May the worst days of your future be better than the best days of your past.
May the worst days of your future be better than the best days of your past.
According to domestic violence experts, more than three women a day lose their lives at the hands of their partners. That means that since the night of February 15th in Atlantic City, more than 600 women have died. So this is yet another call to men to stand up and take responsibility for their thoughts, their words, their deeds and to get help…. because our silence is deafening and deadly.
May we never forget…
No matter what people tell you, words and ideas can change the world.
You’re only given one little spark of madness. You mustn’t lose it.
Anniversaries are supposed to be happy occasions, a remembrance of important life events like a weddings, college graduations, or years spent at a career. Anniversaries are supposed to make us reminisce and remember with joy, to remind us of how much we’ve grown and changed over the years.
Today marks an important ten year anniversary for my family, however, it is one that fills our hearts with sadness instead of job. Ten years ago, today, the most important man in my life left it too early, becoming an angel in heaven far too young.
Our dad fought a valient 5+ year fight against lung cancer, all the while continuing to take care of his family. He was the most honest, hard working, and loving man I’ve ever known. When I think on everything our family has gone through since – a daughter married, my graduation from medical school, the birth of several grandchildren, and the loss of my grandmother – it aches even more knowing what he has missed and how much he is missed.
Ten years later, and it’s becoming harder to remember his walk, his talk, his strong presence, and his passion. A decade later, it’s still hard, and it still hurts. When it gets to that point, I cling to the hope that somewhere he is watching over us, and that he’s probably looking down and smiling along with his mom and dad. I hold on to the fact that we only hurt because we we care, and that our pain is a testament to how important someone was to us. It’s a pain and a hurt shared with my mom and sisters, and a similar feeling with other family and friends.
What I wouldnt give anything to have him here for even just an hour, just to chat and impart his wisdom. Yet I know that’s not possible. Instead, I will hold my family close and my memories closer.
I carry your heart with me. I carry it in my heart.
One day someone will walk into your life and make you see why it never worked out with anyone else.
Excerpts from Judge Jones’ ruling in Whitewood v Wolf. Beautiful…
“Today, certain citizens of the Commonwealth of Pennsylvania are not guaranteed the right to marry the person they love. Nor does Pennsylvania recognize the marriages of other couples who have wed elsewhere. Hoping to end this injustice, eleven courageous lesbian and gay couples, one widow, and two teenage children of one of the aforesaid couples have come together as plaintiffs
and asked this Court to declare that all Pennsylvanians have the right to marry the person of their choice and consequently, that the Commonwealth’s laws to the contrary are unconstitutional. We now join the twelve federal district courts across the country which, when confronted with these inequities in their own states, have concluded that all couples deserve equal dignity in the realm of civil marriage.”
“With the weight and impetus of the foregoing Supreme Court jurisprudence in mind, this Court is not only moved by the logic that the fundamental right to marry is a personal right to be exercised by the individual, but also rejects Defendants’ contention that concepts of history and tradition dictate that same-sex marriage is excluded from the fundamental right to marry. The right Plaintiffs seek to exercise is not a new right, but is rather a right that these individuals have always been guaranteed by the United States Constitution.“
“Based on the foregoing, we hold that Pennsylvania’s Marriage Laws violate both the Due Process and Equal Protection Clauses of the Fourteenth Amendment to the United States Constitution. Because these laws are unconstitutional, we shall enter an order permanently enjoining their enforcement. By virtue of this ruling, same-sex couples who seek to marry in Pennsylvania may do so, and already married same-sex couples will be recognized as such in the Commonwealth.”
“The issue we resolve today is a divisive one. Some of our citizens are made deeply uncomfortable by the notion of same-sex marriage. However, that same-sex marriage causes discomfort in some does not make it’s prohibition constitutional. Nor can past tradition trump the bedrock constitutional guarantees of due process and equal protection. Were that not so, ours would still be a racially segregated nation according to the now rightfully discarded doctrine of ‘separate but equal’. In the sixty years since Brown was decided, ‘separate’ has thankfully faded into history, and only ‘equal’ remains. Similarly, in future generations the label same-sex marriage will be abandoned, to be replaced simply by marriage.”
“We are better people than what these laws represent, and it is time to discard them into the ash heap of history.”
We must not see any person as an abstraction. Instead, we must see in every person a universe with its own secrets, with its own treasures, with its own sources of anguish, and with some measure of triumph.
Today’s normally scheduled hilarious someecard post has been deferred for another week, for today marks an incredibly important day in Boston, in Massachusetts, and in New England.
Because today is Patriot’s Day, and the annual running of the Boston Marathon. After last year’s tragic events, it seems inappropriate to make a marathon joke in my honest opinion. I can only hope that today’s marathon goes as smoothly as possible. And while the city and the media have taken the past week to reflect on last year’s bombing, I’d like to take a few minutes.
I’ll admit that writing this post is emotionally harder than I expected. It’s hard to explain how a tragedy in one’s city can affect you even if you don’t know anyone personally affected. The disruption of the sense of security and safety during the day of the bombing and the chilling quiet during the city’s subsequent shutdown will linger in the hearts and minds of every citizen of Boston, and to that feeling, I am not immune. But I also remain overwhelmed by how Boston responded to this tragedy. Bostonians are not known to be a warm, bubbly, and friendly population, but the reaction to the marathon bombing proved that our harder exteriors mask a caring and compassionate core.
I think the best way to commemorate the people we lost, those who were affected, and the way life changed that day is through reflecting on the words spoken during that terrible week. On my tenth Marathon Monday, my own comments from last year still ring loudly.
…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.
President Obama’s words reminded us of how good this city is, and the need to carry on. His words forecasted the remarkable moment after the Red Sox won the World Series, and cheering indeed returned to Boylston Street.
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. [...] 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. [...] 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. [...] 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.
But perhaps Governor Patrick Deval said it best in his speech during the interfaith service.
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. [...] 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.
Amen Governor, amen.
May this year’s marathon truly show our ability to recover and repair, to rise and endure, to overcome adversity and demonstrate our will and strength. To all the runners, may you run your hearts out and conquer your dreams. To the friends and family members cheering them on, cheer louder than you have ever cheered before and show the world what we’re made of. And to the thousands of people who call this city home and all those eagerly watching, may you all have an amazing and safe Patriot’s Day and Marathon Monday. I certainly plan on being out there watching and cheering along with you.
In case you missed it, on Monday the president of Uganda signed a bill into law that calls for a sentence of 14 years in jail for first-time offenders of “homosexual acts.” The law sets life imprisonment as the maximum penalty for a category of offenses called “aggravated homosexuality,” defined as repeated gay sex between consenting adults as well as acts involving a minor, a disabled person or where one partner is infected with HIV. The new law also creates the offenses of “conspiracy to commit homosexuality” as well as “aiding and abetting homosexuality,” both of which are punishable with a seven-year jail term. Those convicted of “promoting homosexuality” face similar punishment.
If there’s any good news, it’s that the law originally called for the death penalty for some homosexual acts; that penalty was removed from after an international outcry forced the hand of the Ugandan legislature. But that’s where the good news stops. The situation for LGBT individuals in Uganda has clearly worsened, and yesterday a Ugandan newspaper published a list of what is calls the country’s “200 top” homosexuals, including outing some Ugandans who previously had not identified themselves as gay. And the witch hunt begins…
The whole time during the Olympics, we were worried about Russia, while Uganda was actively working to promote this law (which is highly supported in the country). The US response to the passage and signing of the law has been swift, with John Kerry noting that the State Department would be reviewing it’s relationship with the Ugandan government and potentially changed its stance on US aid to the nation. Desmond Tutu denounced the law, referring to Nazi Germany and apartheid-era South Africa as prime examples of what happens when politicians legislate love. He noted that “there is no scientific basis or genetic rationale for love. There is no scientific justification for prejudice and discrimination, ever. And nor is there any moral justification.”
But the recent actions in both Russia and Uganda raise a critically important question that many in the international community aren’t prepared to face. Are we demonstrating cultural imperialism by denouncing countries that pass laws like Russia and Uganda or are we merely fighting the good fight for human rights? Are we too quick to judge other countries’ social policies… and quite frankly are we hypocritical when many states in our own nation have “legislated” against love?
I do think it’s easier for those of us who sit comfortably in Western societies, protected by a backdrop of laws that guarantee certain freedoms, to criticize nations we believe to be less progressive and tolerant. But this week’s news from Arizona shows us that perhaps we aren’t as progressive as we would like to think. Should we perhaps be more sympathetic to another nation’s social policies?
I firmly believe in this case the answer is no. We aren’t talking about universal health care or socialized welfare. We’re talking about a law that potentially commits you to life in prison for marrying the person you love. We’re talking about people living in fear that they will be “discovered” as homosexuals. We’re talking about a law that potentially allows those seeking retribution to accuse others of being gay with potentially horrendous resulting punishment. We’re talking about a law that also imprisons directors of NGOs or foreign companies for merely assisting any LGBT individual; a law that affects individuals from other nations who travel to Uganda and are now afraid to provide humanitarian aid out of fear that they will be imprisoned.
It’s easy to say “oh that’s their social policy, leave them alone” when you’re sitting “across the pond” and will never be affected by it. But someone must speak up. For if we’ve learned anything from history, both that of our own nation and of the world, bad things happen when people don’t speak up. Martin Niemoller’s “First they came for the Socialists” quote is a glaring reminder of the dangers of silence.
I can’t say that I’m the biggest supporter or follower of Nancy Pelosi (@NancyPelosi), but I saw this tweet the other day from her and couldn’t help myself. I actually think it applies more broadly than Uganda and probably to more than the LGBT community, but it’s an important sentiment.
I stumbled on this blog post written by a nurse, framed as a letter to the family of her ICU patient. I think it speaks well to the ups and downs that medical professionals, and ICU nurses in particular, go through daily. It also illustrates the tension between families and medical providers in the especially tense ICU setting.
The excerpt below is just the tip of the iceberg but sets the tone of the entire post.
Working in the Intensive Care Unit (ICU) is an experience that can’t quite be put into words. It’s fast-paced, intense, and the stress of some situations can even occasionally make my own heart rate go up as high as one of our trauma patients.
Some people love us. Some people hate us. I can promise you that you do not want to be a patient in my unit. If you are then that means you’re really sick. But I can also promise you that if you end up here you will get stellar care by a team of the best health care providers available.
Often times we may act a little wacky though. We may seem rude at times. Maybe you catch us acting totally inappropriate for the situation at hand. Maybe you’ve even thought, “how can they act that way with all this going on with my family member?”
Well, we have our reasons.
Sometimes my friends are geniuses…
Expressing your feelings, especially affirming sentiments, should not be reserved for the space between your ears.
For the past few years, Facebook has allowed its users to construct a “Year in Review”, full of highlights from the past year – photos and status updates that received the most “likes” or comments from other users. To be honest, I just did mine today because to me, a year in a review truly cannot be done until the year is virtually over. But before I ran the year in review, I wondered what it would look like, what would be featured, and what I could gather from that review…
Indeed, the past year has been one full of changes and challenges, of fulfillment and turmoil, of triumphs and terror. It has been punctuated with tremendous highs – graduating with a Masters in Public Health, traveling to and operating in Haiti, becoming an uncle again, enjoying my relationship with my significant other and growing into a better person as a result. The year has had its share of lows as well – the uncertainty of returning to general surgery training, readjusting to a “work/life” balance upset by medicine, feeling rusty and inadequate as a physician and surgeon, grappling with a challenging personal issue involving my family, and grasping and coming to terms with the immeasurable loss of my grandmother.
I certainly would not have survived without the love of my dearest friends, a love that became all too clear after the terrifying events of the Boston Marathon bombing and ensuing lockdown. There are moments in life where you wish for your family to be close by, to hug and to hold your parents and to have them tell you that everything will be okay. Sadly, my family does not live near Boston, and in those horrifying moments after the bombing, it was my friends that I turned to for comfort, support, and camaraderie. They are the rocks on which I rely for strength, the shoulders to cry on, and the ears to talk to. It has been said that friends are the family we choose for ourselves, and I like to think I’ve chosen wisely.
So yes… I wondered what that “year in review” would reveal. And then… I remembered why I love New Year’s Eve so much to begin with, because New Year’s Eve is not meant to be a time to only rewind, regret, and wonder what could have been. Reflecting on the year that has gone is great but only as a stepping stone for the year ahead. For those who don’t like New Year’s Eve, those who get bogged down in the mad dash of the holiday season and the need to figure out what to do, New Year’s Eve isn’t about the best party plans or sitting alone wallowing in self-pity. New Year’s Eve is a gift we are given each year, an opportunity to change the bad, to put our fears, regrets and sorrows behind us, and to start over again with a clean slate. New Year’s Eve is the ultimate chance to look ahead, not backward. So take a moment to reflect and ponder, generate your “year in review” and remind yourself of all the good times. Then ask yourself not what could have been – but what should be done. And once you have your answer, raise your glass and toast to what will be.
Last year on New Years Eve, I posted a few of Marc and Angel’s 30 Things to Start Doing for Yourself. Since it’s the day after Christmas, and for most of us that means we have many new things in our life to be thankful and grateful for, I figured it would be a good time to take a look inside and think about the things we can change.
I’m not sure how to begin this post, other than to admit that I’m exhausted. I’m currently on rotation at an outside hospital, and although the operative experience has been incredible thus far, the long hours in the operating room and the random pages in the middle of the night while I’m at home have been taking a toll. Rare is the day that I leave the hospital before 7pm and make it to the gym. If it sounds like I’m complaining, I’m not – I’m greatly enjoying the amount of operating that I’m doing, but it would be a lie to say that I’m not constantly tired these days. Needless to say, the number of thoughtful and witty posts on the blog have declined significantly. Hopefully in the new year that will change a little.
The one thing about a crazy and hectic schedule that works well for me is the need to push aside all the extraneous things in life that don’t really matter. Staying constantly focused on work only leaves room for the important things in life, although I’ll admit that I’ve had trouble staying engaged in the sometimes mindless chatter at holidays parties this season given my “one track” work mind. That all changed today at work, and life caught up.
When people find out I’m a surgeon, they are often impressed and comment that I’m doing great work and “saving lives.” I’ll be completely honest when I say my job is not an episode of ER or Grey’s Anatomy, and that there is nothing all that glamorous about repairing hernias and removing gallbladders (although to be fair one could spin that as improving a patient’s quality of life). I’m going to say the thing that doctors should probably never admit, but on my worst days, I tend to view medicine as just a job/career and nothing more. On the worst days, taking care of patients is the duty I’ve signed up for. Thankfully those days are few and far between, and most of the time I find medicine and surgery incredibly rewarding. I currently have an elderly patient in the ICU who is slowly improving after being very sick and undergoing a very large surgery. Knowing that I’m playing a part in her care definitely makes feels good.
Sometimes, all it takes in medicine is one patient to remind you of who you are, what you are doing in life, and what you’ve given up to get to this point. That patient was a 40-something year old man who came to the hospital with what he thought at worst was appendicitis and turned out to be a tumor that had already spread to his liver and likely his lungs. His charming wife, three months pregnant, sat by his side this morning when the bad news was delivered. The look on his face spoke volumes as he was clearly overwhelmed with information and grasping for some sort of understanding. The idea of curative treatment slowly slipped out of his grasp, and his spirit was visibly crushed.
I walked out of his room knowing that we had done the right thing, giving him all the information he needed to make educated decisions about his future care. My attending had prepped him for the worst while maintaining hope. But I couldn’t help but feel devastated myself, the conversation and my patient’s history taking me out of “doctor mode” and forcibly throwing real life in my face. We as physicians often forget what our patients go through, the “hula hoops” we make them jump through and the “tight ropes” we make them walk. Our patients often put their lives on hold, at least temporarily, for the treatment they seek. They endure pain and suffering, sometimes at our own hands, for a cure – no matter how elusive it may be. We forget because it is easier to forget rather than dealing with the pain, suffering, and death. This man and his plight made it all too real, and it took every fiber of my physically exhausted being to hold it together.
There is a place deep in the heart of Boston. It is a place we normally associate with triumph, a place that has been traversed by thousands. It is a place where people from all over the world stand in anticipation, waiting to cheer on their friends, family, and loved ones. A place where applause is abundant, words of encouragement; a place where we laud endurance, courage, and athleticism.
It is a place that was tarnished just six months ago. A place that was defiled by the actions of a cowardly duo. A scene of fear, despair, sadness, and tragedy. A place that was scarred. A place that tested the strength of our city, showcased how strong Bostonians can be, and highlighted our ability to reach out, help out, and band together. It is a place that has healed over time.
That place is, of course, the finish line of the Boston Marathon. And today, it was restored to its rightful place, thanks to the Boston Red Sox. And as predicted by our President, there would be a time “when the Sox and Celtics and Patriots or Bruins are champions again, to the chagrin of New York and Chicago fans, and the crowds will gather and watch a parade go down Boylston Street.”
I’ve written previously on end of life care and hospice on this blog. It’s a topic of conversation that while often uncomfortable and depressing is unfortunately lacking in clinical settings as well as medical school training. Physicians, nurses and medical personnel have a very different view when it comes to death and dying.
In February 2012, Dr Craig Bowron wrote an opinion piece for The Washington Post about our nation’s unrealistic views of death and dying. Dr Bowron touched on some interesting points regarding our collective inability to accept death, but the portion of the piece surrounding medicine and public health is what caught my eye in particular.
Our unrealistic expectations of what medicine can do begin with the notion that medical care has been the driving force behind the increase in life expectancy over the past century. There’s no denying that life expectancy has increased; according to Bowron, the average life expectancy in 1900 was 47 years and 78 years as of 2007. That’s a rather impressive change, and you might assume that there weren’t a lot of old people around back in the “good old days”.
But modern medicine didn’t invent old age, because average life expectancy is heavily skewed by deaths in childhood, and infant mortality rates in 1900 were astronomically high – to the tune of about 10% of live births resulting in infant death. That rate now? Less than 7 deaths per 1,000 live births in the year 2000. We have simple public health measures to thank for that change – things like improved sanitation, nutrition, education of expectant mothers and safer deliveries. These same interventions led to a steep decline in maternal mortality. According to Bowron, by 1950, average life expectancy had increased to 68 years of age.
According to this logic, if a woman born in 1900 “managed to survive childhood and childbearing, she had a good chance of growing old. A person who made it to 65 in 1900 could expect to live an average of 12 more years; if she made it to 85, she could expect to go another four years.” Modern times haven’t changed thos numbers much. In 2007, a 65-year-old will live on average another 19 years; an 85 year old could expect to go another six years.
So why are we so loathe to let go? Medical professionals know that “at a certain stage of life, aggressive medical treatment can become sanctioned torture.” We often end up doing more harm than good. But for many Americans, medicine has turned death into an option rather than an obligation. We’ve come to view death as a failure of medicine rather than an inevitability. Faced with the prospect of failure, we automatically turn to the notion that something else must be done. And for many, “doing something often feels better than doing nothing.” Sitting by and idly watching death make its curtain call often feeds into a feeling of guilt on the part of family members who wonder why they cant do more.
What I gather from Dr Bowron’s opinion piece is that if we are to do anything, it’s one of two things, and possibly both. We must be honest, open, and upfront as physicians that death, like taxes, is inevitable. While we can prolong life, we cannot defeat death. We must also encourage the idea that sometimes doing nothing is the right course of action; we must stand by the principle of non-maleficence and help families understand that interventions often do more harm than good. And finally, most importantly but also most difficult, sometimes we must be willing to stand up and say “no”.
I am begging you to resist the pressures of pragmatism, of money, of the oily cowardice of diplomats and to stand up resolutely and proudly for humanity the world over, as your movement is pledged to do. Wave your Olympic flag with pride as we gay men and women wave our Rainbow flag with pride. Be brave enough to live up to the oaths and protocols of your movement.
~British actor/journalist/activist Stephen Fry, to the international community on the treatment of the LGBT community in Russia and the Sochi Olympics