One Less Light

I felt I needed to write about some stuff I’ve been thinking about. Maybe you can relate.

Do you have any albums that you listen to where all the tracks are great? Like you never have to skip a track because they are all amazing? I have a few. Morning View by Incubus, By the Way by the RHCP, and a few albums by Linkin Park. For many people my age Linkin Park was our introduction to the world of hard rock. They developed a unique genre of metal/rap fusion with deep lyrics. Hybrid Theory and Meteora were part of the soundtrack of my high school years. I remember when we had just learned to drive and listening to Chester’s screaming vocals with the radio turned up loud enough to nearly deafen us. Linkin Park continued to put out more albums, some good, some not so great. But they kept going all these years, putting out a solid album last May and continuing on tour. Many of the alt rock legends we knew hadn’t made it this far. Many artists I knew back from the 90s and early 2000s had since quit the music business or died. Victims of drugs, depression, or tragic accidents. But Linkin Park was still going strong. It seemed they had made it. They escaped the curse so to speak.

Then I learned of the shocking death of Chris Cornell. No one saw it coming and it sent a shock wave through the music community. Chris was part of two bands I grew up listening to: Soundgarden and Audioslave. He even did the opening song for Casino Royale. I never saw him live but I was deeply saddened to know that I would never hear anything new from him again. And although I never knew him personally I grieved his loss. But time went on as it always does. I was excited to hear new stuff from Incubus and Linkin Park.

Then on Thursday I casually checked Facebook while walking the halls of the hospital only to learn Chester Bennington of Linkin Park had committed suicide. He hung himself just like Cornell had done just a few months before. I was shocked and then once again in a strange state of strange grief for someone I didn’t really know. I thought about the times this happened before with Chris Cornell, Robin Williams, and others. The death of artists for some reason can really affect us. We connect with them through their art. They share part of themselves in their work and when we listen it becomes part of us too.

I don’t really understand what drives someone to suicide and I’m not going to pretend I do even though from time to time I treat people who tried to kill themselves. Perhaps it’s a feeling the world would be better without them. Or maybe they can’t handle the weight of their own issues. I don’t know what drove Chester to make that choice. Some people say that suicide is a person’s choice and they shouldn’t be inhibited from making their own choices. But the truth is when you take your own life you also kill the part of your life you shared with other people. I can’t help but wonder if Cornell hadn’t taken his life would Chester be alive too? I will continue on with my life knowing that another part of my adolescence decided life is not worth living. But Chester had six children now without a father. And that’s far more tragic than not getting to hear a new Linkin Park song on the radio.

Stay strong guys. And if you ever need someone to talk to I’ll be here

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Mercy and Grace

It’s been a while and I’m nearing the end of my second year as a resident of internal medicine. I have learned a lot but still have a lot more to learn. Perhaps it will always be that way. Anyways the population we serve in downtown Pittsburgh includes a lot of people whom the healthcare system has failed. Many are homeless, uneducated, addicted to drugs or alcohol, or have psychiatric disorders that impair their ability to remain healthy or adhere to their medical treatment. I have been yelled at several times for refusing to give patients certain meds that they want because it would cause them more harm than good. Once a patient followed me down the hall to yell at me because I didn’t give him the number of oxycodone he wanted to go home with. I have also seen patients fake symptoms or intentionally make themselves sick to stay in the hospital longer.

True, I have become somewhat calloused from these experiences as have many of my peers. It’s easy to roll your eyes when your’re admitting a patient for the fourth time for alcohol withdraw. Few people would blame you for having an attitude of disdain even, or a feeling of superiority. Why can’t Mr H get his life together? Why doesn’t he simply take his medications and stay on a low salt diet when he leaves here so he doesn’t keep coming in with heart failure? This is certainly why the cost of healthcare is so high!

It’s here I’d like to take a minute to explain the difference between Grace and Mercy. Grace is not just something a ballerenia has. Grace is a virtue of God in which we are given rewards that we don’t actually deserve. Mercy on the other hand is the witholding of deserved punishment. It is by no mistake that our hospital is named Mercy. It was decided by the group of nuns who founded it with the goal of serving the underserved and it a goal we continue to pursue. It is a goal to try and exemplify the mercy and grace shown by Christ.

If I think about myself I realize that I am no better than the worst patients I treat. I have continued to sin repeatedly, in the same ways but then still have the audacity to ask God for things I want as if I deserve them. God could easily roll his eyes and give up on us, leaving us to our own filth and death. But God comes through with mercy and grace anyways. Jesus died for us on a cross even though we can be total jackasses sometimes. How lucky we are! At this hospital I am given this opportunity to see a little of what it is like for God to provide grace and mercy. I provide excellent health care to people that you might say don’t deserve it. For people who will yell at me and call me names for it. It is not easy but we can be better, and maybe once in a while make a lasting difference.

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My thought on a great season

There has been a lot said about the championship and what winning has meant to different people. The story of Clemson triumphing over Alabama has been compared to the story of David defeating Goliath. I don’t feel it is quite that much of an underdog win but it is pretty amazing that Clemson was able to beat a team that many said was unbeatable. It was truly an unforgetable night but what I think is more memorable is how we got there.

It started with a gutsy victory in Auburn. We made the decision to forgo a field goal and trust the defense to hold. That nearly cost the game when Auburn threw the ball into the endzone with seconds to go however the pass was incomplete. The next game we struggled against Troy and everyone wondered what was wrong with our offense as we pulled off a win by a difference of only 6 points against a non division 1 team. Three weeks later we are down in the fourth quarter against a strong Louisville team and it looks like all hope is lost until Watson leads the team in a final drive to take the lead 42-36. Then two weeks later the team struggles again against an unranked NC state team. I remember standing in Death Valley with my dad as NC state drove down the field and lined up for an easy field goal with two seconds on the clock. I remember saying “well, we had a good run” as I resigned us to a loss. Then the stadium erupts when the kick sails wide left and we win in overtime. The next game found us in the most hostile of environments playing a tough Florida State team who won the National Championship just a few years prior. We fought and clawed our way to victory. After the game FSU’s coach would go on record to call the ref’s officiating “cowardly, gutless, and wrong” after a controversial call in a crutial part of the game. Then came the stunning loss to Pittsburgh at home in Death Valley. That loss seemed to turn the team around. It was the wake up call they needed. They would go on to beat Wake Forest and have a commanding victories over South Carolina and Ohio State.

If any small event had gone differently they may not have made it to the rematch with Alabama. If any one of hundreds of plays had been different the whole season could have been different. It was meant to be. It was destiny. And it was awesome.

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Us vs Them

On the show M*A*S*H there’s a conversation between Captain Pierce and a priest during an operation that goes like this:

Surgeon: “War is Hell”

Pierce: “War isn’t Hell.  War is war and Hell is Hell, and of the two war is a lot worse”

Priest: “How do you figure that?”

Pierce: “Easy Father. Tell me: who goes to Hell?”

Priest: “Sinners, I believe”

Pierce: “That’s right, There are no innocent bystanders in Hell. But war is chocked full of them: little kids, cripples, old ladies. In fact except for a few of the brass almost everyone involved is an innocent bystander.”

OK America it’s time we sat down and had a talk. I get it, you’re afraid.  That stuff going on in the Middle East with ISIS is pretty frightening.  And the attacks in Paris reminded us that we are not safe no matter what we do. We’re in a war and it’s not like any war we have fought in the past. It’s not a war against a country, it’s a war against a set of beliefs. But we are letting the terrorists get in our heads and control us.  People are coming out and saying all Muslims are bad or Islam is evil, but most of these people either don’t know any Muslims or do and they just don’t realize it. I couldn’t believe that people really wanted to refuse Syrian refugees after the horrors they had endured in their country.  When did we become a nation of cowards hiding behind our borders? Donald Trump proposed making all Muslims in the USA carry ID tags and people actually agree with the idea!  I’m not saying we should irresponsibly let anyone into our country, but we also can’t ignore the suffering and the needy. The terrorists want us to be afraid and allow suffering and by closing our borders to refugees we are doing just that. Saying all Muslims are bad or suggesting they all have to carry ID tags violates the first Amendment on which our country was founded. And the vast majority (99.9%) of Muslims are peaceful people. We have to be better than these terrorists, and we have to be brave because the world needs us to be. We boldly love people even when we know it may hurt us. It’s what makes us different from the terrorists.

At the same time within our own country there is division between people of different races sparked by events in Missouri, Baltimore, and South Carolina. You see stories all the time saying “black man/woman brutally attacked by police” and it’s terrible to hear. The fire of division is stoked by the news media who just loves a good us vs them story.  But why are we not upset that a person was hurt simply because they’re a human being?  Why doesn’t the story read “man/woman attacked by police”?  Why do we need to polarize ourselves? I also see stories sometimes like “white news media doesn’t care about [insert topic]”.  This title is clearly meant to divide people further.  I sometimes wonder what the world would be like if we were all the same color, but then I realize that we are so good at dividing ourselves we would find something else to judge each other. It’s time we stop letting the color of our skin define who we are.  Instead of black lives matter, how about all lives matter?  How about if instead of assuming we know what another race of people experiences and yelling at them we sit down and try to understand what they are feeling.

We humans are great at dividing ourselves and then thinking our group is better.  It’s always us vs them whether it’s us (Americans) vs them (Middle East) or us (Christians) vs them (Muslims) or us (Whites) vs them (Blacks) or us (Citizens) vs them (Police). It’s easier to say this group of people is all bad, but what would Jesus say?  Jesus was all about eliminating the us vs them philosophy.  He was always seen with people that others would say were “bad”, “evil” or “dirty”. He spoke with and drank water from a Samaritan woman, who Jews would typically not associate with.  He had dinner with a tax collector who others would insult or ignore.  He healed the lepers who were seen as unclean and cast out of society. Even as he was being crucified he shouted “Father forgive them for they know not what they do!”  This is the kind of radical love that Jesus demonstrated for us. This is the kind of love that can transform lives and save our planet.

 

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Physician-Assisted Dying

I have always been against physician assisted suicide.  I believe it goes against the Hippocratic oath that most physicians make while in medical school.  However it has gained popularity and is legal now in some countries including Belgium, Switzerland, the Netherlands, and Canada.  Debates continue in the United States and Great Britain.  It is allowed now in five states including Oregon, Vermont, New Mexico, Washington, and Montana.  Some countries allow it in the case of terminal illness while most also allow it in the case of psychiatric conditions, non-lethal disease, or even just being “tired of living”. In other words this is not just something that is being practiced when patients have terminal illness which is outrageous.  The physician’s job is to improve the quality and length of life, not to end it.  It’s like if I was a carpenter and I went to fix someone’s house but they were tired of living in it so instead of fixing it I burned it to the ground.

I understand why it is appealing.  Life is scary and disease can be terrible. I talked about death in a previous post you can find here.  Dealing with end of life decisions is difficult but that is why we have palliative care physicians.

Let me side track here for a minute and explain a little about what palliative care physicians do.  When many people hear about palliative care they think that they are being given up on and now we are just going to “keep them comfortable” until they die.  But palliative care does much more than that and don’t just treat patients who are about to die. Palliative care doctors are experts in communicating about difficult topics such as prognosis, disease progression, and end-of-life care planning.  They work with other physicians like family care doctors and oncologists to help them develop treatments that are in accord with the patients’ wishes and beliefs.  In a 2010 study of patients with non-small cell lung cancer, it was found that early palliative care “led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival”.

Suffering is not something we want to have to go through but it’s an inevitable part of life.  So many people have attempted or though about ending their lives then later regretted it. Elective life ending therapy brings up so many questions such as:  How do we decide who is eligible?  Even if we say it is just for people with a terminal illness, how do we know for sure the illness will kill them immediately or in the near future?  How about people who believe they are a burden on their family and are pressured into ending their lives this way when it isn’t really what they want to do?  What does it mean if we say that if a person is suffering it’s ok if they just give up and kill themselves?  Is this a reflection of how we have de-valued life?

I’m sure there are a lot of people who will disagree with me on this issue, I just don’t believe it is the job of someone who is supposed to be healing/saving lives to do the opposite.  Death and suffering have never been easy but they are a part of life and I believe through suffering we learn more about ourselves and become stronger.  And we have the ability to minimize suffering at the end of life so it doesn’t have to be that scary.  Here are some sources I have used:

http://www.medscape.com/viewarticle/849465

http://www.nejm.org/doi/full/10.1056/NEJMoa1000678

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Being a Doctor

So finally I’m doing what I’ve been training for.  But I’m also still training.  When you’re a doctor learning and being tested never really end.  Here’s what it’s been like so far.

I started out on the general medicine floors.  Day 1 I get up about 5 am, shower, eat some breakfast, put on my tie, and say a prayer that everything goes well.  I don’t have a white coat.  They had not, still haven’t come in if you can believe that.  And I didn’t spend four years in med school to work my fist official day as an MD in my short coat from med school.  So I end up having to carry my clipboard everywhere.  I have my pager and I know I’m scheduled to work until at least 8pm.

I show up to a busy resident lounge at 6am and I’m given a second pager to carry.  This one apparently goes off when there is a “condition” which is what they call a medical emergency with one of the patients.  I’m paired with a second year resident who has to guide my lost self through my first few weeks.  We don’t have any med students or other residents, it’s just us on our team.  However I’m lucky and our list is mercifully short.  I review everything about our patients as quickly as I can and we go round.  Our team is unique in that we have three different attendings we work with and the patients are all familiar to their practice.  This makes seeing patients a little easier since the attendings are familiar with the patients before we see them.  Rounds are pretty informal but happen really early.  I have my first practice answering pages about our patients.  At first every move I make I verify with the senior resident.  I’m actually placing orders and it’s a little frightening.  The condition pager goes off and I have to rush away to see what the emergency is.  A patient is in respiratory failure and I look around to see what I should be doing.  I find out that my responsibility is to find a computer, put in orders, and then document what happened.  I can handle that.  Later in the day I am given the team pager.  Now I am up to three pagers and they are going off faster than I can answer them.  It’s a busy day, kind of chaotic, but this is what I signed up for.  Many people would be overwhelmed but I thrive off a challenge.  I do best when I am busy.  The day finally ends and I finish the progress notes and actually leave not too long after my shift was scheduled to end. Not a bad first day.

Later I find an unused white coat that belonged to a transitional year intern last year, tape a white piece of paper over the name, and it becomes my temporary coat.  It may not have my name on it, but at least I am not being mistaken for a med student.  People greet me in the hall saying “hello doc”.  It feels nice but I still have so much to learn before I’m ready to be fully independent.  That first weekend I work my first 16 hour call, which means I have to go in at 8pm Saturday and don’t leave until Sunday at noon.  I worked the night shift answering relentless pages about patients I was not familiar with.  Most of them are easy: “so and so wants something to help her sleep” or “can you change this order to PO…” but others I have to ask for help.  I attempt to sleep by convincing myself that the pager is not about to go off again but as soon as I do get to sleep it does.  I get broken intervals of sleep for about a total of 1.5 hours.  Then I get home and sleep through most of the afternoon and night then get up again at 5:15am the next morning and go back again.  I already feel like I live in the hospital.  I’ve been going to bed several nights when it’s still daylight outside.

Every day I get a little better but the knowledge required is overwhelming at times.  And staying awake during afternoon lectures while sleep deprived can be a real challenge. This week our list became greatly longer and the senior resident and I have been challenged with managing about a dozen patients.  We are doing it though, and each day is a little less stressful.  It’s about admitting new patients, getting them better, and finding how to get them out of the hospital again.  Some patients can’t wait to leave while others will do desperate things to stay. I have to say the real practice is never as simple as it is in the books.  Patients are much more complicated, often on a dozen meds, and have long complicated histories.  You find out that a lot of what you learned in med school and seemed simple isn’t really simple at all.  It’s a challenge.  But the challenge is what makes it interesting.  I am where I’m supposed to be.

The look of a new intern, fear mixed with confusion

The look of a new intern, fear mixed with confusion

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Flags

It seems today that flags are a hot topic.  Flags are made to fly in the air.  Flags are something that people identify themselves with.  There are flags for carrying into battle, flags for symbolizing peace, and flags used for identification.  You can pledge allegiance to a country’s flag or burn it.  A flag can inspire hope, fear, pride, or anger.  Back home in South Carolina there is a sharp divide between people who fly a Clemson flag and people who fly the flag of USC.  But what power does a flag really have?

Apparently a lot.  Many people are angered or insulted by the Confederate flag.  To others it is a symbol of pride and represents their history.  Having grown up in the south I can see both perspectives.  It has been used for so many purposes no one really knows what it means anymore.  To me it doesn’t mean much of anything. It’s like some kind of relic you would see in a museum: at one time it had a clear purpose but now that purpose is gone.  Since the Civil War it has been used as a symbol for many other things like hate groups and simple southern pride.  It’s a part of our country’s history, maybe not a good part, but a part none the less.  I’m not trying to say it belongs on the statehouse grounds.  If it disturbs more people that not it probably doesn’t.  Honestly until recently I didn’t even realize it was still there.  When I was in college I had a roommate who was randomly picked to stay with me.  He hung a big confederate flag on the wall in the room we stayed in.  I never talked to him about it but it made me a little uncomfortable, not because it offended me personally but I didn’t want people to assume I was a racist.

Racism disgusts me, I’m amazed it still exists in our country like it does.

Then there is another flag that has been getting a lot of attention lately: the rainbow flag.  The Supreme Court decision doesn’t bother me.  You can marry whoever you want I don’t really care.  Would Jesus support gay marriage?  I don’t really know.  But let’s think about who did Jesus hang out with?  On many occasions he deliberately spent time with the people that others called sinners.  The ones everyone else gave up on.  He stayed with the sick and the “unclean.”  He had very harsh words for the religious elite who believed they were better than other people.  I could see the Jesus of today spending a lot of time with homosexuals, telling them that he still loves them. This is why I don’t understand the hate coming from so many people who call themselves followers of Jesus.  It seems like they completely missed the points Jesus made.  I want to say “DID YOU GUYS READ THE GOSPELS AT ALL?!” The Church is meant to be a place of open doors, of welcoming sinners and the poor and needy.  Like a hospital for the soul. It’s also disheartening to see the hate from the other side, the ones who trash the Church and the name of Jesus for something he’s not guilty of.  Maybe though if the people of the Church did a better job loving people this wouldn’t happen.  Maybe homosexuals won’t have a marriage in the traditional way, but they’re going to spend their lives together one way or another.

What if we stopped letting flags define us?  What if we stopped excluding and hating people who aren’t represented by our flag?  What if we just learned to appreciate our differences as what makes us unique and what makes the world an interesting place.  Our nation has come a long way but it still has a long way to go.  We are in the middle of a great cultural revolution.  The world isn’t big enough for us to ignore each other any more so we might as well find a way to get along.  Let’s take Sheldon Cooper’s perspective on flags: https://www.youtube.com/watch?v=Xl12Sp1KiEk

Later

Fun With Flags

Fun With Flags

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