when doing your best is not good enough (grumble, grumble)

 

If you're a health care provider, try to imagine a day in the office when you're able to stay on time despite the inevitable delays and interruptions that tend to put you behind schedule. Imagine having time to accommodate the patient who presents with "a little indigestion" that turns out to be angina, or to stitch up the patient who arrives unannounced with the laceration on his hand, or to deal with the teen who thinks she has a UTI, but turns out to have an STD.

"Relax.

Everything is running right on schedule."

~The Universe~

Imagine being able to decide for yourself how much time to allow for each patient, and how much to charge for each visit. Imagine what it feels like to know you've done an accurate and thorough job. Just think how appreciative your patients would be...knowing you took your time with them. Do you remember what it was like to make eye contact with them?

Back when I started to practice this is exactly how we operated, without the superimposed constraints of intrusive hospital/healthcare systems, and insurance behemoths whose #1 priority is corporate profit. Back then (yes, in this lifetime) uninsured patients were likely to bring in a bushel of apples, or a couple dozen ears of corn if that's all they could afford. And we were happy to accept it. If we needed a ten-minute appointment with them for a sore throat, we took it. If we needed thirty minutes, we took it.

"If you are not in control

of your time,

you are not in control of your results."

~Brian Moran~

This issue haunted me this week because two people I know and love recently had surgery. Not long, complicated operations, but short out-patient procedures. That. Took. All. Day. Long. Hours in registration and pre-op. Hours in post-op and recovery. Because the surgeons were running behind schedule, or the nurses were tied up with endless administrative tasks. 

This will happen. I get that. But it reminded me how much I disliked running late when I was in practice. Keeping patients waiting when they had to get back to work, or pick up their children, or get home to milk the cows. Hurrying to keep up, and worrying I would miss something. Always apologizing. Always anxious.

I know a few things about healthcare finance and economics. Still, I question the motivation and logic behind scheduling patients so tightly it keeps the provider under constant pressure to see more patients faster. All day. Every day. While, at the same time, it keeps patients waiting. Impatient and dissatisfied.

This is a problem when it translates into this:

"Sometimes doing your best 

is not good enough.

Sometimes you must do what is required."

~Winston Churchill~

How does that align with excellent patient care?

jan

we are all just stardust

 

One of the best things about being a physician is you get to live in a state of perpetual awe. It starts with the first pass of the scalpel on your first day in the anatomy lab. It continues as you tease out every organ, blood vessel, and nerve in the body you’ve been assigned to dissect. A sense of wonder takes your breath away the first time you hear a beating human heart. Suddenly it dawns on you that your own heart has been pumping steadily and predictably without any effort on your part since before the day you were born. You’d have to believe in miracles if you understood the way a broken body heals, what it takes for an open wound to close, how a lifeless heart can pick up the beat again. 

But that's just the beginning.

You would be flabberghasted if you understood the complexity and precision of a single cell cycle in your own body. How every cell knows when to pump out the chemicals it takes to defeat an infection, or battle depression, or laugh at a good joke. How it processes the energy it needs to survive, and how it knows when its time is up. How every cell in your body...the body you sometimes abuse and neglect, the one you sometimes detest, the one you overwork...is intimately connected with the entire universe. The majority of the atoms that are present in our bodies today have existed since the Big Bang...the moment the universe came into being.

"The amazing thing is that

every atom in your body

came from a star that exploded."

~Lawrence M. Krauss~

But that's not all. Each and every cell possesses its own DNA. A single strand of DNA is approximately 3 meters long, yet it fits into the nucleus of each cell, into a space of 2-3 cubic microns (1 micron=1 millionth of a meter). The DNA in your body, if unfolded and stretched out like a string, would wind around the Earth over 2 million times, or loop to the moon and back over 130,000 times, or stretch to the sun and back over 300 times. It is estimated that there are some 50 trillion (that's 50 million million) cells in the human body, all cooperating, all communicating, all contributing to the effort to keep you alive and well. And that's a lot of work.

"Be good to yourself.

If you don't take care of your body,

where will you live?"

~Kobi Yamada~

Your skin is entirely replaced every month. The lining of your stomach is replaced every four days. Your skeleton today is not the same one that held you up three months ago. The gaps between the neurons in your brain are bridged by an estimated 100 million million dendrites that make it possible to process an inestimable number of signals at lightning speed. To read this sentence, your brain arranges a precise pattern of millions of signals in just a few milliseconds, and then eliminates them instantly, never to be repeated again.

"We touch heaven

when we lay our hand on a human body."

~Novalis~

Shall I go on?

If we could see our bodies as they really are, we would never look at them the same way again. If we truly understood how the human body functions, and how it is connected to the universe, we would fall to our knees in praise and adoration. We would feed and care for it properly. We wouldn't overwork it, or poison it the way we sometimes do. We would look into the mirror, and see heaven and Earth reflected there.

"We are just stardust, after all."

~Jodi Lynn Anderson~

jan

life support 101

I practiced medicine for over thirty years before I retired a few years back. I saw thousands of patients during my career. How is it, then, that the distant memory of one of them popped into my mind for no particular reason this week? After nearly fifty years.

"A memory is what is left

when something happens and does not 

completely unhappen."

~Edward de Bono~

The patient (I still remember her name) was admitted to my service with a classical case of bacterial endocarditis--an infection of one of her heart valves that resulted from a congenital defect. She was in her forties. Unfortunately, she experienced one of the dreaded complications of the condition when she suffered a stroke that left her unable to speak or move one side of her body. The stroke caused intractable seizures, so we ended up pumping her full of antibiotics for the infection, and antiseizure meds as she lapsed into coma. After a couple of weeks in ICU, the time arrived to make a decision regarding whether to continue life support...or not. Given her dismal propsects for recovery, the decision was made to start withdrawing treatment, little by little, to see what we ended up with. The first meds to go were the antiepileptic drugs. I can still remember the look on the nurse's face when the sedative effect of the antiseizure drugs wore off, and the patient opened her eyes for the first time. Long story, short...once the patient was awake, she made slow but steady progress until she eventually walked out of the hospital on her own. Taking her off life support brought her back to life. Her recovery was so remarkable, it has stayed with me all these years, and it just pops up every so often because it taught me a lesson.

"Somewhere, something incredible

is waiting to be known."

~Carl Sagan~

This is the thing: No one knows how memories are made, or where they're stored, or what they're made of. No one knows why some persist while others fade, or how they arise unbidden, complete with authentic emotion (sadness, anger, joy), and physical reification (shaking, nausea, sweating).

"Embodiment means we no longer say, 

I had this experience;

we say, I am this experience."

~Sue Monk Kidd~

We can, however, codify the context of memory-making and retrieval this way. Memories will be created and stored most effectively:

1. when the experience is associated with:

• fear
• pain
• anger
• sorrow
• joy 
• gratitude
• love

2. when the experience challenges us, or teaches us something new 

3. when the experience changes the course of our life, or our attitude toward it

4. when we are moved by beauty, or kindness, or a sense of calm

5. when the experience causes us to wonder, to question, or to seek an elusive answer or truth

The list goes on.

Memories foster and animate storytelling. They preserve experience, embody emotion, and teach us so we can teach others. Every so often, they re-emerge from no-one-knows-where to surprise us, to remind us where we've been, who we are, and where we're going.

"We are the universe 

experiencing itself."

~Carl Sagan~

jan