Stuff

How much “stuff” do you have? And is it the right kind of stuff? Does your stuff make you happy? Or do you have stuff that’s bringing you down? After Haiti, I’ve realized that the most important assets that we have aren’t necessarily what we tend to accumulate as Americans. And as we are packing the house to put things in storage for a bit, I am forced to look at what needs to be readily available, what can be deferred for the future, and what is no longer serving a significant purpose and should be given to others or discarded.

I am sure that you can all relate to how daily, it’s easier just to order a replacement for something that we can’t find, than take the effort to keep organized or look for it. We pick up that extra jar of specialty olives, just in case it’s needed for the recipe we saw six months ago. We buy the latest video game, DVD, or sports equipment, convincing ourselves that this time, we’ll use it regularly and enjoy it. But after the newness wears off and we get bored, it sits unused until it is time to move. In many ways, these are the easiest things to deal with. It’s a “sunk cost,” and you convince yourself that you really will use it the next time, or, if you are pragmatic, you discard it.

It’s much harder when your stuff is associated with other lives, experiences, and connections to the past. Our oldest two boys have completed college and are finding their way in California. Our daughter just turned 20 and is leaving for 7 months in Paris. I am looking at pictures and projects from their school years. I know I should save some, even if they haven’t looked at them for years. Then I stumble across photos of my parents, my high school yearbook, and letters to friends and family. Looking at a young couple, he’s in uniform – how could they imagine what lies ahead. What would they bring from their own families and then pass on to their children and grandchildren? All of us try to provide for those we love, sometimes it’s material things, hopefully, it is the stuff of support and understanding.

In America, we are encouraged to be consumers- our economy is driven on production and consumption. When the kids were home, there were six computers logged onto the network. For all of us, it was almost cheaper to buy a new computer than pay for the latest Windows and Office upgrade. Then jobs disappeared and credit dried up. The latest downturn has made all of us refocus on what it is we really need, on the intangibles that make us whole, and what truly brings us energy and enlightenment. It is not about accumulating stuff.

The local Salvation Army Donation Center is about a mile from my home on the border between an upscale neighborhood and downtown. I’ve become a regular over the last couple of months. Stacks of clothing, furniture, children’s games, household supplies – they were all cataloged, (for my tax deductible donation), placed in the back of the SUV and driven down. The men working there had faces that told stories of struggle and hope. I carried the bags to the loading dock, then turned and drove off. But as I looked back, I saw the center was connected to the meeting hall, the thrift store and the adult rehab center. Several residents were outside, cleaning up around a lone tree on the edge of the sidewalk. Families and students from local colleges were emerging from the store, with clothes, a couch for the apartment, or maybe a puzzle for a birthday gift. I expect that what they paid was small, but that money helped feed the men next door and gave them a place of respite. The stuff that I no longer needed, or perhaps had never used, was giving to others.


I returned to the now empty house, the floors were swept clean and movers had left. As I walked through each room, my footsteps echoed against the bare walls, there was no stuff to muffle the sound. It is no fun to move, and future directions are uncertain, but it many ways I felt lighter. I had taken the opportunity to cull through and feel the accumulations of the past, define the things I need now, and position myself for the future.

And the cool thing about these movers – everything was cataloged, so when it’s time for a new place, they can deliver enough to make it comfortable and homey. The rest can stay in storage, if necessary. After all, I’m sure our three kids will need some good stuff (and the memories that come with it,) as they start to build their own lives.

Pride

My blogs will be brief over the next few weeks. We are in the process of downsizing, and my energies are needed elsewhere. I’ve realized that over the months, I’ve been examining human emotions in different lights. A recent experience led to these thoughts.

I was asked a question recently during an interview. “What is the one thing of which you are most proud?” I’ll share the answer later, but it caught me a bit off-guard. Pride, unlike hope, joy, and charity, can have mixed meanings. It is considered the original of the seven deadly sins, as it is seen as synonymous with hubris and the opposite of humility. One with excessive pride elevates his status in his own eyes, and can dismiss the work of others. Yet a failure to take pride in what we do leads to mediocrity and a lack of accountability. Indeed it is the sense that we have achieved that of which we are capable that leads to appropriate pride and the energy to move forward and tackle new tasks. And I also believe that pride is felt more clearly when there is struggle to achieve those self directed goals.

As I pondered the interviewer’s question, I mentally ran through my life, CV, work experiences, and bullet points on my resume. My parents were from the generation that didn’t express emotion or tell their children of their pride. I remember things that were accomplishments and made me feel good, but nothing stuck out. I was fulfilled by going to Milot, and appreciated the acknowledgment of my friends and colleagues, but didn’t feel the need to puff out my chest. If anything, I hope this blog has reflected the sense of gratitude for the opportunity. In fact, I came to recognize that you are most proud when the achievement is also a reflection of your sense of self.

I’ve published papers, been a surgeon, taught students, flown planes in instrument conditions, run marathons, and led departments. I feel fulfillment for the things that I’ve achieved, especially if it has laid the groundwork for those who follow. But my greatest source of pride has been the development of three human beings who I’ve help raise and hopefully nurture over the last 2 and a half decades. To see the kind of young adults that they’ve become, and to watch them find their cores – well, accuse me of hubris, but I have never felt such pride.

The interviewer didn't seem surprised.

Hope

I want to end the week on a light note. We all think about what it means to have hope. There are times when our situation seems so dire that there doesn’t appear to be a way out.

Samuel was trapped under the rubble in Port au Prince. Not only was he pinned, but his neck had been broken and he couldn’t feel or move anything below his shoulders. What do you think went through his mind? He was subsequently rescued and transferred to HSC, where I participated in his care, along with many other dedicated professionals. Even in the US, an injury of this magnitude has a high mortality. Sam was placed into a halo vest for stabilization – his head wouldn’t feel a pillow for 2 months. He developed decubiti, urinary tract infections, and pneumonias. Yet he wouldn’t give up. He would sing to us during dressing changes. And he found a guardian angel in Joanna, an occupational therapist whose own family was touched by spinal cord injury.

The last I saw Samuel was when I flew him to the spinal rehab center. (See “It Seems Routine”) At that time, we had gotten him out of his halo, but I had real doubts as to his long term prognosis.
And then this picture showed up on my Facebook wall.




The bright eyes are the same. He’s gained some weight, and appears to have increased function in his arms. I anticipate that he will continue his rehab, then hopefully find a place that can not only care for him, but allow him to give back with his energy and experiences.



A similar fate befell Dr. Brad Berk, a brilliant cardiologist and CEO of Strong Memorial Hospital in Rochester. Brad broke his neck while biking and has retold the story of how he recognized that life wasn’t over, just different. He returned to his role paralyzed, but every bit the leader he always was. (Image from: http://www.thescizone.com/news/9910/urmc-chief-dr-brad-berk-returns-after-devastating-injury.

I am inspired by these stories and the people that made them happen.

Although they all experienced despair, they were eventually fulfilled by hope.

May all of us remember to find hope in our lives every day.

A Tax Deductable Donation

We all hate the call from an 800 number right around dinner time. There’s a brief pause, you hear voices in the background, followed by “(Your first name), how ya doin’?” You are then thanked for a previous donation to a cause that sounds vaguely like three others and asked again for tax deductable charitable donation. Do you give? How do you feel afterwards? And how often during the day, are we performing charitable acts?

As is usual with these blogs, several things happened in close relationship that caused me to reflect on how we, as humans in a complex society, help those in need. Shortly after the call from the paid solicitor, came an invitation from our neighbors to join them at their corporate table for the Heart Association black tie ball this weekend. As I opened my email, there was a note from CRUDEM responding to my questions as to dates when physicians were needed in Milot. I also found my grade on my accounting final, which included an analysis of the charity care and bad debt as a percentage of Net Patient Service Revenue at a major academic medical center. Finally, I had begun to compose a letter to my Hopkins classmates about my experience at Henry Seidel’s memorial, which will encourage them to make a donation to a scholarship in his memory.

Then the light came on…I was being surrounded by charity, so it seems.

Charity is a universal concept. It is derived from “caritas” meaning preciousness or unlimited loving kindness for all others. Islam (Sadaqah) and Judaism (Tzedakah) both speak of beneficent giving as a component of a full and rich life. The basic human emotion of compassion and empathy leads us to do for others, even if we do not directly gain. And it is interesting to note, that as a group, lower income individuals give a larger percentage of their income than the more well off.

When I was at the Miriam, I recognized the vital role that our donors played in helping us meet our mission. I remember our black tie Gala where we rolled out the robot to have nonmedical folks see what their donations had done. Donors thanked us for the opportunity to give to this new program and help build the new OR. As they were thanking me, I remember thanking the development group at Hopkins after making a donation and agreeing to be class agent. We all want to show gratitude to people and institutions that helped us, or to organizations that are committed to solving problem that may have touched us or our families. Charitable giving helps us fulfill our needs.

Yes, there are groups who play the charity card as a way to raise money for self serving needs. And clearly their tactics work, or would they wouldn’t keep doing them. As health care providers and institutions, we provide free or reduced cost services to those in need, regardless of their ability to pay. It is part of our mission and a requirement to maintain not for profit status, yet it is substantially impacting the financial health of hospitals, some of which have closed. Excessive charity can create dependency and unintended consequences.



My time in Haiti could be considered a charitable donation. I paid all my expenses and expected nothing, but the opportunity to serve. But as you’ve seen from my blog, the personal return was far greater than any tangible thing I could have bought or donated. And I know that I will go there again.

So maybe you should cut the telemarketer a bit of a break. Because even if you don’t give to “The Society to Wipe Out Gout of the Left Great Toe,” you are being reminded that we have the opportunity every day to do good for others.

I also know that even if you don’t see it, someone out there is doing good for you. And there’s no tax deduction involved.

Lemmings

“OK lemmings, let’s go for a swim.” I would often lead off with this comment prior to starting teaching rounds on the wards. It was a half serious attempt at humor and a reminder to the residents and students that if they followed their leader blindly and without question, we could all go over the cliff (and take our patients with us.)

I am on the train returning from a meeting in New York where we discussed how to deliver better care to more patients, safely and cost effectively. The agenda included the Presidents of The Joint Commission, The National Patient Safety Foundation, and The American College of Healthcare Executives, as well as CIOs and CEOs of major healthcare organizations and industry. The message was consistent and, to me, exciting. There will be increased demand for health care without significant expansion of resources. Yet we have tremendous opportunity to decrease overuse of services, improve the process of providing care, and decrease complications. This will require true realignment of incentives for providers and hospitals, with patients also taking responsibility for their health care. Information technology will not just be about forcing the use of electronic medical records. What if it could provide the patient with the ability to review their labs and radiology, schedule appointments, and pay their bills with the same ease as you check you frequent flier account? Fantasy? No - it’s in use currently at a major AMC in the Southeast. And some of the best stories are of patients picking up on significant abnormal results that may have otherwise slipped through the system.

We will need to change physician and hospital behavior, which is challenging for all of us. This is not just about dangling a carrot. It will require the combination of rules, tools, and norms that must be inculcated into the culture starting with school and continually reinforced by appropriate modeling. The next generation of providers (see “The New Millennials”) are far more comfortable with technology, salaried employment, and an increased balance in their personal and professional lives. They are more likely to engage their community and blur individual boundaries and silos. We can teach them the importance of self examination and open discussion of error. We, as the leaders in medicine, must continue to adapt to the new paradigm and not hang on to the past in hopes of salvaging the old system and its disparate incentives.

Now I’m all for Darwin’s theories of survival of the fittest. There are lots of explanations why lemmings seem to follow each other off the cliffs to the abyss. Be that as it may, I’d love to see some young upstart speak up to the elders that maybe, this time, a right turn to higher land would be a better plan. We have the opportunity to chart the new direction, and lead others. So lemmings, are you ready?

Ain't No Cure for the Summertime Blues?

I’m gonna take the weeks, gonna have a fine vacation
I’m gonna take my problem to the United Nations
Well I called my congressman and he said “Whoa!”
“I’d like to help you son but you’re too young to vote”
Sometimes I wonder what I’m a gonna do
But there ain’t no cure for the summertime blues.

Most of us look forward to summer as a time for travel, lazy weekends by the water, hazy sunlight, cookouts, friends and family. Yet this summer has been the continuation of a difficult period for our country and the world. The economic meltdown, natural and manmade disasters, and continued political instability in multiple regions have led many to become cynical, despondent, and feel unable to deal with the immensity of the tasks ahead. Yet history shows that humans are resilient, and when faced with challenges, will find a way through. There may be stumbles, there will be conflicts, but in the end new and better options will emerge as we either evolve or wither.

I received a clipping from my relatives in Canton that the Jewish Community Center closed this week after 46 years. It has been the victim of a declining population and the general economic malaise of northeast Ohio. I had many memories of the place, from afterschool programs to the Beau Sweetheart dance in High School and my famous red suit. I felt sadness for those still in Canton. But rather than shutter the doors, a plan was eked out to sell the facility and an adjoining Temple to a religious college nearby. With the proceeds, a renovation of the remaining synagogue would be possible, combining multiple services and preserving the vitality of the community.

The extent of the devastation in Haiti is indescribable. But as I hope you’ve gleaned from my reflections, there is a sense that this time, they’ll use all available resources, both within and outside the country to get to the next level of function. For those of you that listened to the “This American Life” podcast, you realize this change could be reflected by an increase in mango exports. Sometimes you must have a massive catharsis, even with this level of death and destruction, to truly begin anew.


The oil spill in the gulf reminds us of the old commercial “it’s not nice to fool with Mother Nature.” More importantly, can we see what our unfettered demand for cheap fossil energy has done? This is the wakeup to reexamine alternative sources, including nuclear (even with Chernobyl, far less death and destruction has occurred than with oil drilling and coal mining.) The fighting over wind turbines in the Bay shows how shortsighted we can be. And do we all need huge homes when we use only small parts of them?

The Health Care bill will increase coverage in the short term, but will bankrupt us long-term if we don’t look at how we provide care. We must be more responsible for our own health, and have reasonable expectations of what our providers can and should do. I imagine we will begin to see increased rates of lymphomas, thyroid cancers, and leukemia due to the explosion in CT scanning that is patient driven or defensive medicine. And we ourselves are to blame. But we can look to countries like Japan, Canada, and Sweden, where life expectancies are equal or higher, expenses lower, and general satisfaction greater than here.
Today’s blog is not to be pessimistic. In many ways, as I write this, it provides me some optimism for the future as I transition through change. And it’s also good to know, that this is not a unique feeling.

Anybody want to guess when “Summertime Blues” was written? Sounds like fairly current discontent.....
.
The Answer: Over a half century ago, in 1958, by Eddie Cochran. We were in the Cold War, VietNam was heating up, and polio was just being eradicated. Somehow, we survived, adapted, and grew.

So head for your favorite spot, open a cool drink, realize that we are in for some rough patches, but know that it is during times of crisis that some of the greatest advances and opportunities occur.

Mentors, Role Models, and Silent Partners

Haiti continues to struggle with class distinctions and it's own racism. A recent experience reminded me that we can overcome these challenges with persistence,pragmatism, and a commitment to make things better for the next generation.


I attended a celebration this week in Baltimore. It was spurred by the death of the man who was my Dean of Students. Dr Henry Seidel was a first generation Jewish kid who went to Hopkins during a time of quotas, graduated in the class of 1946, trained as a pediatrician, and subsequently stayed on as a physician, role model, advisor, and dean for over 60 years. His style was one of listening to students with the same ear that he would listen to patients. When meeting he would always want to learn more about you as a person, and his advice would be tailored to that understanding. He subtly pushed at barriers. When he died this year, at age 88, there was no doubt that despite the sadness, a celebration of his life was in order.

Rachel was spending June in Baltimore, so the two of us drove her car down on Monday. It’s not often that you get one on one time with your young adult children, and I thoroughly enjoyed the conversations and insights. After getting her settled on Tuesday, I returned to the East Baltimore campus and sat in the same auditorium where I received my diploma and subsequently gave one of the presentations at our 25th reunion. Henry’s picture stood by the podium and pictures of the classes he counseled were flashed on the screen. The speakers reflected on his genuine nature and availability to them throughout their careers. The then Dean of the Med School acknowledged that Henry was the true dean. A fourth year student sang a soulful rendition of “Lean on Me.” Finally, his son closed with reflections on his life, including the story of Alfred Blalock and Vivien Thomas, who collaborated on the “Blue Baby” operation and quietly dealt with the issues of racism that surrounded them. Henry’s son also said how pleased his father would have been to see the diversity encompassed in the current student body.


After the reception, I walked in bright sunlight back to the famous dome and inside of it, the statue of Jesus with outstretched arms. Earlier, I alluded to the story of Blalock and Thomas, which was captured in the movie “Something the Lord Made.” The closing scenes take place in the dome.




Alfred Blalock was the chief of surgery, and was raised in Southern aristocracy. Vivien Thomas was a grandson of slaves with a superb intellect, who could not attend medical school, due to his race and the depression. They first met at Vanderbilt, when Thomas was working as a technician in Blalock’s lab. Blalock recognized Thomas’ skills and gave him increasing responsibilities for surgical procedures on animals. When Blalock was recruited to be Chief at Hopkins, he convinced the administration there to allow Thomas to join him, at a time when the only black employees were janitors. Together they designed an operation for pediatric congenital heart disease. Thomas performed the operation multiple times on dogs, and his skills were so great that Blalock viewed the results and commented that it looked like something the Lord had made. Blalock insisted that Thomas be to his right at every operation on children, to quietly advise the chief. Noone else could stand in that spot. Yet despite the great respect they had for each other, they could not be seen together socially. Blalock would ask Thomas to bartend at parties, both to allow him to be in his home as well as support him financially. The men would share a drink at the end of the day in Blalock’s office, but understood that in the 40’s, in Baltimore, they had certain mores that they must obey. Their quiet partnership endured, and after Blalock’s death, Thomas stayed on in the animal lab, supporting future generations of Hopkins surgeons. In 1976, he received an honorary Doctor of Laws degree. Portraits of Blalock and Thomas (images from the JHH archives) hang in the Hopkins Hospital. And the barriers began to soften -Dr. Vivien Thomas had a nephew, Dr. Katulle (Koco) K. Eaton, who graduated from Hopkins School of Medicine in 1987 and now practices as an Orthopaedic Surgeon.

In attending the memorial celebration, returning to the Dome, and again watching the movie, I was overwhelmed with emotion, awe, and gratitude. I cannot imagine the strength of character of both Blalock and Thomas; I am humbled by the stories of how Henry Seidel touched so many and stayed true to his values: I can only hope that I have been able to support in some small way those that I’ve had the chance to mentor and advise. But mostly, I was filled with a sense of energy and promise, recognizing that those who came before me laid the foundations for the successes of my generation, and that what we do every day in our own lives, even by quietly listening, will pave the road for those that follow.