Medicine From The Trenches

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

New Gross Anatomy

Many medical schools have gone from cadaver dissection to prosection to digital dissection in their Gross Anatomy labs. Certainly concerns of inhalation of formalin are removed with digital delivery but hands-on dissection of the human body is quite sacred and tremendously educational for a physician. I also understand that digital dissection is far cheaper than having cadavers for teaching purposes.

With digital dissection, many lose the ability to see the variations possible. When I was in Gross Anatomy Laboratory, it was wonderful when another group shared an anatomic variation or a great dissection with the rest of the class. We could see and touch it. It was the touch with the appreciation for anatomy in three dimensions that was a wonder. That three-dimensional anatomy and seeing structures within context probably crystallized my love and appreciation for the variations I see in surgery on a daily basis.

All human bodies are a wonder to observe, examine and treat. On any given day, each patient with their capacity to heal, is a marvel that can’t be made by man. My study of medicine after study of biochemistry, deepened my appreciation for all that the human body is capable of performing without exception. Dissection and observation with hours of hands-on work only served to deepen that appreciation.

We might argue that digital learning is powerful because the medical student can be in the anatomy lab at any time. Digital anatomy platforms like Anatomatage can move through the body layer by layer but just as something is lost with a text message instead of a phone call, looking but not touching the structures is a loss.

The best use of digital dissection is as an adjunct to dissection of the cadaver. During those hours in the Gross Anatomy lab so many years ago, I carried my Netter Atlas, my Grant Dissector (filled with notes) and my list of structures that I needed to find so that I could see and feel them in all of their dimension.  The experience was profound; deepened my appreciation for those physicians who had spent hours doing the same thing in the quest to learn medicine.

Today, education experts and designers look at teaching and delivery of curriculum as a profit-making entity. Many of these experts have never studied my discipline, practiced medicine/surgery or even taught in a classroom. My duties as a professor are to be leader and coach for my students. I give them the benefit of what my anatomy professors, surgery professors and mentors in medicine passed on to me. Education experts tend to discount experience, one of the essentials of medical practice, and attempt to replace with newer (read cheaper) substitutes.

Yes, digital delivery of curriculum is a great adjunct but it doesn’t replace hands-on experience especially in the Gross Anatomy Lab. Prosections are great but the process of discovery is lost when one does not find structures for oneself. Vivid memories of the dissection of the venous supply of the face remain in my memory today though I seldom perform surgery on the face.

I would hope that those who didn’t get a chance to perform cadaver dissection at least spend some time in the Pathology lab assisting/observing autopsies. The marvel of the human form will not be lost upon you taking the time to do this. Even today, unless you are near a forensic lab, you don’t see too many post-mortem exams taking place. If you have an opportunity to observe one, take advantage and watch. Every structure, normal or abnormal is miraculous.

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23 September, 2017 Posted by | academics, medical school | | 5 Comments

Getting Into Routine

Since the nature of medicine (and life) is change, getting into the best routine to greet and excel in a changing environment is being in the best mental and physical condition possible. It’s very easy with study, long hours of duty and other demands, to gravitate towards anything that bring rest and relaxation/lack of stress. My challenge for those who are starting school, getting ready to start school, starting a new year of clinical duties or any changes; is to have a routine with good stress that allows for optimal performance within the context of changes and challenges.

For many in medicine, stress is the bane of our existence. We are stressed with long hours that often demand the good performance in early morning hours, as most of the population sleeps. We are stressed with keeping up with our academics and studies that mark our ever-changing profession. We are stressed with keeping a sound balance in life that will enable us to enjoy our personal lives in addition to our professional lives. This sound balance is as vital to having a great career and general well-being but finding that balance is not easy or quick.

As the summer has always been the time that I try to improve on my routines and make changes, I will invite you to consider making small changes that will help you deal with the mental and physical challenges to come as your careers change. These challenges need not derail your health and mental resilience but might enhance the enjoyment of your career at any stage.

Good Nutrition

When one is tired physically, mental acumen wanes and one becomes both mentally and physically exhausted. This mental and physical exhaustion can lead to choosing foods that are high in sugar or fat which might lead to a quick energy fix but weight gain in the long run. Trust me, carrying extra weight around doesn’t help with mental or physical exhaustion, often leading to more of both.

Eating a well-balanced diet that has more fresh fruits and vegetables with less fat and refined sugars helps keep your weight under control in addition to keeping you healthier. You can make small changes in terms of grabbing a piece of fresh fruit for a snack rather than relying on the high fat alternatives of the vending machine. Also cooking a week’s worth of healthier food that you pack rather than eating the burger and fries in the hospital/school cafe can help make small changes.

Small changes can lead to larger changes or that routine that becomes more comfortable for you. While I love an occasional burger and sharing fries/chips with my friend (the only way I indulge in these), I keep these occasions as special and not routine. Not only does eating a healthier diet help my immune system, my healthier diet helps me avoid long term chronic disease such as obesity, atherosclerosis and diabetes.

Regular exercise

Exercise tends to be one of those activities that suffers when one enters a demanding profession. It is easy post call, to come home, drop on the sofa and rest. This was my routine in medical school where I gained significant weight after being robustly active during my graduate school years. It took years of work to rid my body of the excess weight but once regular exercise became my routine, I found that I had more energy and more time rather less.

Today, I am a distance runner, using that time on the running trail to work out problems, meditate and simply enjoy myself. I have strength and energy for my work and for recreation. I also have a greater capacity for dealing with stress and the physical stress of a 10-mile run helps everything in my life. Running is quite solitary which appeals to me but anything that gets your heart rate up at least 30 minutes 5 times per week is better than nothing.

My workout time is as precious as my work time. I have mapped out running routes around my hospital, in my neighborhood and when I travel. I keep running gear in my locker (running shoes and shorts) so that I have no excuse not to move. I also try to get my workout done in the early morning before I start my day.

You don’t need to block hours of time for a bit of an aerobic challenge as you can run up a flight of stairs several times per day; park the auto further away and walk briskly to your workplace; take a brisk walk for 10 minutes as a time over lunch with a friend. Distance running isn’t for everyone but most of us can do something as simple as walking. Incorporate small changes which can become a habit that becomes part of your life.

Avoiding excuses (reasons)

As one becomes mentally stressed and physically exhausted, reasons for not adhering to healthy habits abound. For each of us, there will always be challenges that take us out of our routines. Take a moment to reflect on what reasons/excuses become commonplace and how you might meet or avoid them. For me, I looked at every hour of my day and examined where I could make small changes. Those small changes became my routines.

For example, I wanted to have more time for journal reading thus I looked for where I could set aside 30 minutes daily for my journals. I ended up finding at least an hour for my journal reading which became a welcome habit. I looked at where I could “sneak in” a workout even on my busiest day. I also left time for complete relaxation when I needed that too.

Staying in good physical condition is the best way to stay in good mental condition. As I look around me, those friends who are physically fit are the most mentally resilient too. In my life, my good physical condition has been a key to many successes in my career. As my physical capacity increased, with a combination of endurance and strength training, the greater my capacity to work and play with my pleasures coming from enjoyment of craft beer, good food and fellowship with friends and colleagues.

Final Thoughts

Take a moment and look for the following:

  • Where you might incorporate small changes that will increase your physical conditioning.
  • Where you might substitute better food choices in terms of avoiding high fat and high refined sugary foods for foods that are whole grain, fresh fruits and vegetables with leaner meats.
  • Where you might take time for small tasks that enhance your professional development.
  • Where you can find some time for pure recreation and enjoyment of life.

Make the changes today, that will help your life and enjoyment of life in the long run. It’s easier than you imagine as you don’t have to become a spartan or fitness nut. Your studies and your mental health with be much stronger which is the key to success in today’s world of medicine.

18 July, 2017 Posted by | academics, medical school, practice of medicine | | Leave a comment

Crisis Averted

I try to meet my challenges in academics, my religious studies, medical practice and physical conditioning as they come. Recently, my academic work, specifically my teaching style, came under sharp criticism (very negative) and increased scrutiny. Now, I don’t mind criticism and will listen with an ear for what might be worthwhile but none of what I faced was even worthwhile; directed as a personal attack upon me. This scrutiny forced me to question everything and forced me into a position of vulnerability that I couldn’t help. I was in a tailspin; looking for anything of validation.

Couple my largely “mental tailspin” with my loss of my friendship of one of my most valued friends. I had retreated back to a point of reliving the death of Gene and my almost catatonic reaction post. I was feeling most of the same types of issues that I faced when I thought my world had come to an end. These were feelings that I couldn’t control but now I have learned that I can feel them and use them to force me to meet challenges with renewed strength.

My spiritual challenges are there but with my renewed strength, I allow myself to serve and feel without apology. I make mistakes in performing my duties at the cathedral during Sunday mass but I learn from my mistakes and from my very generous mentors. I know that they question me but by questioning me, I am forced to question myself too.

My friend who has been quite generous in advising me in my academic work is back in my life which gives me renewed hope that I can learn more from him. I should have listened to him in the first place but my extreme fears would not allow me to benefit from his wisdom. I am blessed and grateful that he spends even two minutes with me and I appreciate all the wise counsel that he has shared with me.

I have watched him interact with his students, his infinite patience and critiques. His student population is more vulnerable and more difficult to teach but he is kind and had great insight into where each student lies in their learning. I learned patience and kindness from him. One day, I watched him answer questions as he walked with his students into the parking lot; surrounded by those who truly appreciated what he had to say. Whenever I see him, I know that I am in the presence of someone who is far greater than myself.

I headed off to interview for another academic job challenging in that I had to deliver a grand rounds presentation and interact with some of the greatest surgeons in this country. I more than passed that test; surprising myself with how wonderful it was to assist on cases that I haven’t performed in years. Sometimes a skills check with master surgeons is good for the soul too. It also helped that a couple of my former professors from residency affirmed that they were proud of how I have made my way in practice.

My physical conditioning continues to be a source of challenges and growth. My trainer balances weight training with running so that I will conquer the marathon distance and I will continue to enjoy vigorous good health. I am getting faster and stronger; finally seeing some of the definition that I sought but with a smaller muscle mass. I am enjoying my increased running mileage while meditating; keeping my head together. I observe the world as it moves past me.

My spiritual growth comes in the form of reaching inside myself for affirmation these days. I am alone with my thoughts and examine each one carefully. I am happy with my solitude, enjoying exploration of my creative side (not very creative at all) and some of the artistic resources in my city. The creative resources of our local artists, musicians and actors have brought a kind of renewal of spirit for me. I seek to interact with humanity and I am acquiring the tools to do so. In that acquisition of tools of spirit, I know that I am not alone and that I am quite happy with the spiritual state of my life.

I don’t focus on material objects much as they have always had little meaning for me. My connections with my patients, my students and my colleagues have been most important. I read the writings and poetry of my like-minded physician colleagues always surprised by the insight and the richness that they bring to my world. One in particular, posts a daily affirmation that moves my meditations quite often. I am truly blessed to know this extraordinary individual who gives so much to the world.

I know that happiness in life comes from the “good stuff” and I have the “good stuff” in abundance these days. My crisis of spirit is no longer a crisis but an acceptance that while I am not good enough for some people; not valued by most, I value and accept myself. I am made by my creator and I seek to be kind, generous and accepting of those around me; no longer a crisis.

30 July, 2016 Posted by | academics, life in medicine, practice of medicine | | 2 Comments

Make Your Life Simple

As many are starting medical school, the most important task to master is getting your life under control. You are starting a journey of study that will absorb most of your waking hours in the next couple of years. Because of this, you have to take more than a few moments of time and figure out your basic needs. Starting medical school without taking a bit of life inventory is asking for problems that may cut into your precious study time. You have to figure out what you need and separate your absolute needs from the things that you want.

All of us who sit in that first lecture; open that first syllabus or textbook want to do well. We didn’t come to medical school to do poorly in our coursework. We seek out the wisdom of those who are a year in front of us and we start with the intention of “learning it all”. This drive for mastery comes largely from our premedical coursework where we always knew that in order to get into medical school, we had to have high grades and scholarship. Once in medical school, staying there and doing well becomes our next tasks as we adjust to the volume of information that will be presented in our pre-clinical coursework.

Making your life simple means that your living arrangements have to stable and comfortable. I largely used my apartment for showering, eating and sleeping. Much of my eating was done as I poured over my lecture notes and textbooks. I quickly found that doing much of my study at school was less distracting at first but I also found that heading off to bed early, getting up around 1AM and studying at home was also good for me. There were fewer interruptions from the phone and others as I was getting up when many were heading to bed.

My bed and bedroom were quiet, dark and restful. I refused to have any study materials in my bedroom; using my bed only for sleep. I also found that breaking my study time into 50-minute chunks worked well for me as I would often pace and recite my coursework, as a review, into a tape recorder so that I could listen to my study tapes on the subway as I made my way to class each day.

Making my life simple also meant that I bought my food for the week, on the weekends; making grocery shopping a break from studying. I had a great study group that like to meet on Saturday afternoon which meant that Saturday morning was great for food shopping. I also cleaned my house on that precious Saturday morning; getting rid of clutter that made me tired and less efficient.

Making my life simple meant that I planned each of my study sessions carefully. I made a list of what I needed to accomplish and marked off tasks as I completed them . Seeing those check marks gave my brain a sense of accomplishment that helped make the volume of material seem less intimidating. Still, I never felt completely ready for an exam but I always felt that I had a chance to do well because I studied for mastery (took no shortcuts during first and second year). “You can’t review what you haven’t learned in the first place.” was a favorite quote from one of my professors.

I always attended class prepared for the upcoming lecture by putting the previous lecture in perspective. This task helped me to see the “big picture” which can be neglected if one focuses solely on memorization. I sought understanding and perspective; organizing my studies around mastery rather than memorization.

If I have one regret in terms of my medical school work, it is that my physical conditioning suffered. As a graduate student, I was a middle-distance runner. My running helped manage stress and kept my weight down. I gained weight in medical school because the fastest foods were the ones that were unhealthy (high fat, high sugar). When I finally lost my medical school weight, it was my distance running that brought calm and organization to my life. Find a way to incorporate a minimum of 30 minutes of aerobic exercise in your schedule. Trust me, your grades will improve; your sleep will be more sound and efficient; your life will be simpler but more effective.

At the first sign of trouble, see your faculty instructors for help. They are the experts on the curriculum and should be your first and best resources if you need assistance. Your classmates are great but you should do a knowledge check with your instructor long before the exam comes up. Your instructor can also help you with organization should you become overwhelmed (very easy with the volume of material to master).

Finally, don’t forget family and friends. These people keep you sane but they can take up time if you don’t plan your interactions carefully. I often stated at the outset, “I have a couple of hours, let’s have a quick cup of coffee or breakfast”. I would set a timer on my watch so that I didn’t go overtime. It may seem rude but they adjusted to my general absence and helped my stay on task.

28 July, 2016 Posted by | academics, medical school | | 2 Comments

Summer Vacation?

As many people are heading for medical school (or finishing up a year in medical school), the summer is a time for readjustment. This readjustment process can simply be looking a things that worked, or did not work, in terms of your studies. The readjustment process for those heading for medical school will be starting to simplify your life in order to anticipate and meet any challenges ahead.

Adjustments mean that one has to anticipate and evaluate all matters that involve your studies and your daily life in order to give your full attention to any tasks that must be completed. For example, for those starting medical school, most will have to adjust your study skills to master large amounts of information. The good part of this mastery is that the information will be presented in a manner for quick mastery but one has to have the mental confidence to put doubts behind and efficiently take care of your needs. In short, you won’t have time to be wasted. You have to hone in on what you need, ask for help with organization and keep moving as you adjust to the pace. Have the confidence to know that if you have been accepted into medical school, you have all of the tools to stay there.

If your year that is ending has not been as successful as you would like, make the adjustments that you need for success. Summer is a great time to have a chat with your faculty adviser in order to change anything that might need to be changed for the upcoming year. Allow the experience of your faculty adviser to guide your objectively so that you can be more successful. Rather than spending precious mental energy on comparing yourself to your classmates, compare yourself to you and upgrade you to master what needs to be mastered.

The most valuable lessons that I have learned in surgery, all center around one unchanging fact. That fact is that medicine/surgery demands that I constantly self-evaluate my practice, my learning and my approach to my work and make adjustments that will enable me to perform at my highest level. My patients don’t care about my doubts but only care about my ability to solve their clinical problems. To this end, I do my self-evaluation and self-criticism outside my clinical practice and bring my best into my clinical practice. I seek critique from my partners, my chairman and in many cases, from my friends who know me well.

I have to be willing to listen with an objective ear, something that is difficult for all of us whether we are inside or outside of medicine. We all love to believe that we are the best that we can be but part of that “believing that we are the best” requires that we have the mental ability to accept subjective criticism. Let the summer be a time that one seeks out the subjective, listens to what is valuable and rejects (be objective on your part), those items that don’t apply. Try to keep emotion out of this process as much as possible.

My other summer activity often centers around keeping (or getting) myself into the best physical condition possible. In my recent quest to master the marathon distance (26.2 miles), I have tended to neglect my strength training in favor of aerobic conditioning. While this has enabled me to lose plenty of weight, I know that I need to be both strong and aerobically sound. This summer will mean that I will spend some time with the weights again. At my age and at any age, strength training is great for discipline which is great for the demands of life (and medicine).

Physical conditioning and sports participation help to counter the extreme hours demanded by study and medical practice. Participation in team sports have always helped me appreciate the value that every member of the team brings to a successful challenge. In this manner, medicine is no different from winning a rugby match (my favorite team sport). Medicine, though the physician is at the top of the team, involves appreciation of the contribution and knowledge of every team members role in the health of your patients. Use your sports knowledge to help your professional knowledge and role as your learning moves along. Medicine is never practiced in isolation.

Summer is definitely a time to rest as well as readjust. This rest can take the form of a much deserved and needed vacation or simply involving yourself in something that is different from your medical studies. For me, travel is my rest and relaxation. My travels overseas have allowed me to look at other cultures that are far different from my own. My favorite activity is to put on my running gear and just explore my surroundings and observe people who are observing me. Every step that I take is a chance for me to connect with nature, my body and those around me. I tend to be the type of runner who greets those running around me and keeps moving. This habit has been a metaphor for my life and practice.

If you have a chance to do a bit of summer research, take the opportunity to relearn evaluation of scientific evidence, question practice guidelines and build up your knowledge database. Research moves at a slower pace than regular academic work thus taking a fresh look at your scientific questioning can be a useful undertaking. If you are new to research, summer is a great time to become familiar with the tools that will serve you well for the rest of your practice.

Medicine and surgery are professions of experience. Those with more experience teach and impart their knowledge to those will less experience. For me, a person who attended medical school at a later age, I learned that experience isn’t related to age. I learned to listen with care to those whose experience was greater than my own. Even today, I seek out experiences at every level because I appreciate the input of those who look at what I do with fresh eyes (those with less experience) and those with more experience. Medicine demands that I keep moving, just like my distance running demands that I keep moving.

Yes, summer is approaching quickly and will be gone just as quickly but summer offers an opportunity to slow down and self-evaluate. If part of that self-evaluation process involves reinvention of ones self as needed, then summer will be a great vacation.

 

 

26 May, 2016 Posted by | academics, medical school, medical school preparation, stress reduction | | Leave a comment

A Weekend of Affirmation

I am now down to 4 days to my first marathon. I had a great last long run this past Sunday with one week to go. I feel great; passing the time between elation that I have done my best in terms of training and a little fear that I can’t finish the race. I have not run a total of 26.2 miles in a training run having been advised against running the total distance by my coach. She is confident that I can complete the distance.

My friends, save the one whose friendship I miss most, have been very supportive. My heart is glad for having set this goal and worked diligently toward it. I pray and meditate on hoping that my lost friend finds his way back into my life as he is such a generous and energetic spirit that I miss unspeakably. I am totally at peace with his decision but I can’t get past that I am without his lively character and his affirmation. That affirmation went in two directions.

I spent some great time with two of my professors from residency. It was a wonderful experience of seeing two men that profoundly affected the way I practice surgery and medicine. They are generous and wise teachers whose wisdom whispers into my ears when I am in a tough clinical situation. One, who was my residency director, is the most heroic person I have ever known, a former marathoner. The other, just joyful in his generous sharing of his knowledge and teaching. It was a great experience to see these men after many years of development on my part. I am at profound peace with where I am and how I practice.

I had many opportunities to exchange ideas and information with some of the brightest and best minds from across the nation in surgery. Such rare opportunities are not to be taken lightly. I found my brain brimming with ideas and commentary on my two long runs of last week. The weather was warm with clear blue sky and plenty of lake water to run along side. I couldn’t help but smile at every biker and fisherman that I passed, sampling the good will of people that I will never meet again. Such is the stuff of affirmation.

My running is for me and myself alone. I haven’t had an opportunity to sit on the roof of my hospital lately but I am philosophical as I take on the challenge of completing my academic duties for the semester and year. Before I left town for a short trip, I had become embroiled in a useless “ego” trial that cost me a friend, my ultimate academic friend, and shook my confidence in my teaching style/ability. My experience in reconnecting with my former professors restored my resolve to be the best that I can be without engaging in any type of “ego” exercise.

Medicine and teaching have no room for agendas other than imparting the best knowledge possible to those who are students. I renewed my resolve to impart the best and explain all that I can explain to my students. Still, as I was on the verge of my ultimate “burn-out” for many reasons, I now have a calmness and peace that my experience has been a great teacher for me. Still, I have so much that I would love to share with my lost friend, I am sad that I won’t be able to do this.

My research continues and will be running “full steam” during the summer season. I look ahead with great expectation that we will accomplish much. I will get through my marathon in the coming weekend and move forward with the things that are on my agenda for “after” the marathon. I feel that my end of week affirmation, along with my taper and rest will be the best part of my training.

Yes, I worry that I won’t finish but I will give my best. Yes, I worry that I might suffer an injury in the start of race jostling but I will give my best and keep my eyes open. I have the positive wishes and prayers of my spiritual companions from my theology course along with my wonderful and wise friends. I have learned many lessons in the past week and I have been very sad but I keep my eyes focused on where I go from here. I prepare my head and my heart for what is to come. I have no doubt of the gifts that I have been given and I am infinitely grateful for all of them; even the painful experiences.

10 May, 2016 Posted by | academics, life in medicine, medical school | | 3 Comments

End of the year reflections

At the end of each calendar year, I try to reflect on what I have learned and what surprises me. After some years of teaching and medical/surgical practice, one would believe that there is nothing surprising out there for an old surgeon but I have moments of amazement and wonder every day. This is the nature of my practice of medicine even today.

This past year, I have become more comfortable with my extreme connections with my patients and students. I see the greatness of their humanity and in the case of my students, I have had some moments of disappointment in their lack of humanity. In the case of my patients, I see more humanity because I spend more and more time with those who have cognitive, intellectual and physical impairments.

My patients with cognitive impairments often communicate without words. For me, this is the greatest gift that I have received from them and I am fortunate to be able to stop and make those connections. From a wonderful colleague (Daniel C. Potts MD; his blog is linked to this blog), I have learned to be more mindful which has enabled me to stop in the moment and appreciate all that this group of patients has to say and wants to say. These relationships are pure gold for me.

My patients with intellectual impairments show me the wonder of human achievement daily. Most of this group of patients thrive on having a physician that connects with them and not their caregiver or the person hired to accompany them on visits to the physician’s clinic. It takes a bit more time to make that connection but the relationship here is as rich for me as for the patient. I am thankful that I make and take the time to give these patients what they crave no matter how much it falls outside of the time constraints.

My students have been the greatest surprise this year; not always in a rewarding manner. Many have shown an unwillingness to meet goals in the professionalism that the practice of medicine demands. I know that it is my job, as professor, to make sure that they have the tools for practice but this year has been a challenge for me in many ways.

Many of my students have a fixation on comparing themselves to others. My mantra for countering these comparisons is to say that the only person with whom one can compare, is yourself. Every day, or every second for that matter, is a chance to change your thinking. What another person does or does not do, has no bearing on what you can do for yourself. I constantly remind my students to use social media for information but evaluate that information and surely do not use what is posted on Instagram, Snapchat or Facebook as a means of comparison with others. You have to be the best person that you can be and not compare yourself to what you believe others are.

The lack of appreciation for the humanity of those who would be the future patients for my students is also a challenge for me as their professor. I was fortunate to have mentors and professors in medicine and surgery who reminded me of the privilege of practice. My professors spoke often of the extreme trust that patients place in physicians. We earn that trust by mastery of our craft and by humility because we are not the healers; we are the instruments of healing. To practice medicine/surgery for ego is a straight line for burnout and exhaustion because of all professions, medicine will destroy an ego very quickly.

I am grateful for being able to climb onto the roof of my hospital (14 floors up) and just meditate in the early mornings. In the predawn darkness, I can hear the traffic below, smell the fuel of the helicopter as it lands and I can take a few moments in the stillness of that place to center myself. I can see for miles on some mornings but on others, I am surrounded by rain and fog which is equally comforting. My days of sailing have taught me to love the moments before the sun rises and appreciate the ever changing colors of each new day.

As the Christmas holidays approach and the first semester has come to an end, I try to take some moments to appreciate my wonderful friends. They are a source of wonder and discovery. This year, one very new friend has been a “touchstone” for me in terms of validating what I always knew in terms of the spiritual nature of medicine. His friendship has been truly inspiring and affirming. Though we are totally opposite in just about every aspect of our lives, we are in total agreement in terms of how we approach medicine. I am very grateful for all that I learn from him on a daily basis.

This year has been one of change for me as I have achieved many of my goals in terms of physical and mental conditioning. I have made running and weightlifting a significant part of my lifestyle. I was a varsity athlete in college but moved away from regular conditioning as I navigated graduate and medical school. I have reached many of my physical goals, being able to play rugby again but I am working on getting stronger and stronger.

This year, I learned to kayak (my new means of exploring nature) which has added a different range of being able to appreciate being outdoors. Being solitary in nature for me, has always meant hiking, again so that I can be alone with my thoughts and meditations. With learning to kayak, I have been able to explore rivers and two of the Great Lakes (Erie and Superior). Being on the water alone in a kayak is to perceive much in terms of spirit renewal. I strongly recommend finding some means to get away with your thoughts and enjoy what is around even if you are only able to take a walk in a nearby park.

This year, one of my extreme experiences was to spend a week hiking Joshua Tree National Park in the California desert. There is no location on earth like this magical place. The desert was magical, spiritual and allowed me to appreciate each grain of sand that surrounded me along with the huge stone formations of Joshua Tree. The Joshua trees were amazing in that no two are alike but all are like friends with arms outstretched in fellowship. I loved each spine on each cactus plant too. The desert, the surrounding mountains and the Joshua trees gave me a great sense of place in humanity.

As this semester ends for those who are in medical school, those trying to gain admission to medical school and for those who are in some stage of medical practice, I would hope that you strive to see your place in humanity by any means that you can. I would also hope that you enjoy the spiritual and connective nature of the profession that you have dedicated yourself to. There is pure magic in what we do on a daily basis and I am very grateful for the privilege to see that magic.

 

 

17 December, 2015 Posted by | academics, medical school | , , | 3 Comments

Some wisdom for every physician, physician assistant or anyone in medicine

A very wise and gifted colleague of mine, Daniel C. Potts MD FAAN published this piece a few days ago on his blog. It is about communication. It’s one of the best-written pieces I have encountered on this subject. Please enjoy this writing as it is worth several reads. Mindful Listening: Learn to Communicate Without Words With Your Loved Ones

6 December, 2015 Posted by | academics, medical school | 1 Comment

Starting the New Academic Year

Introduction

As many of you head back to school (or begin medical school or university), the time is great for considering some small changes that may make a large difference in your health and academic success. I wanted to list a few things since I am on an extended vacation/adventure and now have a little time to tend to my neglected blog.

Head Check

This is a great time to “let go” of anything negative from past academic endeavors. This is a new start, a new year and a new time to reinvent yourself. Why not spend a few minutes each morning with some positive thoughts (for heaven’s sake, this can be as simple as smiling at yourself or a positive affirmation). When students begin to become overwhelmed, negativity creeps in first and threatens to magnify any problems into significant issues. I have found that my first actions when I start each day are to meditate and begin the day positive with my spiritual thoughts. This places me in the proper frame of mind to meet each challenge as they come.

Consider that in this era of expensive education and limited funds/opportunities, the fact that you are a student is a great advantage. You have a body of knowledge to master and build upon. Keep your mind open and positive so that you take the greatest advantage of your present academic challenges and events. Nothing can limit a determined individual who calmly prepares themselves for anything to come and adapts to changes when they occur. Resist the urge to see your academics as a battle with your professor or fellow students. Your only competition is with yourself to do your best honestly and constantly.

Do not neglect your spiritual needs. Find some form of spiritual outlet, be it something creative or religious (even better do both). If you are in a new location, find a church that speaks to you even if you wind up exploring another religion or belief. Allow yourself the freedom and openness to learn about other religions and beliefs. These explorations can serve to strengthen your own beliefs or widen your spirituality. The fellowship and connection with others, preferably outside of medicine or school is great for your heart and soul. Yoga is a wonderful activity to explore with its calming and peaceful effect on both mind and body.

Body Check

Plan your meals for the week and plan healthy. The pizza and beer may be a wonderful treat but one can’t eat high fat foods and consume alcohol on a regular basis. Good academic performance takes a strong body to nurture sound thinking. Packing snack-sized bags of apple slices, a few almonds, cucumber slices, baby carrots and grape tomatoes are healthier, easy and cheaper than grabbing a high sugar candy bar from a vending machine. High sugar may give one a quick energy boost but in the long run, that boost doesn’t last. Ease up on the caffeine (dehydrating) and go for water rather than fruit juice. If you must have fruit juice, make it within the context of eating the fruit whole such as a whole orange or grapefruit rather than drinking bottled or canned juice.

Perform some type of aerobic exercise where you get your heart pumping for at least 30 or more minutes daily. You don’t have to run for long periods of time as you can break your aerobic work into 10-minute sessions. My favorite trick from residency was to run the steps (up and down) in between my surgical cases or run jog the length of the subway platform several times as I waited for the train. I used climb to the top of the parking garage and just enjoy the air and the birds from the heights (I used to wave at the train engineers from the garage too). You can even park your car far away from the building and hike in for some much-needed aerobic work. Let your aerobic work be relaxation and not competition or stress.

Pumping iron in the gym is also great for stress relief. I will admit that I use my iron work to give myself positive reinforcement. With each rep, I am grateful and thankful that I can perform those reps. I generally don’t have loads of time for the gym but I take advantage of every moment when I am able to get into the gym and get a good weight-lifting work out completed. I also follow-up with a dip in the pool as a means of keeping myself flexible (vitally important in surgery).

Sleep Check

You have to figure out how much sleep you need for peak performance. Trying to “train yourself” to get by on less sleep rather than more sleep is not a sound idea for optimal learning. There are plenty of fitness devices on the market that will give you an idea of how much sleep you actually are getting and the quality of that sleep. Figure out what is optimal and get proper rest.

Anxiety can often cut into sleep and can cause your quality of sleep to deteriorate. This can cause chronic tiredness and can make your study time far less efficient. Find healthy ways to reduce anxiety (not drugs or alcohol) so that you can sleep well. Even herbal supplements can erode the quality of your sleep thus you need to make sure that you are getting proper rest without chemicals unless properly prescribed by a physician for a diagnoses where an anxiolytic is indicated.

Unplug from your electronics

I have been guilty of keeping the smart phone next to the bed on most days. Now that I am on vacation, I started to turn off the phone and rely on my natural clock to awaken me. I have discovered that I don’t over sleep and I am more peaceful. My phone is in my purse which is across the room so that I am not tempted to grab it first thing when I awaken. I plan to carry this practice into my work life when I return home.

I have many wonderful connections with my friends on social media and enjoy those connections very much. I have learned to treat my social media times as part of my recreation time. Social media is a means for me to connect with colleagues and friends and not to iron out political problems. More times than I would love to admit, I have “UN-friended” someone because they are bent on berating me for my beliefs. I just don’t have time for that much stress these days.

Consider that during this time of emphasis on academics and school, you have a limited amount of energy which should be spent on your studies rather than being outraged about things that you may not be able to affect. Yes, you need to be aware and informed but gossip, shaming and bullying take too much energy and produce negativity. Support causes that you believe in but not to the point that you are consumed by your causes.

Finally, these are a few things that I am “tweaking” as I go along. As an attending physician, I take myself far less seriously than I did as a resident physician. I have come to embrace my humanity and to embrace the wonder that is the humanity in others.  There is tremendous joy in medicine and patient interaction especially when your patients begin to see that you care about solving their problems and you connect with them. At this point in my life and career, my patients, my students and the residents me teach me so much. For that I am eternally grateful.

24 July, 2015 Posted by | academics | , | 8 Comments

The Gift of Study

Introduction

Many who read this blog will begin their studies of medicine in a few short weeks while others will move into new roles perhaps with more responsibility and duties. I wanted to take a few lines to write about moving into your new roles be they medical student, intern (PGY-1), resident or attending physician.

Preparation

A mentor from my first days of medical school, actually during orientation, said in his soft southern accent, “Now go out and grab a copy of The New England Journal of Medicine and read it from cover to cover.” “You won’t understand it at first but keep reading it and studying the words of medicine.” Little did he know that he had just added more fodder to my constant journal reading and now had stoked a fire so huge that I could have been consumed in the flames, so to speak. As I look back now, years from those words and others that have shaped my current practice. Listen to those little bits and pieces of wisdom from people who will enter your medical education early on.

For those of you who will begin the study of medicine, your preparation is to open your mind, your ears and to consider the privilege of what you are to undertake. Yes, you will be “sipping from that fire hose of facts and materials” to be mastered but you have been given the gift of being able to study those facts and materials. You may want to allow yourself from time to time to marvel in what you will learn from the application of science to the practice of medicine. In short, take a moment to breath and enjoy the process.

For those who move “up in rank”, take a moment to look back on the things that you have studied. Every time one encounters a familiar concept, there will be new insight. For example, my intern year was spent learning the craft of patient care preoperative, intraoperatively and postoperative. As the weeks went by, I became expert, perhaps efficient in being able handling patient admissions to the hospital post-surgery, from the emergency department or from the clinic. Additionally, I learned to anticipate and manage the needs of those inpatients from their first moments under my care to their discharge from my care. My insight at this point was how my studies of symptoms and signs coupled with science now allowed me to care for my patients and see how amazing the human body and human spirit can be.

On my first rotation, as my learning curve was steepest, I felt as overwhelmed as I felt in my first week of medical school when biochemistry, anatomy and microbiology came flooding at me in torrents. At this point, it seemed that the work of history and physical exam with admission orders, checking tests/studies, checking wounds and discharge summaries would consume me but one week in, I was thriving and looking for every chance to get into the operating room in addition to my ward duties. I could take that moment to appreciate interaction with patients, nursing staff and get to scrub surgical cases. I was “basking in the glow of bright lights while playing with cold steel, “as one of my professors would say.

When I look back, one of my gifts on those first rotations was being assigned as the intern to the chief resident that everyone had whispered being the most difficult in our ranks. I came to appreciate my chief, the only person that I know who is as compulsive and anal as myself when it comes to the practice of surgery, is that I actually found that I could “get down there and nail things” faster than he could after three weeks. He made me stronger, faster, more efficient and more comprehensive. This allowed more time for me to obtain operating time which is why I became a surgeon in the first place. What other surgery interns avoided, I happily sought out. I was also the recipient of more valuable study advice from my chief, “Force yourself to read at least 30 minutes every day, more if you can, and at least 2 hours on the weekends.” There again is that gift of study. I stuffed my pockets with articles, pages from my textbooks and the surgical atlas. Even if I was exhausted, I had something to read or study in the back pocket of my scrub pants.

Performance

Back to my professor of surgical critical care: “Surgeons are not made, they are forged” was one of his favorite quotes to me. I thrived in the forge of residency because I didn’t look at study and learning while performing medical/surgical care as being in some sort of purgatory or prison. I was getting the opportunity to build a solid foundation of knowledge and skill that I would use for the rest of my life. I learned through being forged that I could solve problems and touch a multitude of fellow human beings in ways that others would never appreciate.

My professor would later say at my graduation that I never complained or said that I was tired when he knew that I was the oldest resident in the ranks. (I had attended medical school after graduate school). He said that he found that somewhat remarkable because as he had aged, he felt entitled to complain more and accept less mediocrity. He said that I was a person who accepted everyone as I found them without agenda. (Still one of the most interesting comments that I have heard about myself).

Under the scrutiny of my mentor in residency who like my first chief, was known for having a very challenging personality, read malignant here, I learned the clarity and performance of surgical skill. My mentor (faculty adviser), taught me to waste no movement in honing surgical skills. He loved that I studied as I learned and assimilated what I was taught in craft and theory. Again, back to those study skills.

Little did he know, I cut the spines from my surgical texts, punched holes in the pages so the they would fit in a ring and were more portable than the entire text (Sabiston’s Textbook of Surgery). My best memories of my faculty adviser are of him folded in a lounge chair in the surgical lounge with his Danskos next to his feet grilling me on how to handle this complication and what would happen next as this was more valuable than gold for me.

Even today, the residents, medical students and physician assistant students appreciate my high expectations of them in terms of work and study. I do not subscribe to the practice of berating as a means of teaching but go back to my very tough first chief resident and my faculty mentor in residency who generously gave of themselves to guide me towards performance at the highest level. I don’t have the difficult personality traits that were characteristic of many of my fellow surgeons but I have high expectations of those who have been assigned to me for instruction.

Practice

The gift of the study, and later practice, of medicine (if you are fortunate) is still one of the most divinely mystical and satisfying acts of a lifetime. Even if you are beginning your studies and are not enjoying much patient interaction, try to cultivate a love and appreciation for the gift of study. Those studies will allow mental efficiency which can lead to some of the most intimate and spiritual gifts from one human to another. Appreciate those gifts without complaint because many others will never have the privilege of enjoying them as you have them now.

26 June, 2015 Posted by | academics, medicine, practice of medicine | | 4 Comments