What we can learn from pain…

The following was sent to me after I reached out to a dear friend who had suffered rib fractures (and more) in a fall.  I was so touched by his perspective and the potential power of these words to heal  that I asked permission to post it here.

I’ll say the week started last Thursday, when I sucked it up and scheduled a host of delayed medical procedures, got blood drawn for an array of things, and planned a weekend of work plus my first attempt at cycling since surgery over two years ago – on the place the bike seat hits. I dislike medical tests because I hate to not make great scores on tests, and unlike other tests, it is hard to study for a cancer marker test or blood pressure test. But it was past time.

By Saturday, the weather was Springlike, and all I had to do before climbing on a bike was some roof leak patching. See earlier missives on Facebook about how THAT went. By Sunday I was pushing a morphine pump (almost without effect) wondering just how crushing my skeleton into pieces was going to be the big breakthrough I knew was spiritually on the way to this week. But not doubting the breakthrough at all.

I was too messed up to use even a cellphone, but the outpouring of love, compassion, caring, helpfulness, prayer, gratitude, and ICU humor was so huge I could feel it even through the opioid mist and, I am told, Olympic class pain. It continues even today.

Did you know that gratitude is one of most biologically and spiritually powerful “drugs” ever tested? It measurably switches genes on and off, by the thousands, but always in a good way. Well my gratitude graph is off the chart this week, starting with so many close friends and family. I have reconnected with several long loved dear souls, and connected with several new dear souls. If I had gotten on the bike, death or paralysis were likely outcomes, due to medication issues. If I hadn’t been in ICU, several hidden medical issues would not have been detected.

My beloved wife has almost slipped up a couple of times this week and let her secret wings show. I believe the modern definition of marriage encompasses humans marrying Angels, so I can still call her “wife”.

Then we get to medical tests. Cancer markers – none, again. Extensive CT scans necessitated by my air cargo disaster – no sign of cancer etc. Vertebrae, spinal or brain damage, or chances of dying of testicular cancer? Approaching insignificant. Crickey, my body acted like a crumple zone protected Volvo. Major systems were cushioned by minor (numerous and very painful) fractures.

Medical issues? Of course. But the extensive testing and freak accident have revealed reversible issues, including ones caused by my medications, which would not have been detected in the ordinary course of things. Issues that might have been lethal if I hadn’t gone to ICU and smart people put the puzzle together.

Closer than ever to my wife. Reconnecting with dear friends of all ages. Making new friends. Confirming that my former cancer is truly leaving the building. Re-prioritizing work, play, health, etc. And remembering that the only shortages of Love in this Universe are from people kinking the hoses. We could never use the actual, Infinite, supply. As I write this, I prepare to go hang with beautiful souls tomorrow and share some healing. Pain is just the contrast needed to highlight the transcendent, joyous, beautiful, loving ride we call Life. Since I really should be dead or paralyzed right now, every breathtaking twinge is a reminder to be grateful. Easy peasy.

I had to postpone an appointment with an old, wise, preacher I have known since childhood. I was talking to him on the phone about the combination of joy, gratitude, pleasure, humor and serious pain, and he said he would quote one of his old buddies who is used to suffering. He says”Hallelujah anyway”. I hurt myself laughing at that one, so, just “Hallelujah ya’ll!” Sums it up for me.

Peace, Love, Joy.

They are choices.

Ouch, anyway.😘

New Year Resolutions

The “clean slate” of a new year almost always leads us to think of resolutions … things we could change to make our lives better.  This is a great time for reflection to realize what you have accomplished, where you’d like to be in a year, and what changes you need to arrive at that goal.  I just finished reading Making Habits, Breaking Habits: Why We Do Things, Why We Don’t, and How to Make Any Change Stick by Jeremy Dean which provided some useful ideas about making resolutions.

Photo credit

Know why you want to make the change

“There has to be an ultimate goal that is really worth achieving or the habit will be almost impossible to ingrain.”  Jeremy Dean

Let’s take one example – losing weight.  It’s fine to say you want to lose weight… but why?  Wanting to fit into your clothes is not a trivial reason, but will it really motivate you when it gets tough as much as these?

  • Being able to “walk the walk” when you talk to patients about losing weight
  • Reduction in your risk for diabetes, heart disease, cancer and a variety of other health problems
  • More energy, better mood, less pain…

What’s important is that you find reasons that resonate for you.  Do a little research and write down why you want to make the change.  Plan to review this, and revise it when needed, on a regular basis.

 

Make the resolution then make a plan.

Photo credit

To continue the losing weight example, what are the specific new habits you want to develop?  Are they “SMART” changes?   (Specific, Measurable, Attainable, Realistic and Time-Based).  For example…

  • I will eat 8 servings of fruits and vegetables every day.
  • I will set the alarm clock 15 minutes early to do push-ups, crunches and squats before I go to the hospital.
  • I will plan my meals and shop once a week so I can take healthy food with me to work.
  • I will schedule my workouts every weekend so I can attend at least two spin classes a week.
  • I will cook one healthy dish on the weekend that I can eat for at least 4 meals during the week

 

Develop the “what if” plan.

 Photo credit

The next step is to imagine all the things that might derail you and write down a specific plan for each of them.  This will be an ongoing process… as you come up with new excuses to not follow through with your new habit, add it to the list.

Back to the example of losing weight….

  • If I forget to bring fruit/veggies with me to work, I will go to the cafeteria or lounge to get at least 2 servings to eat at work.
  • If I walk by MacDonald’s and feel drawn in by the smell of the fries, I will remember that I’m trying to set a good example for my patients
  • If I hit snooze on my alarm clock, I will move it across the room.
  • If I think I’m too tired to go shopping for the week, I will remember that this is the key to having healthy food at work.

“Making healthy habits should be a voyage of discovery.” Jeremy Dean

 

Keep track.

Photo credit

Self-monitoring is critically important to maintaining a new habit.   It doesn’t matter if you use an app like My Fitness Pal, a calendar, a spreadsheet or a system like the Bullet Journal… stay accountable by keeping track.

 

As the habit becomes engrained, change it a little to keep it interesting.

Photo credit

Working out with exactly the same routine quickly becomes boring. It’s one of the reasons people love group classes like spin classes  – the instructors are always changing the routine.  Be mindful and creative… but stay out of ruts!

“Making or breaking a habit is really just the start. To develop a truly fulfilling and satisfying happy habit, it’s about more than just repetition and maintenance; it’s about finding ways to continually adjust and tweak habits to keep them new; to avoid mind wandering and the less pleasurable emotional states that accompany it. There is great enjoyment to be had in these small changes to routines. When life is the same every day, it gets boring.”  Jeremy Deans

 

Photo credit

Looking for inspiration?  Here’s a list of New Year’s Resolutions for medical students, residents and busy docs.  Pick 1 or 2 and start working on your plan, your what-ifs and how you will monitor them!

  1. Learn to meditate and spend at least 10 minutes every day meditating with HeadSpace. (Here’s the TED talk that introduced me to this great app.)
  2. Eat fruits and veggies with every meal.
  3. Walk 10,000 steps per day.
  4. Take the stairs instead of the elevators.
  5. Learn the names of all the people you work with… the guy who mops the floor, the clerk at the desk, the person who works in the blood bank.
  6. Write down three things you are grateful for every night before you go to bed.
  7. Log all cases (if this applies to you) the same day and finish medical records within 24 hours.
  8. Use a system like the Bullet Journal or Remember The Milk to become more organized and never miss a deadline (including the birthdays of your family and friends)
  9. Cook your own meals at home (take a class if you need to).
  10. Be on time to conferences, rounding, meetings, classes, etc.
  11. Spend at least half a day a week “unplugged” and use it to play.
  12. Keep a journal to remember the important events of the day, vent about things that upset you, and make plans for the future.
  13. Read something that is not medical every day.
  14. Stop eating fast food.
  15. Drink less alcohol or stop all together.
  16. Get at least 7 hours of sleep any night you are not on call. (and have a plan post call to sleep more)
  17. Cut out all added sugar.
  18. Drink more water.
  19. Keep your house neater… or at least a part of your house!
  20. Stop texting while driving.
  21. Learn about motivational interviewing to help your patients.
  22. Read a major textbook in your field in one year.
  23. Learn something new from every patient you see
  24. Try a new way to exercise every month
  25. Set your intention for the day every morning.
  26. Eat breakfast every morning.
  27. Set limits on checking email, Facebook, Twitter, Instagram and other social media sites.
  28. Practice mindfulness.
  29. Plan your meals for the week on the weekend to make sure you have great food on call and at work.
  30. If you have to sit a lot at work, come up with a plan to not be so sedentary.

 

Photo credit

 

 

 

Getting Organized:  The Bullet Journal

I’m a huge fan of using technology to organize my “to-do” list.  I’ve used (and loved)  Remember the Milk and Evernote as the backbone of my system.  But I recently discovered a simple, non-tech method which is proving to be the most effective tool I’ve used.

The Bullet List was designed by Ryder Carroll, who is a digital product designer.  The system is elegant, simple and requires only a blank notebook to get started.  (Although I adapted the system to use in Evernote to make it at least somewhat digital … and to avoid the inevitable crisis for an absent-minded person of losing the notebook!).

bj-from-blog

Photo credit

The Bullet Journal is based on these five “sections” of the journal:

  • The Index – to know where things are in your notebook
  • Future log – to list big events for future months (ex: Plans for interviews for residency/job, rotation schedules, reading plan
  • Monthly log – a combination of tasks and events for the month (ex: reading plan to prepare for residency inservice exams)
  • Daily log – tasks, events, and notes for the day
  • Collections – list of things, for example books to read, track a goal (like exercise or sleep), technical points as you learn a procedure, or a gratitude log

Here’s the overview video from the site bulletjournal.com, which in 4 minutes explains the how to use a Bullet Journal.

wtf-is-a-bullet-journal-and-why-should-you-start-2-7818-1464863548-0_dblbig

Photo credit

In addition to making sure you don’t miss important deadlines and events, the Bullet Journal also serves as an actual journal to help you remember important events.  For example, one of my entries last year was…  “Took residents to watch patient take first sip after Heller myotomy.  Everyone cried.”  Don’t underestimate the healing power of journaling during medical school, residency or after your training.  Recording these small moments will help, but using them as prompts for writing the story of your day can be even more powerful.

p.s. If you are in anyway an artist a) I’m jealous and b) have fun!

art-bj

Photo credit

 

Making a Bullet Journal Work in Residency from The Deliberate Doctor

Visual Bullet Journal from dxmedstudent.tumblr.com

How to Bullet Journal from thelazygeniuscollective.com

 

 

 

Last Minute Holiday Presents for Medical Students, Residents and Busy Docs

It’s the holiday season in a very short time, so I thought I’d put together a list of last minute presents!  These are presents that would work for anyone, but are particularly suited for medical students, residents and busy physicians.

A really good water bottle

None of us drink enough water at work …. having a water bottle does help!  There are many out there but make sure the one you choose doesn’t have BPA in it.  Glass and steel bottles are probably the safest, but BPA free plastic bottles are fine, too.   As an added bonus, you can put something in the bottle before you wrap it… chocolates or another favorite candy, gift cards to Starbucks, etc.

water-bottles

Photo credit and link to a site listing “best” water bottles

 

Pandora One

Listening to music you like without commercials is a great gift for listening while studying, in the clinic or in team rooms.  Pandora can be played on any computer but also has apps for mobile devices.  There are other sites, too, but this one is my personal favorite.

pandora

Here’s where to go for a gift certificate.

 

iPad

I am a total fan of my new iPad Pro, which has taken over as my computer on a lot of days.  Because of it’s amazing power, there are medical apps, like this anatomy app that won’t run on other iPads.  But the iPad mini may be a better choice for students and residents …. mostly because it fits in the pocket of a white coat.  Make sure you get a cellular network plan with the wireless option, if this is the gift you choose.

doc-with-ipad

Link to information on the iPad mini

Anatomy Coloring Book

This is a great combination of the proven stress relief of adult coloring books and learning anatomy.  (or reviewing it, even for docs in practice) Don’t forget to order the pencils, too!

anatomy-coloring-book

Link to order

 

Electric Pressure Cooker

Pressure cookers in general are an amazing kitchen tool… but the modern electric pressure cooker is also a rice cooker, slow cooker, steamer which makes it the single best kitchen appliance for students and residents.

pressure-cooker  Link to order

 

Prepped meals (ready to cook)

If they like to cook, but don’t have the time to find the healthy recipes and prep the meal, this is a great idea.  Check out Green Chef, Blue Apron, and Hello Fresh as examples.  You might want to search locally to see if there others close to you.

blue-apron

Photo Credit

 

A gift card to get them started with Stitch Fix

Stitch Fix is perfect for both men and women that either a) hate to shop for clothes or b) love to shop for clothes but don’t have time.  It’s a service many of my friends use and love, so I can personally recommend it.  After you sign up, they send 5 items a month (or at whatever cadence you want).  You send back the ones you don’t want and get billed for the ones you keep.

stitch-fix-box

Photo credit

 

A membership to a local museum

If there are museums in the area that correspond to an interest this could be a great gift. Museums like the Houston Museum of Natural Sciences, the Museum of Modern Art in New York, etc. are a great way to enjoy time off. Include a note that says you are giving this to them as a break from their studying or work!

museum

Photo credit

Best wishes for a joyous holiday season, peace in your lives and on earth and a New Year filled with health, happiness and joy!

happy-holidays

Advice physicians should follow. But don’t.

This is a truly wonderful piece from Emily Gibson, re-posted here with her permission from her beautiful blog, Barnstorming.  Enjoy!

octevening298As we drown in the overwhelm of modern day health care duties, most physicians I know, including myself, fail to follow their own advice. Far too many of us have become overly tired, irritable and resentful about our workload.  It is difficult to look forward to the dawn of the next work day.

Medical journals and blogs label this as “physician burnout” but the reality is very few of us are so fried we want to abandon practicing medicine. Instead, we are weary of being distracted by irrelevant busy work from what we spent long years training to do: helping people get well, stay well and be well, and when the time comes, die well.

Instead, we are busy documenting-documenting-documenting for the benefit of insurance companies and to satisfy state and federal government regulations. Very little of this has anything to do with the well-being of the patient and only serves to lengthen our work days — interminably.

Today I decided to take a rare mid-week day off at home to consider the advice we physicians all know but don’t always allow ourselves to follow:

Sleep. Plenty. Weekend and days-off naps are not only permitted but required. It’s one thing you can’t delegate someone else to do for you. It’s restorative, and it’s necessary.

Don’t skip meals because you are too busy to chew. Ever. Especially if there is family involved.

Drink water throughout the work day.

Go to the bathroom when it is time to go and not four or even eight hours later.

Nurture the people (and other breathing beings) who love and care for you because you will need them when things get rough.

Exercise whenever possible. Take the stairs. Park on the far side of the lot. Dance on the way to the next exam room.

Believe in something more infinite than you are as you are absolutely finite and need to remember your limits.

Weep if you need to, even in front of others. Holding it in hurts more.

Time off is sacred. When not on call, don’t take calls except from family and friends. No exceptions.

Learn how to say no gracefully and gratefully — try “not now but maybe sometime in the future and thanks for thinking of me.”

Celebrate being unscheduled and unplanned when not scheduled and planned.

Get away. Far away. Whenever possible. The backyard counts.

Connect regularly with people and activities that have absolutely nothing to do with medicine and health care.

Cherish co-workers, mentors, coaches and teachers that can help you grow and refine your profession and your person.

Start your work day on time. End your work day a little before you think you ought to.

Smile at people who are not expecting it, especially your co-workers. Smile at people who you don’t think warrant it. If you can’t get your lips to smile, smile with your eyes.

Take a day off from caring for others to care for yourself.  Even a hug from yourself counts as a hug.

Practice gratitude daily. Doctoring is the best work there is anywhere and be blessed by it even on the days you prefer to forget.

 

The Tools We Hold: The Allis Clamp

alliss-forceps-e1455994204113

Photo credit

Today I used an Allis clamp in the operating room.  Like so many surgical instruments, it is a thing of beauty.  It’s a balanced, well engineered tool designed to hold without crushing.  And it has been used by surgeons all over the world since it was first first created.… in 1883.

1883-fashions-71-woman-austrian-customeWomen’s fashion in 1883

Imagine if you will the operating room of 1883… it’s still the beginning of modern anesthesiology and the concept of antisepsis in surgery had been published by Lister less than 20 years before.

wpid-1-2-1751-25-explorepahistory-a0l7y0-a_349Photo credit

Surgeons in 1883 performed operations which were gory and painful. Patients routinely died, if not from the actual procedure then from the infections afterwards. Operating on the bowel in the 1880s was particularly dangerous with a mortality rate of 30-40%.

statistics-on-bowel-anastosmosisPhoto credit

But despite the mortality (not to mention the morbidity and outright suffering), bowel obstructed by cancer or necrotic from strangulated hernias still needed to be resected. Faced with these outcomes and this suffering, surgeons in 1883, like we do now, studied, discussed, performed experiments and tried new techniques to improve the treatments they offered their patients. ( For a great review on the history of bowel anastomosis, click here.)

One of those surgeons was Oscar Huntington Allis.

oscar-huntington-allis

Dr. Allis was born in 1836 in Holley, New York.  He attended Jefferson Medical College and did an internship at the Philadelphia General Hospital.  Like many surgeons of the era, he spent several years studying in Europe. Upon his return, he worked as a general surgeon at Presbyterian Hospital in Philadelphia. Dr. Allis died of a cerebral hemorrhage in 1921.

Here is Dr. Allis’ account of developing and using the Allis clamp (referred to as “toothed forceps”), which was delivered to the College of Physicians of Philadelphia in 1901. As you read this, remember that he was using a straight needle, much like a tailor would use.

My operation was performed in the following manner:  If the reader will divest himself of his coat and place the cuffs parallel, he can look down into the sleeve ends as into a double-barrelled gun. The inner surfaces of the sleeves correspond to the mucous surfaces, and the outer surfaces to the serous surfaces of the gut ends. Now, if the reader will sew the two proximal edges of the coat sleeves together, by a suture that passes entirely through them, he will find that he can readily sew fully half their circumference together. If now he will turn in the remaining borders, he will find that he can readily complete the circuit by sewing the outer surfaces. It was precisely in this way that I finally successfully approximated the intestines in Case 2. The fact that the mucous membrane could be safely included in a suture emboldened me to repeat the operation; and finding by experience that my fingers could not always accomplish my purpose, I have added to my case two instruments that I have found very convenient not only as special aids in anastomoses, but also in general surgical work. 

screen-shot-2016-10-25-at-7-06-27-amThe first may be called tenaculum forceps (Fig. 1, a). I use them very much as women use pins and basting thread to secure their work temporarily while they are sewing it more securely. It does not matter what stitch is used–the whip stitch, through-and-through stitch, or over-and-over. All that is essential is that the approximated bowels should be securely united. Having firmly approximated one half the circumference, I remove the forceps, and, turning the partly united structures half round, I seize the seam with my tenaculum forceps, and with a pair basting the work a little further on (Fig. 3), the through-and-through suturing can be continued almost entirely around the entire circumference.

screen-shot-2016-10-25-at-7-04-49-amWhen near the end of the approximation I have found toothed forceps (Fig. 1, b), with serrations on the edge, convenient for turning in the mucous edges, adjusting the serous, and holding them approximated until sutured (Fig. 4)

screen-shot-2016-10-25-at-7-02-47-am


images

 

I Forgot To Tell You About My New Favorite Breakfast!

This morning I was lecturing to the first year medical, PA and DNP students. At the end of my embryology lecture I included some advice on how to eat well as a busy student. I talked to them about how to set a good example for their future patients, how to increase vegetables in their diet by making Mirepoix every weekend, shopping at the farmer’s market, and how to plan for the week. I also talked about why it’s important to eat breakfast. I told them about one of my favorite fast breakfasts, but forgot the second one!

keep-calm-and-have-second-breakfast-4

MLB BREAKFAST TACOS

Here are the ingredients:

FullSizeRenderThis batch had beans, cheese, a red bell pepper, a jalapeño and some cilantro, but you can add anything!  Spread out the tortillas and divide up the ingredients between the tortillas.

IMG_3511-1024x1016Roll them up, put them in the freezer. Two minutes in the microwave and they are ready to eat!

 

OVERNIGHT OATS

This is SO easy and really delicious.  Put ~1/3 cup rolled oats in a bowl and add twice as much (~2/3 cup) liquid. (You may need more of both depending on your caloric needs)

My favorite liquid is kefir (liquid yogurt), but it can be milk, almond milk, soy milk, etc. Leave it in the refrigerator overnight. Eat it in the morning. That’s it!

You can add any variety of fruit, nut or nut butter the evening before or in the morning. My current favorite is blueberries and slivered almonds added in the morning.

Screen Shot 2016-08-19 at 5.58.27 PMPhoto credit

 

 

 

 

 

I