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Being human Reflections on Life, Being Human, and Medicine Reflections on the Christian Life

How Do You Live in Uncertain Times?

These are interesting times. The Coronavirus Disease 2019 (COVID-19) is shutting down a lot of our world and activities. I get asked what I think about it. I think the most honest answer is, “I don’t know.” 

How do you deal with uncertain and potentially hard times?  That is what this blog is about.

There are dozens of very well written articles about COVID-19, the importance of limiting spread, the risks of a rapid spike on overwhelming healthcare resources, how to reduce your risk, etc… I too have read many of these articles. I don’t need to add anything to that body of literature.

But how do you handle uncertainty about the future?

 As I look with wonder at everything that is going on it makes me wonder what it must have been like to live through other times in our history. This is not the 1st time that humans have had to deal with very hard times. 

The polio epidemic comes to mind. Interestingly, 98% of the people who contracted the poliovirus had only minor or mild symptoms and no neurologic effects. But in 1-2% the virus entered the bloodstream and attacked the nerves resulting in paralysis and death.[1] “Because so little was known about the virus or its inconspicuous mechanism of transmission, fear and near panic occurred as parents forbade their children from attending public places where large numbers of people gathered.”[2]

Sound familiar? 

We know more now. We do know about transmission and how to prevent spread.  That is not the point I am trying to make. The point is that we are not alone in history in what we are going through. And for me that seems comforting. 

Human beings are resilient and strong. Within them is strength greater than we expect. 

I think of the 1918 influenza epidemic. It was called the “Spanish flu” because the outbreak in Spain received more publicity than elsewhere. It was actually the 1st  H1N1 outbreak. One flyer during the time instructed people: “There is no medicine which will prevent it. Keep away from public meetings, theatres and other places where crowds are assembled. Keep the mouth and nose covered while coughing or sneezing. The attendant shall put on a mask before entering the rooms of those ill of the disease.”[3]

My grandfather’s family contracted the Spanish flu. As a child he became the man of the house. At the age of 11 he became responsible for running the farm and caring for his ill parents and siblings. His father died and then he continued on running the farm. I cannot imagine this. What must it have been like for him and for his family?

Human beings have great strength.

I have seen it in Sarah and in her mother. Sarah’s mom was a person who could fall prey to worrying about things. She had good reasons to do so. She had suffered the amazing tragedy of losing three of her children all from different and unrelated illnesses. She also was a survivor of childhood polio having been one of those 1-2% who contracted near fatal paralysis. Somehow she survived but had to contend with post-polio syndrome her entire life. For her, life was never certain.

Sarah’s father became very ill. He was in the intensive care unit and we didn’t know if he would survive. I was anxious about what this stress would do to Sarah’s mom. On top of everything that she had already been through, certainly this would unravel her. 

It was absolutely amazing how she responded. She didn’t panic. She was like a rock, stable and steady throughout the whole time. She was like a soldier. One minute soldiers might be fussing about minor things and then in the heat of battle with explosions all around them, they march forward with outrageous courage and strength to just do what must be done.  In that time, I saw an amazing and strong core within her. She had depth and strength. She could deal with whatever she had to deal with. When the “explosions and chaos” were at their worst, she could just do whatever needed to be done.

So how do we deal with the stress of these uncertain times?

  1. Understand that we are not alone. Human beings throughout the ages have faced many very hard and scary things. I find this quite comforting. If those before had the strength to endure and walk through the challenges before them, I can too.  I call upon their strength to help me remain calm and strong regardless of whatever may come. If you would like to read more about this here is a link to another of my blog posts: https://www.linkedin.com/pulse/established-1950-gone-now-michael-dickinson/
  2. God is still on his throne. When evil persons attack, the Scripture reassures us that, “The one enthroned in heaven laughs; the Lord scoffs at them.”[4]  God is not surprised by this or by any of the tragedies that might strike us. We do not walk through this alone. We go forward with a belief in a God who has created all things and who sees all things. “For God gave us a spirit not of fear but of power and love and self-control.”[5] He also tells us “Never will I leave you. Never will I forsake you.”[6] At my core, I am able to not be shaken because I have a firm belief that there is more to my existence than just what is happening here. I hope that you too can find comfort and strength in this.
  3. Look beyond yourself. This is powerful. How can you rise up in strength in the midst of the chaos? Can you too be a soldier that shines in the midst of the battle? What are the needs around you? There is a tweet now gone viral (>1 million hits) about a woman helping an elderly couple get groceries. I want to be like her. Will you? Or are you going to be another crazy person buying a year’s supply of toilet paper? Look for the needs. In your anxiety use that energy to look at your friends and neighbors and their needs. For those of you who are believers, how are you going to show the love of God in the midst of the disruption in your lives and schedules?
  4. This too shall pass. We do not know exactly what is coming but we do know that we will get to the other side. When you cannot say anything else, you can say this, “This too shall pass.” And just keep moving forward.

[1] https://www.historyofvaccines.org/timeline/polio

[2] https://www.jospt.org/doi/pdf/10.2519/jospt.2004.0301

[3] https://en.wikipedia.org/wiki/Spanish_flu

[4] Psalm 2:4

[5] 2 Timothy 1:7

[6] Hebrews 13:5

Categories
Being human Medicine Reflections on Life, Being Human, and Medicine

Penance

I meant well. My patient called and had a recurrence of her medical problem.[1] In the past I had sent her to a specialist. He had made some recommendations if the problem recurred. I could have made her call or go back to the specialist. In hindsight I wish I would have. I wanted to help her and everyone. I meant well. I was trying to make things easier. I looked at the recommendations from the specialist. I prescribed one of the medications that he suggested could help with her problem.

She developed a horrible complication from the medicine.  It was a rare complication. But it had been reported with the medicine I had prescribed.

I acted quickly. I immediately saw her. I called specialists and asked for help. I did whatever I could find to help her recover from the complication.  All the king’s horses and all the king’s men…

She got worse. A lot worse. ICU type worse.

And then every day, sometimes twice per day, I walked to the ICU to see her. I carefully monitored her condition. I looked at everything. I spoke with the ICU team and all the specialists. Together we worked hard to do the best we could to help her get better.

It was hard. It was hardest on her. I wish that I could go back in time. I wish I could do anything possible to prevent her from having the complication. I have replayed the events over and over again in my mind so many times since then. 

It was also really hard to continue to be her physician in the midst of all of this. I had prescribed the medicine. And every day, sometimes twice a day, I would walk down the hall and climb the stairs to go to her room. It felt so heavy. My heart was a lead weight as I climbed the stairs every time. I wouldn’t take the elevator. It didn’t seem right. I climbed the stairs. I would swallow hard and go in to see her. Be the best physician that I could be. She deserved the best. 

I kept doing the walk. Every day. Sometimes 2 or 3 times a day. I had to. She deserved physicians who would do that. 

And I needed to do it. The word that comes up now as I think about it years later is “penance.” It was for me like something that I needed to do. I am sorry. I am really sorry.

I wish I could tell you that everything worked out fine. It didn’t. She survived but ended up with complications. It left her injured. There was nothing that I or anyone could do to fix it. Unlike in childhood when there would seem to be someone to rescue you, in real life there are times when there are no fixes or rescues. She had to learn how to live with the complications. I had to learn to live with the guilt that a decision I made in treating her caused those complications.

I had to learn to go on living and making decisions. I had to learn that this life is not a fairy tale. Sometimes things go wrong. And sometimes you cannot fix them. What do you do when that happens? You must put one foot in front of the other and you keep walking. Even if your heart is heavy and you feel sick inside, you just keep putting one foot in front of the other. 

That is what so many of you have had to do. We all wish that Mom or Dad would come in and clean up the mess. But that is not the way it works in real life. And when you become Mom or Dad you want to be the one who fixes everything for your kids. But you know that in your own life not everything can be fixed. You know that you have to just keep walking. It gets even harder when you begin to worry that you cannot or should not fix everything for your kids too.

The pain has shaped me and molded me and taught me. I am not going to say that I am thankful for it. That would not be honest. To this day I would do whatever necessary to spin time backwards and not to have prescribed that drug. But I did learn.

I learned that bad things happen. I learned to think more whenever I make a decision in medicine. Just because there seems to be a clear action, we have to think again about what “could” go wrong. Even if it is not frequent, we still are obligated to think what could go wrong. 

I learned about sharing the decision making with my patients. The risk was small. But I read about the obligation that doctors have to disclose risks to their patients. This is not always done in medicine. Doctors are trained to balance risks and make the “best” decision. We are told to be objective. We may not want to worry our patients. But we also have an obligation to involve our patients in the decision making as much as possible. Often we don’t go through the discussion with the patient. We should.

I learned about guilt. Penance doesn’t help by the way. It doesn’t make things better. It really doesn’t fix anything. It doesn’t even make you feel better. 

In retrospect I am thankful that I did the walk every day. But it has nothing to do with penance. What is important is to accept the reality and still do the right thing regardless of your feelings of guilt. Do the right thing regardless of whether it is easy or hard. Just do it anyway.

Just keep walking. Everyday. Sometimes 2 or 3 times a day.

This too shall pass. That is the expression. I say it to encourage me and others. This too shall pass. Not completely however.  When things are hard you can keep putting one foot in front of the other. Over time it gets a little bit better. It doesn’t just go away. It didn’t go away for her. I still feel it too. My heart isn’t as heavy now. But it is still with me. I will always think about it. I will always think about her.

Bad things do happen in medicine. Complications are going to occur. When I switched to cardiology and was doing procedures the burden would weigh heavy on me. Every time my pager would go off, I would jump and worry that something bad had happened. Most of the time everything was fine. But sometimes complications would occur. 

Somehow in medicine we have to learn to deal with this. Patients will have bad outcomes even if we do everything perfectly. Patients will have complications from procedures even if we are skillful and careful. Sometimes we will make mistakes. That too is a certainty because we are all human.

So, what do you do when there is a complication?

  1. Be the best physician you can be regardless of how you feel. Continue to do the right thing for the patient. Do it even if it is hard.
  2. Objectively look to see if there are lessons that you can learn. Was it preventable? If you had it to do all over again would you do anything differently? No fair changing your mind because you know the outcome. You don’t have a crystal ball. Based on what you knew at the time would you still do the same thing again? From a safety perspective there are ALWAYS lessons to learn. What are they? Learn them.
  3. This too shall pass – or at least – we can continue to move forward in spite of the complications that have occurred. We owe it to the next patient that needs us. Complications are going to happen. We must learn and go on. Just keep walking.

I see this happen to our surgeons and proceduralists. They all have had to learn how to deal with complications. Some handle it better than others. But if you expect to never have a patient have a complication you will never be able to take care of any patients. You have to keep moving forward. Learn what you can. Be objective. Not about guilt or not guilt. What can you learn? Is there any better way? There may not be. But ask the question. And do the right thing. Even if it is hard. Be objective. Penance doesn’t help by the way. It is not about penance. Just do the right thing. That is what helps. 

What about for those who read this who are not doctors?

  1. Life is hard sometimes. You WILL have times that you will not be able to fix things. That is just the way it is.
  2. When life is hard, just keep walking forward. One foot in front of the other. Even if your heart is heavy, go ahead and walk. Every day. Sometimes twice a day.
  3. This too shall pass. Or sort of. It does get easier with time.
  4. Penance doesn’t really help. Even thought you might want to submit yourself to some penance to help with your guilt, it doesn’t really help. Don’t try to hide it. Don’t try to “make up for it.” Stop. Think. Just do the right thing. Even if it is hard. Just do it anyway. In the long run you will be happy that you did.

[1] For purposes of patient privacy, I am nondescript intentionally. The exact circumstances don’t matter. They do not change the reality of what I am trying to communicate.