Finding Your Voice

A friend, who is a new medical resident, confided that she was frustrated on her latest hospital rotation because one of the attending physicians made it a sport of intimidating anyone within spitting-while-yelling-at-you distance.  She confessed that her fear was probably interfering with the care that she providing.  Hoping to encourage her to choose caring for her patients even if it meant suffering at the hands of an insufferable attending physician, I told her the following story.  I learned the very hard way that we all have to avoid the “mute button” when that little voice inside yells at us to do so….

After placing my order at Cosi’s and collecting my hummus and vegetable sandwich, I set my sights on joining the queue that would ultimately separate me from the $6.97 of paper and coins in my right pocket.  As I worked my way through the lunch-time masses, I excused myself to pass an elderly woman.  When she turned and smiled, the air in my lungs was vacuumed out by the sight of a ghost.  The words that leaked from my mouth must have left this grandmotherly figure thinking that English was not my native language.  Unable to comprehend her presence, I moved past her and joined the cash register line where I could assess her without further risk that someone would telephone the police about my behavior.

I have often heard that everyone has a twin.  Beyond feeling bad for the guy running around looking like me, I have not given that idea great thought.  But then again, the only plausible explanation for the presence of the wrinkled, gray-haired woman slumping on her cane four feet away from me was this concept.  After all, her “twin” is dead, and the memory of that death haunts me many months later because I think that I may have contributed to it with my silence.

On what was a perfect spring afternoon, I noted how the sun had coaxed smiles onto most of the faces that paraded by me and that many people were humming, singing or whistling.  Winter, I was starting to believe, was a memory (for now).  Arriving at the hospital, I donned my white coat and was quickly given a job to do.  Coming out of Room 13 a few minutes later with a patient’s history bouncing in my mind, I was startled when someone grabbed my arm.  Before I could say anything, a man in his 50’s jumped from his chair and assured, “Mom, it’s ok.  We can’t bother this doctor right now.  They’ll get to us soon.” 

In part because warm weather brings more accidents, more fights, more drunks and generally just more emergency business, the ED was littered with stretchers that lined the hallways as overflow for the filled rooms.  Knowing that the resident physician with whom I was working was not in a rush to hear my presentation on the “belly pain” in Room 13, I turned and found a scared old woman attached to the hand on my white coat sleeve.  This octogenarian, and mother of the man now standing next to her, was uncomfortably resting on a full backboard.  Her head and neck movement was restrained by a hard yellow collar.  Her sad eyes reminded me of that confused look my dog has anytime the veterinarian requires him to wear a protective plastic “collar” around his neck.

Gently plying her surprisingly strong fingers from my arm, I took her hand in mind and asked if there was something I could do.  Ms. W. complained about pain and was a little difficult to understand.  I smoothed her hair and told her that I would let her doctor know that she was uncomfortable.  Her son thanked me (for nothing) and told me that his mom was waiting for a CT scan after falling down a flight of stairs.  Confirming that the son did not want a ginger ale or graham crackers (there was a limited selection at my disposal), I set out to find those in charge of Ms. W.’s care.  I found the resident physician charged with ensuring that Ms. W. left the ED better than when she arrived, updated her on Ms. W.’s pain and apparent delirium.  Dismissing me with both words and a look – the look of “thanks, medical student for wasting my time” – she said she would check on Ms. W. when she had a chance.

Taking an arterial blood gas (“ABG”) in Room 17 and then observing the attempted – and failed – resuscitation of a 47-year-old man who had “been down” for 40 minutes upon arrival at the hospital because the condoms of heroine he was transporting as a “drug mule” in his intestines had ruptured had kept me out of the hallway where Ms. W. was housed.  When I caught a “break” (a very relative term for the incredibly hard-working doctors, nurses and staff in an emergency department), I tracked down Ms. W. and was disappointed to find that she was in her original location.  Her son remained pleasant, and I was struck by how calm he was and how irate I would have been if my mom was immobilized in an uncomfortable position, place and state.  Ms. W. seemed more confused and remained in pain.  She didn’t look well but I wasn’t sure that she looked worse.  Again, I spoke to her, smoothed her hair and held her hand while her son grinned pleasantly.

I sought out Ms. W.’s resident and found her in the middle of presenting to one of the attending physicians.  I waited.  I made my presence known.  We made eye contact and she glanced away, even turning her back a bit to make it clear that my opinion was not needed at that moment.  While thinking about how to proceed, a previously unannounced (often the case when someone is thrown out of a moving vehicle by “friends” at the ED’s front door) trauma boomed through the overhead speakers and I headed toward the red pod to meet my assigned boss for the night.

After watching the emergency physicians stabilize the 17-year-old boy with multiple gunshot wounds and the trauma surgical team wheel him out of the ED, I returned to the nurse’s station that had been my home base all night.  Over my shoulder, I noticed that Ms. W.’s son was stretching in the corridor.  I risked his ire and went to check on his mom.  He remained calm and pleasant.  He informed me that his mother had been to the CT machine and they were waiting for news.  His mom had settled down but remained in pain and confused.  I apologized (on behalf of whom, I do not know) for the delay and joined him in hoping that answers would come soon.  He asked me about the photo dangling on the pocket of my white coat and, consequently, we talked briefly about my daughter.

Moments later, a gurney – the gurney she had been on for literally hours – carrying Ms. W. flew around the corner with a flurry of people in tow.  She was brought into one of the trauma rooms, CPR was initiated and a nurse gave an update that she had found Ms. W. unresponsive in the hallway.  Questions about the failure of having her on a monitor were pressed to the corner of the room while the team worked aggressively to revive her with medications, joules of energy and simple hope.  Her gown had fallen to the side, exposing Ms. W.’s naked body to the indecency of the cold, trauma room.  An attending asked about advanced directives.  The resident physician – the one who had ignored my earlier communications and who had accepted responsibility for Ms. W. – calmly started to leave the room indicating that she would speak to the family. 

Ms. W.’s son, who was now joined by two other brothers, remained a giant among gentlemen.  He quickly convened a family summit and within seconds concluded that the efforts being made in the trauma room were not what his mom wanted.  With that decision, the resident carried the news back to the team working aggressively to revive Ms. W.  Everyone stopped.  The attending physician ordered that Ms. W. be covered appropriately, that tubes be removed, and that everyone in the room leave immediately to make room for the family.  As I left, I diverted my gaze away from the son, holding each tile of the floor with my eyes.

Ten, maybe 15 minutes later, I passed Ms. W.’s son and his brothers in the hallway.  Unsure, I nodded.  He stopped.  Gripped my hand with both of his and thanked me for caring so much about his mother and taking such great care of her.  Though we had discussed my status as a medical student, he introduced me to his brothers as “the Dr. who checked on Mom all night.”  I had done nothing but show him that someone was paying attention, even though I had failed to exercise the limited power that I had.  I had not questioned why an 89-year-old woman was in an unmonitored bed after a substantial fall.  I had failed to push the resident to pay Ms. W. the attention that she needed and deserved.  And most concerning, I did not seek out the attending – the resident’s supervisor – to share my concerns.  If I had found my voice, I had to wonder, would Ms. W. had lived through that night?

On the ride home that early morning, I turned right off of one of the city’s still sleeping streets and spotted flickering red ambulance lights that helped dilute the darkness of a new day.  I apologized silently to Ms. W. and her sons.  The exhaustion of the past 12 hours, the dehydration and hunger of the extended shift, and the sorrow of her death caused a quiet, reflexive promise to escape my lips: “I will find my voice next time.”

It is not always easy but, I hope that you’ll remember that people like Ms. W. are counting on all of us to find our respective voices when it matters.

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Ready to Save a Life?

Last Thursday, my best friend, Dena, posted the following message on Facebook:  “Had a surprise visit today at work from someone who I knew for less than 30 minutes, and haven’t seen in 7 years. We shared a moment today that reminded me how simple acts of kindness make the world a better place. Needed to share that reminder… it is such an important one!”   

Dena is not someone who often posts Facebook messages.

I thought that the comment was loaded with intrigue and a great take-away message.  Not wanting to push her to share the underlying story publicly, I simply clicked the Facebook “Like” button and moved on with the blizzard of activity that blurred my day.

Today, in the middle of catching up with Dena about life, I burped, “what was the story with that Facebook post last week?”  With enthusiasm that is characteristic of everything that this mother of three, wife and pediatrician does, her face exploded with a smile that is the same as when she was 13 years old and she buzzed, “you won’t believe this,” and handed me a tiny envelope – the kind that is often taped to a floral arrangement.  Written by a young woman’s hand were the words:  “Dena, Without you, I would never have been given this opportunity.  A million thanks could, still, never be enough.”  (It was the kind of message that tickles your heart and causes surprise tears to fill your eyes, even without understanding the story.)

Instead of signing the note “from” or “sincerely” or even “love,” the handwritten message concluded with a simple, scribbled heart and the author’s name.  A second, small piece of smooth, glossy paper was folded with the note.  Before my fingers massaged the single fold apart, I knew what the unique paper represented.  I carry two nearly-identical pieces of paper in my wallet; one for each of my children.  The small square revealed a black and white image, familiar only to those who have had an ultrasound evaluation of their pregnancy.  Most parents treat the strip of four or five “photos” that they are given like gold, dividing them only among spouses, partners, and future grandparents. 

Reading the note and smiling at the image did not clarify the chance meeting that Dena had or its apparent value.  Feeling a little like a reporter, I pushed.  There is not much that I do not know about Dena – the beauty of those few friends who are like siblings – but, I needed help connecting the dots. 

Seven years ago on September 16, Dena was at home trying to get some rest while completing her residency in pediatrics.  The nighttime quiet of Dena’s then small-town neighborhood was shattered along with metal, plastic and glass of the car that crashed into Dena’s house.  As someone trained to triage in tragedy and save lives, Dena did just that.  Though an investigation would ultimately reveal that older boys were driving under the influence of alcohol, all that mattered that night was that Dena found an unresponsive teenage girl who had been ejected from the single-car accident.

The girl, maybe 16 years old, was dead by layman standards.  She was in cardiac arrest and had no pulse.  She was in respiratory arrest and was not breathing.  If not for Dena’s instinct and training that demanded her hands begin CPR chest compressions, that girl would not have lived long enough for the emergency assistance of a helicopter crew and hospital-based healthcare providers to sustain her life and, in no uncertain terms, give that girl a second chance.

But, that’s exactly what Dena did.  She pushed the girl’s sternum, hoping that the pressure of the chest bone would exert corresponding pressure on the girl’s heart.  And if lucky, the energy from Dena’s hands would translate into the energy required for the left ventricle to force open the aortic valve and push the oxygenated fluid of life through the girl’s lifeless body.  Blood, under the power of Dena’s hands, flowed to the girl’s brain.

Today, looking back on that night, Dr. Dena stands far from her heroic and life-saving acts and says that it was likely that the girl, whose teeth were knocked out in the DUI- and speed-caused “accident,” had something – blood or a tooth – blocking her airway, and that the obstruction caused her breathing to cease and heart to stop beating.

I do not think that the physiology lessons contained in bringing life back from death are critical in this story.  The basics, however, are.  The girl was so severely injured that survival can only be attributed to a miracle, including that the accident took place on a doctor’s front lawn.  Life was sustained because someone knew what to do.  A funeral was avoided because CPR was taught and learned.

To underscore the significance of what happened on September 16, 2003, the rest of the story should be told.  The girl recovered from her injuries.  A year later, she returned to the scene of the accident and left flowers and a note of appreciation for Dena.  The new owner of Dena’s house telephoned our doctor hero, and told her about the flowers.  Every year since then, unbeknownst to Dena, the girl returned to the house and left flowers.  This year, however, the not-so-new owner of Dena’s old house was home to intercept the annual, mysterious visitor.  She updated the now-23 or 24-year-old woman that Dena had moved.

Motivated by an understanding that today her lungs fill with oxygen and her heart beats to sustain life because of Dena’s fast-acting response, the young woman tracked down Dena at her pediatric practice, flowers and note in hand.  Dena’s office receptionist reported that a “special visitor” was in the waiting room.  The exchange was everything that you would imagine:  A girl, who is now a grown woman, tracks down the young medical resident, who is now a veteran pediatrician, explains who she is and that she is there last Thursday because Dena was there – really there – seven years ago.  She shares the ultrasound picture and the message, softly reminding Dena that the dead girl of seven years ago would not today be a very alive, pregnant woman if not for the acts of a stranger.  Many lives would have been so different if Dena did not know what to do.

On Facebook, Dena tried to remind us that simple acts of kindness matter.  I think she meant that she was touched by the girl delivering the most important thank you in the form of flowers and news of her pregnancy.  I agree that kindness matters, especially that of strangers.  But, the real take away here is that Cardio-Pulmonary-Resuscitation (CPR) saved a life.

If a car crashed in front of your house tonight, could you do something meaningful after dialing 9-1-1?  Could you properly compress the chest?  Do you know the depth of the compression necessary to sustain life?  (It’s a much harder push that you would think.)  Do you know the 30-2 rhythm of compressions and breaths?  Do you know the protocol if you’re alone versus with others who can assist in the life-saving mission?

In most communities, the American Red Cross (www.redcross.org) and the American Heart Association (www.heart.org), among others, teach classes in CPR, first aid, and the use of Automatic External Defibrillators (think of the TV scene where the doctor yells, “Clear!” before delivering an electrical shock).  Isn’t it time you take a few hours out of your weekend and get certified (or recertified)?

Sadly, there are moments every day that require us to rise to the occasion and save a life (a car accident that happens in front of you on a highway; a woman who chokes in a restaurant; a man who falls to the grocery store floor, clutching his chest while having a heart attack; and a child who falls breathless in front of you on a playground, to name just a few).  Join the movement to be prepared to help.  Remember the words on the note:  “Without you, I would never have been given this opportunity.”  Without YOU….  Hey, I’m counting on you, just like you’re hoping that you can count on me.

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The Break-up Letter

I have never received a “Dear John” (or even a “Dear Benjamin”) letter before.  Sure, I have had my share of breakups on the bumpy road of dating that eventually lead me down a seemingly mile-long aisle to an exchange of vows.  And though many of my ex-girlfriends may be critical (still) of many things that I did or failed to do, I know none of them can complain that I ended our love affair with a stroke of a pen or – in today’s parlance – the stroke of a computer keyboard. 

While it is easy to focus on the way that this relationship ended – with no hug, no opportunity to respond, no chance to express meaningful gratitude, and no possibility to beg for another chance – the real problem is that getting dumped means I need to fill an important void, worry about my well-being until I do, and still mourn the loss of an empathetic, caring, compassionate and smart woman from my life.  Some, as they say, “don’t know what they’ve got until it’s gone.”  I knew how fortunate I was, and that makes the loss more difficult.

After re-reading the words on the letter – both the standard typed words and the personal handwritten note in the margin, all I could say was:  “Grand Rapids.  Really?  Grand Rapids.”  With the words settling into my stunned mind, I realized that this was a fait accompli, and I would have to accept the change.  Before moving on, though, I reflected on our experience together.  Whenever I needed her, she was there.  She was patient.  She listened and never judged.  She eased my pain.  When things were going wrong, she cheered for me.  She cared for me, and I trusted her because I could see in her eyes and hear in her voice that she was genuine.  Truly, the real deal.

Maybe the lesson that I should take from having had the opportunity to learn from her, to have been fortunate to have met her for what amounts to a few minutes in our lives, is that our relationship… this type of relationship is so important.  It has the possibility of being something great when built on honesty and respect.

I know that she has her reasons for departing, and I’m relieved that this breakup had nothing to do with me.  But, I still will miss having Karen Garibaldi as my doctor.  And while I am searching for someone to replace her, I will continue to compile the lessons that I learned from her:  Never look at your watch or a clock when with a patient; listen intently; move the little, physician’s rolling chair closer to your patient; recognize that a hug can sometimes be acceptable between a doctor and a patient; empathize with real stories when appropriate; follow-up; answer e-mails; return telephone calls personally; reassure; remember (or at least peak at you’re the chart to remember) things about your patient so they do not feel like one of 4,000 charts; if you bump into a patient at a public restaurant, genuinely introduce the patient to your dinner partner as “my friend, Benjamin;” and above all, lose the white coat and just be a human being who cares and has a special skill set that may ease pain and suffering.

The lessons that made Dr. Garibaldi so successful are applicable to all of the jobs that we do and to the lives that we live.  Don’t you think?

In medical school, students are bombarded by lectures that contain minutiae that most practicing physicians – if honest – would classify as irrelevant, long-forgotten and – if really honest – only part of an unnecessary, pledging process.   Students are asked to memorize neurological tracks that will not impact care, cells in a microscope that will never be seen again, and muscles that are dismissed by practitioners “as things that only the anatomists know.”  While looking for a new physician (and hoping that I do not need one in the meantime), I cannot help but note that I do not care if my doctor can “guess” where a stroke might be in my brain (because they cannot treat it without scanning my brain); I don’t care if they can pick a pronormoblast out of a line-up (because they will never see one again); and I don’t care that if they can’t remember “genioglossus” faster than I can stick out my tongue (because  it matters far more if I can make my tongue protrude midline, after all).  I do care, however, that my new physician learned the lessons that made Dr. Garibaldi a great doctor.  Though, I do worry that maybe nothing in medical school made her the person that makes me wish that she was still my doctor.  Then again, maybe she will tire of the pretty rapids that run through downtown and recognize that the Gerald Ford Presidential Museum is not a great draw for friends to visit, and come back and take care of me….

Among other things, I plan to write about various medical experiences, and I thought that highlighting how important the doctor-patient relationship is, how fortunate some of us are to find a true caregiver, and how we should all work to ensure that patients get the kind of care that Dr. Garibaldi gave me, was a good place to start.  I’d love to know what you think.

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September 11; then and now

September 11. 9/11, to some. The day that planes crashed, buildings fell, and loved ones died. For the past nine years, I have joined much of the nation in struggling to deal with the anniversary of the worst day in American history. I remember a client and his seven-month-pregnant wife, who died when at 8:46 AM their American Airlines Flight 11 tore a hole in the World Trade Center’s North Tower and an even larger hole in this nation’s soul. Of course, no matter your location or the task you were completing, we reeled in pain as United Airlines Flight 175 hit the South Tower at 17 confusion-laden minutes later. When the Pentagon and, thanks to the heroism of the “ordinary citizens” on board, a field in Pennsylvania received the third and fourth terroristic blows, we cried and yelled and made promises and pledges and did what Americans do: we moved forward.

So today, I struggled to decide whether this was an appropriate forum to discuss the horrors that bent the will of Manhattan, our nation’s capitol and citizens who found people falling from buildings on their televisions, cellular service interrupted, and a level of camaraderie not experienced in a generation. And then, I realized that medicine and law live at the intersection of humanity. And, in the aftermath of the murders that took place almost a decade ago, we must focus on what brings us together, what pushes us forward, what leads us to respect difference (and not just tolerate it), and how we pledge through our actions to prevent terrorism here and abroad.

I cannot answer the question of why 19 young men decided that turning airplanes into weapons made more sense than living. And, I cannot explain why a Florida pastor (let’s stop saying his name and end his “15 minutes” of embarrassing fame) thought that burning copies of the Quran would pay homage to the nearly 3,000 people, including nationals from over 70 countries, who perished on that fateful day. I struggle to make sense of hate no matter what religion or flag it is committed under.

I choose to remember those who died and honor those who valiantly tried to save life that day by honoring the heroes of today. When is the last time that you thanked a police officer or firefighter for their service? When you see a veteran of a foreign war or an active-duty member of the military, do you offer words of support or just let them know you care by saying something like, “Stay safe”? Heroes walk amongst us. I think we celebrate the lives lost on September 11, 2001 by honoring the first responders who keep our streets safe, who ensure that fires will be extinguished, and who keep us alive until we arrive at a hospital.

Yesterday, Connecticut buried Kenneth Hall, a 22-year veteran of our State Police, who was killed when a reckless driver turned his cruiser into metal fragments. (http://bit.ly/b1Bj6P .) He had previously served our country in the Marines. He was a dad. And now, as Connecticut’s Governor M. Jodi Rell eulogized, “in one sudden, inexplicable moment, we lost him.”

I will never have the opportunity to thank Trooper Hall for his service to the State of Connecticut and the United States. It’s too late for that. But, if I remember that when the Twin Towers were falling, there were police officers, firefighters, EMTs and paramedics who rushed in, I honor him too. When we ran out, they rushed in. Through the smoke and fire, they ran in to get people out… they ran into the fire.

So, while it is true that nine years later, I cannot make sense of the tragedy that is now part of the tapestry of this great nation. I can ask that we recognize the people who each morning and each night, work diligently to keep us safe, to rescue us and care for us.

We did not invite a confrontation with evil nine years ago. Yet, when we reflect on the hours, days and years that have passed since the attacks, we must acknowledge that the true measure of a nation’s strength is how it rises to master the moment when it was tested. We flew flags… lots of them. We pledged allegiance to democracy. We made promises to do better.

It was said that angles crowded the streets of heaven as we mourned those lost on September 11. Trooper Hall further crowds those streets. The only questions remaining are: Will you let hate or humanity direct your actions? Will you simply tolerate or learn to respect others? Will you worry more about arguing over a speeding ticket or the risk that an officer takes while standing by your car as other vehicles race by on the highway? In memory of those who died nine years ago and those who placed their lives in harm’s way to save victims of the destruction, let’s ensure that our actions show we remember.

‎”In this unique confluence of Rosh Hashana, the anniversary of 9/11 and the ending of Ramadan, my wishes go out to all my friends and colleagues for a coming year filled with peace, with wonder, with civility and openness.”

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Empathy: Learned But Not Taught

 This week and last, students around the nation started medical school. Medical school is an incredible, overwhelming and challenging experience. Those who survive will have to fulfill a remarkable task for the rest of their professional lives if they are going to be one of the truly great physicians who care for us. We want our doctors to not only care for us but also care about us and be empathetic to our pain and our fears.

Retired Major League Baseball pitcher Vernon Law once said, “Experience is a hard teacher because she gives the test first, the lesson afterward.” I have learned (again) that our experiences allow us to be genuinely empathetic, and that without such experiences we are left with the less powerful tool of sympathy. In medical school, great emphasis is placed upon learning to be empathetic. But, it is a skill that cannot be taught. It can only be learned.

A good doctor may feel and express sympathy if they understand a patient’s illness or challenge but they cannot truly feel that patient’s pain. Not convinced? Consider that same patient who visits, for example, a cancer support group composed of people who truly understand – empathize, that is – with the horrors of radiation or the symptoms that result from poisons doctors call (chemo-) therapy. There is a difference. The failure of the physician to grasp the true impact of illness or suffering or pain is not a failure of the system, medical training or personal character. Rather, it is a simple reality of life. It is only after experiencing a challenge can we truly relate. Sure caregivers can strive to understand and to project authentic caring, but if one has not walked in the proverbial shoes of another, it is impossible to perfectly empathize. And even that lesson is one that is learned the hard way….

After a easy time getting pregnant with our now-three-year-old-daughter, a medically uneventful (but, otherwise very eventful!) pregnancy, and a long but trouble-free labor and delivery, my wife and I – without verbalizing it – believed that the blue strip on the pregnancy “pee stick” at the beginning of 2009-2010 academic year would mean an identical ride. It was, after all, all that we knew. Consequently, we started to talk about names for our newest addition. We imagined room changes and paint colors. We started to envision Ysabel being a big sister, even recognizing that she may be the type of kid who asks, “Ok, when is that crying machine going back into mommy’s tummy?” We started to plan. We got excited. We allowed ourselves the gift of all the magic that we knew was forthcoming.

Though the details may be clinically important, they still feel totally irrelevant. My wife miscarried. No, she suffered a miscarriage. In truth, we both suffered. We lost a part of us. We cried a lot. We tried to get on with our life but I could not concentrate in school and my wife struggled to make sense of how our plans and our joy had been erased by pink urine. We had suffered a loss and we were devastated.

Though we had adhered to the strange American custom of keeping one’s pregnancy a relative secret until the 12th week, we did share our loss with some family and close friends. With few exceptions (notably our friend, Dr. J.R.), we received consolation packaged in words like: “This is your body’s way of saying something was not right;” “It happened for a reason;” “You’ll try again soon;” and “It just wasn’t meant to be.” The words left me numb. Worse, though, was the realization that I have offered the same well-meaning but hollow phrases to at least a score of friends who over the years have had trusted me with the news of what medicine euphemistically calls a “spontaneous abortion.” This realization made me want to vomit like the sickest of first-trimester-pregnant women (or so, I would and can only guess).

How could I know what my friends who had experienced miscarriages would be feeling until we struggled through ours? I couldn’t. Life is filled with lessons, and if we’re paying attention, we actually learn some of them. It seems patently clear to me that try as it may, medical school cannot teach empathy. It can, however, ask the future physicians to grow from their experiences and to pivot the lessons that they learn from such experiences in a direction that eases pain… or at least lets their patients know that they are trying to understand their pain. I will never forget how the loss of our pregnancy made me feel. And, the next time a friend or patient shares the same, I will realize that they suffered true loss. I will offer support while they mourn, and encouragement only when they are ready for that part of the process. Empathy really means that I have suffered and I now have the tools to help me understand that you are suffering. Empathy cannot be taught and it hurts to learn it.

Special thanks to my wife, Patti, for letting me share this story.

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Lessons from a 3-year-old’s broken arm

Status post Snoopy sling and ice cream!

A friend of mine – someone who I really respect – sent me an email about my first blog post.  Though she’s an accomplished specialist in the world of dentistry, an expert in head and neck anatomy (trust me, the most complicated part of the human body!), and an adored professor for medical and dental students, she wrote:  “Enjoy the DAD part the most – it is the most difficult part, but the most rewarding.”  Though the other words of support that she sent meant a great deal, I did not initially focus on her analysis of being a parent.  And then, a whirlwind of stress, fear, tears, relief and love surrounded my family for the past 48 hours or so.

When my wife arrived Friday afternoon at the spectacular daycare program that cares for our three-year-old daughter, she immediately recognized that the crying emanating from the playground belonged to her offspring.  A quick report indicated that Ysabel had fallen off the “monkey bars.”  After ice was rejected, the tears were absorbed by the sponge of a mommy’s hug.  Though the short ride home was uneventful, Ysabel’s arm hung almost lifelessly by her side as the evening moved from dusk to dark.  Breaking my promise to never examine my children (you would not believe how many times I have rejected my wife’s pleas to examine an ear or a sore throat), I did a decent orthopedic evaluation of Ysabel’s baby-soft, miniature arm.  I was relieved to find no gross abnormalities but disappointed to see her wince in pain when I touched her shoulder (the proximal humerus, for some of you reading this).  Seeing pain in your child’s face – real pain like what she exhibited Friday night – leaps from their facial features and stabs you in deep in the heart.

After a deep breath (by me, not Ysabel), I telephoned our concierge pediatrician (my best friend and Ysabel’s Godmother), who shared her years of training and practice as a physician, and convinced us to give Friday night a chance to deliver some magic healing.

Though Hurricane Earl spared us, a major storm of pain erupted in Ysabel’s big-girl bed as she tried to sleep.  Each time that slumber came, she rolled over on her fragile wing and woke with a shriek.  Ultimately, I “slept” in her bed, holding her in place so that the tiredness that filled her sad eyes could win the battle for sleep.  Joined by her vigilant dog, Johnny, we watched her find peace and we watched the clock turn from night to day.

In the morning, Ysabel’s arm remained disconnected from the frenetic movements of our very active, “Denise The Menace” little girl.  After telephone calls and consults, we loaded up the team (going anywhere with a three-year-old and an eight-week old is, as my friend Eric used to say in reference to his girls, like “packing up the circus.”) and went to our pediatrician.  His examination was the same as mine and he reached the same conclusion that I had:  the collarbone (clavicle) had been spared but the shoulder (really the humerus) required imaging.

Ysabel could not have been a better sport while resting on the x-ray table preparing for her first dose of radiation and what we told her were special pictures of her arm.  (Each time Liz, the x-ray technician told her to stay still for the picture, Ysabel smiled at the “camera!”).  After getting a 25-carat-sized pink ring and a purple bracelet from the x-ray folks for being such a good listener, we returned to the waiting room to rejoin Mommy and Baby Dylan.  After a few minutes, we were told that the films revealed a buckle fracture (Not a true break but a common injury among children).  My heart sank.  I wanted to cry.  The news made Ysabel’s “boo-boo” far more real.  I had a brief flash of anger:  How could this have happened?  How did I let this happen?  And then my medical school training reminded me that buckle fractures were minor in the world of broken bones and that a few weeks in a sling (assuming we can convince Ysabel to protect her shoulder) should allow her rapidly remodeling bones to recover. 

After a quick trip to get a “Snoopy” sling, we did what was tradition for me whenever I forced my parents’ hair to turn a little grayer by taking me to the emergency room:  We went for ice cream.  Ever-resilient as children are, Ysabel ignored the scratchy strap of the sling against her neck and excitedly ordered what her parents had pronounced was a special-treat lunch:  “French fries, banilla and chocolate ice cream with [whipped] cream and rainbow sprinklers.”  (No typos in that quote!)

When we arrived home, Ysabel took a nap.  And, so did I.  I was exhausted.  The stress of the day had accumulated:  worrying about the unknown; holding hands and wearing a lead gown while photons penetrated Ysabel’s pink tank top shirt and her flesh until the calcium atoms of her bones absorbed them to create an image of her wound; the tears of a child – my child; negotiating with Ysabel to wear a sling (“It has daddy’s favorite “Snoopy” on it!”); and even the greasy meal at Friendly’s.  When I awoke, I was relieved to find that time, the sling and regular doses of ibuprofen (q4 hrs.) were conspiring to make my sweet little girl smile.

Trying to catch up on lost time, I quickly checked my email and found a reminder for an event held today to raise money for the second annual Big Wheel Derby fundraiser.  The Big Wheel Derby was inspired by 5-year-old Alyssa Temkin, a typical happy child who was born with a rare genetic metabolic disease called Glycogen Storage Disease Type 1a (GSD).  (By coincidence, we studied this rare disease in medical school.)  Alyssa has difficulty eating by mouth and relies upon her parent’s round-the-clock (q90 minutes) tube feedings because her body does not store glycogen (fuel) like most people.  The second annual Big Wheel Derby is an opportunity for kids to help other kids by raising money for Alyssa’s Angel Fund and finding a cure for GSD1a. A portion of the money raised will help families with children who have GSD1a travel to and receive care from an expert in Florida. The other portion goes toward gene therapy and finding a cure for GSD1a. 

Sometimes broken bones don’t seem so broken.  We all need reminders about keeping life in perspective.  When I practiced law, I would regularly remind panicking colleagues that “no one died.  So, relax.”  When I came to medical school, I had to delete that phrase from my vocabulary.  Alyssa’s struggle and her parents’ remarkable resolve are inspirational on so many levels … even for a dad whose heart was broken over the smallest of fractures.

As my dentist/professor/Mom friend said, being a parent is the best and most difficult job.  It was truly difficult as we sorted out Ysabel’s little arm.  And today (less than 24 hours after her x-rays), watching her peddle a “big wheel” with one hand (and the other in the sling) to help other children, I was honored to be her dad; honored to have the best job in the world.

To support Alyssa’s Angel Fund, contact Jane Pasternak, (860) 231-6342, jpasternak@mandelljcc.org.  For more information, visit  http://bit.ly/9gbFXx .  Like all of us at some point in our lives, they could use a little help.

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Letters After My Name… An introduction.

Twenty-six letters makes up the English alphabet.  From those letters, we form words, sentences, and messages.  Letters have meaning.  They allow us to communicate (You just read this, right?).  They torture us with their rules (“‘I’ before ‘E’ except after ‘C.'”).  When joined together and associated with one’s name, though, they seem to convey greater and sometimes misleading messages.  While it would be easy to get lost in a Seinfeld-esque (“‘I’ before ‘E’ except after ‘S’ apparently) way in terms of how letters modify one’s name (Ms. versus Mrs.; Judge versus “Your Honor,” etc.), one’s analysis should really be focused on the story and not the titles decorating a name.

When an upperclassman threaded my medical school white coat (a shorter version of an Attending Physician’s white coat) onto my arms and I took the Oath of Hippocrates publicly for the first time, a friend summarily commented that it would be difficult for me to have my name properly embroidered on my coat when I was one day granted an “MD” because others schools had previously conferred a “BA,” a “JD” and an “MBA.”  This concern was quickly diluted by the myriad things that I had to worry about as married, oldest-in-my-class, practicing lawyer, first-year medical student.

After my daughter’s safe arrival, something on one of the white coats that briefly entered my wife’s labor room made me consider the physician’s white coat that I believed would one day hang both in my closet and on my shoulders.  It was at that sleepless, overjoyed, and relieved moment that I realized I wanted at least one white coat that said, “Benjamin S. Albert, MD, JD, MBA, DAD.”  I knew that the “DAD” part represented the most important title with which I have ever been blessed, and I also knew from a practical point, it would be a good discussion point for breaking the ice with a nervous patient.

Letters after one’s name – whether “Jr.” or “Ph.D.” – can inform.  But, they fail to tell a story.  If a university grants a degree, does it say the recipient did well?  Hardly.  If someone shares their name with their great-grandfather, grandfather, and father and a “IV” is adhered to the end of their surname, does this suggest love among generations or simply ego?  Similarly, if one has a JD after their name (or, inappropriately, “Esquire”), does it mean that they will zealously advocate for you or that they have the skills to be your lawyer?  Definitely not.  A number of people complete the requirements for a graduate degree without ever gaining the skills to successfully do the associated job.  I have often observed (and sparred with lawyers who proved my view) that a baboon (no offense to any baboons reading or to baboons, generally) can get through law school.  It doesn’t mean that they’ll be a good lawyer.

More concerning is that there are a number of stories that are not being told because the absence of letters after one’s name suggests that the experiences never happened.  What if, for example, you managed to complete your prerequisites for medical school, actually get accepted into medical school, and then because fate intervened in a negative way, the long sought-after “MD” is never bestowed?  That’s what happened to me, and I can assure you that my decision to withdraw from medical school did not take away the patient’s lives that I helped save, the unique experience of dissecting every inch of the human body, the gifts of trust and confidence given to me by patients and their families, the privilege that I had helping patients complete their life’s journey, the helicopter rescue missions, the suturing and stapling of wounded skin, the nurturing of broken hearts, or the fact that for almost four years, I did wear a white coat.  And a stethoscope.  And most importantly, a promise – Dr. Albert Schweitzer’s promise – that:  “Here, at whatever hour you come, you will find light and help and human kindness”.

No one can take away the lessons that I have learned, the experiences that I have had or the gifts of friendship and love that patients gave to me during this chapter of my life.  And maybe, if you keep reading, I can share some of those experiences and some of the lessons that came directly and indirectly from patients and caregivers.  It is not just about the letters after my name….  It is about all the stories that make me who I am.

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