Monday, September 29, 2014

Busting the "Hidden Curriculum"





The medical school at my hospital is now offering a structured Wellness Lecture Series for the first and second year students during their lunchtime break, and I was proud to be a part of it last week. I was the first presenter this year with my Heal Thyself talk. It was an honor to share with them my personal experiences in wellness and stress management, and I hope to continue doing it ever year!

The planned lectures to follow include more detailed information about some of the things I discuss in my talk, namely nutrition, exercise, mindfulness practices, etc. So it seemed perfect that my lecture started things out this year! I'm curious what detailed advice the other experts will be providing.

I also recently hosted some female junior medical students at my home for a potluck, and I asked them what kinds of information they would like to see in the Wellness Series. They said that they wanted concrete examples and details of how to take care of themselves. I found this questionnaire from the book The Resilient Clinician, and I thought it might be worth sharing here too. Take it and see if it helps you identify some new self-care strategies!  

In last year's NY Times expose Medicine's Search for Meaning, the "hidden curriculum" of medical school is described as one that teaches future doctors to be self-denying, push emotions to the background, and cover up parts of themselves for the sake of work. We have to undo this type of thinking early in their training, before the bad habits set in. We need to be able to uncover ourselves and families. Different institutions have a variety of ways that they deal with this, including entire courses such as The Healer's Art, which is now taught nationwide at more than 70 medical schools. So glad to be a part of an institution that's trying its own methods for raising self-care awareness!

Check out the talk slides and the questionnaire and let me know what you think!

Monday, September 22, 2014

Taking Time to Enjoy the Raspberries

(My hand, my raspberries)

We have a couple of raspberry bushes in our yard, and our neighbor has a tall one that hangs a bit over our side of the fence. While none of these could be considered copious producers, each bush steadily makes daily raspberries - a few at a time - from mid summer to early fall. At this point in September, their bounty is fleeting... which made me think about how much pleasure I get from the unassuming plants each year.

Every day, I wander past the bushes. Oh look! A few more berries! Sometimes they are dark and perfectly soft. Sometimes the white buds are just starting to turn pink, and they are too hard for picking. No matter; they'll be ready for me to eat them soon. A few berries might be shriveled and drying because I didn't notice them soon enough (always a sad sight). I might glimpse, for the first time, a little droopy, leaf-covered clump holding a cluster of perfect, yet-to-be-picked berries. How did I not notice them until now?

It is rare to collect more than a small handful in a day. Depending on my mood (and hunger level), I might just pop them all into my mouth at once and savor the juicy burst of flavor. If there are only a few, I may eat them individually in succession, experiencing their distinct berry-ness one by one. In the case of a nice handful, I will carefully take them inside, balancing delicately in my hand, to eat with some yogurt or pudding later.

In the midst of our complex lives with daily conflicts to resolve, work duties, roles as doctors (or patients), as spouses and parents and caregivers and friends, it is a treat to find so much pleasure in something so simple. The equivalent of less than a dollar's worth of raspberries that are home-grown and fresh, perfectly tasting and yet with slightly different characteristics each time, gives me immense happiness. Which is something I need lately in the midst of life's challenges. I'll be looking forward to their arrival next year!

This recent Huffington Post piece talks about the often forgotten act of noticing and points out some things in our lives that deserve to be noticed. One of them is "simple pleasures". What's your simple pleasure? Share it here!

Sunday, September 7, 2014

PracticeBalance Again Featured on KevinMD!

My recent post about the challenges of NORA was picked up by the Medpage Today's popular medical blog KevinMD.com. This was a timely release, given the recent events surrounding Joan Rivers' death. To be honest, I hadn't heard about her death being a possible result of an endoscopic procedure until I started reading some of the comments to my post. (Shows you how much TV I watch)!

Of course at this juncture, it is difficult to know the details of how she suffered cardiac and/or respiratory arrest during an elective procedure at an outpatient medical center. She could have been receiving moderate sedation or something deeper, and there may or may not have been an anesthesiologist present (I cannot piece it together from the conflicting reports I have read).

The thing to note is that she was 81. She may have had lots of plastic surgery that made her physical appearance belie her age, but sedation or anesthesia on an 81 year old is never without risk. And sedation or anesthesia of any type on anyone is not without risk. 

Anyway, here is the link to the syndicated post. If you can't stand to read the post again but are curious about the comments, those can be found here.

Monday, September 1, 2014

Two Weeks of Waiting = Torture

(Image courtesy freedigitalphotos.net)

The hardest part of doing IVF is this phenomenon known as the Two Week Wait. After an embryo is implanted, the pregnancy hormone HCG does not rise to detectable levels for approximately 10-14 days; thus, you have to wait two weeks to find out if the procedure was successful and you are actually pregnant. This is an especially torturous time for women, as it's easy to scrutinize every little thing you feel or do:

"I have some cramps... does this mean I'm pregnant?"

"I tripped in the garden yesterday and lurched forward... what if that made the embryo dislodge?"

"My breasts hurt... No wait, now they don't hurt..."

When people ask me how I'm faring in my IVF journey, I always say that the mental aspect of things is MUCH harder than the physical aspect. The mind game of waiting is a big part of that. I can shoot myself in the belly and butt with hormones until I'm blue from bruises, but I have a hard time relinquishing control and living with the unknown.

You see, I am an anesthesiologist. My job substantially involves performing interventions that produce near-immediate results. I give a drug to induce anesthesia, and the patient jokingly says, "I'm going to fight it, doc!" or "Don't you have people count backwards? One hundrrrr..." Boom. They're out cold. I always win. In the middle of a case when the heart rate gets too high or the blood pressure goes too low, I give a drug and within seconds things are back to normal. I'm used to seeing the direct results of my actions.

This is not the case for many other doctors, and it is definitely a reason that some people end up choosing anesthesia or surgery or possibly emergency medicine over other specialties. If you are a general practice doctor seeing a patient in a clinic and you prescribe a new medication or ask them to try some new behavior in regards to their health, you must then send them home with instructions and wait to get the results at the next visit. Changes happen over a much longer timeframe. Even my husband, who is a patent lawyer, submits a new patent application and then must wait months to hear back from the US Patent Office regarding its status.

The other thing is, we have to wait for things in life all the time. When we are going on vacation, we cannot (yet) be immediately transported through thin air to our destination like Star Trek characters. We must wait in lines at airports or spend time driving to the desired location. We set out to change our diets or exercise more, and the results of our personal experiments do not show up overnight; they take months to manifest.

We might get a negative IVF result and then have to wait 2-3 months to try the whole thing again. And this might happen multiple times, accumulating into a period of months or years of waiting. Maybe we do get pregnant, but then we have to wait 9 months for the baby to arrive. A child is born, and we do not immediately plan out his life path; 18 or so years go by while he is growing into his future adult self.

I suppose performing anesthesia, which occupies a significant portion of my life yet is the exception to the rule that outcomes of interventions are rarely immediately known, has skewed my view of time. I'd better adjust my attitude about this waiting thing!