Is Life and The People In It Passing You By?

So often I live my life like the guy in this video.  Rushing around to get done all my to do’s while

not taking notice of those around me, not connecting, and not taking in all that is available in the moments.

This video reminds me to slow down and be mindful of those around me and to stop and take in each and every moment as if it were our last.

The #1 Way to Show Your Patients that You Care: Acknowledgment

“All the tests are back, and their is nothing wrong with your daughter.”  For years, I would step into a patients room and annouce the good news that there was “nothing wrong with you” thinking that the patient would be so releaved.  I was reminded of the impact of such a statment at work recently.  A physician had brought her daughter in to the Emergency Department for abdominal pain, and at the end of the visit, the nurse went into the room announcing to the physician that there was nothing wrong with her daugher.  The physician became very upset stating, “I would never bring my daughter into the Emergency Room if there was nothing wrong with her!”  With some ‘service recovery’, I was able to calm this physician mom.  But I was reminded again of how the “there is nothing wrong with you” statement must land with my patients.  For the last several years, I have changed my phrasing.  I now acknowledge that clearly there is something wrong but that our technology can’t find out what exactly is causing the pain.  This simple shift of phrase acknowledges and confirms our patients pain, suffering, and anxiety.  It is not about working harder or even spending more time.  It is working smarter and making the time really count by asking the right questions, saying the right things, and developing your presence (more to follow).

One Country, One Destiny

Brooks Brothers created a coat for Lincoln. Lincoln asked that they embroider a large eagle and the wording: One Country, One Destiny so that that symbol and those words would be against his skin at all times. Seeing this coat with the visible blood stains across the embroidered eagle was the most powerful moment for me in my visit last week to Washington D.C. It was a reminder of my favorite president, his incredible convictions, his life, and his tragic death. It was also an amazing illustration of a structure. A structure is a tool used by someone as a reminder of something that is important, a goal, a vision, an action step (like tying a ribbon around a tree, or a string around a finger, or carrying a trinket in your pocket, or a sticky note on your mirror, etc). Leave it to Lincoln to have such a inspiring, moving, visionary structure.

Robbie Tribute: Words of Wisdom

My friend and partner’s son died 2 weeks ago.  He was 14 with severe cerebal palsy.  At his funeral, it was mentioned that he only spoke 4 words.  “Good” and “I love you.”  Wouldn’t the world be a better place if we all only spoke those few words?!

My friend and partner spoke at the grave site and said that he has been angry and questioning God only 2 times in his life: The first when Robbie was born, and the now the second when God took Robbie from him.  WOW! The powerful truth that so often the only way to the mountain tops is through the valleys of life.

Anti-Appreciative Inquiry

I have mentioned the concept of Appreciative Inquiry, the power of appreciation, and the effectiveness of positive psychology  in prior posts with plenty of supporting scientific and empiric evidence to support their efficacy.  But the sad truth is that our world is convinced that these things either don’t work or they are too hard to impliment.  These concepts are so foreign to us that they can be very hard to break old habits.

The typical Inquiry remains the dreaded yearly or quarterly employee evaluation.  This is the place where the boss critiques the employee.  We have all been ‘evaluated’, and we have all been found wanting.  Even if you receive a glowing evaluation, it takes only one ‘but’ to ruin it.  “You continue to do an amazing job, BUT you could improve in this or that…”  We are convinced that this negative feedback is essential and productive.  BUT if you are at all like me, I only hear the negative, and it burns into my heart.  I go sleepless for days stewing over my critique.  In fact, the negative causes me often to be counterproductive, frustrated, sad, depressed, discouraged, etc.
 
now in a parallel universe:
 
Your boss calls you into a room and gives you a list of sincere appreciation.  A list of blessings. A list of all the great things that you do.    Would your productivity go up? Would you work harder? Would you sleep well that night? Would you wake up excited to go to work the following day? Would you appreciate and encourage my co-workers and boss more? Would we all be more likely to smile, laugh, encourage, and bless those around us???

Now What?

What if we started to sincerely appreciate those around us? What if we took the time each day to choose someone to bless with words of affirmation? Can we all try this? I did.  WOW!  It almost brought the person to tears…it is THAT powerful.  If we all got into a rhythm of daily blessing those around us with words of encouragement, what might happen?? Please share with us your experience in trying this…

Appreciative Inquiry

I am re-reading Dale Carnegie’s great book in which he points out that rule #1 in dealing with people is–never condemn, complain, or criticize.  Why? Because humans, no matter who they are or what they have done, believe that they are good and with equal confidence are convinced that whatever the issue is it isn’t their fault.

I also just finished Blue Like Jazz by Donald Miller. He points out that it is not our responsibility to change anybody (and as Carnegie has pointed out, you can’t so stop trying!).  We can, however, try and see them as God does (as a beloved son or daughter) and love them as God does (unconditionally).  By putting away our ‘judgmentalism and pride and loathing of other people’ and instead treat everybody ‘as though they were [your] best friend’, they will change for the better.

When organizations discover that they are having a problem, they get a team together to look at the problems and try to find a solution better known as problem solving.  About 10 years ago, a team of expert problem solvers were hired by a large corporation to come in to ‘fix’ their problems in hopes of increasing their production rates.  They found that after their problem solving their production rates actually went down instead of up.  Puzzled, they tried a different method.  Instead of looking at the problem and filling everyone with negative thoughts about each other and the organization, they looked at the positive.  They looked at all the things that worked well, and they focused on making them work even better.  The production rate soared.  This method is known as Appreciative Inquiry.

It has been thought that allowing and encouraging people to air their grievances about other people in the organization and list their complaints about others and the organization is the path to improvement.  This has been shown time and time again to have the opposite effects. It produces negativity, discourages others from working harder to make things better (why bother if you are only going to hear the negative from a select few?!), and it creates a work environment that is defeatist, negative, counter productive, and filled with cattiness and  pettiness.  So next time your organization decides to send out questionnaires to critique, or wants to create a work group to problem solve, I would hope we all can consider Appreciative Inquiry and the wisdom of Carnegie, Miller, and Christ.

Chess With God by Dr. Veysman

This is a GREAT glimpse into the world of an ER doctor:

Chess With God

Boris D. Veysman, MD

[Ann Emerg Med. 2010;55:123-124.]

Give me a bad position, I will defend it. Openings, endgames, complicated positions, dull draws, I love them and I will do my very best.—Hein Donner, Chess player, 1950

Not only does God play dice, but… he sometimes throws them where they cannot be seen.—Stephen Hawking

Amidst a busy shift when patients pile in, seasoned nurses start to grumble, and my blood sugar and bladder volume are most discordant, I overhear a fourth-year medical student share wisdom with a third-year newbie. “ER’s got a good schedule if you like doing overpaid triage.” I smile, enjoying the involuntary adrenaline boost from sublimated anger, before refocusing on the labs of the 80-year-old woman with digoxin toxicity and acute renal failure, presenting with runs of unstable tachycardia, prolonged QT interval, hyperkalemia, hypocalcemia, and a filthy cough suggesting preseptic pneumonia.

The next 20 seconds is a synaptic typhoon. Could elevated lactate mean not sepsis but mesenteric ischemia? A benign exam would not rule it out, and she is too sick to complain of abdominal pain. Tachycardia and hypoxia suggest pulmonary embolism (PE), given her edematous legs and recently stopped Coumadin when she had a GI bleed. This also increases the risk of mesenteric clot. Yet the contrast timing is different for CT angiograms of chest and abdomen, and I will have to choose which to optimize. Both studies are perilous because of the dye load, given acute renal failure, but failure to make either diagnosis would be fatal in a patient this sick. Meanwhile, empiric anticoagulation risks another massive GI bleed. Dialysis and transfusion may be necessary damage control to be considered concurrently with the diagnostic studies. Furthermore, calcium gluconate is contraindicated in digoxin toxicity because of mostly hypothetic cardiac tetany but would probably help with the blood pressure. Calcium would also treat hyperkalemia and hypocalcemia (strangely equal at 6.5), which both contribute to cardiac toxicity. If the heart gives out, it’s my fault either way, and I find that liberating. Digibind for the hyperkalemic digoxin toxicity, but that will worsen the heart failure. Definitely fluids for hypotension and sepsis but absolutely no fluids because of pulmonary edema and renal failure.

“Dr. V, she’s 80/50,” the nurse reports. Time’s up. Make a move….

We may choose emergency medicine for different reasons, but we fall in love all over again when after a few years of practice we begin to understand its magic. For me, it’s the intensity of thought when time is short and stakes are high in a battle against the worthiest of opponents. There are many hard cases that challenge the depth of our ability and ingenuity. We believe that God plays fair and you often get a shot at winning, regardless of how dismal the malady. A broad differential and rapid and often imperfect diagnostics are often the only way to find in time what’s lethal and irreversible. And before the diagnostics are back, preemptive strikes of empiric therapy based on calculated risks and hunches may earn you a guerrilla victory.

There are no simple cases. Not at this level. There are simple doctors unwilling to try harder to optimize efficiency, cost, and outcomes, to do it with less radiation exposure, fewer side effects, and higher real and perceived quality. Every ankle and ear doesn’t need radiographs and antibiotics, but some do, and most need thoughtful pain management and anticipatory guidance, with the entire encounter limited to only a few seconds by more pressing cases. Every patient, sick or well, is a chance to be our best, to recognize when our best is not enough, and to get help before it’s too late. If it were easy, I wouldn’t want to do it.

When consultants who see the patient the next day whine about “shotgun workups,” “excessively broad antibiotics,” and “inconsistent management,” emergency physicians laugh nostalgically and think, “that was a good save.” However lacking in elegance the evaluation may appear to the hammer who sees the world as a nail, he should have spoken when he was somehow unavailable at 2 am on a Saturday. We are emergency specialists and we step up to the board, for anyone, at any time, and with a unique skill set.

We know that you don’t always get second chances playing against God. Specialists wishing to “see the patient in the morning,” surgeons who interrupt with “what did the CT scan show?” and primaries requesting to “wait for the blood cultures before treating” are occasionally right, but more often they fail to feel our sense of urgency and appear not invested in the battle. Seasoned ER docs are not desperate for approval, camaraderie, or admiration; often we can even write a rain check on respect. When squaring off against our adversary 30 times a shift, self-respect is earned and goes a long way toward self-esteem. But we deserve alliance, for others to be on our side in caring for the patient. This means trusting our instincts. This means respect for our expertise in ambiguity and patients who don’t read the textbook.

The metal doors burst open and the paramedics roll in a man who looks grayer than the sheet. “All we know is he’s got a kidney pancreas transplant with a pacemaker and he’s been depressed lately. We found him unresponsive next to some pills. Good vital signs in the truck but now I can’t feel the pulse.” The third-year med student stares blankly at the paramedic, while the fourth-year looks close to passing out. The nurses run to the gurney to transfer the lifeless body onto the stretcher, begin working on access, connecting leads. I stand up slowly and take a deep breath. The board is set; the next move is mine.

Welcome back, old friend. You open well. Let’s play….

Chess With God

Boris D. Veysman, MDemail address

Article Outline

Copyright

[Ann Emerg Med. 2010;55:123-124.]

Give me a bad position, I will defend it. Openings, endgames, complicated positions, dull draws, I love them and I will do my very best.

—Hein Donner, Chess player, 1950

Not only does God play dice, but… he sometimes throws them where they cannot be seen.

—Stephen Hawking

Amidst a busy shift when patients pile in, seasoned nurses start to grumble, and my blood sugar and bladder volume are most discordant, I overhear a fourth-year medical student share wisdom with a third-year newbie. “ER’s got a good schedule if you like doing overpaid triage.” I smile, enjoying the involuntary adrenaline boost from sublimated anger, before refocusing on the labs of the 80-year-old woman with digoxin toxicity and acute renal failure, presenting with runs of unstable tachycardia, prolonged QT interval, hyperkalemia, hypocalcemia, and a filthy cough suggesting preseptic pneumonia.

The next 20 seconds is a synaptic typhoon. Could elevated lactate mean not sepsis but mesenteric ischemia? A benign exam would not rule it out, and she is too sick to complain of abdominal pain. Tachycardia and hypoxia suggest pulmonary embolism (PE), given her edematous legs and recently stopped Coumadin when she had a GI bleed. This also increases the risk of mesenteric clot. Yet the contrast timing is different for CT angiograms of chest and abdomen, and I will have to choose which to optimize. Both studies are perilous because of the dye load, given acute renal failure, but failure to make either diagnosis would be fatal in a patient this sick. Meanwhile, empiric anticoagulation risks another massive GI bleed. Dialysis and transfusion may be necessary damage control to be considered concurrently with the diagnostic studies. Furthermore, calcium gluconate is contraindicated in digoxin toxicity because of mostly hypothetic cardiac tetany but would probably help with the blood pressure. Calcium would also treat hyperkalemia and hypocalcemia (strangely equal at 6.5), which both contribute to cardiac toxicity. If the heart gives out, it’s my fault either way, and I find that liberating. Digibind for the hyperkalemic digoxin toxicity, but that will worsen the heart failure. Definitely fluids for hypotension and sepsis but absolutely no fluids because of pulmonary edema and renal failure.

“Dr. V, she’s 80/50,” the nurse reports. Time’s up. Make a move….

We may choose emergency medicine for different reasons, but we fall in love all over again when after a few years of practice we begin to understand its magic. For me, it’s the intensity of thought when time is short and stakes are high in a battle against the worthiest of opponents. There are many hard cases that challenge the depth of our ability and ingenuity. We believe that God plays fair and you often get a shot at winning, regardless of how dismal the malady. A broad differential and rapid and often imperfect diagnostics are often the only way to find in time what’s lethal and irreversible. And before the diagnostics are back, preemptive strikes of empiric therapy based on calculated risks and hunches may earn you a guerrilla victory.

There are no simple cases. Not at this level. There are simple doctors unwilling to try harder to optimize efficiency, cost, and outcomes, to do it with less radiation exposure, fewer side effects, and higher real and perceived quality. Every ankle and ear doesn’t need radiographs and antibiotics, but some do, and most need thoughtful pain management and anticipatory guidance, with the entire encounter limited to only a few seconds by more pressing cases. Every patient, sick or well, is a chance to be our best, to recognize when our best is not enough, and to get help before it’s too late. If it were easy, I wouldn’t want to do it.

When consultants who see the patient the next day whine about “shotgun workups,” “excessively broad antibiotics,” and “inconsistent management,” emergency physicians laugh nostalgically and think, “that was a good save.” However lacking in elegance the evaluation may appear to the hammer who sees the world as a nail, he should have spoken when he was somehow unavailable at 2 am on a Saturday. We are emergency specialists and we step up to the board, for anyone, at any time, and with a unique skill set.

We know that you don’t always get second chances playing against God. Specialists wishing to “see the patient in the morning,” surgeons who interrupt with “what did the CT scan show?” and primaries requesting to “wait for the blood cultures before treating” are occasionally right, but more often they fail to feel our sense of urgency and appear not invested in the battle. Seasoned ER docs are not desperate for approval, camaraderie, or admiration; often we can even write a rain check on respect. When squaring off against our adversary 30 times a shift, self-respect is earned and goes a long way toward self-esteem. But we deserve alliance, for others to be on our side in caring for the patient. This means trusting our instincts. This means respect for our expertise in ambiguity and patients who don’t read the textbook.

The metal doors burst open and the paramedics roll in a man who looks grayer than the sheet. “All we know is he’s got a kidney pancreas transplant with a pacemaker and he’s been depressed lately. We found him unresponsive next to some pills. Good vital signs in the truck but now I can’t feel the pulse.” The third-year med student stares blankly at the paramedic, while the fourth-year looks close to passing out. The nurses run to the gurney to transfer the lifeless body onto the stretcher, begin working on access, connecting leads. I stand up slowly and take a deep breath. The board is set; the next move is mine.

Welcome back, old friend. You open well. Let’s play….

Tribute to ER Nurses

This is a great tribute and article pointing out the hard work and compassion of our ER nurses:

“I heard a guttural scream,” Rich says, “and a man was handing me his lifeless son.”

“How old?” I ask.

“Nine months. We worked on him for over an hour.”

Rich moves his chair, coughs. It’s freezing in the conference room. [Note: For privacy, nurses are mentioned only by first name.] The muffled din of the emergency room is audible through closed metal doors. It’s 7 a.m., and Rich’s 12-hour shift has just ended. “I flashed to something I heard once about how a casket doesn’t weigh very much—just enough to break a father’s heart,” he says, “and I lost it. I’m standing there, between beds one and two holding that dead baby, and I’m sobbing. I am in charge, and I’m crying.”

As an 11-year volunteer in Cedars-Sinai Medical Center’s emergency room, I’ve seen close up what ER nurses deal with. It takes rare emotional courage not to burn out when you know that every time those doors open—whether you are working triage in front, where a guy may stumble in with a heart attack, or in back, where paramedics may race in with a girl who has been knifed or shot—it’s bad news. Then there’s the physical strength required to survive 12-hour shifts with two half-hour breaks and 45 minutes for lunch. ER nurses never sit. But it’s the children—every ER nurse will tell you—who take the biggest toll.

“For a very long time,” Rich says, “I viewed it as a badge of honor—How much crap can I take? How much horror can I see and not show emotion?” He clears his throat. “But you can’t keep stuffing it down; you have to deal with the emotion.”

Rich has been a nurse for 22 years. He has a 12-year-old son. There are 98 nurses in Cedars’ ER. Their ages range from 24 to 67, and they are as different as heavy metal is to polka. What they share are guts and a desire to give. “I was an operating-room tech in the army. My CO said, ‘Nursing?’ And I thought, Maybe,” Rich says.

He is big and bulky, with soulful eyes and a wild sense of humor. When I ask why he really became a nurse, he jokes, “I liked the cute little hats, the white nylons and the sensible shoes.”

Rich was diagnosed with leukemia last year in his very own ER, when he showed a doctor some large bruises on his body. The doc ran tests while Rich was on shift and returned with the diagnosis. The story goes that he asked the doc if he could finish his shift so he wouldn’t get docked pay. After eight months off, five rounds of intravenous and oral chemo and too many bone-marrow biopsies, Rich is back working nights. I don’t know how he does it. I don’t know how any of them do it.

“It affects your soul,” Melissa says. She could be called the queen of trauma, having done 20 years in what she terms “the knife and gun club” at St. Luke’s Roosevelt Hospital in Harlem and five years in Newark, New Jersey, before coming to L.A. “Newark made New York look like kindergarten,” she says.

Hearing Melissa’s accent is like flying to N.Y. and walking into Original Ray’s. She recalls a guy “who was having a big heart attack in room nine…In the middle of his pain, he heard me, looked up and said, ‘What part of the Island are you from?’ ”

“Why nursing?” I ask.

“I had a scholarship to the American Ballet Theatre, and I was good, but I wasn’t brilliant…and my dad said, ‘You need an education—go be a nurse.’ ”

I can’t imagine Melissa in ballet shoes, but 29 years ago, she traded them for a stethoscope. We’re at Orso, across the street from Cedars, having dinner after Melissa’s 7 a.m.–to–7 p.m. shift. She’s wearing a chic black jacket over blue scrubs, but there are smudges under her eyes. “Where do you find joy in the job?” I ask.

Without blinking, she says, “Using my knowledge to participate in stopping bad things that happen to people.”

Of course, they can’t always be stopped. You can’t stop a mother’s pain when her 18-month-old drowns. “The mom was still wet,” she says, “making a puddle by room three. When she knew her baby was gone, she wailed…just melted to the floor.” She pauses. “I swaddled her in warm blankets. It was all I could do for her.”

“What do you do for you?”

“I compartmentalize,” she says, finally smiling. “And I buy very expensive shoes.” She must have a closet full of Manolos.

Shari runs to cope with the stress. She did the 2007 Boston Marathon. “I’ve also run after psych patients who escaped the ER and took off down Gracie Allen toward 3rd Street.” She works mostly as a charge nurse, overseeing patient flow. If paramedics bring you in on a gurney, you’ll see the charge nurse first. That’s who decides whether the man in room four gets kicked into the hall because the room is needed for the woman the LAFD just scooped up off the pavement.

Some ER nurses charge, but all work triage and patient care. There are approximately 15 nurses on each shift, and shifts change all day. There are 41 beds in the ER—58 if they fill the halls. Cedars is a number one trauma center—the wait can be 10 minutes or four hours. Think of all the L.A. hospitals that have closed.

Shari, who was raised on a farm in Racine, Wisconsin, has been a nurse for 21 years. The only other job she considered was a baker…and that was when she was five. “How come you didn’t do that?”

“They have to get up really early,” she says, taking a bite from her perfectly wrapped homemade sandwich. She expertly cuts her peach with a paring knife.

Shari came on at 11 a.m. and will work until 11 p.m. We’re in the cafeteria on her dinner break, but she looks like she has just showered—blond curls escaping a perfect ponytail—a Goldilocks nurse who behaves like a general. I have seen her hustle a parade of bloody, broken patients through the door with the cool calm of an air-traffic controller moving jets through a bank of thunderstorms.

Abby and Sylvia carpool from Santa Clarita. They call the drive back and forth to Cedars their “psychotherapy hour.” Abby, fast and funny, was born in the Philippines. She has been a nurse 27 years—Hoboken and then L.A. “Why nursing?” I ask.

“I got into the short line,” Abby says, and she and Sylvia fall into a fit of laughter. “I’m Chinese, and when you’re Chinese, you’re supposed to study math—go into accounting, banking. So I went with my girlfriends to apply to school. All of the lines were really long, but there was this one short line, so I got into that one.”

“It was the premed, premed tech and nursing line,” Sylvia adds, smiling widely.

“I passed the test,” Abby says, “and I said to my friends, ‘Nursing?! My mom is going to kill me.’ ”

The ER can bring out the worst in people—not just the patients but the people bringing in the patients. Week after week, I see fear breed anger and despicable manners. I ask Abby how she deals with that. “You can’t take it personally,” she says. “You have to get over it and move on.”

“What’s the joy in this job?” I ask Sylvia, who has three children and has been a Cedars nurse for 19 years—not long enough to dim her radiant smile.

“You get to help people,” she says. “You make a difference.”

The nurses remind me about the funny stuff: the toddler whose potty got stuck on her head when she tried to put it on like a hat; the four-year-old who shoved an aspirin up his nose. “Did you have a headache?” Rich asked the kid.

Some of the nurses are on their second careers. Paul, one of the calmest in the ER, was a Navy SEAL. Jerry, who could find a vein in a stone, was a fashion designer. Joe was in marketing at Anheuser Busch. “And then came 9-11,” he recalls, “and I was watching those firefighters on TV, and I just knew I had to change my life. I had to do something honorable.”

Clean-cut, in pressed scrubs and Clark Kent glasses, Joe is the one you’d want to marry your daughter. “Can you have the same compassion for a drug addict as you do for a cardiac arrest or the patient back for the third time with terminal cancer?” I ask.

“You have to. What about the guy booked on a double vehicular manslaughter, still drunk, spewing ef-yous and showing no remorse? He’d kept driving after he hit them,” Joe says, eyes narrowing. “You have to give him the same care.”

Lots of people are brought into the ER in cuffs—think of gang shootings, car wrecks, domestic violence. Bad guys get hurt just like good guys, and they’re all brought to the same ER.

Kelly wanted to be a cop. “First an actress, second a cop,” she says. Raised in Tennessee and Arkansas, she calls herself a hillbilly but looks like a movie star. She hunts, motorcycles, parachutes and has an 11-year-old son. A nurse for 10 years, she once did CPR on a woman in the ER driveway.

“I was triaging, the doors opened, and someone was yelling for help. It was the sound of the help; the hairs on the back of my neck stood up,” Kelly recalls. “Female, mid seventies, cold as a cucumber, not breathing, in the passenger seat. I pulled her down onto the cement. There wasn’t any time; her feet were still in the car.”

Flor nods. She, Kelly and I are at Du-par’s on their day off. “I did CPR on a doctor once,” she says. “We were moving him to the OR, and he went into cardiac arrest. I jumped up on the gurney, straddled him and did CPR—in the elevator. It probably didn’t look good,” she says, brown eyes wide.

Flor is a “good Catholic girl” from Manila—nuns and rosary beads to Kelly’s bikes and rifles. “My aunt was a nurse in the U.S., and when she’d come home, it was like she was a celebrity. People gathered around—they made a fiesta: We have to kill a pig,” she says, grinning. “They respected her, and I thought, I want to be like that.” She has been a nurse for 31 years. She has three kids in college and looks like she’s their age. “I’m a caregiver,” she says. “That’s what I took the oath for.”

Triage is the hardest, most ER nurses agree. It’s not just the patients’ vitals. What are the skin signs, the alertness, the level of consciousness? Sweaty, pale, faint, red? It’s not just their pain.

“Triage is the most dangerous,” Nili says.

“You use your clinical judgment to assess the patient. You can’t let anyone slip past you, and you can’t make a mistake.” Tall and impressive, if Nili walked into your room with a needle, you’d extend your arm. “Why did you go into nursing?” I ask.

“Oh,” she says shyly, “I was out of control at Cal State Northridge, and my parents said, ‘It’s either nursing school or leave home.’ ” She has been on the job for 16 years. “Not everyone can do it.”

Well, that’s for damn sure. I’ve seen Nili on the trauma team, suited up in blue plastic, waiting for the paramedics to arrive, like a solider about to take a hill. I’ve sat next to her at the radio when the LAFD calls. The silent blue lights in the corners of the ER flash and spin, and a nurse on the blue team hotfoots it to the radio room. “Cedars base, copy,” and the line crackles: “This is Rescue 41. I have a 57-year-old male, altered LOC, in moderate distress; this is Rescue 27, I have a 16-year-old female…” And on it goes.

“Every day is a crisis,” Nili says.

ER nurses don’t give long-term care. They don’t get to know you, and they don’t even know what happens to you after you leave the ER. They are a platoon of adrenaline junkies with invisible capes and angel wings, there to take care of you at your worst moments. And it never ends. “Patients are like waves of ocean hitting the beach,” Shari says. “New ones just replace the old ones.”

“If I have to cry, I cry,” Mark says. “You can’t carry it to the next shift.” Blond and lanky, he has the mischievous air of a reformed bad boy. He did 10 years as a paramedic before his 10 as a nurse, so he has seen his share. “I wanted to be that person who knew what to do, how to run a code—perfectly.” A code, even laypeople know, is when the heart stops.

Mark thinks about the process for a moment and flashes one of his rare smiles. “It can be a miracle,” he says.

“Does it scare you anymore?”

“No,” he says. “I’m either enlightened or f–ked up.”

Life Principle #2: Give Honest, Sincere Appreciation

I have been struck by the power of affirmation and appreciation.  I have also been struck by the destructive power of criticism.

Recently I tried to encourage someone to always find the good, always look for the opportunity to compliment and appreciate, and never complain or criticize.  Their response was, “But if you only knew that person, if you only knew how difficult they can be, and how much criticism they deserve.”

This response misses the point completely!  It was only when I dropped the contempt and criticisms did I start to see the gifts in the other person.  It is only when you look for the appreciation will the critical spirit in YOU fade away.

It is NOT about the other person; it is about YOU.  It is about healing YOUR image of yourself, the world around you, and others.

Our marriages and relationships would truly be transformed if we followed Carnegie’s first 2 principles always leading with this one.

“I consider my ability to arouse enthusiasm among my people…the greatest asset I possess, and the way to develop the best that is in a person is by appreciation and encouragement.  There is nothing else that so kills the ambitions of a person as criticisms from superiors.  I never criticize anyone.  I believe in giving a person incentive to work.  So I am anxious to praise but loathe to find fault.  If I like anything, I am hearty in my approbation and lavish in my praise… in my wide association in life, meeting with many and great people in various parts of the world… I have yet to find a person, however great or exalted his station, who did not do better work and put forth greater effort under a spirit of approval than he would ever do under a spirit of criticism.”-Charles Schwab

“Every man I meet is my superior in some way.  In that, I learned from him.”-Emerson

How to Win Friends and Influence People by Carnegie:

  • “That is what Schwab did.  What do average people do?  The exact opposite.  If they don’t like to think, they ball out their  subordinates; if they do like it, they say nothing.  As the old couplet says: “once I did bad and that I heard ever/twice I did good, but that I heard never.”-pg 38
  • “I once succumbed to the Fad of fasting and went for six days and nights without eating… I was less hungry at the end of the sixth day than I was at the end of the second.  Yet I know, as you know, people who think they had committed a crime if they let their families or employees go for six days without food; but they will let them go for six days,  six weeks, and sometimes 60 years without giving them the hearty appreciation that they crave almost as much as they crave food.”-pg 40
  • ” When Alfred Lunt, one of the great actors of his time, played the leading role in Reunion in Vienna, he said, “there is nothing I need so much as nourishment for my self-esteem.”  We nurish the bodies of our children and friends and employees but how seldom do we nurish their self-esteem?  We provide them with roast beef and potatoes to build energy, but we neglect to give them kind words of appreciation that would sing in their memories for years like the music of the morning stars.”-pg 40 one
  • “When we are not engaged in thinking about some definite problem, we usually spend about 95% of our time thinking about ourselves.  Now [just imagine], if we [ could] stop thinking about ourselves for awhile and begin to think of the other person’s good points…”-pg 41
  • “Try leaving a friendly trail of little sparks of gratitude on your daily trips.  You’ll be surprised how they will set small flames of friendship that will be rose beacons on your next visit.”-pg 42
  • “Pamela Dunham of  a New Fairfield, Connecticut, had among her responsibilities on her job the supervision of a janitor who was doing a very poor job.  The other employees would jeer at him and litter the hallways to show him what a bad job he is doing.  It was so bad, productive time was being lost in the shop.  Without success, Pam tried various ways to motivate this person.  She noticed that occasionally he did a particularly good piece of work.  She made a point to praise him for it in front of the other people.  Each day the job he did all around got better, and pretty soon he started doing all his work efficiently.  Now he does an excellent job and other people give them appreciation and recognition.  Honest appreciation got results where criticism and ridicule failed.”-pg 42
  • “Hurting people not only does not change them, it is never called for.  There is an old saying that I’ve cut out and pasted on my mirror where I cannot help but see it every day: ‘I shall pass this way but once; any good, therefore, that I can do or any kindness that I can show to any human being, let me do it now.  Let me not deferring or neglect it, for I shall not pass this way again.'”-pg 42
  • “Let’s cease thinking of our accomplishments, our wants.  Let’s try to figure out the other person’s good points.”-pg 43

Life Principle #1: Don’t Criticize, Condemn, Complain

I continue to revisit a book and audio book that I wish that I had memorized when I was younger: How to Win Friends and Influence People by Dale Carnegie.

Time and time again  I have found myself using (or trying to use) his principles in my marriage, parenting, and other relationships.

Recently I have had conversations about affirming and its counter–criticizing your spouse.  I have seen and heard about a wife or husband who continually criticizes their spouse.  I have been a master at this myself.  For the most part, I have made a major effort to STOP completely this process.  It is a waste of time, and it turns out to do the opposite of what you want it to.  We seem to think that by giving ‘constructive criticism’ the other person will improve, but they don’t.  In fact, they seem to do MORE of the actions that we want them to change!

2 things:  1. The more you affirm and not criticize; the MORE likely their behavior will change!   2. Don’t try and change your spouse; just love them the way they are!

Principle #1: Don’t Criticize, Condemn, Complain

  • “If you want to gather honey, don’t kick over the beehive.”
  • “Criticism is futile because it puts a person on the defensive and usually makes him strive to justify himself.  Criticism is dangerous, because it wounds a person’s precious pride, hurts his sense of importance, and arouses resentment….B.F. Skinner, the world-famous psychologist, proved through his experiments that an animal rewarded for good behavior will learn much more rapidly and retain what it learns far more effectively than an animal punished for bad behavior.”
  • “Lincoln…had learned by bitter experience that sharp criticisms and rebukes almost invariably end in futility.”
  • “The secret of…Ben Franklin’s…success? ‘I will speak ill of no man…and speak all the good I know of everybody.”
  • “Any fool can criticize, condemn and complain–and most fools do.  But it takes character and self-control to be understanding and forgiving.”
  • “As Dr. Johnson said: ‘God himself, sir, does not propose to judge man until the end of his days.’  Why should you and I?”

I am not enough!

I am NOT enough! My eyes have FINALLY been open to this reality.  Most of us have this ‘wound’ but we just don’t know it.  I have written a brief summary of my learnings to help us all to learn from our past so that we may grow spiritually and emotionally in the future:

“Drew, can you be 1st base coach?” How hard could that be? The player’s are only 5 years old so all I had to do was point them in the direction of 2nd base, say, “great job!”, and my job was done. Or was it? My dad came up to me afterwards and said, “You know that you could have coached them more.” How many times has your mom or dad told you that you could have done a better job at something? Well at 35 years of age, my dad’s comment went on deaf ears until I mentioned it in passing to my wife. She thought his comment was significant, and comments such as those can have a lasting impact especially when you are young.  When she said this, I shared with her those times when I was young that my dad would critique one of my school projects, and he would insist that I throw it out and start all over.

More recently, I followed my father-in-law’s advice and bought a new barbeque from the exact same store and arranged the details of the delivery just as he instructed me. I proudly mentioned to him that I had left just the right amount of money on top of the old bbq so the delivery man would willingly take it away when he delivered the new bbq. When I showed off my new bbq to my father-in-law, I couldn’t get the propane tank hooked up to the bbq because my new bbq had a different attachment than my old one. My father-in-law said, “Oh, I always have the delivery man make sure and hook up the propane tank to the bbq before they leave to make sure that it works.” Finally, I recently had the pleasure of trying to pass a kidney stone. Not wanting to miss any work, I arranged to have it extracted during my vacation time. In passing, I mentioned to my retired father-in-law that I had only missed 1 day of work in 11 years. He said, “I missed 1 day of work in 30 years.” Have there been times in your life when your mom and dad have ‘zinged’ you (probably not even knowing that they had)?

Our dad’s (sometimes our mom’s) tell us over and over again as we are growing up—You are NOT enough! In so many subtle and not so subtle ways. This is the wound that so many men (and women) carry with them. It creates a fiercely critical spirit, a chip on our shoulders, and abrasive arguments when anyone tries to give us “constructive criticism”. We become our dad. It was only recently that a friend pointed this “I am not enough” wound out to me.  It was life changing to begin to process what it meant, how often I responded to my wife and others because of it, and how to learn and grow from it.

There are many practical ways that knowing about this wound has transformed my life.  In the past when I would write an article, I would immediately ask my wife to proof read the article for me.  When she would quickly use the red marker to slash and destroy what I thought was an almost perfect article, I would respond in a fury.  Now I see that I was only responding to my childhood experiences of not being enough.  My wife now knowing my wound has taken it upon herself to help heal my wound.  When I ask for her to proof read anything that I have written, she will affirm me, put it aside for at least 24 hours, and then she will slash away with her red marker.  It is amazing how quickly I become unattached to my work, and then can handle her critiques and edits much better.

My wife and I have an amazing marriage, but we have our share of arguments.  To my surprise, most of our arguments revolve around my “not enough” wound.  We argue because I feel that she has told me that “I am not enough”.  It can be simply because she told me that I loaded the dishwasher the wrong or that I should drive around the block again so my oldest son will be late to a birthday party because he does better when he is not the only kid there.  Yes, believe it or not this can set me off because I feel she is critiquing my driving and my favorite mantra that being early is one of life’s valuable secrets.

Two things have occurred since my “wound” was discovered.  Our arguments still occur, but they are much shorter and often end in laughter.  A less obvious by-product of my discovery stems from my wife’s repeated comment, “Ok already, I got it.  You are not enough.  When will it stop being about that!”  The wound is now so obvious and so prevelant that we both can laugh about it.  I have been healed enough through the process to laugh and with my wife’s encouragement to even tell myself, ‘Get over it!’

The Human Whisperer

http://www.stanfordalumni.org/news/magazine/2009/janfeb/features/verghese.html

The Human Whisperer

Whether practicing medicine or literature, Abraham Verghese teaches how to pay full attention at a patient’s bedside.

BY SUSAN COHEN
PHOTOGRAPHY BY MICHAEL SUGRUE

IT TAKES ABRAHAM VERGHESEonly a few minutes to stroll from his public office to his secret one. His main office in the department of medicine contains the medical handbooks, the imposing desk, the ready assistant who copes with the physician’s complicated schedule. His secret office bears someone else’s name outside. It’s only slightly more personal than a motel room, a space devoted to nothing but writing. He jokes that he’ll be forced to eliminate anyone who uncovers its location.

Stanford promised Verghese the dual offices and two days a week to write when it hired him last year as senior associate chair for the theory and practice of medicine and put him in charge of training third- and fourth-year students as they rotate through internal medicine. It was, department of medicine chair Ralph Horwitz readily acknowledges, an unusual tenured appointment for an institution that typically evaluates a paper trail of research grants and publications to hire or promote. Verghese’s paper trail included, instead, a long list of essays, short stories and two much-praised memoirs, one of which was made into a movie starring Naveen Andrews of Lost.

Verghese’s summary of research interests remains blank on his faculty web page.

His list of publications, on the other hand, continues to grow. The newest is an epic novel, set over five decades in Ethiopia and America; Cutting for Stone will be published by Knopf on February 6.

Even more unusual than these literary accomplishments are the personal history Verghese brings to Stanford, and the ways it has led him to practice and teach medicine. Modern medicine can be high-tech, research-oriented, data-driven and time-crunched in ways that are alienating to both patient and physician. Examining a patient can come as an afterthought, neglected in the onslaught of laboratory test results, medical scans, numbers on the computer screen. These days, as Verghese puts it, “If you’re missing a finger, you have to get an X-ray to be believed.”

‘To him the physical exam is a beautiful and worthwhile art that benefits both patient and doctor.’

He is a link to an older healing tradition: devoted to medicine not just as science, but as calling and craft. Verghese doesn’t neglect modern laboratory tests; he’s board-certified in three specialties—internal medicine, pulmonary medicine and infectious diseases. But he loves nothing more than teaching students who are focused on the image of an organ on a piece of film to also look at the person in the hospital bed. And not just look, but touch, listen, even smell, with a writer’s attention to detail and a physician’s intention to discover the story of someone’s suffering.

“I loved introducing medical students to the thrill of the examination of the human body, guiding their hands to feel a liver, to percuss the stony dull note of fluid that had accumulated in the lung, to be with them when their eyes shone the first time they heard ‘tubular’ breathing . . . and thereby diagnosed pneumonia,” Verghese has written. To him, the physical exam is a beautiful and worthwhile art that benefits both patient and doctor.

Horwitz recruited Verghese after being struck by the power of his commitment to patients and bedside medicine “at a time when technology is so seductive.” The first time he heard Verghese speak, he watched this man with the soft voice electrify a boisterous audience of medical students who grew quieter and quieter so that they would not miss a word. Horwitz found in Verghese a scholar and master clinician who represents medicine’s “most enabling and enduring values.” There’s no irony in his voice when Horwitz insists that Verghese is “cutting edge” precisely because “he promotes bedside medicine and its meaning to both patients and practitioners.”

“Stanford needs that,” Horwitz argues, so that with all its emphasis on science and technology “we don’t lose sight of the value and meaning of that science and technology.”

ABRAHAM VERGHESE DESCRIBES HIMSELF as a perennial outsider. His parents were teachers from a Christian region of India, who raised him in Ethiopia. The expatriate life in Africa made him an acute observer of cultures and a seeker of connections. He believes that doctors are often wounded people attracted to medicine in an attempt to heal themselves, people who’ve sought “a way to be in this world” from the margins, and that literature, too, is a way to connect with the human condition. As a boy, he was drawn to both these passions by the stories of doctor-turned-writer Somerset Maugham.

Verghese, 53, began his medical education in Ethiopia, but fled in 1973 as civil unrest turned the country against both intellectuals and foreigners. He had witnessed so much brutality that when he reached New Jersey, where his parents and younger brother had settled a few years before, his only remaining life’s ambition was safety. He worked as a hospital orderly and assumed he’d live a blue-collar life.

One night, while working, Verghese found a copy of Harrison’s Principles of Internal Medicine on a table where a med student had left it. The book revived his calling. With the help of an aunt, he finished medical school in India, which took him in as a displaced person.

Medical training in Madras was “intense at the bedside every day,” Verghese recalls. “I loved it. Those Indian teachers were incredibly skilled. They’d identify all these diseases you’d never find in Western textbooks.” He watched them almost with a sense he was witnessing “wizardry.” He admired not just their ability to diagnose, but also the way they dealt with patients, “the gentleness of the way they taught us” and the love for medicine they conveyed. Many of the physical signs he was taught to notice at the bedside were named after great doctors of the past. His teachers were passing along a grand tradition, and he found himself “not wanting to break the chain.”

When it came time to do his residency, Verghese chose a newly fledged program in internal medicine at East Tennessee State University in the foothills of the Smoky Mountains. He chose internal medicine partly because he saw that foreign-trained students who wanted to be surgeons were recruited to the poorest American hospitals, worked around the clock, and rarely were promoted afterward by the top-ranked medical centers, places the students jokingly called “Mecca.”

Johnson City and the rural towns and hollers around it were a long way from any medical Mecca, but they turned out to be the opportunity of a lifetime for Verghese as both doctor and writer. People grew to depend on this foreign doctor with the brown face, slightly British diction and unplaceable accent. After a two-year fellowship in infectious diseases at Boston University, where he tried and disliked laboratory research, Verghese returned to Tennessee and joined the faculty, choosing to focus on caring for patients and teaching.

THAT’S WHERE HE FOUND HIMSELF in 1985, when young gay men began to return to their small towns and families to die. The HIV/AIDS clinic Verghese established saw more than 80 patients in five years, by which time Verghese felt burned out. It had been humbling. He’d been forced to give up what he called the physician’s “conceit of cure.” But though no one had a cure for the new disease, Verghese had found a lot to offer in the way of care—so much that he had little time to spare for his own family, which by then included a wife and two young sons, Jacob and Steven. He filled journals with his observations and his thoughts, and the details of his patients’ stories, in an attempt to learn as much about himself as about them. He thought he’d prepared himself for so much death. He hadn’t.

In a bold move, Verghese gave up his tenured position in Tennessee to attend the famous Writer’s Workshop at the University of Iowa. He realized later how hard that was on his family. “It was very selfish on my part. To me, it felt like survival.” A year and a half of intensive writing later, money running out, Verghese turned down several traditional academic positions that would have required him to chase grants and publish research papers. He took a clinical position instead—as professor of medicine and chief of infectious diseases at Texas Tech Health Sciences Center in El Paso. “I really liked the sense of being on the edge of America,” he explains. It was a “first world hospital—just barely—taking care of third world disease.” Without the pressure to do research, he wrote fiction.

After the New Yorker ran a short story based on his experiences in Tennessee, Verghese was offered a contract to write a memoir—one of the earliest books by a doctor working from the AIDS front line. He’d never considered writing nonfiction, but My Own Country: A Doctor’s Story of a Town and Its People in the Age of AIDS was a finalist for the National Book Critics Circle Award in 1994. Director Mira Nair filmed it for Showtime TV. My Own Country was, another physician comments, “a really brave book.” His second was even braver. The Tennis Partner: A Doctor’s Story of Friendship and Loss, in 1998, described his bond with a medical resident in El Paso who died of drug addiction. The heavily autobiographical book interwove many themes: his passion for tennis, the failure of his first marriage, his enduring love of medicine in spite of the isolating effect it can have on its practitioners.

He attributes some blame for the appalling levels of suicide and drug abuse among doctors to this isolation. “Medicine is so beautiful, and yet it has its seamy underbelly,” Verghese says. “Most of us in medicine end up being far better doctors than fathers or husbands.” Although it’s his compassion—as well as his vivid and often lyrical writing—that wins praise, Verghese thinks what draws medical students to his work is that he exposes himself as a flawed human being rather than an all-knowing physician.

  

BOY AND MAN: Verghese at the center of a school photo in Ethiopia, and with actor Naveen Andrews, who played him in the 1998 TV movie My Own Country.
Courtesy Abraham Verghese (2)

Verghese believes in the curative power of literature for physicians. Writing is a way to explore what they see every day and can’t share. Reading is a way for students to revive the empathy that gets lost in the process of medical training. Modern training “takes lovely people and converts them into bottom-line, somewhat cynical, disease-oriented people,” Verghese insists. “We teach them to convert into our language, which we need for diagnosis. We rob the story of everything human about it.” After a while: “Imagining suffering is a struggle. The danger is we begin to talk about the diabetic in bed three.” Literature, on the other hand, is full of suffering. He likes to teach his students Chekhov, and is apt to recite a poem off the top of his head by William Carlos Williams—two other writer/physicians.

Six years ago, Verghese created the Center for Medical Humanities & Ethics at the University of Texas Health Science Center in San Antonio, one of an increasing number of programs—like Stanford’s arts, humanities and medicine program—that encourage medical students to explore the arts. He also worked on Cutting for Stone. The novel’s title plays on a phrase in the Hippocratic oath and the name of a central character, Thomas Stone. Stone is a surgeon who’s missing from much of the narrative, just as he’s missing from his twin sons’ lives: a symbol of the wounded doctor who distances himself from people even as his hands render miracles on the operating table. Much of the rich, sprawling story is set in Ethiopia at a mission hospital that the locals call Missing. It’s an ambitious book filled with characters who, in their different ways, reveal Verghese’s view of what medicine does best and worst. Some of its most powerful scenes occur at a decrepit hospital in the Bronx where a newly arrived foreign medical student assumes the helicopter pad on the roof represents the richly endowed American medicine he so envied from afar. But the landing pad exists so doctors from an elite medical center can touch down just long enough to harvest organs for transplant from the trauma patients who flood the inner-city emergency room.

Though Verghese is ambitious for his writing, medicine remains its source. “I’d love to practice medicine until my last day,” he says. There are other physicians who combine the two, of course: surgeons Atul Gawande, ’87, and Richard Selzer, and pediatrician Perri Klass. But there are more of those like novelist Ethan Canin, ’82, a Harvard Medical School graduate who found he had to choose. Canin, a friend who has been familiar with Verghese’s writings for years, says: “I’ve always been amazed at his ambition and attainment in both. Plenty of people are ambitious in both, but few—if any—have attained such distinction in the two fields at once.”

When Verghese received Stanford’s offer to return to teaching at the bedside, an offer that included time to write, plus tenure, it struck him that Stanford valued his books and essays as highly as research. The realization was “precious.”

ON A DAY IN AUGUST, as he walked down a corridor at Stanford’s medical center, Verghese gestured to a glass wall that looks onto a wildly colorful garden, a glorious riot of flowering plants that achieve their profusion with massive—and expensive—tending. “Mecca,” he laughed. As though he had to pinch himself.

Verghese wants Stanford students to see medicine as a historic calling the way he does. He wants them to see a patient not as a diseased liver or a spleen, but as a man or woman in a bad situation. Young doctors may be brilliant at analyzing tests, but he finds many “incompetent” at diagnosing and treating at the bedside. Verghese also wants students to understand that there’s a “huge therapeutic effect” in offering someone hopeful words. Especially, and only if true, the words: “I think you will get better.”

What Verghese seems to have tapped into, even in the scant year he’s been here, is a hunger not just from patients for doctors with a human touch, but also from doctors for the kind of satisfaction many no longer get from medicine. Verghese, who lives with his wife, Sylvia, and their 11-year-old son, Tristan, hosted a speaker’s evening with an expert on evidence-based physical diagnosis. A medical resident grew so enthusiastic about learning more on how various skin conditions might help her diagnose patients that she blurted: “We get to be doctors! Not just order tests!”

Lisa Shieh, an assistant professor who specializes in internal medicine and in-patient care, says she’s found a mentor in Verghese. After hearing him speak, she invited him to instruct second-year students how to take a history and conduct a physical exam. She also followed him on rounds like a student, to see how he interacted with patients and taught. “There’s just so much data now in medicine, and keeping that straight is very challenging. Sometimes with all the technology, the physical exam takes a back seat.”

Verghese is organizing a major conference on bedside medicine that will take place at Stanford next September. Department chair Horwitz sounds like a proud parent when he talks about his successful recruit: “I now live in the shadow of Abraham!” He notes that, instead of the eight or nine graduating students who typically choose a career in internal medicine over other specialties, this year 21 students out of 90 made that choice.

ONE TUESDAY as Verghese led students on weekly rounds, they entered a hospital room where an elderly woman lay moaning, her eyes closed, her mouth open. Her husband, wearing a blue baseball cap and an exhausted look, sat in a chair at the foot of her bed, eyes fixed on her face for any signs she might respond.

“Come closer, she won’t bite,” Verghese called to his students, who hung back by the door while he greeted the man in the cap. “He won’t bite either.”

Verghese examined the patient, ending by lifting her arms and noting the very different rate at which her hands drifted down the sheets. At the small hospital where she’d first been hospitalized, a central venous catheter had been placed in the course of treating her for a possible infection. In transferring her to Stanford, there had been talk of an exotic diagnosis. But Verghese’s exam suggested she had suffered a stroke. When questioned, her husband recalled that she had become confused on the afternoon when the catheter was inserted. Verghese postulated that event had triggered a “cascade of catastrophes”: a drop in pressure, along with her history of irregular heart rhythms, had caused a clot to break loose and disrupt blood flow to the brain.

Verghese explained his concern to the husband in understandable terms, and said that he hoped to have more news later after getting the results of a brain scan. He asked where the family was staying and whether they were comfortable.

In another room, a white-haired woman with pneumonia eyed the gaggle of students, interns and residents with bright-eyed good humor, even as her grown daughter immediately launched into a litany of complaints about the room and the hospital care. Verghese took these complaints for what they were: a caring daughter’s anxiety over her mother’s illness. He moved right up to his patient, put his hand on her thin wrist, percussed her back and listened to her chest with his stethoscope. He left his hand lightly resting on her arm. “There’s something very comforting about the human hand. That’s very nice,” the patient commented.

‘Modern training “takes lovely people and converts them into bottom-line, somewhat cynical, disease-oriented people”’

Verghese smiled. “I’m trying to teach them that,” he said, and turned to his students: “I always take a patient’s hand and then pulse.” He told the ill woman that she looked as if she’d been getting plenty of fluids.

“Oh, good,” she said, laughing, “keep me up!” She raised her arms to indicate he’d lifted her spirits. Her daughter continued to ask questions, but seemed more relaxed. Before leaving, Verghese told the woman in the bed not only that he’d like to send her home, but that she was lucky to have a daughter who took such good care of her.

Before rounds ended, the students gathered around Verghese in the hall and talked about a patient who seemed better but whose CT scan looked worrisome. Verghese reassured them that in this case they could trust their observations. He praised a nurse who stopped to ask about a patient. “That was good nursing care,” he said. “We appreciate that care.” He singled out an intern who’d received a compliment from a patient for smiling and being helpful in the emergency room the night before.

The students trooped after Verghese to radiology to look at the brain scans of the nonresponsive woman they saw earlier. Sure enough, the radiologist pointed out evidence of small bleeds in her brain.

When Verghese and one resident returned to give the husband this news, the man in the blue baseball cap was exactly where they’d left him, at the foot of his wife’s bed and staring at her face. Verghese explained that the MRI seemed to confirm his suspicion that she had suffered a series of small strokes. He would ask the neurologists for some help, Verghese said, but he thought there was a chance the man’s wife would gain back a good part of her function. “One day at a time,” he told the husband, who clung to each word as hard as he was grabbing onto Verghese’s hand. Each day would bring a little more information. Verghese took time to thank the man for describing how his wife became unresponsive, and said the information had played an important role in leading them to their diagnosis. In a way, Verghese had welcomed the husband to the team, and invited him to be part of her healing, even while delivering bad news.

On the walk back to his office—the official one at the department of medicine—Verghese once more expressed his amazement at where he, the perennial outsider, had landed. Directly in Mecca. The trade-off he made decades ago, to spend whatever time he didn’t spend at the bedside writing, brought him here. A career trajectory no one could dream, let alone plan.

At Stanford, Verghese started out feeling as if he didn’t fit in, even though he found everyone extremely welcoming. But then he walked out into the hospital and led his first rounds. He felt immediately at home at patients’ bedsides. That was the evening Verghese told his wife: not only did he feel comfortable at Stanford, he knew he had something to offer.

Men’s Group: The Good Samaritan February 11, 2009

Then an expert in Moses’ Teachings stood up to test Jesus. He asked, “Teacher, what must I do to inherit eternal life?” Jesus answered him, “What is written in Moses’ Teachings? What do you read there?” He answered, “‘Love the Lord your God with all your heart, with all your soul, with all your strength, and with all your mind.’ And ‘Love your neighbor as you love yourself.'” Jesus told him, “You’re right! Do this, and life will be yours.” But the man wanted to justify his question. So he asked Jesus, “Who is my neighbor?” Jesus replied, “A man went from Jerusalem to Jericho. On the way robbers stripped him, beat him, and left him for dead. “By chance, a priest was traveling along that road. When he saw the man, he went around him and continued on his way. Then a Levite came to that place. When he saw the man, he, too, went around him and continued on his way. “But a Samaritan, as he was traveling along, came across the man. When the Samaritan saw him, he felt sorry for the man, went to him, and cleaned and bandaged his wounds. Then he put him on his own animal, brought him to an inn, and took care of him. The next day the Samaritan took out two silver coins and gave them to the innkeeper. He told the innkeeper, ‘Take care of him. If you spend more than that, I’ll pay you on my return trip.’ “Of these three men, who do you think was a neighbor to the man who was attacked by robbers?” The expert said, “The one who was kind enough to help him.” Jesus told him, “Go and imitate his example!” (Luke 10:25-37 GW)

 

Who do you most identify with in this story and why?

 

Have you ever felt like or been the man on the street?

 

What are the barriers to helping the man on the street?

 

Have you ever been too busy to help someone?

 

Is our decision to help someone determined more by our character or by our circumstances?[1]

 

What can we do to better prepare ourselves to be a good neighbor?

 

How can we ‘go and imitate [the good Samaritan’s] example’? [2],[3]

 


[2] “God does not demand of me that I accomplish great things.  He does demand of me that I strive for excellence in my relationships.”-Ted W. Engstrom, The Making of a Christian Leader, 81

[3] Luke 10:37

How can we improve the Emergency Room Experience

This is a VERY informative interview by a patient who came into an emergency room with chest pain.  We as care givers have a lot to learn.

  • TELL our patients what we are doing; what are the tests we are doing for?
  • UPDATE our patients periodically with results
  • SEND them home with what we think they might have wrong and what we think they don’t have wrong
  • DON’T take so long to discharge our patients….WAITING time is always stressful and agrevating to our patients
  • LISTEN to our patients carefully and make sure that they can’t LISTEN in to our casual conversations

Purple People

“Now tell me again who is blue and who is red?”

Racist, stupid, bigoted, evil….these are some of the words used to describe ‘us’ by ‘them’.

Intolerant, arrogant, angry, blind….these are some of the words used to describe ‘them’ by ‘us’.

Something has gone terribly wrong here.

We worship a God who is BIGGER than ALL of THAT!

We follow a God who became a man who was beaten, whipped, tortured, mocked by the ruling government of his day.

We cherish the LOVE of a God who was mocked by guards who made him wear a robe that symbolized royalty, KINGSHIP as they laughted and scorned and cried out, “King of the Jews! Ha Ha Ha!”

The robe he wore was PURPLE: The color of KINGSHIP.

We are NOT blue; we are NOT red.  We ARE the PURPLE people.  We follow and worship the God in the PURPLE robe who loves each of us as if we are the ONLY person in the universe.

Share with us your comments after you listen to Rob Bell’s teaching titled: Beware the Dogs and Greg Boyd’s teaching titled: Defying Tanks.  These are 2 of the MOST challenging sermons that I have heard.  After you listen, PLEASE share your thoughts on some practical and specific ways that we can transform our world!

Vital Signs of Healing: VALUE-Are You Enough? Lecture

Please enjoy a brief lecture on the Vital Signs of Healing: VALUE asking the age old question are you enough?

There are 4 books that I mention during this lecture:

How to Win Friends and Influence People by Dale Carnegie

The Return of the Prodigal Son by Henri Nouwen

The 5 Love Languages by Gary Chapman

The Bible

Vital Signs of Healing: VALUE-Are You Enough? Q&A

This is the GREAT discussion time that we had concerning VALUE.  Join us! Share with us YOUR answers and please leave us a comment below.

The Vital Signs of Healing: VALUE handout: vital signs of healing: value

Here is a brief list of YOUR answers to this VITAL question:

What are some ways that we can show our patients that we think that they have value or that we think that they are ‘enough’?

  • put yourself at their level
  • eye contact
  • show kindness and help out even when it is not your patient
  • do a little extra if you see a need
  • getting to know them beyond their chief complaint
  • communicate consistency between the doctor and the nurse
  • not about you
PLEASE share with us YOUR answers by posting a comment below. THANKS for joining us!