Month: March 2016

This is a rant. It is not a thesis; it is tangential and confounding and confusing. I hope you either love it or hate it so long as you read it.

One of the core beliefs that I (try to) maintain always is that every person has equal value. This means that each person has equally valid beliefs, different from mine as they may be. This, of course, causes me a great deal of cognitive dissonance. Do I truly believe that this is true, or is it some self-serving phrase meant to portray a fictitious altruism all doctors purport? While I am challenged daily to live this belief through actions at work, nothing has tested it more recently than the rise of Trumpism in America, and to a lesser degree, the rise of Ford Nation prior to the late mayor’s passing.

Let me start by saying that I am friends with people who think Donald Trump is the answer to all of America’s problems, and that Rob Ford was the answer to all of Toronto’s problems, and in this phrasing, for those of you who don’t know me, you can tell where my bias lies. And yet, if I am truly to believe that we are all beautiful human beings of equal value, which I think (no, I know… I think) that I do, our respective perspectives also hold equal value (though not necessarily equal truth).

While avoiding a discussion about morality and how my own morality is but a construct of my environment, and is thus nothing more than a set of thoughts applicable only to me, it is important in the discussion of Trump and Ford to at least respect opinions I do not agree with. The challenge comes not so much from the ideological gaps between “left” and “right” (which I could sum up, quite unfairly, as “we are one” and “I am one” respectively) but from the failure of both sides (but mostly the right) to accept evidence counter to ones ideology.

And now I am getting to my first point. Recent controversy over an anti-vaccination film scheduled for debut at the Tribeca film festival highlighted the oddly-present mainstream question of vaccine use. The world is a better place because vaccines were invented and implemented as a matter of public policy and medical marvel. The fact that Trump (and, quite shockingly, pediatrician Ben Carson) feel that the science of vaccines is somehow a subject of question, is beyond baffling.

Yet, I don’t quite put my foot down here. Free speech is something I very much value. If someone wants to screen an anti-vax film, go ahead. For the record, I think that person is an idiot with idiotic views, but, and I understand if you aren’t following me here, those idiotic views are equally valid to my own. See, I like vaccines because I grew up in a household that valued vaccines, with parents who believe in vaccines, and then (skipping ahead) I became a doctor and was taught that vaccines are medical marvels. In other words, I believe in a construct. Now, I believe very strongly in that construct, as do nearly all Canadians, but if you don’t I can’t rule out that your construct is right and mine is wrong (although I’d bet good money that you’re construct is wrong, and mine is right).

The millions of Americans who are supporting Trump have a perspective that deserves respect; Trump himself has tapped into a group of people deeply committed to his cause (which, to be honest, is a bit unclear but certainly involves wall-building). Ford had so many supporters who felt disenfranchised by the political body that runs Toronto he got elected as mayor. And these people, who include friends of mine (who are not stupid people by any stretch), are to be heard.

But here is where I must put my foot down (my second point):

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If you are going to vote for Mr. Trump because you want a wall built along the Mexican border, vote for him. I’ll try to respect your values. But if you vote for Mr. Trump because you believe he will make America great again without any plan articulated, without any shred of vision, because he yells the loudest and fights the toughest, my cognitive dissonance will overwhelm me and I just might end up joining the “I hate politics” camp that you must be in right now.

But, and here is where I am really just writing a letter to myself, we can have politics or we can have a dictatorship. We can have debates about our “leftist’ and “right-winged” values, or we can have someone else’s values shoved down our throats. We can compromise on a solution, or end up with a problem.

Politics isn’t perfect. But the alternative, what Mr. Ford brought to Toronto and what Mr. Trump is selling to America, is far worse. Rob Ford popularized the very worst in us: misogyny, racism, homophobia, and the general belief that government is nothing more than a drain on personal wealth. His legacy, if one can call it that, was to uncover our own ugliness, revealing it starkly in the mirror, revving internal mechanisms in each of us to simply rise above what is now known as Trumpism and care deeply for one another.

So to all of my dear American friends:

Think the way you want. Vote the way you want. I’ll respect it. Just as long as you put a little bit of thought into the values you hold dear.

 

 

 

I’m not a hippy, but I kinda think like one. I’m a committed practitioner of yoga, believe strongly that mindfulness is core to saving the world from itself, and believe in a poorly-defined yet strongly-felt spirituality that is a strangely-woven tapestry of the dozens of religions and philosophies I’ve encountered during my travels. These characteristics give me a mind-over-matter view of my life.

Yet, I’ve been pretty down for the last few months. Most of my friends have been too, and not just the residents I spend an uncanny amount of time around. At times it’s been easy to sink into a couch and feel sorry for myself, though I can never quite label what it is I’m sorry about. Working hard? A decade of life indicates that’s something I thrive on, not wallow over. Being single? Despite my frequent whining, I’m a diagnosed commitmaphobe who enjoys things the way they are. Winter blues? It’s the mildest winter I’ve ever experienced, and a good chunk has been spent in Australia, Bolivia and Cuba…

While I can’t put my finger on what it is that’s been suppressing my usually (annoyingly) cheerful self, I do know that there are tricks I can use to turn around my mood and get my ass in gear. I’m fortunate to have these tools at my disposal: there are friends of mine, patients of mine, and strangers of course, who just can’t. I wonder if I’ll ever be like them, and worry a little over the unknown characteristics of a disease called depression. But, on this first day of spring, I thought I would share what my friends and I have been discussing quite a lot recently: how to stay positive in an increasingly busy, complex and tragic world.

Our Reptilian Brain: Helpful or harmful?

I’m a firm believer that I should respond, rather than react, to every stimulus around me. Reactions bypass the frontal lobe; they reside in the reptilian brain and amount to being on autopilot. They are easy to have, because they happen without doing anything at all. They are executed by the base of the brain, the same brain parts shared by alligators and owls and, I presume, a tyrannosaurus rex. But a response is different; responses are considered reactions. They are a bit slower, a lot more taxing, and infinitely more useful (unless you’re being attacked by a saber tooth tiger!).

Our reptilian brain, responsible for our survival, is where our primitive drives reside: the three F’s they taught us in medical school (fight, feed, and f…ornicate). They are reactive, emotional and often flood our bodies with hormones and neurotransmitters that jack up our heart rate, blood pressure, and sense of sight. They are prehistoric, intended for survival. They have not evolved to take into account an 80 hour work week, QEW traffic, instant messaging, or my resident pager. And yet, these “modern” stresses have the ability to activate our reptilian brain in much the same way as a bear attack does. This is maladaptive; adaptation takes time.

How do we regain control over this maladaptive reactivity? We practice responding rather than reacting.

When others say or do something, we can slow down my reception, respond to the stimulus, and have a considered output that is more useful than a quick reaction would be. Allowing others to bring me down, I would argue, is immature. It shows a lack of perspective and control over my world. Attitude is relative, of course, and it’s hard to stay positive when surrounded by negativity. And so, I work hard to spend time with positive-minded people. When I start to get into that cycle of negativity, I always ask myself three questions:

• Do I have any control over this situation?
• Is my perseverating motivated by anti-kindness?
• Is there a fresh lens I can view this situation through?

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And finally, when all else fails, I simply say “Can I let this go?” Easier said than done, this often involves using physical activity to stimulate the difficult mental work that goes into letting go. A run, a swim, a yoga session… sometimes, I literally need to sweat it out.

Energy Leadership: Part of the solution

I was recently introduced to the concept of “energy leadership” which I found rather enlightening. It basically outlines different “levels” of response to emotional stimuli. By adjusting your own response to stimuli, you can lead and motivate others around you. Here’s the jist of it:

You can respond to a stimulus with catabolic energy, which is negative, or anabolic energy, which is positive. Anabolic energy is constructive and growth-oriented, while catabolic energy is draining and blinding. Without boring you with research, it seems to be based in science.

Leadership, or the ability to influence someone through an interaction, can be knowing or unknowing, positive or negative. In other words, your own output can affect the output of others, and vise versa. You can also lead yourself, which I find I’ve been having to do more and more these days to maintain my same level of happiness and productivity.

Here are the energy levels:

1. Apathy: “I’m losing. Everything is against me.”
2. Anger: “I want to win, so you have to lose. I will beat you.”
3. Forgiveness: “I win, and hopefully, you win too.”
4. Compassion: “I want to help you win, even if I lose; I am here in service.”
5. Peace: “Everyone wins or no one wins; let’s make lemonade out of these lemons!”
6. Joy: “We always win; everything happens for a reason.”
7. Passion: “Winning and losing are illusions; they are false constructs. We are just being.”

Most health care workers live at level 4 when they are with patients, and in level 2 when they are in the break room. We have bursts of success where levels 6 and 7 are displayed, and tragic loses where we spend time at level 1.

I find I can be very hard on myself, as well as others. This often involves judging my actions and decisions on data that I didn’t have at the time those decisions were made. For example, a CT scan comes back normal and I say “Ah, I shouldn’t have ordered that test, it’s normal!” when really, at the time I ordered it, by pretest probability for X supported ordering the scan. I rarely say “Yes, the CT is positive! Ordering it was such a brilliant move!” Here we can see that I perseverate on the “bad” rather than admire the good.

I don’t want to bore you with what may sound like frilly theory, but I’ll leave you with my assurance that I have viewed my world through a different lens since being introduced to the concept of energy leadership. I find I keep things in perspective, forgive myself and others more often, and take more joy out of the work I do. Energy leadership has joined my self-control repertoire, along with mindfulness techniques and yoga and my strange definition of spirit so that I can be just a little less sad.

If you have techniques that work for you, I’d love to hear about them in the comments below or by phone, email, twitter or facebook. We’re all in this together… to win. (For now, winning is still a construct I very much strive for, but I’m a work in progress.)

Thanks for reading this rather long post… I’ll keep it shorter next week.

It’s been 16 hours since I started my call shift. I’m sitting at the nurses station on 6 Surgical as one of them walks in carrying a take out container. Greek fries. She’s brought extra forks. I think of my upcoming trip to Cuba. Then she opens the lid. Irresistible smells waft upwards and I unwrap the plastic from around the cheap hospital fork. On-call calories don’t count, I tell myself, painfully aware of my diet these past eight months as I try to stay alive during my rotating internship. I haven’t cooked a real meal since December, in part because I haven’t been grocery shopping since Christmas. We sit there, 6 of us, and chow down, laughing about the state of US politics and wondering if Cuba will decide to boycott America right after America un-boycotted Cuba. 8 more hours.

Beep-beep-beep-beep. Fake enthusiasm draws laughter as I punch in the 5 digit call-back. It’s the stepdown unit, for a patient I don’t know, operated on by a surgeon I’ve never met. A mild fever. “Just want you to be aware!” Well shit. Being aware on a night shift is a curse. Being aware means being responsible. I leave my loaded fries and new friends and hit the stairwell. (Residents don’t use elevators, because elevators are slow, and because we eat Greek fries on call, and because deep down inside we know that on-call calories DO count).

Fevers can be nothing. Tylenol makes them go away. But fevers can also be canaries, subtle hints that badness is brewing. I check in on the patient. She’s recently had major surgery, and now has a fever. I note a heart rate of 98 – technically within the normal range (60-100) but only just. She says she’s fine, so I ask again, and she admits to some shortness of breath. Fevers can be nothing, but fevers can be blood infections, abscesses, pulmonary embolisms, or necrotizing fasciitis. Once I’m aware of a fever, I need enough evidence to calm my neuroticism before I squash it with Tylenol. No Tylenol, this time. I order an x-ray and labs and make a note to check them later. 7 more hours.

This is how the night will go. Chatter with nurses, picking at foods I tell patients to avoid, answering pages of vague significance, and meeting patients I have never met before, who’s lives the consulting surgeon has placed in my hands until 0700h. Read a chart, review a scan, order some blood work, hang some fluids. Don’t kill anyone.

Beep-beep-beep-beep. Less enthusiastically I pick up the receiver. The emergency department has a patient who I discharged yesterday. Ooops. I head downstairs and the wife assaults me with a venomous tongue. I take a deep breath. 6 more hours.

No one likes to wait. It’s been five minutes since I was paged, and this woman is irate. Her husband, she says, is dying. Gently, I explain he is not. Her husband, she says, has been mistreated. Kindly, I explain we do our best. I assess his surgical site. It is red and painful and oozing blood. Because we just did surgery on it. When you cut skin, it tends to get red and it tends to hurt and it tends to ooze blood. I sense my persona has shifted, like the tides shift with the apogee and perigee of the moon. I’m getting tired; enthusiasm is being replaced with sarcasm. I discharge the patient home, tell him the trochar site will heal, and thank the wife for her graciousness before walking away, rolling my eyes. It’s not that I don’t understand her, or him, or human nature. I get it. But rolling my eyes makes me feel better, if not a tad bit immature. I head back upstairs, knowing the fries won’t be the same cold and soggy.
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It’s 0200h and there are 5 hours left. I realize that my Sunday post will now be a Monday post as I sit down at my laptop. The Tim’s closed at 11pm and there is no coffee here overnight. My Red Bull does the trick. I write a blog post about the only thing on my mind, which is the Greek fries. Cuba… shit, my abs…

I check the bloodwork of The Fever (yes, I know, I should call her Mrs Whatever-her-name-is, which for this blog post I would change to Mrs Whatever-her-name-sounds-like-but-isn’t, but I don’t remember her name). She’s sick. I call the nurse. I start fluid, antibiotics, and order a CT scan. I call the radiologist. I get up, obliged by my own philosophy more than any real occupational requirement to go see The Fever with my own two eyes. 4 more hours. When I come back, I’ll lay down. My eyes will close, but my mind will race. At some point, I might drift into a zone of semiconsciousness I can’t really describe, but which every resident knows.

Until beep-beep-beep-beep.