Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Doing Your Best with Honesty

As the semester winds down for those who are in school, the temptation to cheat or cut corners becomes problematic. I understand that you are just busy and want to do anything that will lessen the load but cheating carries risks beyond getting caught.  Sure, being questioned is stressful but consider other problems with cheating.

Most people will attempt to justify their cheating by saying that, “Everyone does it”, which is not accurate. Most students diligently attempt to complete their exams, papers, and other scholarly activities as honestly as they can. If you copy another person’s work, you are cheating. If you share answers on an exam, you are cheating. If you stash “crib notes” in the loo for consultation, you are cheating.

The other risk with cheating is that once you cheat, you are never honest again. There is no remediation for dishonest, especially in medicine. When a patient is in distress, as others look to you for solutions to that distress, the cheating won’t help you. You can’t “cheat death” and you can’t have a do-over in these matters.

All of us face subjects that challenge us which is part of being a human. When faced with challenges, I try to solve problems so that I can master what needs to be done. I study regularly and constantly making appointments with myself to keep my work covered. Reading and study are my constant companions as a physician which is why I enjoy my work immensely.

I also know that when I do my work as honestly as possible, I figure out where I fall short and make sure that I put extra time on those things that require more intensive study for me. In short, just as I give my sickest patients more time, I give my worst subjects more time. If my mind doesn’t want to focus on the study tasks in front of me, I take a  brisk walk or short run to get my focus back. I hate procrastination in myself and have found that my daily, discipline of running has eliminated procrastination.

As the semester winds down, do the best that you can with honesty and reverence. Resolve to increase your focus on those subjects that require more focus; do them first if you have a choice. Force yourself to do the hard stuff because getting past the hard stuff is most rewarding.

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10 December, 2018 Posted by | academics, medical school | , | Leave a comment

Voyage to the Bottom of the Sea

Living With Adventure

My mind went back to my first “crush” when I was a kid growing up on an East Coast Horse Farm. While my sisters had photos and dreams of Robert Redford and The Beatles on their walls and in their hearts, I had a single snapshot of Richard Basehart in his role of Admiral Nelson of the telly series “Voyage to the Bottom of the Sea”. My crush was Admiral Nelson, not so much Richard Basehart. I wanted to be a scientist who explored the oceans discovering new truths and making observations; figuring out the world with science.

Even in the series, Captain Crane played by David Hedison was the “heartthrob” but for me, it was always the Admiral and his “flying sub” an amphibious sort of a vehicle that captured my heart. Well, I loved Basehart’s voice too. Even as a kid, I was a young woman who appreciated words…

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29 November, 2018 Posted by | medical school | Leave a comment

Welcome to the New Norm!

This past week I attended a wonderful trauma conference in my city. One of the outstanding presentations at this conference highlighted issues that all of us must consider when treating patients who are morbidly obese. A morbidly obese trauma patient can have increased mortality and morbidity from issues surrounding the EMS to the treating institution not being able to accommodate their size. This is the new reality of the patient population that is increasingly entering our trauma bays injured.

Consider that many morbidly obese patients can’t lie flat because of respiratory compromise caused by their size. Consider that sounds such as lung sounds, heart sounds, and bowel sounds are simply harder to appreciate fully in patients who have large amounts of body fat. Consider that CT Scans generally will not accommodate patients who are more than 350 lbs (certainly we see a fair percentage of people who are over 350 lbs). Consider that stretchers, wheelchairs and even chairs in waiting rooms cannot accommodate patients who weigh more than 350 lbs.

Treating a trauma patient is not the time when one has to worry about whether or not their facility can take care of a patient of size. One has to know the weight limits of their resources before that patient arrives in the trauma bay. One additionally needs to be aware of the chronic physiological demands of this patient population in addition to the added stress of a major traumatic injury. One also has to be aware of the demands of staff who may be in short supply when a patient of size winds up in your trauma bay.

I recall taking care of a 5’4″ trauma patient who weighed 644 lbs who presented to my hospital (a bariatric facility).  Even turning this patient for a thorough examination took more than eight people and was problematic. We had beds that would accommodate this individual for vascular access was difficult; determining the extent of the injury was difficult along with safe positioning for prevention of respiratory compromise was difficult. For our trauma team, it was a complete challenge but not an impossible one.

This extremely large patient was taken care of in the initial stages (without CT scan or any of the usual diagnostic tools) but the patient ended up with significantly more morbidity issues because of their size.  Even contributing to this patient’s injuries and recovery were the staff attitudes toward this patient which was the most difficult issue in caring for this patient.

Consider that when one treats morbidly obese patients, these patients didn’t gain their weight overnight. They likely are depressed and have been ridiculed by our society that devalues them based on their appearance. Obesity is a chronic nutritional disorder that often comes with mental health concerns along with physical issues. As physicians, we can’t “punish” this patient population or refuse to treat them because we don’t like the way they look or because they are difficult.

Obese trauma patients are part of the new norm because obesity (two-thirds of our population is overweight or obese) is our population. We can’t badger them to “just lose some weight” because weight loss has probably not been successful for our patients. We are fatter and in many cases less healthy even though diets and nutritional information is readily available for most people. We know the problem but the solution is complex.

Our trauma conference was great to begin to address the issues of these patients. We, as physicians will see more and more patients who are obese and morbidly obese. We owe our patients the best care possible. Often the solution for delivery of proper care is to begin to know our facility capability, discuss how we will handle bariatric patients and put devices and accommodations in place that allow safe care of these patients under all circumstances.

17 October, 2018 Posted by | emergency, medical school, trauma | , | Leave a comment

Staying in Good Physical Condition

Physical conditioning is crucial to keeping your body strong and healthy for meeting your long-term goals. While sound study habits are important for successful navigation of academics but keeping healthy keeps one on track to master a large amount of information and concepts that come with preparation for medical practice. I can’t emphasize the importance of striking a balance between mental and physical conditioning.

Most mornings, I begin the day with a minimum of 30 minutes of running (goal is always 90-120 minutes) as running is my favorite cardiovascular activity for conditioning. As a surgeon, my runs are at 3:00 AM, a time when many are sleeping. I enjoy running the streets of my little suburban village in the dark because I don’t have to dodge traffic, dogs or people on bicycles. If I make my 2-hour goal, I get a very nice distance run to start my day off great. If I can’t get a single run, I do a few runs over the course of the day.

When I was at university, I played varsity tennis and ran 10K. I learned to run in the off-season because I always wanted a strong cardiovascular base for my tennis. My tennis coach didn’t allow us to play contact sports even though a nice soccer or rugby game was always fun for me.  I often had to hide my love for these two sports. Keeping active was a means of keeping my weight down and keeping my muscles strong.

When I began graduate school, I stopped playing tennis and concentrated on running. I loved the middle distance generally not enjoying runs that were longer than about six miles. My graduate school was in a large urban area that offered plenty of opportunities and trails to keep me interested and content with my distances. In the mornings, I ran with a group of Marines from a nearby barracks as they did their early morning runs. I also rode my bike around the city which kept my heart strong and happy.

When I entered medical school, the stress and study demands quickly consumed me which resulted in losing my daily runs. I ended up gaining a tremendous amount of weight. The weight gain coupled with lack of activity added to my stress though, at the time, I didn’t realize this fact. I placed my emphasis on my academics only with the loss of my conditioning. When I entered residency, I gain more weight along with more stress.

I ended up with obesity as my companion in medical practice which became a burden that I knew I could sustain. I knew that I had to place physical conditioning and good eating habits or I would develop atherosclerosis, diabetes or any of the chronic conditions that plague my patients. I also hated that I didn’t want to walk up a flight of stairs of became winded when I had to rush to an emergency from a remote area of the hospital. In short, my size and lack of conditioning were becoming more stressful than my job. Certainly, as a physician, I knew what I needed to change in my life.

Three years ago, I set a goal of walking briskly for a minimum of 30 minutes per day. I walked 15 minutes out and 15 minutes back taking one day at a time. Along with my walking, I stopped eating sugary and high-fat snack foods; exchanging them for fruit or raw vegetables. I ate three meals per day with proper portions, constantly hungry at first but adjusting to my changes. I had to learn portions and choose my foods carefully. I became a critic of the hospital cafeteria foods because they offered few choices for me.

Today, I am a distance runner completing half-marathons regularly as my early morning runs are both training and mental health. On my runs, I meditate, listen to my favorite music so that I start my day with a calm mind; well-perfused brain and heart. My day is more efficient, my stamina readily more than enough to do my job and enjoy my social life. In short, stress is gone, replaced by activities I enjoy.

If you are reading this and thinking that you don’t have time for exercise because of family, academic or job demands consider that taking care of yourself has to be a priority for those demands. You have to keep yourself healthy to keep up with items in your life that are most important for your life.

The human body was made for activity as lack of activity is the single factor that causes our patients to develop conditions which lead to major health concerns. Increased activity helps humans keep their immune systems strong, their cardiovascular system strong and aids in sound mental health. It very easy to see that people who are in poor physical condition are often depressed and prone to picking up infections. Even small increases in physical activity can provide huge dividends in terms of treating conditions like obesity and hypertension.

In the United States, our population is very sedentary and far more overweight/obese than in countries where the population is more active. Our patients sit in front of computers, tellys and eat a diet that is high in fats, sugars, and sodium. We see the results of poor diet and lack of exercise across our patient population with decreased lifespan. Yes, our patients have to work long hours and take care of their families but they need our encouragement to change habits that contribute to early death and chronic disease.

As a population, we have more information and devices readily available to make our lives more efficient but as a result, we have become less healthy as a nation. We can use the drive-thru for ordering food, banking, and even dropping off our dry cleaning. We can order food for delivery to our homes eliminating even walking through the grocery stores. Along with the use of those convenience services, we have less communication with other humans (necessary for good mental health); lives spent on social media where reality is not usually present.

I encourage my students and my patients to start with something simple such as a 30-minute walk in the neighborhood after dinner or parking the car further away and taking more steps to their destination. I encourage my students to strive for a sound night’s sleep with electronic devices turned off. I encourage my students to stop comparing themselves to others on social media because any comparison is generally based on posted items that may or may not be accurate. I encourage my students to make small changes, stick with them so that they become habits especially striving to get into good physical condition.

I can only say that having a strong body contributes to having a strong, resilient mind. I can say that my running/biking helps my mental health so that meeting the demands of my chosen career are easier and enjoyable. I can say that my running/biking allows me to be a kinder and nicer person overall, adding spirit and positive energy to my day. I can also say that running allows my mind as much recreation as in my childhood days of playing allowed; something that all of us could use. It’s hard to take oneself too seriously when one is sweating like a farm animal running down the street at 3:00 AM but it’s great fun.

31 August, 2018 Posted by | life in medicine, medical school, medicine, success in medical school | | Leave a comment

Read, read and read some more!

As a practicing physician (and research scientist), I am a regular journal reader. I read about 30 journals per week as part of my regular reading. Early in my medical career, as a medical student, I learned to evaluate medical and basic science literature. This is more important for practice today than ever before.

Many of my colleagues do not regularly read many journals, especially research, because they just don’t have the time. Practice today is very demanding with the push to see more patients and do more procedures. They rely on the industry, pharmaceutical, and medical device, within their specialty to keep them updated on the latest science out there. This is problematic for many reasons.

The pharmaceutical and medical device industries want to have you sell their products. They go to great lengths and expense to make sure that you get the most positive information on what they are selling or presenting. They are not as closely regulated these days by government agencies (FDA) as in previous times. A clear understanding of how many people who were formerly heads of pharmaceutical and medical device industries are now in charge of the FDA is a huge warning signal for me.

I am forced to evaluate all research on any device or pharmaceutical that is used in my patients. I look at all studies, not just the studies that the industry reps present with their products. Yes, there are new innovations coming at quantum speed but I have to make sure that I have all sides of the equation before using (or implanting) something in a patient.

I made sure that I thoroughly learned to evaluate studies and that I agree or disagree with the conclusions of the studies. I ask for alternatives; doesn’t make me popular with the reps who are often not medical professionals but salespeople with little clinical knowledge. It’s cool to look at displays at conventions but I take the literature, do my own research and call colleagues who might be using the devices.

We owe our patients our best knowledge and good faith. Their trust is in us which is part of the magic of medicine. This is also why medicine is the toughest and greatest profession that anyone can practice. In today’s world of instant access to scientific literature (from a remote computer), it’s overwhelming but we have to learn to take the time to do our own research rather than rely on the industry.

Much of what makes medicine difficult for me these days has to do with the profit margin that my hospital and healthcare system administration pushes in my direction. I am pressured to do cases faster than ever and get patients home as fast as possible. My social workers are burdened with making sure a patient has adequate care at home or in a non-acute facility for recovery as hospital stays are shorter and shorter with sicker patients.

Medical device innovation and development are expensive for companies with millions and millions done in research before the device gets into clinical practice. I am charged with making sure that the studies cover all of the bases and that I am thoroughly aware of the consequences (side-effects) and safe uses of devices and pharmaceuticals. Often my patients will have seen an advertisement for a new product and want the latest done or prescribed for them.

I have to have good information and explain all the risks and benefits of anything that I prescribe or use in my patients. This takes time, diligence and reading the literature. I am happy to do this and even happier if a new device/pharmaceutical helps my patients. Thus, at any stage in your practice, read, read and then READ more. There is much at stake for all of us.

2 August, 2018 Posted by | academics, medical school, practice of medicine | | 2 Comments

Human Sexuality/Well-Being Part One

2017-07-07 10.56.37

In working with my medical students in the Physical Diagnosis course of the past semester, I discovered that there was more than the usual amount of discomfort with the discussion of human sexuality and sexual history-taking. Certainly, my students have studied anatomy, behavioral aspects, and physiology of the genital organs. They are quite comfortable with what is there but having conversations, connecting and explaining human sexuality is something novel for them.

In the past, I was prone to explain my students’ reluctance of sexual conversations with patients as a product of their lack of personal understanding but there are far more aspects than pure lack of understanding. The first item that I needed to introduce is that one does not have to have had a particular sexual experience in order to understand what a patient is attempting to communicate. One simply has to have an open, non-judgemental attitude with conveyed willingness to listen and hear what is said. If one does not understand, then one has to be willing to make the attempt to understand what the patient is saying.

Our patients come to us for problem-solving ultimately.  Patients bring their sexual experiences, which may include shame, guilt, embarrassment along with lack of knowledge. They seek reassurance that what they have experienced is “normal” or why something that they have read about or constantly seen on modern media is uncomfortable from the standpoint of behavior or physical experience. In short, we as physicians, regardless of specialty, need to explain and educate in some cases.

In this country, sexuality is intermingled with advertising, entertainment and the promise of personal achievement. How many times have we been bombarded with images (check out fragrance commercials) of young people in quasi-sexual situations that promise if you wear this fragrance, you too, will have this same situation. The same experiences are with the alcoholic beverage commercials where attractive people hint of increased attractiveness if one drinks a particular beverage.

On social media sites such as Facebook and Snapchat, we share our experiences of connection where some constantly compare our lives (sexual and non-sexual) with our friends without remembering that people only post what they want you to see. Few of us tend to post that we are depressed or confused about aspects of our lives. We tend to post what we are proud of or what we want others to see. The constant comparison with others can cause anxiety in other aspects of our lives.

Sexuality for many of our patients (and us) came from experiences as teenagers, often with or without explanation or discussion. Knowledge may have come from religion, which introduced shame when sexuality is a normal, strong behavioral aspect of the life of a human being. Experiences from youth, coupled with lack of knowledge, can often produce feelings that need to be explored and explained. There is no hesitation in explaining a fracture or diabetes but there is hesitation or even non-discussion when a patient may have a behavioral/sexual issue.

The first step in any behavioral standpoint clinically is understanding our feelings and attitudes. Our attitudes have to step aside so that the patient feels acceptance and feels free to tell us what they need for us to know. We do not have to have experienced something to listen to the experience of our patients. We need only listen, ask questions if we don’t understand and convey an atmosphere of comfort. These conversations may take place over a couple of encounters but they should take place if necessary.

An example from my experience is a 50-year-old gentleman who had symptomatic peripheral vascular disease. He was diabetic, had moderate-to-severe atherosclerosis, was a heavy smoker, and experienced erectile dysfunction. He wanted to discuss his erectile dysfunction and could not find a physician willing to listen to this important aspect of his life. As a surgeon, I made sure that I listened to what he needed to say.

My first task was to allow him to tell me why this aspect of his life was important. For him, it was more important than the pain and limitations his disease has produced in terms of walking from his car into a grocery store. He felt, understandably for a 50-year-old person, that his life was over and that there was no use in seeking treatment for his health problems. His sexuality was important to his sense of well-being and his perception of himself as a man.

My point in this little essay is to remind those who read it, that we as physicians have to allow our patients to tell us everything and anything that they need to tell us without judgment or criticism. Our patients have to feel the freedom to allow us to know all aspects of their lives that may influence future therapeutic interventions. With pressure from healthcare administration to speed clinical encounters along quickly, we have to be aware that some encounters won’t be quick but are necessary over the long-term.

If I don’t have the time to explore something that my patient needs to discuss, I make sure that I note that a sensitive conversation has taken place and schedule them for another encounter as soon as possible. I strive to allow my patients to feel that I have listened even though I am pressured to “move them along”. I listen and accept what they need to say without judgment but with openness, one human being to another.

Human sexuality and sexual behavior are important to all of us. In this country, it’s the one behavioral aspect of life that is shrouded in mystery for many people regardless of educational level or background. Over my years of life and clinical practice, I constantly inventory my feelings and knowledge. I am learning new aspects of sexuality and behavior daily, the magic of medicine for me.

Explore your feelings, seek knowledge and seek to be open to your patients for sensitive discussions. I will be writing other posts about some of my learning experiences in human sexuality as I go forward. My findings are that if I speak openly of my learning experiences, my students feel open to listening and learning, a gift for their future patients and for themselves without discomfort.

14 July, 2018 Posted by | life in medicine, medical school, practice of medicine | | Leave a comment

Starting a Running Plan

2018-04-01 21.17.00 I have been a runner since my days at University.  I was a varsity tennis player who needed something for conditioning in the offseason. Since our coach would not allow any racket sports like squash or racketball, I decided to do some running and weight-lifting to keep my aerobic base intact. I became a 10K specialist loving the middle distance.

In graduate school, I didn’t play much tennis other than the occasional club tournament but kept my running plan. I ran from 2-3 miles daily; my time for relaxation between my teaching duties and research experiments. I used the time to think about problems, angles and write my dissertation in my head. My running helped my research more than anything else.

I didn’t run in medical school; devoting my time to intense study. The volume of material  I mastered for each exam was overwhelming. My stress level was maximal with weight gain and essentially a sedentary lifestyle dictated by needing to produce excellent work in my courses, my exam and board study. My academics soared but my physical conditioning suffered. This was a huge mistake.

Through the stress of surgical residency, I tried to walk the stairs and meditate when I could. Since I had a good muscle base from university and graduate school, I stayed in average shape but didn’t run very much. I carried the excess weight from medical school hating the way I felt and looked. I hid in scrubs and in my professional duties moving to attending physician and professor.

Today, I am a long-distance runner; shedding the weight of medical school at last. I am thin,  powerful and serene. Achieving my goals was not an overnight process but a process necessary for my health and mental acumen. I started out brisk walking 15 minutes out and 15 minutes back every day of the week. My walk became a run and my runs stretched longer and longer.

My running forced cleaning my food intake to fresh fruit and vegetables with lean protein. My trainer added weight-training to my long distance running. Today, I run at 3:00 AM for a minimum of 1 1/2 hours most days of the week; longer distances on the weekends when I am not on call. I am strong, setting personal records and loving the Half Marathon distance as much as I loved the 10 K distance runs of my past.

My hospital has 14 floors that I climb at least twice daily loving the view from the roof in the early morning after a night on call. I enjoy running through the empty streets of my city; greeting the policemen who keep me safe in the early hours. I meditate and pray; gratitude for my excellent health and conditioning. My resting heart rate is in the mid-40s; my body very thin and very strong.

I tell my story because the summer is a good time to start the journey of getting in good physical condition. The weather is warm in most of the country which makes the process easier. Trust me, it’s hard for me to face 2F temperatures and snow of the winters in my Midwest city but I do face them for my early morning runs. Desire and planning pushed me out the door at first but habit now keeps me going.

I lost the tired feelings after a 16-20-hour day; now replaced with the energy to give my best. My physical strength allows me to finish 6-10-hour cases without a second thought. Good physical conditioning lets me park my car in the most remote parking place and dash into the hospital with stratospheric energy. Today, my energy is my most positive characteristic as I can run to an emergency faster than most of my residents with a smile on my face.

The public health part of being in sound physical condition is that in my Midwestern city, three-fourths of the population is overweight or obese. I am 5’8″ tall and wear a US Size 2 which is smaller than 99% of the US population. Even at this thin size, I take no medications other than a multi-vitamin and a calcium/Vitamin D supplement-the hazard of working indoors in rooms without windows to the outside.

I can counsel my patients about weight loss and increasing physical activity as an example of what they might accomplish at any age. I don’t admonish them but stress the importance of taking small steps; changing eating habits replacing them with things that can become a part of an active, healthy lifestyle. Too many obese people look to strategies such as gastric bypass which is a valuable tool but is beyond the reach of many who are without health insurance.

Take the summer to do one or small steps that will benefit your health and career now. While I regret not keeping up with my running in medical school, I am grateful that I did realize how making small changes led me to excellent health now. Learn good nutrition and leave the hospital cafeteria/ fast food/junk food alone. I have not had even a cold in the past 5 years because my physical conditioning keeps my immune system strong.  Be strong and be the example that your patients need.

23 May, 2018 Posted by | academics, life in medicine, medical school | | Leave a comment

Well, Spring is Here! Good Time to Make Some Changes.

DSCN1772    I live in the Midwest where Spring took a long time to arrive. I have been training for an upcoming Half-Marathon but the cold temperatures put a damper on my quest for chewing up a good mileage base for my upcoming race. Still, the warm temperatures arrive with rain (the bane of my existence on the asphalt) which forced me into more resolve to get my running done.

My solution has been to run very early in the morning (3:00AM) and late in the evening after dark. My mind figured that if I didn’t see the pouring rain, it wouldn’t bother me as much as watching the downpour by daylight. My strategy worked a bit but the warmer temperature did come and I have a decent base of training.

As I watched my resting heart rate drop into the 50s, I watched my body become extremely thin. I worried a bit about losing muscle mass but one of my colleagues in Sports Medicine encouraged upping my protein intake. Following her advice, I did up my dietary protein while cutting back on carbohydrate intake. I have also found that I just can eat large quantities of food thus my weight loss continues while my speed is increasing along with my endurance.

My mind is peaceful, organized and disciplined which serve me well in medicine/surgery. My early morning runs are a chance to let my thoughts go in any direction and I tread along the empty streets of my Midwestern suburban town. I don’t have to worry about dogs or kids in the very early morning. The police officers on duty are now on a first-name basis with me with one presenting me with a light-reflecting vest that can be seen for miles under the street lights.

I also take a run around my hospital grounds to lose tension when things seem to interfere with my rest. On those shorter hospital runs, I plan lectures and work out pesky problems. I meditate and pray a prayer of thanks on many of my runs as I am grateful for good joints and a healthy body. As I seem, my patients who are often sick from years of smoking, unhealthy eating, and diabetes, I know that every step keeps me healthy and serene.

I changed my eating habits; no more cafeteria food in the middle of the night replaced with fresh cut vegetables and fresh fruits. Though I love my black French Roast coffee, I limit myself to two cups freshly brewed and savored. I eat nuts, a few raisins for sweetness and drink plenty of water to keep hydrated. Keeping hydrated in the HVAC air of my university and hospital is a challenge for me.

I now live one day at a time because my training for my long-distance races has forced me to do this. I don’t make the excuse that I am too tired or too busy to cook a good healthy meal (chop vegetables on the weekend and keep them in the freezer). I try not to sit for hours on end reading journals and completing records but move or stand when I do these necessities of my profession. I park in the furthest parking space and enjoy the brisk walk into the building. I shop in the outer aisles of the grocery store where I can find fresh fruit and vegetables; limiting my access to processed foods.

My complexion is glowing; my mind is aware and quicker these days based on a few changes to my diet and exercise. I used the changing weather to change how I take care of myself. I felt that I couldn’t counsel my patients in terms of a healthy lifestyle if I wasn’t living healthy myself. I also enjoy shopping (get many of my dresses from Costco) and love that I now wear Size Small scrubs (cuter than the Large ones).

I told myself that I would change one day at a time. If I could do one day, I could stretch my one day to two. Making the changes was difficult at first but now they are my normal routine. I sleep better, move better and get my work done better. There are times when I run the 14 floors of my hospital just because I know that I can do this now. What a difference making a change even at my advanced age can do and mean.

Take the time to make some small changes that will lead to a healthier mind and body. It’s very difficult for me to be depressed and angry when I am running in the wind (and occasional rain) with the world moving by me. I find that I smile more and enjoy greeting the world in the darkness as I head out at 3:00AM. I also find that the phone doesn’t ring at that hour either.

Spend some time taking care of yourself and appreciating what your body can do and how it can change. Be good to yourself and appreciate how powerful self-love and appreciation can become infectious to all around you. Wear brighter colors or change the color of your lipstick. Do anything that makes you feel good about this amazing world where you will help others and allow them to help you.

Spring is here soon to be followed by summer with warm days, beautiful flowers and trees. The smell of freshly cut grass or charcoal burning on the evening grills is a sheer pleasure. The early morning fog, quiet as the sun comes up and hearing an occasional alarm sounding as my neighbors start their days is great too. It’s a bit of a spiritual experience but it’s a good one!

5 May, 2018 Posted by | medical school, medicine, relaxation | , | Leave a comment

Using Every Tool

As all of us in academics (professors, students) enter the final stages before the semester/quarter ends, we make the push to finish strong. If you have been struggling with your studies, now is the time, just like tax time, to get your work shored up for that strong finish. It also a good time to take and inventory of sorts, in your thinking about why and how you master your studies to have the best outcome in your classes.

We finished our spring breaks with the hope of resting perhaps getting away from our studies in order to come back with renewed energy. Depending on how you spend your break-some catching up, some getting away, some planning for the next steps, you may be feeling that the “break” was not a break at all. If that was the case, then take this weekend to put some strategies into place to finish this term/semester/school year as best you can.

I always advise my students at the beginning of the year, that regular planning/study is the key to mastery of your subject matter. Making schedules and sticking to them is as important to success as my daily workouts are key to my training for an upcoming marathon. I have to work out regularly in order to complete my distance race. I can’t arrive on race day and run a marathon, half-marathon or even a 10-kilometer race without doing some daily training/conditioning work.

Like anything that I have to train for, there are days when I don’t feel like putting in the time. Sometimes, I just want to take a break but I can’t take too many breaks. My training runs, like your daily study periods are a time to work on those little details to develop the strength and tools to complete my goals. If I don’t put in that time regularly (do something) I won’t be ready for my long-distance race.

Sometimes, I do take a very short break from my training but at the end of the day, my tool is that I do something more intense so that I get a small benefit of even not running on that particular break day. These are my mini-spring breaks away from training. This strategy, I apply to studies (yes, even as a professor, I am constantly learning, honing and refining). That short break is the tool to remind me to get back onto my regular schedule as soon as possible.

I have used preparation for a long distance race because when I made the change from short-distance running to long-distance running, many other items in my life became easier and better. My studies, like your studies whether you are an undergraduate, graduate or medical student require daily work and refinement; in other words, daily training. We are all preparing and using the tools of preparation for finishing strong in our endeavors.

Consistent work is always key to academic success. In today’s world of electronic delivery of materials, one still has to devote regular study time for complete mastery of subject matter. We have millions of bits of information at our fingertips, online and even on our thumb drives, that we must master for our programs of study. Organization and regular consistent study of our academic materials is more relevant today than back when I was in medical school and graduate school.

Organize your materials, plan your study schedule and take short breaks over the course of the day but be consistent in your study. As I have written in other pieces on this blog, my tools of organization have been to review the previous material, study the present material and prepare for what will come next. These are your tools for making sure that this period before finals and before the semester/year ends are in place so that you may finish strong.

Just as I want to complete my upcoming distance race as strong as possible, I want to complete the race. Use your time wisely, take short breaks away from your studies but make those breaks matter. Don’t give up at this point because you are overwhelmed. When those feelings of being overwhelmed enter your mind, take a short minute, jot down that you are feeling overwhelmed and write out only the next small thing that you will complete.

As you complete many small things, they always add up to completion of the big items. Completing those small items also keeps procrastination from derailing your studies at this time. Until you have taken that final exam, nothing is lost and you can keep preparing but if you stop, give up and allow feelings of “everyone is doing the better that I am” to enter your strategies, you won’t be see any success. Fight the feelings to make comparison to those around you; only compare you with you yesterday.

You can’t change the passage of time and you can’t change the past but you can decide in the next minute to change your thinking about how you deal with the present to affect the future. This is the most valuable tool for anything. I can’t change how I ran my last race but I can keep preparing for the one that is coming up. This is what I tell myself as I head out the door to the gym to do a bit of speed work and lift some weights. Every weight I life, every step I take is moving forward. Use those tools and adapt as you make adjustments to finish strong but don’t forget a tiny break/ reward for keeping things going.

14 April, 2018 Posted by | academics, medical school | , | Leave a comment

Why Don’t We Feel Safe?

Today, March 24, 2018, many high school students and teachers are marching/assembling in major cities to bring attention to their increased feelings of not being safe in their educational settings. I would add my support to them as everyone should feel safe in their homes, schools, places of employment and places of recreation. Safety is a right of every individual in any environment. When individuals don’t feel safe, they experience increased stress far above what is expected in their day-to-day lives.

Even in hospitals, safety has always been of importance both in how we treat patients and the patient environment. We always pay very close attention to situations that potentially put individuals at risk but of recent, safety issues for those of us who are just going about our jobs in emergency departments, hallways and classrooms have come under scrutiny. In short, physicians, professors, students, and patients have been harm’s way because of disgruntled employees and colleagues who seek revenge for perceived wrongs.

It’s persons who feel the need to inflict harm on those who have no role in their perceived situation that is most troubling for the public at large. When guns are fired, even with intended targets, others get hurt and killed. When mentally ill individuals have access to weapons (guns, cars, knives, explosives), individuals without warning, are subjected to random violence. When the electronic and television news media spends hours and hours attempting to find motives and uncover a “story” in these random acts of violence; creating stress in individuals.

Perhaps this 24-hour scrutiny is a product of the electronic information age but there is nothing that prohibits us from turning off the news and disconnecting from social and other media. From the time I first acquired a pager as a medical student, I became acutely aware of the need to just “turn the thing off” in order to reconnect with a world that doesn’t need access to my attention at all times. I never want to be the person walking along staring at my smartphone and ignoring the world around me. Yes, I look at it when I must but certainly, I strive to look around; be aware of those around me.

As those who march in the streets today want to emphasize,  all individuals have a fundamental right to pursue their lives not only in freedom but in safety. As a physician, I don’t want to take care of even one more innocent individual who has become a victim of random violence. My stress is worrying about those I love and whether or not they will come home. The stress is palpable across many in my environment which include where I work and study. There is simply no reason in a civilized society for this to happen.

My answer is to be vigilant and to be aware of those around me at all times. My answer is not to lock-down hospitals and campuses but to pay attention to people around me who may be suffering. My answer is to not look to electronic and television media to examine what I as a physician, must examine for myself. My answer is to treat all people, even those who are struggling academically and personally, with dignity and compassion.

Just recently, more than a few of the medical students that I have taught, found out that they didn’t match into a residency position. The stress of finding employment for next year is gut-wrenching for them and for me as well. The lack of post-graduate positions coupled with a system that is in dire need of an overhaul is necessary. The feelings of despair were very deep for those who didn’t find a match when those around one are celebrating. I found more than one person who is derailed by the process.

Disappointment, anger, and despair when one does not obtain the end result of work and study or any other desired outcome is often a trigger for actions that are uncharacteristic. Even more disturbing is that those who are successful may be perceived as “bragging” on social media when they are just celebrating the next step in their training. My answer to those who didn’t match is that it’s not a personal failing and my answer to those who did is well-done but have compassion for those who are struggling.  My answer is to do everything within my power to allow my students to feel safe as they study and work. As a human being, I can do no less but I can do more.

24 March, 2018 Posted by | academics, medical school | Leave a comment