He was going to be like Michael Jordan in the championship game. He was going to be like Martin Luther King as he stepped up to the podium to give his "I have a dream" speech. He was going to be every underdog who had ever been written off only to then unexpectedly succeed. If the heavens had to open and God himself had to reach down through the clouds and place this mighty hand on Derek's shoulder....he would.
Because it was now or never. Just the act of being hopeful meant that Derek had walked on water already . And he wasn't turning back now. He had entered a foriegn land. Learned the language and culture. Learned the theory and intricacies. Studied for months what others had spent lifetimes on. And he nailed it. Talked to all the experts in the field. Come to one conclusion and one conclusion only. It was his last chance.
If only Sarah was still by his side. Sure he still talked to her but it was different now. Before the break she was so lucid. She could pick apart a situation and attack it from all sides. So insightful. But it had been years. Something happened to her after the birth. She started the slippery slope downwards and was swallowed by her illness. After years of bouncing through mental institutions she found a permananet home. But she couldn't take care of herself. She couldn't take care of their son. She couldn't give any meaningful support during this difficult time in his life. The schizophrenia had erased everything.
So Derek was on his own. He had a few hours to prepare before the meeting. One last time to review his notes. The house was oddly quiet. No wife....no child. For the first time Derek felt truly alone. The idea of failing was so horrifying he only allowed it to cross his mind briefly. He had to succeed. Because if he didn't then what was the sense of living. He had to succeed...his son depended on it.
Saturday, October 25, 2008
Friday, October 24, 2008
She Must Have Been
It must have been...about this time of year. The brisk cool days leading into fall. The leaves parachuting from the trees effortlessly. The breadth leaving my mouth as my body numbingly glides down the sidewalk. The ache in my knees becoming familiar. Diffferent from her aches and pains. Different from the heaviness in her heart.
She must have run...down these same streets. In this same town. She said it was to lose the weight she had recently gained. Or maybe it was to run away. For a moment. From the three young boys left at home. Or possibley the never ending list of tasks that needed to be accomplished. I run for health....she ran for sanity.
She must have hoped...that these jogs would never end. Dreading the finish line. Just one more moment of silence. The absence of thought....must have been such a relief. And yet all I do is think. To forget the physicality.
She must have been...about my age. And miserable. And scared. And lonely. That year.
The year my father died.
She must have run...down these same streets. In this same town. She said it was to lose the weight she had recently gained. Or maybe it was to run away. For a moment. From the three young boys left at home. Or possibley the never ending list of tasks that needed to be accomplished. I run for health....she ran for sanity.
She must have hoped...that these jogs would never end. Dreading the finish line. Just one more moment of silence. The absence of thought....must have been such a relief. And yet all I do is think. To forget the physicality.
She must have been...about my age. And miserable. And scared. And lonely. That year.
The year my father died.
Wednesday, October 22, 2008
Commentary (thoughts related to the story Obsessed)
A physician I greatly admired once told me something I found quite sad and depressing. He said, "Jordan.....if you practice long enough, no matter how goood a physician you are, there will be a small graveyard with your name on it filled with people ." When I heard this I was at the begining of my career. And I did what most young physicians in my place would do....I laughed it off as an exageration.
Afterall....most of us became physicians to help our fellow man. Most of us took seriously the oath to "do no harm". And most of us would have trouble sleeping at night knowing that our actions could lead directly to someone's death.
As time goes on, however, I realize that as with most of life....things are not so simple. For instance what doe's it mean "to do no harm." Sounds pretty straight forwad doesn't it? But it's not. Almost everything I do as a physician has the possibility of doing harm. Every time I dole out an antibiotic for a respiratory tract infection I risk the possibility that the patient will have a life threatening reaction. It happens! Furthermore, often when the clinical situation is not clear I am forced to make decisions that will either benfit or harm the patient depending on whether I am right. Is the patient wet or dry? If I give fluids I could cause worsening heart failure and box the lungs. If I withhold and diurese I could box the kidneys. If I do nothing the patient could die.
And what about all those missed diagnosis. As Jerome Groupman talks about in his book How Doctor's think being a primary care physician can be a scary proposition. Like watching a train pass by with thousands of people and you have seconds to pick out through the windows the 1-2 who are desperately ill and need immediate action. How are you going to catch those? Is inaction that leads to harm the same as "doing no harm".
And lastly there is plain old human error. If you perform an operation enough times occasionally something will go wrong. Occasionally a hand slips. Occasionally a clinician misses the elephant in the room. The longer you practice.....the greater the consequences of your actions. It's a numbers game.
So how do we as physicians deal with this reality? Some leave medicine when the sadness becomes to great. Some become overly obsessive. Many try to protect themselves by becoming arrogant and considering the idea that they make mistakes blasphemy. Many cry...or write...or get started on antideppresants.
When it comes to me......I choose to hope. To hope that if somewhere there is a small graveyard with my name on it then next to that graveyard is a larger city of happy, healthy, thriving people also with my name on it. To hope that the sum total of my actions (like Lawrence's in the story) falls on the positive side.
Because no matter what we do, being a physician is just a magnified version of being human. We all effect the world around us. We all make decisions that have far reaching consequences. We just don't think about it as much.....should I drive home or stay at a friends house becuase I am too tired...should I spank my child or put them in time out.....should I eat that last piece of chocolate cake or should I stay on my diet.
We all make mistakes...
We all occasionally have blood on our hands...
It's just that being a physician makes it so much more painfully obvious.
Afterall....most of us became physicians to help our fellow man. Most of us took seriously the oath to "do no harm". And most of us would have trouble sleeping at night knowing that our actions could lead directly to someone's death.
As time goes on, however, I realize that as with most of life....things are not so simple. For instance what doe's it mean "to do no harm." Sounds pretty straight forwad doesn't it? But it's not. Almost everything I do as a physician has the possibility of doing harm. Every time I dole out an antibiotic for a respiratory tract infection I risk the possibility that the patient will have a life threatening reaction. It happens! Furthermore, often when the clinical situation is not clear I am forced to make decisions that will either benfit or harm the patient depending on whether I am right. Is the patient wet or dry? If I give fluids I could cause worsening heart failure and box the lungs. If I withhold and diurese I could box the kidneys. If I do nothing the patient could die.
And what about all those missed diagnosis. As Jerome Groupman talks about in his book How Doctor's think being a primary care physician can be a scary proposition. Like watching a train pass by with thousands of people and you have seconds to pick out through the windows the 1-2 who are desperately ill and need immediate action. How are you going to catch those? Is inaction that leads to harm the same as "doing no harm".
And lastly there is plain old human error. If you perform an operation enough times occasionally something will go wrong. Occasionally a hand slips. Occasionally a clinician misses the elephant in the room. The longer you practice.....the greater the consequences of your actions. It's a numbers game.
So how do we as physicians deal with this reality? Some leave medicine when the sadness becomes to great. Some become overly obsessive. Many try to protect themselves by becoming arrogant and considering the idea that they make mistakes blasphemy. Many cry...or write...or get started on antideppresants.
When it comes to me......I choose to hope. To hope that if somewhere there is a small graveyard with my name on it then next to that graveyard is a larger city of happy, healthy, thriving people also with my name on it. To hope that the sum total of my actions (like Lawrence's in the story) falls on the positive side.
Because no matter what we do, being a physician is just a magnified version of being human. We all effect the world around us. We all make decisions that have far reaching consequences. We just don't think about it as much.....should I drive home or stay at a friends house becuase I am too tired...should I spank my child or put them in time out.....should I eat that last piece of chocolate cake or should I stay on my diet.
We all make mistakes...
We all occasionally have blood on our hands...
It's just that being a physician makes it so much more painfully obvious.
Obsessed (conclusions)
As Lawrence pulled up to the house he reached into his glove compartment for the garage door opener. He had never returned it. She had never asked. What used to be "their" house was now "her" house. But at least he still had a part of it.
Strangely....he never questioned his actions. Entering unannounced into someone's house is generally frowned upon. But Lawrence was caught in the premise that something must be amiss. The voices were pushing him.....go in....you must find her. And he couldn't resist the urge. From the depths of his soul he thought, better yet knew, that something was wrong and that Carole needed his help.
As he pressed the garage door opener he leaped out toward the entrance. The first thing he noticed was that Carole's car was still running and there was noone inside. He ran to the door connecting the house and the garage and wrenched it open. Then he grabbed the metal trash can in the driveway and heaved it through the bay window in the front of the house.
Lawrence then covered his nose and leaped through the window ...and took stock of his surroundings. Carole's body was spralwed on the floor five feet from the phone and her chest was still moving up and down. Her husband had collapsed on the couch in a pool of vomit. Quickley he grabbed Carole and dragged her through the door. Next he returned and picked her husband off the couch and carried him to the front lawn. Finally Lawrence took out his cell phone and called an ambulance.
.....................................................................................................................................................................
Carole and her husband would survive. After being revived it was discovered that after a long day of work Carole's husband had accidently left the car running and closed the garage door. Unfortunately they did not have a carbon monoxide detector in the house.
Lawrence would leave medicine. After saving Carole's life he finally felt free. He had no more use for rituals. Based on his own existential calculus, in the game of life, he he had come out slightly ahead. He had traded one life sadly lost on the operating table for two lives pulled from the clutches of death.
Lawrence, ofcourse, knew that it wasn't that simple. Obviously throughout his career he had touched many lives. Helping some....hurting others, it was all par for the course. And in a sense this had nothing to do with being a doctor. We all affect the lives of people around us. often not as obviously as in the operating room. But in subtle ways we constantly shape the world.
Lawrence now preffered sublety to the brasch and egotistical life of a surgeon. He almost felt that the act of surgery, ie cutting open the human body and mettling, was to close to intervening with God's plan.
He would leave that to others.
Strangely....he never questioned his actions. Entering unannounced into someone's house is generally frowned upon. But Lawrence was caught in the premise that something must be amiss. The voices were pushing him.....go in....you must find her. And he couldn't resist the urge. From the depths of his soul he thought, better yet knew, that something was wrong and that Carole needed his help.
As he pressed the garage door opener he leaped out toward the entrance. The first thing he noticed was that Carole's car was still running and there was noone inside. He ran to the door connecting the house and the garage and wrenched it open. Then he grabbed the metal trash can in the driveway and heaved it through the bay window in the front of the house.
Lawrence then covered his nose and leaped through the window ...and took stock of his surroundings. Carole's body was spralwed on the floor five feet from the phone and her chest was still moving up and down. Her husband had collapsed on the couch in a pool of vomit. Quickley he grabbed Carole and dragged her through the door. Next he returned and picked her husband off the couch and carried him to the front lawn. Finally Lawrence took out his cell phone and called an ambulance.
.....................................................................................................................................................................
Carole and her husband would survive. After being revived it was discovered that after a long day of work Carole's husband had accidently left the car running and closed the garage door. Unfortunately they did not have a carbon monoxide detector in the house.
Lawrence would leave medicine. After saving Carole's life he finally felt free. He had no more use for rituals. Based on his own existential calculus, in the game of life, he he had come out slightly ahead. He had traded one life sadly lost on the operating table for two lives pulled from the clutches of death.
Lawrence, ofcourse, knew that it wasn't that simple. Obviously throughout his career he had touched many lives. Helping some....hurting others, it was all par for the course. And in a sense this had nothing to do with being a doctor. We all affect the lives of people around us. often not as obviously as in the operating room. But in subtle ways we constantly shape the world.
Lawrence now preffered sublety to the brasch and egotistical life of a surgeon. He almost felt that the act of surgery, ie cutting open the human body and mettling, was to close to intervening with God's plan.
He would leave that to others.
Monday, October 20, 2008
Obsessed (4)
Come on...answer the phone...answer the dam phone!
Lawrence was starting to panic. It was 10 pm and he was making his nightly call. But no one was answering. In all the years since he broke up with her, Carole was always there. If he couldn't reach her on her home phone then at least her cell. But Lawrence had tried three times already.
Why today...why today he thought out loud. On the day he was going to apologize and tell her that he would never call again. Today was going to be different. Today he was taking control of his life. But suddenly he felt the red tied coming back. The cruel waves crushed against his small and insignificant boat of life. Mocking him. Turning him over and almost capsizing....but then jerking him back upwards.
Pick up...you must pick up or something bad will happen. He heard the refrain from the bowels of his soul. Lawrence collapsed onto the floor. He cradled himself in the fetal position hoping the voices would stop. He begged them to leave him alone. He tried to counter their logic..Just hang up the phone and go to bed. He would call Carole back in the morning. She was probably fine. Nothing bad was going to happen.
But the voices spoke searingly...burning a hole in his logic. Imprinting an idea on the soft inner belly of his mind. They commanded him to go to the car. To drive to her house. Or else there would be consequences. They spoke hissingly.....
You don't want her to die like the other one...do you?
Lawrence had to concentrate with all his might to keep his hands steady...
as he steared his car down the driveway.
Lawrence was starting to panic. It was 10 pm and he was making his nightly call. But no one was answering. In all the years since he broke up with her, Carole was always there. If he couldn't reach her on her home phone then at least her cell. But Lawrence had tried three times already.
Why today...why today he thought out loud. On the day he was going to apologize and tell her that he would never call again. Today was going to be different. Today he was taking control of his life. But suddenly he felt the red tied coming back. The cruel waves crushed against his small and insignificant boat of life. Mocking him. Turning him over and almost capsizing....but then jerking him back upwards.
Pick up...you must pick up or something bad will happen. He heard the refrain from the bowels of his soul. Lawrence collapsed onto the floor. He cradled himself in the fetal position hoping the voices would stop. He begged them to leave him alone. He tried to counter their logic..Just hang up the phone and go to bed. He would call Carole back in the morning. She was probably fine. Nothing bad was going to happen.
But the voices spoke searingly...burning a hole in his logic. Imprinting an idea on the soft inner belly of his mind. They commanded him to go to the car. To drive to her house. Or else there would be consequences. They spoke hissingly.....
You don't want her to die like the other one...do you?
Lawrence had to concentrate with all his might to keep his hands steady...
as he steared his car down the driveway.
Saturday, October 18, 2008
So live your life
So live your life
Cause
sadness and regret
only go away
once you stop
Breathing
Cause
Dreams will die
a million deaths
but that doesn't mean
you should stop
Sleeping
Cause
love leads to loss
most of the time
but if you wait enough
even your heart
will stop
Bleeding
Cause
Your demons are faster
and stronger
and meaner then you
but you'll be okay
as long as you
see them
So put your head down
hold on tight
And live your life
Cause
sadness and regret
only go away
once you stop
Breathing
Cause
Dreams will die
a million deaths
but that doesn't mean
you should stop
Sleeping
Cause
love leads to loss
most of the time
but if you wait enough
even your heart
will stop
Bleeding
Cause
Your demons are faster
and stronger
and meaner then you
but you'll be okay
as long as you
see them
So put your head down
hold on tight
And live your life
Obsessed (3)
The ride home from work, for Lawrence, was aways slow. Calming. In some ways he relished the spare moments with nothing to do. His mind would wander over the events of the day. No rituals. No stopping and starting over again. For whatever reason the car was his safety zone. A place where he felt free from the clutter. A place to listen to the radio....to let go of the stress of the day.
But today was different. Lawrence's thoughts returned again to the day that ruined his life. Thoughts he usually only allowed in those fleeting moments at the window sill in the locker room. He saw her face again. He remembered his cocky swagger as he entered the operating room. He had told the family that this operation was routine. That he had done hundreds of them. That she would be just fine.
But she wasn't fine. Thirty minutes in she started to bleed.....and she never stopped. Lawrence tried to stem the red tied of death that sprung from her belly like a torrent. But instead of deterring.... his hands became clumsy. Knocked about between waves of futility he struggled to gain control. And somehow his loss followed him home from the OR that day.
The red tied of death ripped a hole in his heart. And the hole enshrouded his marriage in dependence and it too hemmorhaged, exsanguinated, and died as quickly as the poor girl on the table. So Lawrence did the only thing he thought he could to avert going completely crazy...he went kinda of crazy.
His rituals inhibited his life. They marked him to all those who cared to look. They changed his priorities. But they allowed him to creaste a barrier of safety between him and a total mental breakdown. There were now rules. And rules could either be followed or broken. As long as rules were honored....he would be safe. Patients wouldn't die....marriages wouldn't break up...and Lawrence could bear to look at himself in the mirror again without complete disgust.
Today, however, was a major departure. One of his most strict rules was that he would never think about this again except at his normal specified time. He was breaking the mold. He was going out on a limb. And damb it felt good. Maybe it was time for him to let himself off the hook. Hadn't all his colleagues had patient's die on the table? Hadn't he done some good in all his time as a doctor?
Lawrence made a promise to himself as he pulled into the garage. Tonight when he called Carole he would apologize to her and her husband. He would tell her that he had an epiphany and it was time for him to move on. He was going to thank her for being so patient. And most of all he was going to tell her that he would never bother them again.
Or so he thought. It was not even in his relm of imagination that when he called later that night Carole wouldn't answer her phone.
Something that she had never done in five years.
But today was different. Lawrence's thoughts returned again to the day that ruined his life. Thoughts he usually only allowed in those fleeting moments at the window sill in the locker room. He saw her face again. He remembered his cocky swagger as he entered the operating room. He had told the family that this operation was routine. That he had done hundreds of them. That she would be just fine.
But she wasn't fine. Thirty minutes in she started to bleed.....and she never stopped. Lawrence tried to stem the red tied of death that sprung from her belly like a torrent. But instead of deterring.... his hands became clumsy. Knocked about between waves of futility he struggled to gain control. And somehow his loss followed him home from the OR that day.
The red tied of death ripped a hole in his heart. And the hole enshrouded his marriage in dependence and it too hemmorhaged, exsanguinated, and died as quickly as the poor girl on the table. So Lawrence did the only thing he thought he could to avert going completely crazy...he went kinda of crazy.
His rituals inhibited his life. They marked him to all those who cared to look. They changed his priorities. But they allowed him to creaste a barrier of safety between him and a total mental breakdown. There were now rules. And rules could either be followed or broken. As long as rules were honored....he would be safe. Patients wouldn't die....marriages wouldn't break up...and Lawrence could bear to look at himself in the mirror again without complete disgust.
Today, however, was a major departure. One of his most strict rules was that he would never think about this again except at his normal specified time. He was breaking the mold. He was going out on a limb. And damb it felt good. Maybe it was time for him to let himself off the hook. Hadn't all his colleagues had patient's die on the table? Hadn't he done some good in all his time as a doctor?
Lawrence made a promise to himself as he pulled into the garage. Tonight when he called Carole he would apologize to her and her husband. He would tell her that he had an epiphany and it was time for him to move on. He was going to thank her for being so patient. And most of all he was going to tell her that he would never bother them again.
Or so he thought. It was not even in his relm of imagination that when he called later that night Carole wouldn't answer her phone.
Something that she had never done in five years.
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