wellnessrounds

Don't hurt anything that has a name

Sometimes it hurts…

Posted on February 19, 2017 by marylbrandt

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A few years after I started as an attending in pediatric surgery, I was called to see a little girl who had been with her father at a construction site. For whatever reason, a wall under construction had fallen and she was caught under it. Her injuries were severe, with massive blood loss from a crushed liver. We opened her chest, packed the liver, transfused her massively but to no avail…

I vividly remember what happened next. Instead of the usual quiet moment of reflection, the team started talking about our week, carrying on a conversation as though this was just one more event in a busy day. It hit me how unusual this was as I was driving home. It was the middle of the night and, as I drove into my neighborhood, I noticed that I wasn’t feeling anything, that the sadness and other emotions I usually felt when I lost a patient weren’t there.

A cat darted in front of my car. I got out of the car, looked at the cat and burst into sobs… which continued for a good 30-40 minutes.

The loss of a patient, the loss of a pet, or even the loss of a dream related to your career leads to grief. Granted, the depth of grief may be, and should be, less than the loss of a family member, but it is grief nonetheless. Because these losses are often viewed as “less serious”, people may feel that it’s somehow “not normal” to feel true grief when they occur. This is particularly true for physicians, who often have to suppress these feelings to be able to treat the next patient.

Here’s the single most important message…It’s ok to feel the loss.

The ability to cry over a tragic injury or loss of a patient is the sign of a compassionate physician or provider, not a sign of weakness. For all of us who experience these losses, It is important to allow ourselves to grieve, if that is what we are feeling. Although this will mean different things for different people, here are a few ways that might help…

Share your thoughts with someone you trust. Talk to your friends and, in particular, senior colleagues. It is important for your future patients that you are allowed the space to grieve. It is also normal to worry about returning to work if you’ve experienced a particularly traumatic loss. If you have a colleague who has lost a patient, let them know in direct or indirect ways that you are there for them if they need to talk.

If you are the team leader, talk to your team. It’s important to debrief with your team (and anyone else who was there) immediately afterwards and a few days later. Make sure you acknowledge how hard this is and ask if people are ok. Remember for many of your learners, this may be their first time to experience the loss of a patient… how you respond will be remembered as their example for the future.

“Good models teach us to handle the experiences that change us.” Thomas J. Krizek.

Communicate with the family. Immediately afterwards, just be with them. It is human nature to avoid “bothering them” in their time of grief but try to go. Bearing witness to their grief by sitting silently with them is a powerful way to help. Write a condolence letter. Call, email or write a note 3-6 months later to let them know you are thinking of them and to ask if they have any lingering questions. Offer to meet with them if they would like.

Go to the visitation and/or the funeral. Even after a hard journey together, even if you question if you could have done something different, go to the funeral if it feels like you should. Not just for the family, who will be very appreciative – but for you. There is closure in ceremony for everyone.

Take care of yourself. Focus on self-care by being with family and friends, eating good food, exercising, sleeping and doing the things you love. It is both the burden and privilege of our profession that we experience these moments of intense and tender transitions…. but sometimes it hurts.

New Year Resolutions

Posted on December 29, 2016 by marylbrandt

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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.

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.

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.

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.

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.

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

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!

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.)
Eat fruits and veggies with every meal.
Walk 10,000 steps per day.
Take the stairs instead of the elevators.
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.
Write down three things you are grateful for every night before you go to bed.
Log all cases (if this applies to you) the same day and finish medical records within 24 hours.
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)
Cook your own meals at home (take a class if you need to).
Be on time to conferences, rounding, meetings, classes, etc.
Spend at least half a day a week “unplugged” and use it to play.
Keep a journal to remember the important events of the day, vent about things that upset you, and make plans for the future.
Read something that is not medical every day.
Stop eating fast food.
Drink less alcohol or stop all together.
Get at least 7 hours of sleep any night you are not on call. (and have a plan post call to sleep more)
Cut out all added sugar.
Drink more water.
Keep your house neater… or at least a part of your house!
Stop texting while driving.
Learn about motivational interviewing to help your patients.
Read a major textbook in your field in one year.
Learn something new from every patient you see
Try a new way to exercise every month
Set your intention for the day every morning.
Eat breakfast every morning.
Set limits on checking email, Facebook, Twitter, Instagram and other social media sites.
Practice mindfulness.
Plan your meals for the week on the weekend to make sure you have great food on call and at work.
If you have to sit a lot at work, come up with a plan to not be so sedentary.

Advice physicians should follow. But don’t.

Posted on November 8, 2016 by marylbrandt

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

As 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.

What Big Magic Can Teach Those Who Serve

Posted on April 18, 2016 by marylbrandt

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“Do what you love to do, and do it with both seriousness and lightness.”*

On the flight home yesterday I finished Big Magic: Creative Living Beyond Fear by Elizabeth Gilbert (She’s probably known to you for her NY Times Best Seller Eat, Pray, Love). For me, one of the overarching messages of her book was this – When you see what you do as your vocation (from Latin vocātiō, meaning “a call or summons”), and not just your job, it will transform how you view your work – a concept which I believe may be necessary (but not sufficient) to treat or prevent burnout.

As I read her thoughts on how to live a creative life, I realized that there were other ideas that applied to physicians, physicians in training and others who serve:

Just show up. Every day.

“Most of my writing life consists of nothing more than unglamorous, disciplined labor. I sit at my desk and I work like a farmer, and that’s how it gets done. Most of it is not fairy dust in the least”

Learning and practicing medicine (or any other field) means showing up – really showing up – every day. Everyone in the first year of medical school learns that it is different than college. Cramming for exams is not only ineffective, it’s just wrong. You are no longer studying for a grade on a test…. it’s now about the patients you will take care of in the future. The same holds true during residency and when you begin your practice. It’s not just when you are a trainee. Part of the “work” of medicine remains “unglamorous, disciplined labor”… keeping up with the literature, going to teaching conferences when you could be doing something else, finishing your hospital charts, being on call.

But the work of medicine is also about showing up every day in another sense, too – truly showing up for the people who rely on you – no matter what. That, too, can be “unglamorous, disciplined labor” when you are tired or stressed.

“Work with all your heart, because—I promise—if you show up for your work day after day after day after day, you just might get lucky enough some random morning to burst right into bloom.”

“They are your patients… from the first day of medical school until you retire.

“Most of all, there is this truth: No matter how great your teachers may be, and no matter how esteemed your academy’s reputation, eventually you will have to do the work by yourself. Eventually, the teachers won’t be there anymore. The walls of the school will fall away, and you’ll be on your own. The hours that you will then put into practice, study, auditions, and creation will be entirely up to you. The sooner and more passionately you get married to this idea—that it is ultimately entirely up to you—the better off you’ll be.”

Caring for others gives us joy but also gives us the responsibility to know the best thing to do for them. Whether you are a first year student, 3^rd year resident or a PGY35 attending, we are all still learning. “Life long learning” is not just a phrase, it’s the reality of what we do.

It’s called the practice of medicine for a reason.

“It’s a simple and generous rule of life that whatever you practice, you will improve at.”

Learn the art of deliberate practice early. Deliberate practice, to use a musical analogy I learned in Cal Newton’s fantastic book So Good They Can’t Ignore You: Why Skills Trump Passion in the Quest for Work You Love, doesn’t mean playing the piece from start to finish 20 times in an hour. It means spending 55 minutes on the small section that you struggle with, repeating it 100 times before you play the piece through once. It means instead of reading the comfortable material on the anatomy of the kidney, you deliberately tackle how the nephron works. It means that instead of doing the computer-simulated cholecystectomy 10 times you spend an hour tying intracorporeal knots in the trainer. Find the thing that is not easy and practice it over and over until it becomes easy.

There is Peril in Perfectionism

“There are only so many hours in a day, after all. There are only so many days in a year, only so many years in a life. You do what you can do, as competently as possible within a reasonable time frame, and then you let it go.”

One of the greatest attributes of those who care for others is their devotion to the people they serve. But perfectionism, taken to its extreme, is dangerous. Extending your time to study for Step 1 beyond what is reasonable to try to get a higher score, revisiting decisions about patient care to the point of anxiety, worrying that your GPA has to be perfect are all counterproductive. The motivation to do well is like a cardiac sarcomere – a little worry will make you more effective, but stretched too far, there won’t be any output at all.

Curiosity can overcome fear.

“No, when I refer to “creative living,” I am speaking more broadly. I’m talking about living a life that is driven more strongly by curiosity than by fear.”

It’s something most students don’t realize, but no matter how long you practice medicine, there are days when you are afraid. It takes courage to do what we do. Remember, being courageous is not an absence of fear, it’s being able to do what’s right despite the fear. I agree complete with Elizabeth Gilbert that curiosity helps. When you have something that doesn’t go the way you expect or frightens you, instead of beating yourself up (“I should have studied more”….”I could have made a different decision”…etc…etc) become curious. If you are thinking about a complication, commit to finding everything you can about the procedure and how to prevent complications. If you didn’t do as well on your test as you thought you should, look up different techniques to study, take notes, and remember information, and go back to make sure you really understood what was being tested.

Even more powerful than curiosity is gratitude. Fear and gratitude cannot exist at the same moment. Try it – the next time you are about to snap because your EMR freezes be grateful that you can see the computer, be grateful you have work, be grateful you have been trained to help other human beings …and see what happens.

“We must have the stubbornness to accept our gladness in the ruthless furnace of this world.”

Your worth is not the same as your “success”.

“You can measure your worth by your dedication to your path, not by your successes or failures.”

Wow…. This one is so important.

It’s not what you make on Step 1. It’s not how many cases you do, how many patients you see or how much money you make. This concept is taught by every religion and philosopher I know – for a reason. Be devoted to doing the best you can and to forgiving yourself (and learning from it) when you fall short.

One last thing….for medical students trying to choose a specialty – forget about finding your passion.

This is a little longer quote than the others, and mirrors a similar message in So Good They Can’t Ignore You: Why Skills Trump Passion in the Quest for Work You Love .

Find something, even a little tiny thing, that makes you curious (or fills you with wonder) and follow it. Dedicate yourself to following that curiosity and it will likely lead you to your career.

“May I also urge you to forget about passion? Perhaps you are surprised to hear this from me, but I am somewhat against passion. Or at least, I am against the preaching of passion. I don’t believe in telling people, “All you need to do is to follow your passion, and everything will be fine.” I think this can be an unhelpful and even cruel suggestion at times. First of all, it can be an unnecessary piece of advice, because if someone has a clear passion, odds are they’re already following it and they don’t need anyone to tell them to pursue it…..I believe that curiosity is the secret. Curiosity is the truth and the way of creative living. Curiosity is the alpha and the omega, the beginning and the end. Furthermore, curiosity is accessible to everyone…..In fact, curiosity only ever asks one simple question: “Is there anything you’re interested in?” Anything? Even a tiny bit? No matter how mundane or small?….But in that moment, if you can pause and identify even one tiny speck of interest in something, then curiosity will ask you to turn your head a quarter of an inch and look at the thing a wee bit closer. Do it. It’s a clue. It might seem like nothing, but it’s a clue. Follow that clue. Trust it. See where curiosity will lead you next. Then follow the next clue, and the next, and the next. Remember, it doesn’t have to be a voice in the desert; it’s just a harmless little scavenger hunt. Following that scavenger hunt of curiosity can lead you to amazing, unexpected places. It may even eventually lead you to your passion—albeit through a strange, untraceable passageway of back alleys, underground caves, and secret doors.

*Italics are quotes from Big Magic: Creative Living Beyond Fear. Since I read this on my Kindle, I don’t have page numbers!

Eating Well at Work

Posted on December 26, 2015 by marylbrandt

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It’s hard for those that haven’t been there to understand how medical school, residency and/or long hours in the hospital changes what and how we eat. There isn’t time to sit down to eat, there aren’t good choices and often, the only thing to eat is the “free” food at conferences. But…. Free food isn’t free. There’s a reason it’s cheap (poor ingredients) and that it “tastes good” (lots of fat, sugar and salt)… but it makes us feel terrible after we eat it. (Beware the middle of the night french fries!) More importantly, we aren’t providing the nutrients we need to take care of other people and ourselves. So, what’s the answer?

Spend the money and the time to invest in your health! Grabbing donuts or bagels in the surgeons’ lounge in the morning, pizza at noon-day conference and a hamburger at MacDonald’s in the middle of the night is terrible. (You know it’s true).

So what’s the alternative? Here’s a five-step, easy plan that will let you eat better, feel better and avoid gaining weight in medical school and residency. This is predicated on cooking your own food but you can use this plan if you don’t cook by buying prepackaged foods. But really…. If you can learn how to take out a gallbladder or care for ill patients in the ICU don’t you think you can learn how to sauté a few vegetables???

Make a plan
Make a shopping list
Shop once for the week and (when you can) prep ahead
Use your day(s) off to cook things that might take a bit more time and freeze some for other days
Keep a few “instant” healthy meals in your pantry

Make a plan

Map out your week’s meals and snacks using the “pizza rule” (nothing you cook should take longer to cook than it takes to order a pizza). Pay special attention to call days. It’s important to have really delicious food which can be grabbed in a minute when you are on call. I use Evernote to make my list for the week so I can share it with my family:

If you like to cook, you probably already know where to find recipes you’ll like. If you don’t cook regularly, I post recipes on @drmlb with #CallFood that meet the “pizza rule” and would be delicious on call. Here are few other sites I use regularly: Eating Well, Cooking LIght, My Recipes, Food Network, Kayln’s Kitchen, Skinny Taste. If you use Evernote to organize your list, it gives you one other advantage – you can download their add-on and clip recipes from the internet directly to Evernote. Each “note” (i.e. recipe) in Evernote can then be shared with whoever you cook with (i.e. whoever gets home first can start dinner!). It also lets you search all your notes so you can easily find your recipes in the future.

Make a shopping list

I use Grocery IQ for my shopping list. This app lets you organize your grocery list by the aisles in your favorite stores to make shopping faster. It also allows you to share the list with your significant other which means that whoever is able to get to the store first has the updated shopping list! I don’t really use the “coupon” feature or the barcode scanner, but if you choose to use these functions, please use the FoodEducate app with it to make sure your choices are healthy!

There are other apps for shopping which come recommended by others which, to be fair, I thought I should share: Any List, Pantry Manager, Paprika

Shop once and (when you can) prep ahead

Planning lets you spend less time in the grocery store and absolutely means less food wasted. When you get home from the store think about the meals you are going to cook later in the week. If your carrot soup on Tuesday calls for sliced carrots, diced fennel and chopped onions, chop them when you get back from the store on Sunday and put your “mise en place” in baggies or containers in the refrigerator. Cooking is not that time consuming…. but prepping is!

One other good trick is to make “mirepoix” on the weekend for the week. Diced onions, carrots, celery, bell peppers, etc can be prepped and put in a bag. It can be an instant stir-fry on nights when you need something fast. You can also put a handful in soups, omelettes, or wraps to get extra vegetables in your day. Mix it with leftover rice or other grains to make an instant salad (you can add tuna, if you want, too).

Use your day(s) off to cook things that might take a bit more time and freeze some for other days.

You need good “comfort food” when you are working hard, but it can be both comforting and healthy. For example, this recipe for spaghetti squash lasagna. The preparation for this recipe isn’t that hard (you can steam the spaghetti squash in the microwave instead of roasting it in the oven, for example) but it’s a little too long for nights when you get home late and are really tired.

Learning to use a pressure cooker (my favorite) or a slow cooker like a crock pot is a great way to cook up a batch of something when you are home and doing other things without spending a large amount of time in the kitchen

No matter what you make or how you make it, make enough to freeze individual portions and then store them so they will stay fresh. Don’t forget to mark the containers with a Sharpie and eat them within 3-4 months!

Keep a few “instant” healthy meals in your pantry

Despite my best efforts to plan, there are weeks when I’ve miscalculated amounts, don’t have enough time or just don’t want to eat what I had planned. When that happens, it’s great to have a go-to “instant” meal, which usually comes out of the freezer and pantry. Here are some to get your list started!

Moroccan Lentil Stew – (particulary good with harissa and served over couscous)

Quick meals from frozen ravioli

Shrimp fried rice

Top 10 Holiday Gifts for Physicians and Physicians in Training

Posted on November 15, 2014 by marylbrandt

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The holiday season is rapidly approaching. Here’s my top ten gifts for medical students, residents and physicians…. or any busy friend!

Mark Bittman’s new book How To Cook Everything Fast.

This is an amazing cookbook and it is perfect for busy people. The recipes are interesting, delicious and healthy. The instructions are easy for a novice without being simplistic and the layout of the book in innovative and makes it really easy to use.

An electric pressure cooker.

Slow cookers are often suggested for medical students and residents but I don’t think they are as good as a pressure cooker. You have to be there when slow cookers are (slowly) cooking, which is usually your rare day off. Also, it’s hard to cook vegetables in a slow cooker. Pressure cookers on the other hand cook broccoli in 2 minutes (perfectly!). I’ve been told that the electric pressure cookers take a little longer to come up to pressure, but it seems a small downside for a device that also lets you slow cook, steam, sauté, and cook rice.

Coffee or Tea

There are several options to consider if they are a serious coffee or tea drinker. A Starbucks or Teavana gift card in a cute “medical” coffee mug? A Starbucks Verismo coffee brewer? Nespresso? Keurig?

A FitBit

Anyone in medicine loves gadgets and loves data. The fitbit has become a socially acceptable piece of “jewelry” in the hospital and it unquestionably changes behavior to increase activity. Having washed three of the “clip on” Fitbits with my scrubs, I would recommend one of the wristband Fitbits!

A maid or housecleaning service

Doing housework has to be on everyone’s lowest list of fun things to do on your day off, but it’s especially true for people who are studying extensively or taking call in the hospital. My parents helped finance someone to come occasionally to help clean my apartment when I was an intern. It was without a doubt the best present I’ve ever received.

Anything that helps make it easy to get more exercise

Another great gift is anything that will promote more exercise… a bicycle to commute to school or work? Yoga classes? Spin classes? A gift certificate for new running shoes? Resistance bands for the call room? A membership to a YMCA or a gym close to where they live? Certificates for post workout massages?

“Date night” packages

Whether they are single or have a significant other, being able to socialize is an important part of stress reduction for busy people. Create combinations of gift cards to movie theaters and restaurants to support “date nights”. If they love art, music, or sports think of season tickets (or ticket packages) to museums, music venues or professional sport teams.

An “over the top” alarm clock

It’s not easy getting up at “dark thirty” to make it to rounds, but being on time is important. The snooze button is not a good idea… but it’s so easy to hit. This alarm clock is my personal favorite to make sure you get out of bed. After a few hits of the snooze button, it rolls off the table and around the room until you turn it off!

Great books by, for and about doctors.

If they are a serious reader, think about a Kindle (or other eReader). The Kindle paperwhite is small, lightweight, back lit and has a great battery life – which makes it great for the occasional times on call that you can find 30 minutes to escape into a good book. You can also read it outside in bright sunlight (unlike tablets like the iPad) On my list of great reads for doctors (in no particular order)…

Cutting for Stone by Abrahan Verghese

How Doctors Think by Jerome Groopman

House of God by Samuel Shem

The Immortal Life of Henrietta Lacks by Rebecca Skloot

The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukheries

Being Mortal: Medicine and What Matters in the End by Atul Guwande

William Osler: A Life in Medicine by Michael Bliss

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman

The always appropriate gift of money

If you are going to give gift certificates or money, “package” it with some humor (in a pill bottle with a “prescription”) or a context (this is to help you buy good food for times you are too busy).

Please let me know (comment or email) anything else to add to this list! Happy Holidays to all!

Compassion: Lessons from Roshi Joan Halifax

Posted on January 13, 2014 by marylbrandt

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It’s not often that a talk completely changes the way I think about something.

I’ve been thinking and speaking about compassion fatigue for many years. I recently had the privilege of hearing a wonderful talk by Roshi Joan Halifax. She made a strong and convincing case that “compassion fatigue” is a misnomer… and that we should think about this in a very different way.

We can never have too much compassion nor can true compassion result in fatigue.

Empathy and compassion are not the same thing.

Empathy is a necessary prerequisite for compassion, but compassion goes beyond empathy. Empathy is the ability to be with someone who is suffering, to be able to feel what they are feeling. Compassion, on the other hand, is being for someone who is suffering, being moved to act and find a way to relieve their suffering.

Link to Roshi Joan Halifax TED talk “Compassion and the true meaning of empathy”

Self-regulation is the key to being able to remain compassionate and this skill can be taught.

We all respond to situations of suffering with “arousal”, a state that varies in intensity depending on the severity of the suffering, and our own memories and experiences. How you respond to this state determines whether you can stay present, effective and compassionate. Roshi Joan Halifax offered the mnemonic “GRACE” as a way to teach this skill to medical students, residents, physicians, nurses and other health care professionals.

G: Gather your attention. Take three deep breaths. Be present.

R: Recall your intention. We choose careers in medicine to help heal the sick and to reduce suffering. It’s not easy to remember this intention when we are overwhelmed. But, in the moment we are faced with a human being who is suffering, we must let our own response (and the demands of the day) go and remember why we are here.

A: Attend to yourself. Being able to detect what is going on in your own body is the same “wiring” you use when you feel empathy. After gathering your attention and recalling your intention, pay attention to what is going on in your body. Watch your breath, feel where there is tension, pay attention to sensations.

C: Consider what will really serve. Moving from empathy to compassion is defined by considering the actions that will relieve suffering. Really consider the person and the situation and decide what is most likely to improve the situation.

E: Engage ethically.

“Developing our capacity for compassion makes it possible for us to help others in a more skillful and effective way. And compassion helps us as well.” Joan Halifax

This Year’s @drmlb’s Top 10 Gifts for Medical Students, Residents and Busy Docs.

Posted on December 14, 2013 by marylbrandt

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This time of year, family and friends of docs and/or docs in training are looking for the last minute holiday gifts (if you are trying to have them shipped) or planning the trip to the store(s) for gifts.

The one thing any busy person doesn’t have enough of is time. If you think about it in that context, you can find presents to support interests, fitness, studying (or just having fun) in a thoughtful way.

1. Someone to help clean their home. It is the most amazing present to come one once a week (or even once a month) to a house that has been cleaned by someone else. If there are family members who are willing (and it’s appropriate) you can put together a gift of cleaning supplies with a certificate for monthly housecleaning. If not, word of mouth to find the best person is usually the best way, and will often help you find someone who also does laundry and ironing. (a true gift!). There are professional services in every city as well that can be found with an easy internet search.
2. Something to help integrate fitness into their every day activities. If they don’t have a good bike to commute to school or the hospital (and this is something they would like) this is a great present. Don’t forget the helmet, reflective vest and very bright lights as part of the package!
3. A fast computer. If they have the same computer they had in college and you are able to do this for them, the time they will save in uploads will be very appreciated!
4. A smart phone or mini iPad (especially the new iPad air). Like the computer, if the phone they have is more than 3-4 years old, the upgrade will be much appreciated. The mini iPad (instead of the regular size) fits in a white coat pocket, which is why it’s ideal for anyone who wears a white coat. If they have an iPad, think about some of the more expensive medical apps. (or a certificate for the App store
5. Kitchen appliances to save time (and promote healthy eating). My favorites on this list would include a rice maker (which can also be used to steam meat and vegetables), a pressure cooker a slow cooker or the Krups multi-cooker. A blender is always a good gift (to make smoothies and soups). If you are feeling particularly generous, a VitaMix instead of a blender is much more versatile (and makes much better smoothies!).
6. Prepared meals. If you have family who love to cook, you can make a “certificate” for homemade food in freezable portions. If you can afford it, there are personal chefs who do the same thing. You can also give them a gift certificate for a grocery store like Whole Foods that has healthy prepared food or companies that deliver healthy meals (In Houston, it’s companies like MyFitFoods – but this varies from city to city).
7. Fitness equipment for home. For medical students who are spending a lot of time studying think about a FitDesk, FitBike or a treadmill desk. The standard stationary bikes, treadmills, etc are another option, but they are expensive and you have to really know that they are preferred over going to the gym (see #8). A less expensive but very effective gift would be a “fitness care package” with resistance bands, FitDeck cards, a gift certificate for running shoes, and other small less expensive gifts.

8. A membership in a local gym. You can also consider a certificate for group classes in spinning, yoga, or whatever they enjoy.
9. Time with family and friends. Think about a “certificate” for time together – maybe with restaurant gift cards or movie gift cards attached. A “certificate” for a monthly home cooked meal? If you aren’t in the same town, think about how to make it easy for them to spend time with their friends. If you know their favorite restaurant or hangout, see if you can get a gift certificate. If not, go for tickets to the local theater, one of the movie chains (find out which one is closest to where they live), or their favorite restaurant chain. If they have children, babysitting is a wonderful gift.
10. Whatever you can think of that makes gives them more time and/or will support them during times of stressful and busy work!

HAPPY HOLIDAYS TO ALL!!!

Last year’s suggestions on wellnessrounds.org

Yellow Hospital Socks: Gold Humanism Essary Award Winner

Posted on January 27, 2013 by marylbrandt

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The following is the 2012 First Prize winning essay in the Arnold P. Gold Foundation Annual Essay Contest, written by Carmelle Tsai, a Baylor College of Medicine student. It’s my pleasure to share it with you – and congratulations to Carmelle!

There is nothing normal about being a physician, or training to become one.

On the second day of medical school, I cut open a dead man’s body. Soon thereafter, I found myself in the lab many times over, pulling various body parts out of drawers and staring at them for hours. Alone. Sometimes until midnight.

I have stood in a trauma operating room, wearing a gown splattered with a dying person’s blood. I have seen, heard, and smelled things I never thought could come from the human body. I have stuck tubes and needles into other people’s flesh. I have put a gloved finger into someone else’s rectum more times than I care to count.

It’s just. Not. Normal.

It’s horrendous, grotesque—plain weird, some of the stuff we do. But it’s all in the noble name of medicine, of saving lives, of healing. I know that. We all know that. We even think it sounds heroic. So to soften the somewhat uncouthly nature of what we do, we give procedures benign names and talk about them gently, as if doing so could somehow preserve the dignity of the human beings involved. We kindly write on the chart “Below the Knee Amputation,” and we gently explain that we will be doing a “simple procedure” to remove your cyst.

And yet once in a while, I just want to scream: “It’s NOT OKAY! It’s NOT NORMAL! There is NOTHING NORMAL about using SAWING OFF a poor old woman’s leg!!!” It’s like something inside of me cries out just for us to call it what it is, and to quit tiptoeing around, pretending that what we do is dignified.

Before I entered medicine, I always knew I wanted to heal my patients compassionately by listening, holding their hands, and being present with them. But what I did not understand was how I would learn to steward medicine by healing patients and myself through some less-than-likely moments.

I was wheeling Mrs. N into the operating room. She was a sweet, middle-aged woman with a husband and three kids. The anesthesiology team and I worked together to be compassionate and kind as we prepped her for surgery.

Though things were chaotic the moment we burst into the OR and were greeted by a barrage of shiny machines and people, we all set swiftly into motion. As we did, we paid attention to Mrs. N’s comfort as best we could. My resident smiled as he told her about his own kids. The nurses thoughtfully brought her a pillow. I held her hand as the arterial line was being placed.

“Y’all are so sweet,” she said with a tinge of Southern drawl.

I smiled at her through my surgical mask as I gave her oxygen. Soon, Mrs. N was asleep. As the resident began to place her central line, I walked around the monitors, tucked in her blanket, and adjusted the sock on her left foot that had gotten twisted around in the pre-surgery shuffle.

As I gave her foot a reassuring pat, I caught myself thinking, “What? You’re ridiculous, Carmelle. She’s asleep. She can’t tell that it’s cold and she’s not awake to be annoyed that her sock is on funny.” For a moment I felt foolish. I mean, really?

My resident looked at me and raised an eyebrow. I shrugged.

In a few moments, a surgeon would be cracking open Mrs. N’s chest. Then we would put her heart on bypass. Then her entire aortic valve would be replaced. A turned-around sock hardly seemed like a big deal. Plus, the groggy and awful dry-heaving that would precede her extubation, and the pain from having her insides all cut, moved around, and put back together would surely distract her from the ugly yellow hospital socks. And I was right. Later when I saw Mrs. N post-op, I wasn’t even sure if she was wearing socks.

I pondered about Mrs. N and her socks on the way home that day. It reminded me of my first day of anatomy. Before we were about to unzip the bag and remove our cadaver, I made all my teammates stop and just breathe for a moment. I wasn’t really sure why—again, what does it matter, right? The man was already dead and his body had been in formaldehyde for months.

But I realized it did matter. I understand now that my humanity is why I do these things. It is not for the dead man, for Mrs. N, or for anyone else. It is for me. And because it matters to me, in some roundabout way, it matters to Mrs. N, and to all my patients. Because in medicine I am meant not only to heal, but to be healed.

And that, I have found, is what it truly means be a steward. It is to invest in my patients by being humbled enough to recognize that they offer me something too. As much as medicine gives physical healing, and the holding of hands and compassionate silence give emotional healing, it is part of my own healing to maintain that same humanity in the moments that patients neither see nor experience.

I am not any less broken just because I know more about the human body. Just because my normal involves everything that most people think is crazy or disgusting does not mean that I am any different. I also don’t like being cold. I don’t like wearing my socks backwards. I am scared of foreign situations. I am in need of healing.

And so if reminding myself that what seems cruel and abnormal is still compassionate means that I will kindly refer to sawing someone’s leg off as a “below the knee amputation” or tuck in the blankets on a sleeping patient, damn right I’m going to do it. There is no way we can steward medicine if we cannot allow ourselves to be healed, too. Yellow hospital socks and all.

Starting Internship (I know what you are worried about)

Posted on June 24, 2012 by marylbrandt

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I sat at the table this week with our new interns and the outgoing chief residents. Listening to our new interns as they asked questions, I realized everyone starting their internship has the same fears, whether or not they express them: Will I kill or hurt someone? Will I look stupid? What if they find out I’m not as smart as everyone else? Will I get divorced/separated/alienated from my friends? Will I gain weight? How am I going to find time to take care of myself?

What you are feeling is normal. Every doctor who ever started an internship felt exactly the same way. The best way to manage your (healthy) fear is to have a strategy. I’ve written in the past about how to succeed as an intern. But if I were going to condense that advice into three easy rules (for every day except your day off) it would be these:

1. Read at least one section from a textbook in your field every day

2. Learn something (in detail) from at least one patient every day

3. Do something to take care of yourself every day

Read at least one section from a textbook in your field every day.

Your goal for the year should be to read a major textbook in your field cover to cover. You don’t have to buy the physical book. It’s fine if it’s on line or downloaded onto your iPad.

Once you have the book, make a list or spreadsheet of all the sections in all the chapters. For most textbooks, it’s probably going to be a list somewhere between 150 and 200 topics. When you look at the 48-50 weeks you will be working this year, it works out to basically a topic a day (with some days for review).

The real goal is not just to read these topics, but to really learn them. So, when you read, don’t just skim. Read to learn. That means taking notes – and reviewing them.

Put a chart on the wall with the list and give yourself a gold star when you finish a topic if you have to, but find a way to make sure you cover all the topics (at a steady pace) during the year.

Learn something (in detail) from at least one patient every day.

It’s really easy, as an intern, to get caught up in the work and forget that you are fundamentally here to learn – not to provide service. Make it a daily habit to learn in detail about one patient in your care. It will overlap nicely with your goal to read a complete textbook. When you admit a patient with pneumonia, read the section (and make notes) on pneumonia and then check it off your list.

One other important point (that none of us like to hear) – You will make mistakes. Be humble, be honest, and learn from your mistakes. The mistakes you make (and maybe more importantly your “near misses”) are absolutely your most valuable teacher. When you do make a mistake, use it as the topic you will review for the day. You are going to be really upset but be easy on yourself. Being upset is the mark of someone who cares, but don’t let it escalate beyond a healthy response. Talk to your mentors and senior residents. They’ve been there.

Do at least one thing to take care of yourself every day.

This may sound trivial, but it’s not. If you can, try to eat well, get some exercise and be social every day. At a minimum, though, pick one specific thing you are going to do for yourself and then do it.

Eat well

Get Some Exercise

Be social