Category: Reflections on Life, Being Human, and Medicine

Reflections on a variety of topics. My hope is to stir your thinking and perhaps even give you things to talk about in regards to what it means to be human, about life in general, and often times on the practice of medicine.

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Being human Reflections on Life, Being Human, and Medicine

Filters: How I See the World

SiriusXM radio added a new channel recently. It was the Johnny Carson channel. It constantly played old Johnny Carson shows. I found it oddly interesting and entertaining.

On the dash display in my car it told me the date that the show was broadcast. As I drove, I found myself thinking about what I was doing when the show was on television. More than that, I thought about who I was, what my world was like and how I perceived the world. It was a really interesting mental exercise. 

One morning on my drive to work, I was 13 years old. It was in the winter. I imagined my 8th grade science teacher. I can still picture the arrangement of chairs in the room. I thought about my friends. I thought about what was important to us and what our world looked like then. I thought about how I would have perceived what Johnny and his guests were talking about. 

The other day it was August 1974. I was 9 years old. I remembered how 9-year-old me thought about the performer that Johnny was interviewing. It was in the summer. In an instant I was thinking of riding my bike and playing outside. I imagined the long summer evenings and the heat. I thought of the sound of the fan that we would have set up in a window hoping it would cool off the upstairs bedrooms just a little. 

Recently I was thinking about a friend who went through a very hard time. It hit me that I was filtering my perceptions of his experience through me and my current life. I shifted gears a bit. I thought about what I was like and where I was in life at his age. The change in perspective was strong and powerful. Things seemed to click. It made me understand more. It seemed to make things make more sense.

Filters.

That is the word that came to my mind when I was thinking about all of this. We all have certain ways in which we perceive our world. We filter through all the of data that is coming in so that we can process it. Our present and past realities and experiences impact on how we perceive what is going on. I guess that is obvious. But it amazed me how much difference it made in my ability to empathize and understand just by trying to shift my filters a bit.

I filter my understanding of others and their experiences through the filter of my own past. Where I am now and how I think brings certain assumptions to how I think about what others are going through.

It isn’t true.

They have their own filters and tools that they use to interpret the world. Their past is not my past. Their present reality is not my present reality.

And both understandings may not be entirely correct.

I cannot and should not assume that I can fully empathize. 

But I also have a desire to help them, if I am able, so that they do not have to suffer or struggle or make errors that I made. 

Can I be so wise as to look through both sets of eyes? Like putting on special glasses where you could dial in different colored or polarized lenses or filters, could I attempt to look at the world through my eyes first and then push myself to at least try to look through their eyes? The goal of course then is to synthesize both together into a more complete and accurate understanding.  This achieved then I could decide what comes next. 

Sometimes it will be nothing. Silence, caring understanding, and empathy is often the best response. 

Sometimes it will be an attempt to help. But hopefully it will come from a perspective of compassion and looking how to communicate a foreign concept to them that took me years to learn or figure out. It is almost like speaking a different language but more than that – a different emotion – or interpretation of what is happening. I cannot and should not force my understanding on them. It took me a long time to gain that. But can I be an interpreter? Can I carry over the wisdom of my past failures or successes or multiple years of similar experiences and then translate them into their understanding? 

To one friend suffering with a serious illness, the multiple filter analysis taught me to better feel his pain. No words. Silence. But compassion.

To another when she asked for help, it was an exhortation for the strength she needed to walk through a very hard situation. There was a hope that helping her see through the cloud of emotions to a balanced truth would keep her from being destroyed.

What am I trying to say?  Don’t assume that how you think is how others think. Step one is to acknowledge that you might not be able to truly understand. This is especially important when it comes to your kids. Push yourself to remember what it was like. I still vividly remember the traumas and major events of my teen years. The events were and still are earth shaking. That is what your kids are living. Dial in the setting for your old “teenage filters” to view their reality. Understand that it still may not be entirely accurate, but it might help you to be a bit more understanding.

There is a risk of course. You could do this and then assume that you truly do know and understand. Be careful to not presume. You are doing this so that you can listen and really hear more clearly. It is not so that you can jump to conclusions or judge others. 

Johnny Carson got me thinking about how differently I have seen things at different points in my life. SiriusXM only ran that channel for a month. It is isn’t on anymore. But I am thankful for how it made me think differently. 

What advice or how would you have supported 9-year-old you? Or 13-year-old you? Or 24-year-old you?

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Medicine Reflections on Life, Being Human, and Medicine

The Curtains – Or – Mike’s 1st Lesson in Change Management

I needed curtains for my examination room.

I was working at the Sewell’s Point clinic. It was in the early 90s when I was an active duty U. S. Navy doctor. The problem was that the exam table was visible as I opened the door. Every time I entered the room, I exposed my undressed patient to everyone in the hallway.

I needed a curtain that could be pulled between the exam table and the door. It seemed like such a simple thing.

They sent the person in charge of facilities and requisitions to me. He had me fill out a form (“chit” in military jargon). It was 5 layers thick with carbon paper between each layer. I had to press hard to fill in all of the spots on the form. I worked through the lengthy form. When I had it finished, I gave it back to him and asked him to look it over. He told me that it looked fine.

“You will never see these curtains by the way.”

I asked him, “Why not?”

“You will like be out of the military or moved on before this request is processed and approved.  That is just the way things work.”

“Is there anything I can do to accelerate this? I really just need one curtain.”

“Nope!” he said as he walked away.

I spoke with one of my corpsmen to explain what happened. “Don’t worry doc, I’ll take care of it,” HM1 Jones reassured me. The next day I came to work and there was a very nice little moveable divider wall in my exam room. It was quite effective. It did exactly what I wanted. 

“Where did this come from?” I asked him. 

“Don’t ask doc.  Just be happy with it.” 

He did tell me that he had overnight watch and that sometimes you just need to conveniently reappropriate things from one area to another in the military. 

I didn’t ask any more questions and went on working. All was good for about 2 years. I had my divider and I was happy. And then one day a crew of people showed up with tape measures and tools. The next thing I know my divider was gone and in its place was a very nice and new curtain. In fact, all the exam rooms on the hallway now had nice curtains up.

I asked what had happened.  Perhaps my requisition had done some good. 

Nope. 

It was all about an impending Joint Commission visit. The CO of the clinic had staged a mock visit using the clinic staff. They walked around the clinic and watched operations. As they went through the clinics, they watched the naked patients being exposed to the hallway when the doors were opened. Suddenly there was a crisis. This was an emergency. They could not have this problem when the Joint Commission came through in the next week. Immediately the money was approved to go outside the normal pathways and to go to a local store and buy the supplies and just get the curtains up.

And so, I had a very important lesson into change management.

The lesson has been repeated over and over through the years. As an agent of change, it is hard to get things moving. But change management teaches us that the first step is to, “Create Urgency.” You need to get people to feel the strong need for change. Sometimes you just have to invent a crisis. But you need to somehow get people to move out of the inaction that keeps positive change from happening. There is a momentum that inhibits us. We need to overcome that. 

Sometimes this is referred to as a “burning platform.” 

That term comes from a tragic disaster on an oil platform in the North Sea. At 9:55 pm on July 8, 1988, an explosion occurred and the entire platform was engulfed in flames. More than 200 workers were trapped on the platform. Ultimately 167 people died. Andy Mochan was one of the men trapped on the platform. He jumped into the icy waters more than 150 feet below. He knew that he would only survive about 30 minutes in the water unless he were rescued. When he was asked about his decision, he said he was faced with little choice. He either needed to, “jump or be fried.” As much as he didn’t want to jump, he was forced to make a change because he had to.

It is this sense of a strong and pressing need that can force people from the status quo to what needs to be done to counter change.

It reminds me of the history of heart transplant.  On December 2, 1967, Christian Barnard performed the world’s first heart transplant. The patient was Louis Washansky and he lived for only 18 days before he passed away from complications. In talking about the patient’s decision to get a heart transplant, Barnard later wrote, “For a dying man it is not a difficult decision because he knows he is at the end. If a lion chases you to the bank of a river filled with crocodiles, you will leap into the water, convinced you have a chance to swim to the other side.”

All stories aside, it is an important principle to understand.  It is amazing to me how the impossible becomes possiblewhen a crisis arises. Resources and abilities become available that you can be told absolutely don’t exist until there is a strong motivation for change.

The military had messed up my pay. In fact, they had messed up a lot of people’s pay. In order to get the problem resolved, I had to leave the hospital and walk a 10-15 minute walk across the military complex to the pay office. There a civilian contract worker was responsible for sorting out the pay issues. He had me fill out a bunch of paperwork and told me to come back the next week. I came back the next week and he told me that he still could not get my issue resolved. There was just too much work and he had not gotten my forms processed. I was frustrated. I was on call every 3rd night and even on non-call days I worked 12-hour days. As I left to go back to the hospital, I saw him leave his desk to walk outside with his buddies to smoke for a while. 

When I got home, I told my wife. She was really frustrated! She remembered that in orientation the doctor’s wives met the wife of the Admiral in charge of the hospital. She had told them to call any time if there were problems. She picked up the phone and called. I did not want Sarah to do this. This went outside of the chain of command and was not the way the military was supposed to work. Helen (the Admiral’s wife) didn’t mind. She told her that they had messed up her husband’s pay also. She called her husband’s aide. The aide called the pay office. Within 5 minutes I had the same civilian contract worker calling me and apologizing. He had my pay fixed that day.

Funny thing about it being too much work and too complicated to get it fixed. 

Seems it all depends on how motivated people are for change.

Ok – so here are the lessons I have taken away from this and similar experiences:

  1. Sometimes you have to create, invent, declare or make a crisis to get movement to get what ought to be done.
  2. Most of the time your job is to be able to communicate what you are feeling or thinking. Why do you feel the need for change? Is there really a pressing need? You cannot expect to get what you want if you cannot make other people feel the need as strongly as you do. The 1st step might be for you to spend time thinking about what is driving your desire for change. Until you can explain that clearly, you may not be able to move things forward.
  3. External regulation and review can be a tool for good. In this case the Joint Commission turned out to be a very helpful thing for me. Maybe the best thing you can do is to submit yourself or your organization to some kind of external scrutiny to get them to listen and respond and change.
  4. If that all fails – perhaps you need an HM1 Jones to creatively “fix the problem” while he is on watch overnight! At least that could be an interim solution!