proud of my alma mater (x2)

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opinion

This weekend marked the culmination of my graduate education as I accepted my Masters in Public Health degree from my undergrad alma mater, Boston University.  The university hosted its campus wide graduation ceremony on Sunday, with keynote speaker and founder of Teach For America Wendy Kopp and honorary degree recipients Morgan Freeman and Boston Mayor Tom Menino.

With nearly 6,700 graduates, Boston University’s commencement ceremony is the city’s largest each year.  On such a joyous occasion, President Robert Brown stopped and reflected on what has been a trying year for the university.  Since last spring, Boston University has lost 11 students in a series of tragedies including an apartment fire, a biking accident, and the Boston Marathon bombings.  Each of these tragedies struck hard for a large urban school that often lacks the sense of community feeling that is far more common for smaller colleges and universities with a backdrop of rolling green hills and ivy-covered halls.

I’m incredibly proud of my alma mater for awarding posthumous degrees to two of those students who would have graduated this year.  A world class move Boston University; classy indeed.

#truth

The arc of the moral universe is long, but it bends toward justice

“Healing Our City” Interfaith Speech by President Barack Obama

Hello, Boston. Scripture tells us to run with endurance the race that is set before us. Run with endurance the race that is set before us.

On Monday morning, the sun rose over Boston. The sunlight glistened off the State House Dome. In the commons, in the public garden, spring was in bloom. On this Patriot’s Day, like so many before, fans jumped onto the T to see the Sox at Fenway. In Hopkinton, runners laced up their shoes and set out on a 26.2-mile test of dedication and grit and the human spirit.

And across this city, hundreds of thousands Bostonians lined the streets to hand the runners cups of water, to cheer them on. It was a beautiful day to be in Boston, a day that explains why a poet once wrote that this town is not just a capital, not just a place. Boston, he said, is the perfect state of grace.

And then, in an instant, the day’s beauty was shattered. A celebration became a tragedy. And so we come together to pray and mourn and measure our loss. But we also come together today to reclaim that state of grace, to reaffirm that the spirit of this city is undaunted and the spirit of the country shall remained undimmed.

To Governor Patrick, Mayor Menino, Cardinal O’Malley and all the faith leaders who are here, governors Romney, Swift, Weld and Dukakis, members of Congress, and most of all, the people of Boston and the families who’ve lost a piece of your heart, we thank you for your leadership. We thank you for your courage. We thank you for your grace.

I’m here today on behalf of the American people with a simple message. Every one of us has been touched by this attack on your beloved city. Every one of us stands with you. Because, after all, it’s our beloved city, too. Boston may be your hometown but we claim it, too. It’s one of America’s iconic cities. It’s one of the world’s great cities. And one of the reason(s), the world knows Boston so well is that Boston opens its heart to the world.

Over successive generations, you’ve welcomed again and again new arrivals to our shores; immigrants who constantly reinvigorated this city and this commonwealth and our nation. Every fall, you welcome students from all across America and all across the globe. And every spring, you graduate them back into the world — a Boston diaspora that excels in every field of human endeavor.

Year after year, you welcome the greatest talents in the arts, in science, research. You welcome them to your concert halls and your hospitals and your laboratories to exchange ideas and insights that draw this world together.

And every third Monday in April, you welcome people from all around the world to the hub for friendship and fellowship and healthy competition — a gathering of men and women of every race and every religion, every shape and every size — a multitude represented by all those flags that flew over the finish line.

So whether folks come here to Boston for just a day, or they stay here for years, they leave with a piece of this town tucked firmly into their hearts. So Boston’s your home town, but we claim it a little bit too. I know this — I know this because there’s a piece of Boston in me. You welcomed me as a young law student across the river — welcomed Michelle too. You welcomed me — you welcomed me during a convention when I was still a state senator and very few people could pronounce my name right.

Like you, Michelle and I have walked these streets. Like you, we know these neighborhoods. And like you, in this moment of grief, we join you in saying: Boston, you’re my home. For millions of us, what happened in Monday is personal. It’s personal.

Today our prayers are with the Campbell family of Medford. They’re here today. Their daughter Krystle was always smiling. Those who knew her said that with her red hair and her freckles and her ever-eager willingness to speak her mind, she was beautiful, sometimes she could be a little noisy, and everybody loved her for it. She would have turned 30 next month. As her mother said, through her tears, this doesn’t make any sense.

Our prayers are with the Lu family of China, who sent their daughter Lingzi to BU so that she could experience all that this city has to offer. She was a 23-year-old student, far from home. And in the heartache of her family and friends on both sides of the great ocean, we’re reminded of the humanity that we all share.

Our prayers are with the Richard family of Dorchester, to Denise and the young daughter Jane, as they fight to recover. And our hearts are broken for 8-year-old Martin, with his big smile and bright eyes. His last hours were as perfect as an 8-year-old boy could hope for, with his family, eating ice cream at a sporting event. And we’re left with two enduring images of this little boy, forever smiling for his beloved Bruins and forever expressing a wish he made on a blue poster board: No more hurting people. Peace. No more hurting people. Peace.

Our prayers are with the injured, so many wounded, some gravely. From their beds, some are surely watching us gather here today. And if you are, know this: As you begin this long journey of recovery, your city is with you. Your commonwealth is with you. Your country is with you. We will all be with you as you learn to stand and walk and, yes, run again. Of that I have no doubt. You will run again. You will run again because that’s what the people of Boston are made of.

Your resolve is the greatest rebuke to whoever committed this heinous act. If they sought to intimidate us, to terrorize us, to shake us from those values that Deval described, the values that make us who we are as Americans, well, it should be pretty clear by now that they picked the wrong city to do it. Not here in Boston. Not here in Boston.

You showed us, Boston, that in the face of evil, Americans will lift up what’s good. In the face of cruelty, we will choose compassion. In the face of those who would visit death upon innocents, we will choose to save and to comfort and to heal. We’ll choose friendship. We’ll choose love. Because Scripture teaches us God has not given us a spirit of fear and timidity, but of power, love and self-discipline.

And that’s the spirit you’ve displayed in recent days. When doctors and nurses, police and firefighters and EMTs and guardsmen run towards explosions to treat the wounded, that’s discipline. When exhausted runners, including our troops and veterans, who never expected to see such carnage on the streets back home, become first responders themselves, tending to the injured, that’s real power. When Bostonians carry victims in their arms, deliver water and blankets, line up to give blood, open their homes to total strangers, give them rides back to reunite with their families, that’s love.

That’s the message we send to those who carried this out and anyone who would do harm to our people. Yes, we will find you. And yes, you will face justice. We will find you. We will hold you accountable. But more than that, our fidelity to our way of life, for a free and open society, will only grow stronger, for God has not given us a spirit of fear and timidity, but one of power and love and self-discipline.

Like Bill Ifrig, 78 years old — the runner in the orange tank top who we all saw get knocked down by the blast, we may be momentarily knocked off our feet — but we’ll pick ourselves up. We’ll keep going. We will finish the face.

In the words of Dick Hoyt, who has pushed his disabled son Rick in 31 Boston marathons, we can’t let something like this stop us. This doesn’t stop us. And that’s what you’ve taught us, Boston. That’s what you’ve reminded us, to push on, to persevere, to not grow weary, to not get faint even when it hurts.

Even when our heart aches, we summon the strength that maybe we didn’t even know we had, and we carry on; we finish the race. We finish the race, and we do that because of who we are, and we do that because we know that somewhere around the bend, a stranger has a cup of water. Around the bend, somebody’s there to boost our spirits. On that toughest mile, just when we think that we’ve hit a wall, someone will be there to cheer us on and pick us up if we fall. We know that.

And that’s what the perpetrators of such senseless violence, these small, stunted individuals who would destroy instead of build and think somehow that makes them important — that’s what they don’t understand.

Our faith in each other, our love for each other, our love for country, our common creed that cuts across whatever superficial differences there may be, that is our power. That’s our strength. That’s why a bomb can’t beat us. That’s why we don’t hunker down. That’s why we don’t cower in fear.

We carry on. We race. We strive. We build and we work and we love and we raise our kids to do the same. And we come together to celebrate life and to walk our cities and to cheer for our teams when the Sox, then Celtics, then Patriots or Bruins are champions again, to the chagrin of New York and Chicago fans. The crowds will gather and watch a parade go down Boylston Street. And this time next year on the third Monday in April, the world will return to this great American city to run harder than ever and to cheer even louder for the 118th Boston Marathon.

Bet on it.

Tomorrow the sun will rise over Boston. Tomorrow the sun will rise over the — this country that we love, this special place, this state of grace. Scripture tells us to run with endurance the race that is set before us. As we do, may God hold close those who’ve been taken from us too soon, may he comfort their families and may he continue to watch over these United States of America.

Boston Interfaith Service Speech by Governor Deval Patrick

In my faith tradition, scripture teaches: “In every thing give thanks.” (I Thessalonians 5:18) That isn’t always easy to do. On Monday afternoon, I wasn’t feeling it. What I felt, what so many of us felt then, was shock and confusion and anger.

But the nature of faith, I think, is learning to return to the lessons even when they don’t make sense, when they defy logic. And as I returned to those lessons this week, I found a few things to be thankful for.

I’m thankful for the firefighters and police officers and EMTs who ran towards the blasts, not knowing whether the attack was over – and the volunteers and other civilians who ran to help right along side them.

I’m thankful for the medical professionals — from the doctors and trauma nurses to the housekeeping staff, to the surgeon who finished the marathon and kept on running to his operating room — all of whom performed at their very best.

I’m thankful for the agents from the FBI and the ATF, for the officers from the State Police and Boston PD, for the soldiers from the National Guard and all the other law enforcement personnel who both restored order and started the methodical work of piecing together what happened and who’s responsible.

I’m thankful for Mayor Menino, who started Monday morning frustrated he couldn’t be at the finish line this time, as he always is, and then late that afternoon checked himself out of the hospital to help his city, our city, face down this tragedy.

I’m thankful for those who have givenblood to the hospitals, money to the OneFund, and prayers and messages of consolation and encouragement from all over the world.

I’m thankful for the presence and steadfast support of the President and the First Lady, our former governors, the civic and political leaders who are here today, and for the many, many faith leaders who have ministered to us today and in the days since Monday.

I’m thankful for the lives of Krystle and Lingzi and little Martin, and for the lives of the families who survive them, and for the lives of all the people hurt but who still woke up today with the hope of tomorrow.

And I am thankful, maybe most especially, for the countless numbers of people in this proud City and this storied Commonwealth who, in the aftermath of such senseless violence, let their first instinct be kindness. In a dark hour, so many of you showed so many of us that “darkness cannot drive out darkness,” as Dr. (Martin Luther) King said. “Only light can do that.”

How very strange that the cowardice unleashed on us should come on Marathon day, on Patriots’ Day, a day that marks both the unofficial end of our long winter hibernation and the first battle of the American Revolution. And just as we are taught at times like this not to lose touchwith our spiritual faith, let us also not lose touch with our civic faith.

Massachusetts invented America. And America is not organized the way countries are usually organized. We are not organized around a common language or religion or even culture. We are organized around a handful of civic ideals. And we have defined those ideals, through time and through struggle, as equality, opportunity, freedom and fair play.

An attack on a civic ritual like the Marathon, especially on Patriots’ Day, is an attack on those values. And just as we cannot permit darkness and hate to triumph over our spiritual faith, so we must not permit darkness and hateto triumph over our civic faith. That cannot happen. And it will not.

So, we will recover and repair. We will grieve our losses and heal. We will rise, and we will endure. We will have accountability, without vengeance. Vigilance, without fear.And we will remember, I hope and pray, long after the buzz of Boylston Street is back and the media has turned its attention elsewhere, that the grace this tragedy exposed is the best of who we are.

To and From Boston, With Love

It was a beautiful spring day, long deserved after a brutal winter.  It was the perfect day for reenacting history, for a baseball game, and for a celebration of athletic prowess and endurance.

I have lived in Boston for nine years now, having spent four years of my late adolescence, as do so many in this city, attending one of its many fine institutions of higher learning.  Celebrating Marathon Monday remains one of my fondest memories from those years.  Standing on the streets of our city next to friends, neighbors, and strangers alike, cheering on runners from around the world.  Marathon Monday is a day when college rivalries dissolve, and Red Sox and Yankees fans stand next to one another, offering ‘high-fives’ to people facing the holy grail of athleticism head on.  It is a day where the people of Boston remember why we love this town so much.

For a single day each year, the world focuses its attention on our beautiful city.  And it is a limelight in which we revel.  We are not a London or Paris or New York City; the spotlight does not always shine on us.  We are a small city, but we are an intensely proud one.  We are a city of academics and students, doctors and nurses, lawyers and judges, athletes and champions.  We are a city that has faced adversity in the past – the Boston Marathon is run on the very day commemorating the brave patriots who fought British aggression on the battlefields outside of Lexington and Concord.  We are a city that mourned with our fellow Americans on 9/11, saddened further that our fair city was the origin for two of those doomed flights.  We are a city with a storied past, a history well known.

To all of the first responders – police, firefighters, doctors, nurses, paramedics, and EMTs, we thank you from the bottom of our hearts for your courage and diligence.  To the runners who finished the race and turned back to help or ran to local hospitals to donate blood – you truly are superhuman.  To the citizens of our city who opened up their hearts and homes, thank you for showing the world what Boston is truly all about.  And to the families that are mourning – know that we are hurting with you.

To the person or persons who perpetrated this cowardly act, you have messed with the wrong town.  You have gravely miscalculated how our city responds to violence that kills and injures innocent bystanders, especially when it comes to our children.  For when you perpetrate acts of terror against Boston, you are dealing not only with our city but with all of New England.  One only need to hear a speech from our mayor or attend a Boston sporting event to know that we proudly and fiercely defend her.  We are a town that does not easily forgive and never forgets.  We may talk a lot of trash in this town, but trust and believe that our bark is nowhere near as bad as our bite.

No single person can adequately describe yesterday’s events, and sometimes pictures do speak volumes.  The links below are from various writers and articles on the day’s events.  And they are each beautiful in their own way.

A perfect day, and then the unimaginable – The Boston Globe

Boston’s beloved day – The Boston Herald

If you are losing faith in human nature, go out and run a marathon – The Washington Post

Unbelievable Acts of Kindness – BuzzFeed

29 Reasons to Love Boston – BuzzFeed

So Close, Yet So Far – Amby Burfoot

Nurses rely on trauma experience to help wounded – CNN

Love to Boston

We are Bostonians, we are New Englanders – whether native or import.  We are a strong, tough, resolute and resilient breed of Americans.  Bostonians have faced adversity in the past, and we shall meet this challenge head on.  Together.  We will not stand for those who disrupt an event celebrating athleticism and endurance, an event that draws people together from around the world.  United we stand.

Humanity in medicine, part 2

As a follow up to yesterday’s post on humanity in medicine, I’ll refer you to this article in the New York Times WellBlog section written by medical student Dhruv Khullar.  The quote below is fairly powerful – and I believe it would strike a chord with anyone who works in healthcare.

Like many of my classmates, I entered medical school with an idealized notion of medicine. But I will leave with the knowledge that the reality is far more complex. There are patients who don’t listen, who can’t listen; who try, who don’t try; who smile, thank and love; who steal, curse and hate. Each of these patients deserves the full extent of our respect and abilities. But too often those most in need of our compassion are least likely to receive it.

The balancing of complex emotions, time constraints and limited resources will only become more difficult with the influx of millions of previously uninsured people into our medical system. As we continue to carry out the Affordable Care Act and enter an era of tremendous change, we must confront our natural tendencies to favor patients we find pleasant — especially when it comes at the expense of those we find less so. We must recognize that sometimes the patients who behave the worst are those who are hurting the most.

growing up alone

Tags

gay, overread

In his book, Beyond Queer, Bruce Bower includes a speech from 1994 that he gave to the Saint Johns Episcopal Cathedral in Denver, Colorado in an effort to help straight parishioners to better understand the issues surrounding homosexuality.  In the essay, he recounts the story of a teenage boy standing alone at the magazine rack in a bookstore in New York City, a boy who timidly approaches and then in secret feverishly devours the contents of the New York Native.  Bawer questions what he may have found and therefore thought of gay life in the early 90′s, and laments that he did not talk to this boy about the reality.  Bawer notes that many gay readers responded strongly to this anecdote, and a few straight readers have protested that this was similar to when they read Playboy for the first time.  Below is Bawer’s response to these critics about the terrible isolation felt by so many who grow up gay.

A straight kid is surrounded by images of what it means to be straight, surrounded by potential role models.  His parents, his parents’ friends, the couples on TV shows and in movies, the relationships that are sung about on the radio and MTV, the family situations in the stories and books that he’s given to read in school.  His inner sense of himself, or his sexual identity, is reflected all around him in a spectrum of images of which Playboy is only one extreme.  For a gay kid, things are utterly different.  It’s not easy to explain how different it is, and how it feels.  To be a gay kid in most families is to grow up very confused.  It’s to find an utter contradiction between your very powerful but unarticulated inner sense of who you are and the notions of who you are that are communicated to you by your parents and other peopl ein your life and in fact by the whole world.  It’s to look around and see all of these images of men and women sharing their lives together and being intimate, and to feel an utter lack of identification with those images.  From infancy onward, your parents assume you’re straight.  It’s expected that when you reach a certain age you’ll want to start dating someone of the opposite sex; everybody asks what kind of girl you like and if you have a girlfriend.  And somehow, even if you haven’t figured it out yet and connected who you are with that funny word gay, it all feels wrong, as if somehow you’d been set down on the wrong planet.

For too many gay kids, there’s no one in their lives to make them feel right.

Profiles of Love

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gay

I’m down in New York City this weekend, visiting friends and taking in the city’s St Patrick’s Day festivities.  I have the pleasure of staying with two very close friends of mine who happen to be recently engaged.  The combination of Valentine’s Day merely a month ago and my friends recently becoming engaged makes me think about love, that enigmatic emotion and feeling that we as human beings all ultimately strive for.  Never having been in love myself – that I know of – I decided to ask various couples I know what love meant to them and how long it was after they started dating their significant other that they knew they were in love.

I hadn’t intended for us to be in a relationship.  But as we started to get to know each other, I knew that our connection – whatever it maybe – was special. I fall in love with him everyday, and that’s how I know that I love him.

warm fuzzies; unexplained giddiness. It’s not always easy, and long term takes work, but the heightened emotions can come pretty quickly and pretty early on.

I guess I knew because the thought of him not in my life, and possibly in someone else’s, disturbed me greatly.

I’d say it was 3 months or so. It was a feeling that came out verbally when we were talking, and I guess I just knew. And there are ups and downs. So if on one day I feel totally in love and the next day I don’t, I trust both as completely normal, and realize that love is like that. But at least for me, it is something I just know in my gut.

The last quote came from one of my recently engaged friends, and the idea that love can be there one moment and gone the next was surprising to me.  What may be surprising to you is that all of these quotes came from men, and more than that from gay men.  The point here is that love is universal.  Love does not care if you are white or black, gay or straight, Jewish or Catholic.  Love does not judge us or cast us out for being different.  Love crosses – no smashes – through boundaries;  language, religious, cultural, and ethnic barriers on which we as human beings often place far too much emphasis.  At our core, every human being strives to achieve love, and there is no choice in that matter.  We do not choose to love or choose who we love.  We just do.

Remembrance and Recovery

Saturday, January 12th marked the 3rd anniversary of the devastating magnitude 7.0 earthquake that struck Haiti at 4:53pm.  The epicenter of that earthquake was in the town of Leogane, approximately 16 miles southwest of Port-au-Prince.  Two weeks later, over 50 aftershocks reaching a magnitude 4.5 or greater had been recorded.  Much of Port-au-Prince was damaged or leveled.

Saturday, January 12th 2013 became a day of remembrance for those of us working at St Luke’s, St Damien’s and FWAL.

The day started with the children who live at the orphanage at FWAL walking in a processional from the orphanage to the chapel at St. Damien’s.  When mass began, Father Rick delivered the mass mostly in Creole but recited portions of the mass in English and Italian as well.  I was somewhat surprised to see that this would not be a funeral mass as no bodies or caskets were present.  It turned out, I was wrong.

For the second morning in a row, we had an unexpected arrival of a casket.  My initial reaction was “this seems cruel in front of all of these children”.  Thinking about it later, I realized many of these children have already experienced death and loss all too early in their lives.  The family was also present this time, so the mass turned from a remembrance mass into a funeral service.  However, Father Rick’s homily centered almost entirely around the anniversary of the earthquake.

Father Rick’s homily was great, but there was a particular moment that I found fascinating.  He began discussing the chapel.  On one side of the chapel, there are five crosses, dedicated to five nuns who died in the earthquake at the original St. Damien’s in Petionville.  On the other side of the chapel, the first five victims of the cholera epidemic are buried.  These ten individuals are a constant reminder of how much has changed in Haiti since the earthquake.  The sisters were buried at the chapel because their mother house had also been destroyed during the earthquake.

Outside of the chapel is a large bell (it honestly looks like the Liberty Bell), that was recovered from the mother house of the sisters that worked in Petionville.  The bell was brought to St Damien’s for safe keeping, so that looters would not steal the bell, and remains sitting on the ground.  The bell serves as a silent reminder of all those that died in the earthquake, and will be returned to the sisters once their order has been restored.  Finally, Father Rick turned to the church itself and noted that the church itself is broken and on crutches.

Although it’s not obvious, the mural in the back of the chapel, which seems to integrate so well into the rest of the chapel, is actually not painted on stone but rather on wood.  During the earthquake, the rose window and the back of the chapel suffered significant damage.  Wooden buttresses were used to support the church for quite some time, until this solution was devised.  And what Father Rick then said was absolutely incredible to me.  With so many people in the country left homeless, the chapel would not be rebuilt until everyone in Haiti has a home.  The broken chapel serves as a reminder that there is much more work to be done, that the promised recovery has yet to fully materialize.

Following mass at St. Damien’s, we ventured into Port-au-Prince to attend a national remembrance mass outside of the old Cathedral.  This was really our first view of “downtown” Port-au-Prince.  Chaotic would be an understatement.  We definitely saw some tent cities on our drive. 

When we finally arrived at the Cathedral, there were hundreds of Haitians attending the mass.  My understanding is that the Cathedral won’t be rebuilt, but is to serve as a lasting testament to the destructive power of Mother Nature.  I have to admit, there was something enormously beautiful about the remains of the former Cathedral.  You could tell that it was once a magnificent structure, reduced to a shadow of it’s former self by the earthquake.  But here, in the spiritual center of Port-au-Prince, were a people gathered together to remember a horrific day and to continue on the long road of recovery.

the marriage question

Tags

family, gay, opinion

In light of all the debate around DADT & marriage equality, the results from the most recent election in Maine, Washington, Maryland, and Minnesota, as well as President Obama’s inauguration speech, I want to leave you all with an excerpt from Bruce Bawer’s book Beyond Queer, which contains a piece from author Andrew Sullivan, former editor of the New Republic.  This excerpt appeared in the piece “The Politics of Homosexuality” which he wrote for the New Republic on May 10, 1993.

But the critical measure necessary for full gay equality is something deeper and more emotional perhaps than even the military.  It is equal access to marriage.  As with the military, this is a question of formal public discrimination.  If the military ban deals with the heart of what it is to be a citizen, the marriage ban deals with the core of what it is to be a member of civil society.  Marriage is not simple a private contract; it is a social and public recognition of a private commitment.  As such, it is the highest public recognition of our personal integrity.  Denying it to gay people is the most public affront possible to their civil equality.

This issue may be the hardest for many heterosexuals to accept.  Even those tolerant of homosexuals may find this institution so wedded to the notion of heterosexual commitment that to extend it would be to undo its very essence.  And there may be religious reasons for resisting this that require far greater discussion than I can give them here.  But civilly and emotionally, the case is compelling.  The heterosexuality of marriage is civilly intrinsic only if it understood to be inherently procreative; and that definition has long been abandoned in civil society.  In contemporary America, marriage has become a way in which the state recognizes an emotional and economic commitment of two people to each other for life.  No law requires children to consummate it.  And within that definition, there is no civil way it can logically be denied homosexuals, except as a pure gesture of public disapproval.

In the same way, emotionally, marriage is characterized by a kind of commitment that is rare even among heterosexuals.  Extending it to homosexuals need not dilute the special nature of that commitment, unless it is understood that gay people, by their very nature, are incapable of it.  History and experience suggest the opposite.  It is not necessary to prove that gay people are ore or less able to form long-term relationships than straights for it to be clear that, at least, some are.  Giving these people a right to affirm their commitment doesn’t reduce the incentive for heterosexuals to do the same, and even provides a social inventive for lesbians and gay men to adopt socially beneficial relationships.

But for gay people, it would mean far more than simple civil equality.  The vast majority of us – gay and straight – are brought up to understand that the apex of emotional life is found in the marital bond.  It may not be something we achieve, or even ultimately desire, but its very existence premises the core of our emotional development.  It is the architectonic institution that frames our emotional life.  The marriages of others are a moment for celebration and self-affirmation; they are the way in which our families and friends reinforce us as human beings.  Our parents consider our emotional lives to be more important than our professional ones, because they care about us at our core, not at our periphery.  And [therefore] it is not hard to see why the marriage of an offspring is often regarded as the high point of any parent’s life.

a feeling of frustration

January 11th turned out to be a rather hectic day for us in Haiti.  As the next day was the anniversary of the earthquake, Friday would be our last full day at the hospital.  After morning mass, we traipsed over to St. Luke’s and began seeing clinic patients.  I’d like to think we helped streamline things a little more that morning.  Previously, clinic patient would show up, proceed to the triage nurse, and have their vitals taken one by one.  This day, we trialed a new way of taking vitals by going down the line and writing everyone’s vitals down on a piece of paper.  From what I was told, it seemed like a more efficient process.  In the meantime, I was seeing a variety of “surgical” patients, which would ultimately prove to be rather frustrating.

The first patient that came to see me was an elderly gentleman.  I asked one of our interpreters why he was in the clinic, and I was informed that he needed prostate surgery.  My first thought should have been “he’s in the wrong place for that” but I think I instantaneously blurted out “why?”.  In retrospect that seems like a reasonable question, although my delivery probably was not the best.  My question was answered with a very long conversation between the patient and the interpreter in Creole (yet another reason I need to learn Creole)… strangely the answer was a simple “he has an enlarged prostate”.

This is perhaps where my frustration began.  What should have been a rather simple conversation ended up taking a very long time.  Rather that tell more of a story, this elderly gentleman required directed questions.  So we painstakingly went down the line:

How do you know you have an enlarged prostate? “I was seen at the l’Hopital de l’Université d’Etat d’Haiti” (l’Hopital Generale or General Hospital)

 

Do you have prostate cancer? “No, I had biopsies done at the General Hospital.” (from what I had heard about the l’Hopital General, I was both surprised and skeptical.)

 

And what did they tell you about your prostate? “That the biopsies were negative, that I would need surgery but it wasn’t an emergency so they wouldn’t do it at the General Hospital.”

 

Did they start you on any medication? “No, they told me it wasn’t an emergency.”

 

So at this point I basically knew my patient presumably had benign prostatic hypertrophy (BPH) or an enlarged prostate.  We then went down the whole litany of questions about symptoms (do you have trouble urinating, do you have a weak stream, do you wake up in the middle of the night needing to urinate, do you leak urine every so often, burning with urination, etc) as well as general symptoms, medications and the such.

At some point during my history taking/investigation/interrogation, I sat back and sighed deeply.  Despite a diagnosis of BPH, this man had never been started on therapy.  He sat before me now after months of straining to urinate, which he now reported burning.  He more than likely needed a TURP (transurethral resection of the prostate – think of it like a roto-rooter).  At which point, I became even more frustrated because so many things were not right here.  For one, despite having a limited knowledge of urology from my medical school days, I was not even remotely qualified to take care of this man.  The fact that he had erroneously ended up at St. Luke’s for surgical consultation was extremely worrisome, and the fact that no trial of medication to relieve his symptoms or slow the growth of his prostate had ever been attempted was disheartening.  Whether he could afford them or not wasn’t the issue – they simply had not been offered.

I then realized that my hands were slightly tied.  I sent him to the lab to test his urine for a possible urinary tract infection, although I admit that I started him on an oral antibiotic anyway just in case.  I consulted with Dr. Augustine and we ultimately decided to start him on Flomax (we figured the alpha blocker could also help his elevated blood pressure).  I wasn’t really comfortable starting him on Avodart or Proscar without knowing that he would have regular follow up.  Ultimately, I had to refer him back to the General Hospital in order to get surgery.

As he walked away, I realized this was the first time I had become frustrated while in Haiti.  Frustrated with not having everything at my finger tips.  But more so frustrated at giving this man what I would consider sub-standard care if we had been in the United States.  And quite frankly, sub-standard care regardless of where we were from a physician without enough knowledge to adequately treat this man.  And for the first time I was scared.  Scared that he would not be able to afford the Flomax, scared that he wouldn’t go to the General Hospital for the treatment he would clearly need.  Scared that his urinary symptoms would get to the point where they were an emergency, and worried that he might not seek medical attention.

I went to church that night, as Father Rick was holding vespers.  To be completely honest, I had no idea what that meant (vespers is a sunset prayer service that is traditional to Catholic, Eastern Orthodox, and some Protestant sects) but for some reason it felt right after a long, gritty, frustrating day that also included cleaning and organizing the entire wound care area.

Unexpected Arrival

A note: some may find this post upsetting.  Know that is not my intent, but on some level what you are about to read should upset you.

The mass on the morning of Friday, January 11th started like any other mass we attended in Haiti.  This morning’s mass would also be a funeral mass.  However, despite the two bodies that lay in the chapel before us, the congregation at Friday’s mass consisted entirely of Italians and Americans.  Father Rick took the unusual step of starting mass in English and Italian.  Admittedly, I was glad for being able to understand what was going on during mass in both English and Italian that morning.   This was also the first morning that mass was being held within the beautiful little chapel (rather than outside), and I was struck by the simple beauty of this place.

Everything changed halfway through the mass when several men from the hospital unexpectedly arrived and brought a third body into the chapel.  Several people scrambled to make room for the third “casket”.  By this point, a few locals had arrived, and Father Rick proceeded in Creole as well.  His sermon, however, he delivered in all three languages.

As I’ve mentioned before in this blog, and as several friends and family members can attest to, I am not a deeply religious person.  Father Rick’s sermon changed that for a least a little while that day.  He spoke about death – again, a topic all too familiar here in Haiti – about mourning, about the soul leaving the body and meeting God in heaven.  How in Catholic belief, the soul does not depart from the body for three days.  He pointed to the unexpected arrival of the third body (whom I’ll refer to as “A”), and described how A was likely still warm and that according to God, A was not ready for that journey to heaven.  A’s soul had not yet departed from this earth.

In the moment after Father Rick said that A’s family probably didn’t know that A had even died, I shed a tear.  To imagine that we, as complete strangers, knew of A’s death and yet her family did not felt wrong, foreign, and impossibly heart wrenching.  To know that those of us in that little chapel, completely unrelated to A, would serve as the witnesses to her funeral mass was both astonishing and upsetting.  That her family would not be able to properly mourn A’s death during mass was distressing and unfortunate.  And yet a part of me couldn’t help but wonder how commonplace an occurrence that was here.

The almost mystical and magical combination of three bodies present and three languages spoken during mass was both beautiful and overwhelming.  The rest of the mass proceeded uneventfully, until the end when the burial clothes were removed from the caskets and body bags.  Suddenly, it made sense why Father Rick read five names during the funeral blessing.  To my shock, the last body was not merely one body, but that of three small children.  Three tiny bodies that had already departed from this world.  Three small lives cut incredibly too short.  Part of me wondered if these children were better off, having potentially escaped a lifetime of hardship.  Part of me sensed the feelings of pain and anguish from my female colleagues who are themselves mothers, and I wondered where the mothers of these little ones were and why they were not present.  But most of all, my heart broke a little that day – for three mothers who had lost their precious children and for three children who would never know what amazing lives they might have lived, for the experiences they would never have, and for the impact they could have made on their communities.

I left mass that morning once again humbled by what was so tragically commonplace in Port-au-Prince, and for the lives we so easily take for granted in the United States.  And I lamented how things had turned out this way.

Angels of Light (FWAL)

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adorable

After visiting Cite Soleil, we returned to our camp and ate lunch.  Sensing that we needed something to restore our spirits, one of the other volunteers Bridget (also INCREDIBLY helpful during my time in Haiti) offered to take us over to FWAL.  I must have made the Scooby Do face because Bridget began to explain.

FWAL stands for Father Wasson Angels of Light.  The Angels of Light program began in Haiti shortly after the earthquake in 2010.  FWAL initially started in the days after the earthquake out of tents as a place for some of the children from St Damien’s to go and get away from the misery and destruction and to grab a bite to eat.  Over time, it became clear that some of these children had become orphaned by the earthquake.  The program has grown considerably during that time and now also houses an elementary school, also attended by children in the community.  Many of the kids at FWAL will eventually move to the larger orphanage in Kenscoff as they grow older.

We had a chance to take a tour and meet some of the kids at FWAL.  It was right after lunch time, so there were rambunctious.  I have to say they were very well behaved and helped clean up after lunch.  Despite their situation, they genuinely seemed incredibly happy.

The more time I spent with this organization in Haiti, the more amazed and inspired I became.  To think that just a few people put their minds together and thought – let’s create an orphanage.  But let’s not just create and orphanage, let’s give these kids an education too.  And feed them from the bakery (boulanjri) that we also run next door at Francisville.  In fact, FWAL provides a meal to every child that attends school there.  Oh, and their uniforms are also made at the “atelye” at Francisville, which employs locals to make the uniforms.  GENIUS.

Forgive me for sounding sappy, but sometimes with all of the bad news we are constantly bombarded with from the world – it’s easy to forget that there are genuinely good things happening out there too.  I left FWAL that day feeling good about everything that was happening here, helping to negate some of the sadness observed while in Cite Soleil.

Prepare for a cute bomb.

yes, those are Crocs they are wearing

 

my new friend at FWAL

these kids knew a surprising amount about iPhones

Abandoned

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adorable, opinion

After mass, we were waiting to hitch a ride to St Mary’s Clinic over in the neighborhood of Cite Soleil.  I’ll give more details about Cite Soleil in a future post, but to call it a “neighborhood” would be a stretch.  Some have described it as the worst slum in the Western Hemisphere.  If one were to google pictures of Cite Soleil – these pictures are not dramatic representations of the living conditions; they are the real deal.

While we waited, Dan offered to give us a tour of St Damien’s Hospital so we could see for ourselves just how great the facility really was.  He took us around the maternity side of the hospital first where we stopped in to see the operating rooms for labor and delivery.  Though they felt a little small and cramped, they were quite modern and impressive.  Danielle and I actually managed to sneak into a C-section that was about to be performed.

Outside of each of the operating rooms was all of the equipment needed for neonatal resuscitation as well.

Photo of two of four quadruplets delivered at St Damien’s in October 2012, photo courtesy of St Damien’s Hospital

We pressed on after the C-section, and Dan took us through both the Neonatal Intensive Care Unit as well as the Pediatric Intensive Care Unit.  I have to say, both were stunningly impressive wards that matched anything I’ve seen in the United States.  St Damien’s has one of only a handful of pediatric ICUs in Haiti and one of the only neonatal ICUs in Port-au-Prince, a stark contrast to the city Boston which has several serving a much smaller population (by comparison, Port-au-Prince contains roughly 1/3 of Haiti’s 9 million residents).

We concluded our tour by passing through the Emergency Room at St Damien’s and were almost on our way out when we heard Dan say “oh wait, we should go see the abandons!” almost as if it was an after thought.  I had a sinking feeling that I knew what Dan meant, but I imagine he gathered the somewhat bewildered look on Danielle’s face as he quickly explained that these were children who were abandoned at St Damien’s for one reason or another – either their mothers were too young to take care of them or the family was unable to afford to take care of a sick child.

Utterly heart breaking does not describe the feeling one has on hearing that children were left at a hospital because quite simply there was no way to properly care for them.  Also, the children are tucked away in a corner of the hospital in a room that looks just like every other pediatric ward in the building.  If you didnt know they were there, you would end up passing on by.  On the bright side, these children will receive amazing care at St Damien’s until they are either claimed by family or are well enough to join the nearby orphanage (also under the direction of Father Rick).  As a way to pay respect to all that Father Rick has done, the children who’s names are not known when they are abandoned at St Damien’s are named “Frechette” in Father Rick’s honor.

Walking into the room, my eye immediately caught this adorable little nugget whom I instantly wanted to adopt and take home with me.  I mean, come on – that face is priceless.

    I think she has a budding career as a model or actress because as soon as I pulled out my iPhone to take a picture, she was all smiles.  And yes, she’s cute and absolutely adorable.  Yet there is obviously more to this story than meets the eye as she after all is one of the “abandoned”.  The sad thing is I know neither her name nor her story.  But there’s something fitting to me in that lack of knowledge because in reality, she could be any child in Haiti.  To me, there doesn’t need to be a name or story to this face because whatever it is, that is her past, and sad and tragic though that past may be, her future is potentially far brighter.

I’m posting a few more pictures so prepare for a cute-bomb.

These are of Dan and Danielle with one of the many “Frechettes” that have been residents at St Damien’s over the years.  And again, though it’s sad and tragic that we may never know this girl’s real name, more importantly these kids appear to be happy, healthy, and well cared for.  And in a place where hardship is all too real, and death comes far too quickly, to be healthy, cared for and loved can only be described as priceless and divine.

Prayer

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opinion

Our second day in Haiti started a bit earlier than the first.  Bright and early before sunrise, we awoke to prepare to attend 7am mass.

Catholic tradition holds that at least one mass must be held everyday so that Catholics may receive the body and blood of Jesus Christ each day.  Upholding that tradition, Father Rick performed mass each morning that he was in Port-au-Prince at a small chapel next to St Damien’s Hospital. Mass is usually attended by many of the locals and some of the Haitian physicians; after all roughly 80% of Haitians are Catholic.  Most of the volunteers that work for NPH Haiti and the St Luke Foundation also attend mass, even if they are not Catholic.  Granted I had not been in church since Christmas Eve, but it felt like the right thing to do.

Mass in Haiti is unlike any mass I’ve ever attended, partly because it was in Creole and therefore I didn’t quite understand everything that was going on.  But the amount of joy and happiness through song was astounding, haunting and beautiful all at the same time.  Here was a group of people gathered together to give thanks to God for what they had – for what we in the United States would consider so little but to them was so much.

As it turned out, the mass on our second day in Haiti was a funeral mass.  The irony of the fact that our ICU patient had died yesterday and now lay before us was not lost on Danielle, Jamie, or me.  Nor was he alone, as several other bodies lay to either side of him.  Nor would this be the only funeral mass of the week; in fact, nearly every mass was a funeral mass.  And at some point, I was struck by the notion that though Father Rick was upholding a Catholic tradition, I wondered if he ever imagined that nearly every mass he performed in that chapel would be a mass for the dead.  For death in Haiti is all too real – where the average life expectancy is around 62 years old and extremely high infant and maternal mortality rates – and was once again all too clearly displayed in front of us.

Death, much like the births that occurred not too far away in St Damien’s Hospital, was an all too common occurrence here.  But even in death, I was amazed by the Father Rick’s selflessness.  Burying the dead is expensive in Haiti, and many of the deceased go unclaimed by family members who simply cannot afford a proper burial for their loved ones.  For by performing this mass, Father Rick wasn’t just maintaining his duties as a priest, but through proper burial he was giving the dead the dignity they so rightly deserved.

Code Blue

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opinion

Walking out of Dr Augustine’s office, one has to walk past the ICU in order to exit the building.  On our way out, I couldn’t help but notice an older male patient laying on a bed in the ICU.  Now, I’ve seen hundreds (if not thousands) of patients in intensive care units so far in my training.  There wasn’t anything particular about this one man that caught my eye, but as often happens when walking through an ICU, you notice particular patients who appear to not be doing well.

This man was clearly not doing well.

He was struggling to breathe, and was already on a 100% non re-breather when I spotted him (for those of you who are not medical professionals, this is a mask that is attached to a “reservoir” bag so that the patient continuously receives 100% oxygen no matter how fast they are breathing).  Danielle and I asked the ICU physician what was going on, since we were both already under the impression that this man would need to be intubated and put on a ventilator.  The ICU physician informed us that they thought the man was suffering from aspiration pneumonitis (inflammation of the lungs due to inhaling stomach contents); they were planning to intubate, but they were waiting for oxygen to arrive.

The look on my face in that moment must have been a combination of disbelief and frustration – I’m fairly certain Danielle had the same look on her face.  Here was a man struggling to bring in enough oxygen.  The ICU physician knew what needed to be done, but she had to wait for another oxygen tank for the ventilator to arrive before she could properly treat her patient.  Don’t get me wrong; it’s not like I forgot what country we were in.  This is Haiti after all.  I fully expected there to be shortages of things like drugs or equipment, but it never crossed my mind that something so essential as oxygen would be in short supply.  The ICU doctor explained that all of the oxygen tanks were filled at Francisville, and it would likely be a hour or so before the oxygen arrived.  While they waited, the patient would be placed on CPAP for increased respiratory support until the oxygen tank arrived.  Unable to offer much assistance, Jamie, Danielle and I left and headed back to our compound to eat lunch.

Several hours later, we returned to the ICU building in order to check out the operating room and attempt to organize equipment.  We returned with Dan, a medical student from Minnesota who speaks Haitian Creole.  When we walked into the ICU, the scene was very different this time.  The patient was in more respiratory distress than when we had left hours before.  The CPAP had not helped, and the man was still struggling to breathe.  His oxygen saturation (a measure of how well oxygenated the blood is) on the CPAP had been in the range of 60% (normal is generally above 94% on room air); at least on the 100% non re-breather his saturation was hovering in the mid 80′s.  And yet, the oxygen tank for the ventilator had clearly arrived.  We asked Dan what was going on and why the patient hadn’t been intubated yet.

I have to give Dan a lot of credit (not just in this moment for Dan was incredibly helpful throughout my stay in Haiti).  Having already spent several months in Haiti, Dan instantly recognized the aggressive clinical mentality that Danielle, Jamie and I were so clearly displaying.  After all, Dan knew that if this same scenario were unfolding in hospital in the United States, the patient would have been intubated hours before in order to support the heart and lungs, to decrease the work of breathing and to increase blood oxygen levels.  But this was not the United States, with our seemingly infinite resources and endless supply of ICU rooms, ICU nurses, ventilators, and medications.  We were not in the proverbial Kansas anymore.  This is Haiti.  This is a land of clearly finite resources, a place where every exam, every test, every procedure, and every action done on behalf of one patient potentially means that another will have to go without.

It turned out the ICU physicians were deciding what to do.  In their heads, they were calculating the risks and benefits of intubating this patient, and not just the risks and benefits for this patient, but for the next patient that could show up in a moment’s notice and potentially benefit more from a ventilator than this man.  Everything in Dan’s words, expression and tone of voice told us that this was ultimately a decision that the ICU physicians needed to make, an algorithm they needed to perform, an experience and clinical expertise they needed to garner.  Dan essentially told us to wait.

For an American trained surgeon, waiting is tantamount to Chinese water torture.  But I understood what Dan was saying and respected the need to allow the Haitian physicians to mull over what they already knew they had to do.  Their decision was somewhat delayed, and I suspect part of that delay was due to apprehension, trepidation, and hesitation at the prospect of intubating a patient.  As it turns out, the physicians do not frequently intubate patients at St Luke’s.  I’m not sure how much time elapsed before they made their decision (to me it felt like hours), but ultimately they decided to intubate the patient.  In that moment, Danielle, Jamie and I sprang into action to offer assistance in a procedure that we routinely perform in the United States.

The story does not end there though.  Once again, this isn’t the land of plenty; in Haiti, every decision needs to be carefully calculated and planned.  When every resource is not at your immediate fingertips, planning is paramount.  After all, we had no idea what drugs would be available to sedate the patient, what equipment was available for intubation (size of the endotracheal tube, intubating blades, suction catheters, etc).  While Danielle and Jamie seemed to be preoccupied with obtaining the proper medications and equipment, I did what I almost always do in tense clinical situations with extremely sick patients.  I watched the patient, watched the cardiac monitor, and kept my fingers on his pulse.

The timing and sequence of what occurred next is mostly a blur, but several attempts were made to intubate the patient to no avail.  In the meantime, I watched as the patient’s oxygen saturation slowly drifted down from the mid 80′s and his heart rate, which had been far too fast in the 120′s, dropped into the 80′s and then further into the 40′s.  At some point, I no longer felt the firm pulsation of arterial blood flow cursing past my fingertips.  The lack of oxygen and the medication used for intubation had deprived the man’s heart of too much oxygen, and his heart was no longer beating strongly enough to pump blood to his extremities.

In an instant I shouted that the patient no longer had a pulse and that we needed to start CPR.  This was no longer a simple intubation but a full on code blue.  I’m not particularly proud of what happened next, but Danielle, Jamie and I immediately did what we’ve been trained to do over and over again in these situations.  We lept into full blown American medical provider mode and essentially took over the resuscitation of this patient.  Danielle shouted for medications while I placed my hands on the patient’s chest and began chest compressions.  Several more attempts were made to intubate the patient, however his lungs were too full of gastric contents to do much good.  We gave the patient atropine to jump-start the heart, for there was no epinephrine available.  We performed several rounds of chest compressions.  At some point, Danielle and I looked at each other, clearly acknowledging that what we were doing would in the end be for naught.

But the decision to stop was not ours to make.  Eventually one of the ICU doctors came over to discuss what to do.  I will never forget what she said, not because it was wrong or contradictory, but the way she said “I think maybe we should stop” will stick with me forever.  She recognized that what we were doing was futile, but surrounded by the aggressive actions of the visiting Americans, she felt that she couldn’t forcibly tell us to stop.  I think she was beyond relieved when we agreed with her.

We hung around for a bit after the code to talk with the physicians.  In the end, we had been misinformed by the ICU physician we spoke with in the morning.  The patient had, in fact, suffered a massive heart attack.  Intubating the patient and putting him on a ventilator would not have helped; nothing we could have done would have been beneficial.  Ultimately the man would have needed cardiac catheterization to survive, a procedure not available in Haiti.  That was why the decision to intubate the patient had been so protracted – because the benefit to this man was negligible.

I tell this story not to point out the inadequacies of the Haitian health care system or any of the potential failings of its physicians.  I tell this story because I question what would have happened had we not been there.  I wonder whether the Haitian physicians would have intubated the patient at all, a man who had lived well past the life expectancy for the average Haitian.  A man who had suffered a massive heart attack for which there would be no cure in Haiti.  A man who most likely would have been given medicine to make him comfortable and allowed to peacefully pass away into the night.  Instead, he died the way so many in the United States do – with countless IVs, tubes, machines and broken ribs – and I question whether we had benefited this man at all or merely made his death long and painful.

I tell this story because I greatly admire those men and women, for their ability to work within the confines of a healthcare system with greatly limited resources.  I respect their ability to reason through the risks and benefits, to weigh the pros and cons of the clinical decisions they make.  But more than that, I admire the willingness… no, the necessity to think not only how their actions affect the patient in front of them, but of every patient that could potentially follow.  I respect them for doing what I fear so few American physicians are able to do.  To me, this is not a story of the inadequacies of an underfunded system, but a lesson in how our own nation’s collective desire for aggressive treatment is ultimately harming the very people we aim to benefit.

Looking not backward, but forward

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holidays

We as human beings are intrinsically priceless, and it’s the unfortunate ones who don’t see our inherent worth.  We are here to choose, not to be chosen, and only those who see our true inherent worth should be given the opportunity.

It’s not long until midnight, until 2013 officially begins and 2012 becomes yet another year for the history books.  For some reason, starting with what I wrote a year ago in anticipation of the promise held by 2012 seemed to be the only appropriate way to look back on the year.  I ended last year’s NYE post with the words above… and I have to admit that message rang true this year.

2012 started with an emotionally bruised and battered me, rushing off and running away to the Caribbean for some serious heart mending and soul searching, and that trip to Barbados was the perfect beginning to a roller coaster year – but one of mainly ups.  True, this heart would have mended even without that trip to Barbados.  However, the pain and heartache would have lasted much longer; the strength and confidence to carry on may never have reached their summit.  The inner peace would have been a long time coming without that long walk on the beach under full moonlight.

But I came back from the Caribbean looking not backward, but forward.  Though this blog was started many years ago, I took a renewed interest and a different focus in February.  The rest of the year was spent much the same way.  Looking ahead for challenges and opportunities, truly taking many of the “30 Things to Stop Doing to Yourself” to heart.  I learned not to make the same mistakes as I did in 2011.  I learned to be a little more selfish, to not let my past relationships get in my way, and to not get into relationships for the wrong reasons.  Jumped head first into school/work and took some chances that turned out to be great ideas in the long run.

Somehow I managed to do all of the things I worried about when I worried about turning thirty.  I’d like to think this year successfully balanced the competing desires to be successful, start a relationship, and keep up with friends – all while taking care of and not losing my own sense of self.  I’m not trying to sound self aggrandizing here.  These are, in fact, the same lessons I’ve posted on this blog every day this month.  This past year is merely a testament to putting them into place, and New Year’s Eve is a call to action.  NYE is a moment to reflect, learn, move forward and do.

I don’t quite know exactly what 2013 has in store.  There will be some big things for sure – finishing my MPH, returning to surgical residency.  A trip back to the Caribbean in January – although this time not for soul searching in Barbados, but for helping those in need in Haiti. The remainder of it is unplanned, and the uncertainty of it all almost doesn’t matter.  Because whatever it is, I got this – and if I cant do it alone, I know there are people to whom I can turn for help.  But I do know one thing for certain. This year when the clock strikes midnight and the crystal ball in Times Square reaches the number 2013, I know exactly where I’ll be.  I’ll be standing next to and holding onto the one I chose… and the one who chose me.  And I wouldn’t have it any other way.

Happy New Year everyone.  Reflect on the good and the bad from this past year.  And then look forward, go out, and make something of the new year.

30 Things to Start Doing for Yourself

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opinion

Well, now you know the 30 things to stop doing to yourself.  Since today is New Year’s Eve, I think it’s only fitting to post the 30 Things to Start Doing for Yourself.  After all, New Years Eve is a day for us to look back on the past year and make a resolution to change our ways in the future.  Check out Marc and Angel’s full post for the details, but here are some of the highlights in my honest opinion.

1) Start spending time with the right people.

3) Start being honest with yourself about everything.

5) Start being yourself, genuinely and proudly.

7) Start valuing the lessons your mistakes teach you.

11) Start giving your ideas and dreams a chance.

12) Start believing that you’re ready for the next step.

14) Start giving new people you meet a chance.

20) Start listening to your own inner voice.

22) Start noticing the beauty of small moments.

23) Start accepting things when they are less than perfect.

26) Start taking full accountability for your own life.

28) Start concentrating on the things you can control.

a medical tradition

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moody

Saturday night was not a good night at work.  It wasn’t a particularly busy night full of consults and pages with questions (yes, doctors still use pagers).  But in the ICU, there was a young man struggling to survive.  And in the middle of the night, his struggle ended after 45 minutes of CPR and ACLS resuscitation.

I’ve been to many a code blue in my career thus far, short though it may be.  This code didn’t feel any different to me than any other.  The patient had adequate IV access, so my surgical capabilities weren’t needed, but I stayed around to help with chest compressions and offer support for the other doctor as well as the nurses and techs who were in the room.  Nothing struck me as unusual about this code… until the patient’s parents showed up, at which point, the code became traumatic for me as well.  There’s something about having family present that make the situation that much more real and human.  I was the one, in the end, doing chest compressions when the patient’s mother asked that we stop.  In that moment, I started to softly cry, and then I did what we always do… I grabbed a stethoscope.

There’s a ritual we perform as physicians when a patient dies.  In our increasingly high-tech, low touch profession, we pull out our very low-tech stethoscope, place it on the patient’s chest, and listen for a heart beat.  Sixty seconds… one full minute.  It simultaneously feels like an eternity and also almost as if time stops.

The strange thing is that in today’s modern medical world, we still perform this ritual to confirm death’s arrival, when we know all to well that the heartbeat will be absent when we listen.  Clearly in less sophisticated times this ritual was necessary, but our high-tech medicine and the long period of time spent resuscitating the patient to no avail already tells us what to expect… or rather what to not expect.

One of our chaplains during residency meets with us once a month to talk about ethics and the tough times we have during our training.  One of the questions he asks is how we deal with the pain, sadness, and tragedy that were all too common in hospitals.  Perhaps that’s the purpose of this ritual.  Maybe we listen in order to give us pause, allow ourselves to regroup and compose ourselves, and give us a moment to “deal”.  That one minute in time may be our chance as physicians to take one big huge collective breath.  Just maybe…