Death

"No, I want you to stay." My dying patient in response to a staff-member asking me to leave. I stayed there with the spouse. I held my patient's hand. I watched my patient die. This patient was young; unlucky. The suffering ended; it was sad, tragic, but ultimately a freeing and welcome death. My patient finally looked peaceful. The patient's memory will always be a blessing for the family. I was sad, but emotionally okay.

Death in the midst of joy is another thing entirely. I had just finished watching a surgery for a pregnant patient that could have ended her pregnancy. Her unwanted pregnancy - again. She had several unwanted pregnancies. The surgery was successful; the baby did fine. Joy? Hardly.

Upstairs a mother labored - too early. We tried to stop it, but it was too late. Her precious miracle, the miracle she and her spouse so desperately wanted, was coming into the world before its lungs were mature. There was nothing we could do. The baby was born, wrapped up in a blanket, given to the mother. We all cried. We all grieved for this little life that was not to be. Will the memory of this baby be a blessing? I can only hope.

Today I got up to sunshine, birds singing, and children playing the in park. There are people walking their dogs and having conversations with their fur-babies. The trees are flowering and smell amazing. One mother is grieving for her unwanted pregnancy, while another grieves over the death of her baby.

Suddenly these three weeks away from my girls don't seem so tragic.

(Details changed to protect patient privacy)

Your Worth

The danger of deriving your worth from an outside source. I hear it all the time - "my life sucks." Or, "why me?." How about, "No matter what I do I can't get ahead." We blame our lot (reference intended) in life on our parents, our situation, and most disabling of all - God. Hold on a moment, I'm not suggesting you run away from your faith.

However, I am suggesting one place less emphasis on God for all of life's blessings or curses. As Americans we are a selfish nation, by design. We honor and cherish freedom and equality. I think that's wonderful. With that has come the obsession of God "doing" things to us or with us. As though the only thought in God's mind is - you. The "personal relationship with God" movement has gotten completely out-of-hand. Religious institutions use it to draw people into the community. It gives people a sense of wholeness and hope they might otherwise not have. Do I believe it is harmful? Yes.

Organizing your life is up to you. You chose to get up today. You chose to behave the way you did. You are excelling in life or merely getting by, because you chose your path. Which is not to say that sometimes terrible things happen that seem out of our control. But does God really only "bring you to it if he can get you through it?" I don't think so. You can get through it.

So what role does faith have in the 21st century? A sense of tradition. An ability to marvel at the greatness that exists. An example of how we ought to behave. A place to organize help in desperate situations. It is a community. It is a family. It can define and shape us, but again, that's because we allow faith to have that place in our lives. Religion is a steady mate, a perfect mate, a family, a home. It's a wonderful thing to have.

So whether your life is bursting with blessings or writhing in filth and despair, it is you who must live it. You who must shape it. I think God could use a little help from us. In fact, God might appreciate the assistance.

Why me? I don't consider myself an especially empathetic person. In fact, if my Mother were reading this she might laugh at the thought. It's not that I don't care about people - I care deeply. However, I am extremely honest, sometimes to a fault, and that has gotten me into trouble from time to time. But now, now that is a huge asset. I can look my patients in the eye and tell them the truth - about me, about others, about themselves. And they open up. They let years of guilt and sadness and frustration out. They cry. They say things like, "I've never told anyone else about this. I feel very comfortable with you." It's extremely humbling and I cherish it.

Doctors often say, "Don't waste your time; patients never listen." I want to say, "Maybe it's you who isn't listening." People need to be heard. They need the time to find the words and courage to open up and have a discussion. I teach my patients by listening to them. I try to find where they are and join them on their path. Sometimes I suggest a new direction, but always with them by my side.

What will happen to me after I've been doing this for 10 years? I can only pray that G-d will give me the strength to keep on walking with my patients, because the journey is really amazing.

Real Men

I wanted to write this for all men. Every man thinks they are the only one who -
cries - hard
feels guilty
has trouble being honest
loses his erection
can't get an erection
is ashamed to lose his hair
can't provide for his family
isn't very "manly"
enjoys beauty
feels unattractive
worries
feels emotions deeply
loves - and fears losing his love
likes to cook
wants to be at home with his kid(s) more
likes to sing, play an instrument, or write music
has inappropriate sexual thoughts, but tries not to act on them
loves his pet as if it were his child
feels very protective of his family
is tired

In fact, men are as varied, capable, and emotional as any other person - male or female. We give men far too little credit, and men don't tend to talk to other men about personal things. Gentlemen - I like this change. I like this "new" man. You are more interesting and worthwhile whole; please don't pretend to be "manly." You're much better this way.

Welcome to Ohio

I love Ohio. I'm starting 3rd-year rotations next week and we are settled into our new apartment. Now I await board scores. G-d-willing I passed. Other than that, this no-stress time in my life is fantastic. I have slept more in the last week than I have in two years. It's wonderful.

One block from our home is a park. It's like going to a United Nations conference. The diversity and camaraderie are amazing. Everyone is so nice. People are exactly who they want to be or are becoming who they want to become. It's such a unique area. Love it!

I'm very excited to serve the patient population here. I like that I will get to meet so many different types of people. I get the opportunity to learn not only medicine, but how to care for people on a very individual level. From the Amish, to Orthodox Jews, the Urban black - it's all here.

I'll let you know how it goes. My first rotation - rural medicine.

I the meantime - I'm going to go get some coffee.

Retard

Retarded. Slow. Someone who is retarded is slow. Someone who is a "retard" is a moron. No, not the definition of moron, a person with a mental age of 7-12, that's probably the definition of the person using the word "retard." Said "retard" is usually doing something that is considered stupid or otherwise uncool - often considered moronic. The standard moron is generally someone who would be concerned with appearing cool.

I challenge that your average retard - with an IQ of below 75 is probably operating at a higher mental age than your average moron.

The moron is concerned, because their mental age is probably permanent. However, they don't fully realize this. The moron will go on to live an utterly average life, always thinking he is better than a retard.

A retarded person, well before the moron, understands love and kindness. A retarded person does not understand hate. A retarded person excepts differences and embraces them. A retarded person is usually very gifted - in ways many people above a 75 IQ can't understand. It's a little too complicated for us. Example - a retarded person sees someone who is sick, dirty, homeless, possibly mentally ill lying on the sidewalk. The retarded person will note that this person needs some water and something with which to clean up. The retarded person, without hesitation, will offer help. Trusting completely. Knowing how to help. Loving unconditionally. I dare say, the entire country would be a veritable utopia if it were run by retarded persons and not morons.

Yet we are ashamed of retards. We look away, embarrassed by their utter disregard for our seemingly important conventions.

I'm thinking about this as I study congenital abnormalities and I'm faced with too much reality. Abortion. What do we do when we know the child is retarded? Abort. Not always. Certainly not, but often. Why? Really. Why?

I'm not with false hopes. I know that trying to get a child with Down Syndrome to understand that you're going to the park at 3:00 and it's only 10:00 is extremely frustrating. They have no concept of time. You will be asked 10,000 times if it's time to go to the park. No, you can't hug that stranger. Why? I don't know, it's weird.

I beg of you to say, "no" to all the prenatal testing. Cystic fibrosis? Abort. Really? Yes. Blue eyes. . .hmmm. . .risky. . . I joke because I'm uncomfortable.

Give the kid a chance. Are they going to cost us money? Of course, but so does the drunk, the illegal immigrant in the emergency room, the homeless person, the elder. . and on and on. I don't think you have that choice. Can't handle it - try adoption. Worried about your body getting all out of shape - try changing your insides instead of your outsides.

If they were meant to survive, they will. If they were meant to die, they will. Even if only for a few hours - they felt love. Everyone deserves at least that much. Please erase the word, "retard" from your list of insults.

The image was a very easy search. You may have laughed. I hope you'll go back, look at it again, and realize it wasn't funny. That would make you a recovering moron.

Elixirs!

Okay, I must confess - I am a sucker for elixirs. Teas thrill me! I love putting together combinations of plants and voila - instantly healthier! Do I really believe that the kombucha fixed my week-long belly ache? No. Do I think that teas formulated especially for my girl-parts are going to make my plumbing healthier? No. What about things to increase memory? No. On and on and on. . .

It's the principle of the thing. The most gorgeous placebo. It works for me. I feel better. I am able to center my body and let it do the work of healing. Superstitious? Absolutely.

I have a kiddush cup that is called the four rivers. On that cup are 64 words written from the four rivers of Gan Eden. One who drinks from this cup, according to Kabbalistic teachings, is granted the secrets and blessings of healing from sickness - mental or physical, and infertility. According to Kabbalistic tradition, King Solomon learned these secrets from Gan Eden. I bought it. I promptly got pregnant - something I wasn't supposed to be able to do. Did the cup help? Doubtful, but it fed my placebo-addiction.

Why is our fascination with elixirs and placebos so alluring? Because it works. It works, because our bodies are exquisite in design. Leave it alone, focus, let it heal. Of course medicine is a great help - a life-saving help sometimes, but not always necessary.

It is a matter of trust. Trusting our bodies. Trusting ourselves to know when we need outside help. Which brings me to my soapbox - obstetrics.

For 200K years we've been able to keep the species going. Amazing! Hand washing was a great idea. It cut down on a lot of unnecessary deaths. C-sections, too. However, somewhere along the way we got lost, and we've never attempted to get back. We think we are improving outcomes, but we're not. We have entire generations of women who think they can't give birth without a doctor. And entire generations of doctors who are too afraid to say that obstetrics has become a sham. A type of, shall I say - quackery.

Why? Because if someone dies, the doctor is going to get sued into bankruptcy or worse yet, lose their license. We have forgotten that even in the best of circumstances, sometimes people die. But obstetricians rarely have a mother or baby die. Correct. The best midwives have the exact, even slightly better statistics.

Intervention is absolutely necessary sometimes. The real art is in knowing when to use it. In the meantime I encourage you to be realistic, honest, and drink more tea.

(the photo is from theinnershaman.com - no, I don't think these work)