wasn't open on Sunday.
So we went to a nearby park. The kids played softball and soccer with some newly made friends. I walked around a bit, read a bit, and just enjoyed being outside in beaustiful spring weather. In a way, just being normal is a celebration of survival as well. It is time not focused on patienthood, but rather on personhood.
As I think about patients, I have known those who focused on patienthood and some missed out on life along the way. And those who focused solely on personhood, to the extent of denial of disease, and suffered an untimely end. It is a balance that requires continued adjustment as the disease shifts the foundation on which it is made.
Similarly, physicians must learn to balance work and life. "Medicine is a demanding mistress" accordng to Osler. For those of us who write, perhaps Chekhov's quote, "Medicine is my lawful, wedded wife, and literature is my mistress," is perhaps more apt. So where is the time for family, friends, exercise, travel. We must somehow carve it out. So there are now a plethora of work-life balance seminars for physicians.
I have spent much of my life as a workaholic physician. My illness has taught me that I can't do everything, and I can't just put things off. I must accept that I am mortal. I must live in the present. I must take the time to be with my children, to watch them grow. I must take the time to write the family stories down that I hope they will want to know. I must take time to see the places I have always wanted to see and share the experience with my children.
Illness is the ultimate seminar on work-life balance. It forces one to reevaluate priorities. I realize that I must now work even harder to achieve balance in the different spheres of my life. But, I want it to be the best life I can have. I want to do the best for my children.
Organized activites are great to see old friends who have also made the journey, but it is also a time to celebrate life, spend time with children, in nature, reading, or whatever one's pleasures are. As it turned out, an RSVP was required and I had failed to call. The office wasn't open on Sunday.
So we went to a nearby park. The kids played softball and soccer with some newly made friends. I walked around a bit, read a bit, and just enjoyed being outside in beaustiful spring weather. In a way, just being normal is a celebration of survival as well. It is time not focused on patienthood, but rather on personhood.
As I think about patients, I have known those who focused on patienthood and some missed out on life along the way. And those who focused solely on personhood, to the extent of denial of disease, and suffered an untimely end. It is a balance that requires continued adjustment as the disease shifts the foundation on which it is made.
Similarly, physicians must learn to balance work and life. "Medicine is a demanding mistress" accordng to Osler. For those of us who write, perhaps Chekhov's quote, "Medicine is my lawful, wedded wife, and literature is my mistress," is perhaps more apt. So where is the time for family, friends, exercise, travel. We must somehow carve it out. So there are now a plethora of work-life balance seminars for physicians.
I have spent much of my life as a workaholic physician. My illness has taught me that I can't do everything, and I can't just put things off. I must accept that I am mortal. I must live in the present. I must take the time to be with my children, to watch them grow. I must take the time to write the family stories down that I hope they will want to know. I must take time to see the places I have always wanted to see and share the experience with my children.
Illness is the ultimate seminar on work-life balance. It forces one to reevaluate priorities. I realize that I must now work even harder to achieve balance in the different spheres of my life. But, I want it to be the best life I can have. I want to do the best for my children.
Sunday, May 25, 2014
Music in the OR
I don't know whether music was played in the OR for any of my surgeries. Many surgeons like music for all or part of the case. Sometimes, it can be too distracting for critical portions. But, one must be aware of the appropriateness of the music.
Years ago, when I was a resident, we were simply playing a radio. It was Halloween, so the music was macabre. I have long wondered how a patient felt going to sleep with such music. I thought that I certainly wouldn't want to hear such music as I was put to sleep.
More recently, for a dental procedure, I was asked what kind of music I liked. Of course, it was to be done with local, so it did matter to me as the patient. My tastes are quite eclectic, so I let them play Pandora with popular music. It turned out to be the ones my kids know by heart. It was good for me to get a chance to hear more of what they like.
When I am the surgeon, I have liked different genres for different procedures, "heavy metal for heavy metal" when I am doing instrumentation. For other cases, I tend to prefer other genres, classical, folk, classic rock, world, etc. A good friend likes Broadway show tunes for his cases. At times I prefer no music like when approaching or clipping an aneurysm, though I have allowed the residents to choose after the aneurysm has been secured.
Recently, a surgical colleague curated an art exhibition at a medical meeting. Scattered amongst the photographs, paintings and sculptures were pieces of sheet music from Pictures at an Exhibition by Mussorgsky. This seemed so apt for the setting. I only wish it could have been playing to set the mood of those looking at the art.
I do think music does set a mood. And mostly the mood in the OR should be calm and organized. But, sometimes, the tempo should increase, and music can help with this, too. And, allowing the residents to choose will sometimes tell me a bit about them, as well as sometimes introducing me to a new artist.
Years ago, when I was a resident, we were simply playing a radio. It was Halloween, so the music was macabre. I have long wondered how a patient felt going to sleep with such music. I thought that I certainly wouldn't want to hear such music as I was put to sleep.
More recently, for a dental procedure, I was asked what kind of music I liked. Of course, it was to be done with local, so it did matter to me as the patient. My tastes are quite eclectic, so I let them play Pandora with popular music. It turned out to be the ones my kids know by heart. It was good for me to get a chance to hear more of what they like.
When I am the surgeon, I have liked different genres for different procedures, "heavy metal for heavy metal" when I am doing instrumentation. For other cases, I tend to prefer other genres, classical, folk, classic rock, world, etc. A good friend likes Broadway show tunes for his cases. At times I prefer no music like when approaching or clipping an aneurysm, though I have allowed the residents to choose after the aneurysm has been secured.
Recently, a surgical colleague curated an art exhibition at a medical meeting. Scattered amongst the photographs, paintings and sculptures were pieces of sheet music from Pictures at an Exhibition by Mussorgsky. This seemed so apt for the setting. I only wish it could have been playing to set the mood of those looking at the art.
I do think music does set a mood. And mostly the mood in the OR should be calm and organized. But, sometimes, the tempo should increase, and music can help with this, too. And, allowing the residents to choose will sometimes tell me a bit about them, as well as sometimes introducing me to a new artist.
Friday, May 16, 2014
Mother's Day
Today is Mother's Day. I returned from a class yesterday to find a bouquet of flowers that my children had picked for me sitting on the table. My son, who has struggled to deal with my illness, gave me a beautiful string art heart that he had made, together with a beautiful letter. My daughter had given me a self profile with bits about Central Asia, where she was born.
We went to a movie. Of my choosing! Wrote a short piece and am blogging again. And it has been a wonderful spring day to spend with the kids. A celebration of life. And recently, all my checkups have been good, even though I still suffer with a complication of treatment. So, I am looking forward to my life, many years of it, to finish raising my children.
What more could a mother want?
We went to a movie. Of my choosing! Wrote a short piece and am blogging again. And it has been a wonderful spring day to spend with the kids. A celebration of life. And recently, all my checkups have been good, even though I still suffer with a complication of treatment. So, I am looking forward to my life, many years of it, to finish raising my children.
What more could a mother want?
Wednesday, September 11, 2013
Review of "Proof of Heaven"
Here on this blog and recently, at a medical appointment, while speaking to another patient, the book, "Proof of Heaven" by Eben Alexander was mentioned. Dr. Alexander is a fellow neurosurgeon who has experienced being a patient.
His illness, from which he has made an excellent recovery, was meningitis. He was in coma for about a week. He describes his memories of the experience interspersed with the medical events that were happening. While, this is an excellent technique for telling his story and making sense of his experiences, I wonder if the timing was really as he described. The experience of time when one is unconscious is likely very different than when awake. Recently, there has been research that suggest that there is a burst of electrical activity in the brain just before death (http://www.telegraph.co.uk/health/healthnews/7785944/A-cascade-of-brain-activity-as-people-die-could-explain-near-death-experiences.html). So, I wonder if many of his memories are either from the time that he was just lapsing into coma or emerging from it. But, even so, one has to discuss the issue of what he experienced.
Clearly, many people have electrical activity of the brain when they are dying or almost dying. It is from this latter group, the survivors, that we hear about near death experiences. For Dr. Alexander, they involve two major groups of images, first that of a soup in which he sees faces, first grotesque animal faces and later recognizable human faces; and second that of riding on a butterfly with a woman who is acting as his guide of heaven. Only after his recovery does he learn that this woman appeared to be his biological sister who had died, though he had never met her since he had been given up for adoption as an infant. By the time of his illness, he had met other biological relatives.
Many other survivors of near death experiences have reported a light filled tunnel or images of a deity. Others report a sensation of floating above their physical body. It seems probable that prior life experience and belief systems may influence the near death experience. For example, Dr. Alexander mentioned his love of skydiving, describing two sunset dives, including one where his quick reactions saved another skydiver. While there are similarities in some near death experiences, there are also differences suggesting that something more individual influences the experience as well.
As people are dying, there is also a surge in endorphins (natural opiates in the body) which helps to make people feel more at peace. This has been proposed to be a way that animals developed to lose connection to the pain of being attacked by a predator. No matter the reason, it does seem that as death nears, both humans and other animals seem to become more peaceful. To me this is a suggestion of a kindness of nature or a creator.
I have never had a near death experience, though I have experienced things I cannot explain. The first was many years ago when I was struggling with life choices. I felt a presence and a light and a peacefulness telling me that I would know what to do. At that time, my mother was recovering from cancer surgery nearly ten years before her death due to another cause. The second was in the months leading up to my mother's death. I would rehearse running a code (resuscitation) nightly in my dreams, knowing that I was running it on someone I knew and loved, though I never saw the face. These dreams ended abruptly after I ran the code on my mother in a Spanish hospital since they routinely did not resuscitate patients there who were dying. After her death, I have felt her presence many times. (Much of this experience was described in an article I wrote a couple years ago: http://www.physicianspractice.com/work-life-balance/content/article/1462168/2041808.) For me, the rehearsal dreams are the most difficult to explain. They started several months before her death. How could I know that I would need to run a code on my own mother? We were living on separate continents at the time. She had recently been given a clean bill of health by her oncologist with respect to her breast cancer. Why did I know to memorize doses of medications which are usually ordered as "an amp(ule) of ..." in the US during code situations? Yet somehow I did know those details.
While I find Dr. Alexander's book to be an interesting read and I have learned more about him as a person, I am still left with the sense that the interpretation is dependent on a belief system. For me, this is better as I think the mystical is not fully knowable or provable. Yet, for those of us who have experienced it in some way, it is certainly real.
His illness, from which he has made an excellent recovery, was meningitis. He was in coma for about a week. He describes his memories of the experience interspersed with the medical events that were happening. While, this is an excellent technique for telling his story and making sense of his experiences, I wonder if the timing was really as he described. The experience of time when one is unconscious is likely very different than when awake. Recently, there has been research that suggest that there is a burst of electrical activity in the brain just before death (http://www.telegraph.co.uk/health/healthnews/7785944/A-cascade-of-brain-activity-as-people-die-could-explain-near-death-experiences.html). So, I wonder if many of his memories are either from the time that he was just lapsing into coma or emerging from it. But, even so, one has to discuss the issue of what he experienced.
Clearly, many people have electrical activity of the brain when they are dying or almost dying. It is from this latter group, the survivors, that we hear about near death experiences. For Dr. Alexander, they involve two major groups of images, first that of a soup in which he sees faces, first grotesque animal faces and later recognizable human faces; and second that of riding on a butterfly with a woman who is acting as his guide of heaven. Only after his recovery does he learn that this woman appeared to be his biological sister who had died, though he had never met her since he had been given up for adoption as an infant. By the time of his illness, he had met other biological relatives.
Many other survivors of near death experiences have reported a light filled tunnel or images of a deity. Others report a sensation of floating above their physical body. It seems probable that prior life experience and belief systems may influence the near death experience. For example, Dr. Alexander mentioned his love of skydiving, describing two sunset dives, including one where his quick reactions saved another skydiver. While there are similarities in some near death experiences, there are also differences suggesting that something more individual influences the experience as well.
As people are dying, there is also a surge in endorphins (natural opiates in the body) which helps to make people feel more at peace. This has been proposed to be a way that animals developed to lose connection to the pain of being attacked by a predator. No matter the reason, it does seem that as death nears, both humans and other animals seem to become more peaceful. To me this is a suggestion of a kindness of nature or a creator.
I have never had a near death experience, though I have experienced things I cannot explain. The first was many years ago when I was struggling with life choices. I felt a presence and a light and a peacefulness telling me that I would know what to do. At that time, my mother was recovering from cancer surgery nearly ten years before her death due to another cause. The second was in the months leading up to my mother's death. I would rehearse running a code (resuscitation) nightly in my dreams, knowing that I was running it on someone I knew and loved, though I never saw the face. These dreams ended abruptly after I ran the code on my mother in a Spanish hospital since they routinely did not resuscitate patients there who were dying. After her death, I have felt her presence many times. (Much of this experience was described in an article I wrote a couple years ago: http://www.physicianspractice.com/work-life-balance/content/article/1462168/2041808.) For me, the rehearsal dreams are the most difficult to explain. They started several months before her death. How could I know that I would need to run a code on my own mother? We were living on separate continents at the time. She had recently been given a clean bill of health by her oncologist with respect to her breast cancer. Why did I know to memorize doses of medications which are usually ordered as "an amp(ule) of ..." in the US during code situations? Yet somehow I did know those details.
While I find Dr. Alexander's book to be an interesting read and I have learned more about him as a person, I am still left with the sense that the interpretation is dependent on a belief system. For me, this is better as I think the mystical is not fully knowable or provable. Yet, for those of us who have experienced it in some way, it is certainly real.
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