Medicine From The Trenches

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

Conferences and Practice…

Introduction

If you practice medicine/surgery, you will undoubtedly attend a conference or two during the year. Some of them are gigantic like the American College of Surgeons which draw thousands of surgeons from around the country and some are a bit smaller but are,nevertheless great opportunities for learning, even perhaps widening one’s frame of reference. It’s always good to attend conferences at every level of your training from medical student to resident to attending physician. A good conference reinforces what you are reading in the literature and allows networking/exchange of ideas. Once in awhile, one can attend a conference (I did just this week) where one hears something that profoundly changes the way that one views aspects of one’s practice.

This Week’s Conference

First of all, the person who gave this amazing lecture is a genuine “rock star” of the highest magnitude in medicine. His talk was placed right before lunch (the conference had started at 7:15AM so you know he had to be good to fill that space) when most of us were contemplating just being able to get up and walk around ( opposite of food coma). The first thing that he asked us to do was drop the “compartmentalization” of our lives and integrate our roles as members of our communities (parent, neighbor, coach etc). Now why would someone of this caliber start right off asking his audience to “feel and not think about too much” “to let our professional guard down for a second” rather than absorb profound knowledge that no doubt, this eminent speaker could easily impart?

The Message

When we do what we do in medicine/surgery, sometimes there are not good outcomes. Sometimes we have to deal with families and by extension, communities that are suffering profound loss (losses). We are all very familiar with the tragedies that seem to be in the news more often these days. Some are so profound that they can be described by one word, such as 9-11 or a location such as Newtown, CT. “To get up and give a lecture on sad topics isn’t so much fun… but it’s such an important part of what we do”.

He encouraged us to think about the effects of the injury of a child on the child’s family and the effects of taking care of injured children (or adults for that matter) on our team. Often we do our jobs and put our feelings somewhere so that we can get those jobs done. Later on, those feelings, especially when little ones are involved, can well up and overwhelm us in ways that we might not be even aware of. He spoke of us being mindful of those in the family that might be left, our colleagues who have shared the job of caring and the community that might be feeling the loss (schoolmates, teachers and others). ” One child is injured, there are a lot of challenges for that child but the ripple of challenges begins to spread to other children who may have been involved in that event or near that event; to the parents and siblings of that injured child; to the community, their friends, their teachers,  their coaches, their clergy.” He also mentioned “ripple of challenges” can extend to the people who rescued and cared for that child. The effects can be profound even for the trauma surgeon.

While we, as surgeons, can move onto the next patient or the next challenge, often these families/communities have deep and long lasting effects. We have to be aware of those effects both in ourselves, in our colleagues and in our communities. He spoke of Post Traumatic Stress Syndrome which even though we might put our brains in a place to deal with the present, the cumulative effects of all things that happen to us can come back if we don’t acknowledge our feelings (ah,that word that we as surgeons don’t like much).

Honestly, I have never head anyone verbalize what this man spoke about. No psychiatrist could have imparted the message that was imparted, yet it came from a surgeon of all professions. I don’t think that many of the psychiatrists actually “get it” but I actually received validation that when I walk over to a younger colleague who has just finished dealing with an emotional outcome that is tragic and ask, “What are you feeling right now?” “Tell me and don’t try to explain it but just tell me your actual thoughts”, that I can no longer say, “Go home and decompress because for human beings, decompression may not be possible. This is a message that anyone who anticipates a career in medicine (or even the allied health care professions) needs to be very aware of. I have always been aware of how deeply my patients can affect my life/thinking but I always put that awareness in a place where I could think about it at some later time- often in my meditations or when I am out running.

Bottom Line for Me

I will now play even closer attention to my feelings and the feelings of my students, co-workers and colleagues in these situations. I will also pay closer attention to the families and to the communities. Events happen in our community and as physicians, we are often thrust into the heart of raw emotion. We have to speak about our feelings and not be ashamed that something touches us so deeply that we are brought to tears. Even better, we have to connect with the folks on our team and with those who surround the patients that we treat. When I walk into a family room, I now see everyone in that room and not try to “get out” as soon as possible. I look at the families, the siblings and friends of my patients, young and old, to try to get a sense of where they are. I will also try to keep a little closer watch on where they might be going. I am a teacher but even greater, I have been given the gift and trust of the ones who love the patients that are placed in my hands. I can’t compartmentalize anymore and somehow, I don’t think I should.

17 October, 2014 Posted by | medical school | , , | 1 Comment

Achieving a balance

Introduction

As I write this, my career has been shifted into a higher level of comfort. I have spent the years since graduation from medical school and residency honing my surgical skills and the craft of taking care of patients. If anything has suffered in the task to become the best physician that I can possibly be, it has been my personal life. In short, it became easy to head off to the hospital or university rather than deal with things in my life that just were not working. Well, working in medicine has a way of making one reflect on what is truly important and making one move past things that are not a good fit for life.  I had decided after ending a relationship that had somewhat sustained me through medical school and residency, that I would throw myself into my work with vigor and a quest for self-discovery.

Make a definition of your “complete” life

I always knew that I was a person who saw the miraculous in all of medicine and humankind. I am just an instrument for our creator does the actual healing. You can call the creator anything that you like, God, Mohammed, the Great Spirit but positivity and balance have a way of forcing one to move along on a plane that is stable. One gets used to “death” as part of “life” and one can sometimes feel how to be aligned with the universe in one aspect of life but “going through the motions” in another aspect of life. So it was with me and I attempted to fill in my “gaps” and “blanks” with interests, flying, sailing and so forth. Being above the earth or on the ocean/lake can allow one to exhale and just marvel at how wonderful the world is at times. I also knew that I wanted to share the miracles of my life with another soul; as a human we all reach out for intimacy in some form. We can have a close friend or we can have a significant relationship (marriage) that allows us to find that person who can help us complete our mission in life. At times, I believed that I needed to work on myself and put all parts of my life in compartments so that I could achieve a close bond with another human that doesn’t mind that I sleep on my abdomen hugging a pillow and look like a “street urchin” in the morning after my nightly pillow fight; that my phone frequently rings all night if I am on home call; or that I might be away for 30 hours straight taking in house call. These are the realities of being in a relationship with most physicians and certainly with a surgeon. I can also add the time that I must spend in reading and study to keep up with my craft. In short, any person who is involved with a physician needs to see that they won’t have 100% of our attention all the time but when we are “with” you, we are 100% committed and need you like we need oxygen, food and water to live. My definition of my complete life was to meet and find a person who could be my friend first and perhaps more later. The inhumanity that is sometimes represented in my trauma bay can color how I look at relationships between humans. Domestic violence is very difficult to deal with but deal with it, I must and I must have a place in my mind that allows me to give my best treatment to the victims and sometimes to the perpetrator too. I am not the judge but only an instrument to an end point – getting that person back to health and solving health problems. My complete life has to allow me to find that person who can allow me to complete my “mission” on Earth and I complete them.

What I tell myself…

I had told myself that my life could be complete and satisfying with a job well-done. I would enjoy “discovering new truths” in my research and writings. I would enjoy hearing the successes of my students and colleagues. I would have a rich and satisfying career giving back with my skills and teaching. Yes, my life was indeed full but not complete. I didn’t have that intimate relationship that adds the depth and richness that just needs to be there. And so I was going through my career, happily enjoying my friends, colleagues and adventures in surgery, medicine, flying and sailing.

No, one can’t plan everything…

I was happily moving along with the things that occupy my time. I decided to do some exploration in trying to reach out and expand my circle of friends. It’s good to be a trailblazer in some aspects of one’s life. I have always challenged myself to take some risk with something at various times. I took a risk and was happily enjoying the experience when a man reached out to me in a most unexpected manner. There was something in the things that he shared so readily with me. He knew that I was a physician/surgeon yet he said that he saw something that drew him to me. At first, my scientific training kicked in and I attempted to define what was going on here; I ran in the opposite direction. Well, there is no definition but only that one has to have the courage and sometimes the faith to know that your instincts are correct (much the same as how I treat a critical patient). In short, life does not always come with clear directions. I have been in uncharted “exploration” the past few weeks and it’s been both exhilarating and unnerving at the same time.  Here I am in a relationship that I can’t plan or define and suddenly my life that I thought was so full, seems empty before I was able to get to this point.

Why this is so vitally important…

In order to give our best to our patients and colleagues, we have to give our best to ourselves. My best now includes a very brilliant environmental engineer (he can’t stand the sight of blood) who inspires me to reach higher and further in all aspects of life. Suddenly the things that gave me immense satisfaction go beyond that and give me immense joy at the same time. I smile and laugh with my patients, my students and my colleagues. In short, he has made me a better and more fulfilled person. The only downside has been that my favorite OR music has moved from my signature “thrash metal” to a bit more “smooth jazz”. For those who work with me, that’s a huge change but they secretly like the music change. I am not playing as much Pantera or Goatwhore in the background. As you move through your university work and your preparation for medical practice, one has to have the best of humanity brought out from within themselves. To be able to give my heart, a myocyte at a time to this environmental engineer who can’t even see my lectures without getting sick, has made me a better surgeon, physician and human being. One simply has to find balance in all things in life and not shut off any part of life to focus on other parts of life.

10 October, 2014 Posted by | organization, relaxation, stress reduction | , , | 5 Comments