Another year in books

Yes, some people still read. As in books. I do not understand people that say "I don't read books." And I am extremely heartened by the studies that have come out this year saying that reading paper books is better and by the fact that the AAP finally verbalized what all of us have known for some time: that kids should be read to every day. Reading is just good for you. Not magazines. Not Huff Post articles. Books.

However, I do realize that my volume is a little atypical: this year I read 45 books, including 11 non-fiction titles and 8 books-on-tape (which I'm not claiming have the same benefits, but it sure beats falling asleep during my 45 minute commute home from work). And I have decided to share the best with you. Lucky you.

My Top 3 Books of 2014 (in alphabetical order)
The Giver (Lois Lowry, 1993)--okay, this one was a re-read, in honor of the upcoming movie, since I didn't remember much from 6th grade except the sled and the color red. If you haven't read this, please do. It's the original dystopian novel, so much simpler and more moving than "Divergent" or "The Hunger Games". There are echoes of today's society, like "releasing" the deformed, troublesome, and elderly; trying to remove childbearing from marriage; and government regulation of everything. There are people today who agree that all of our freedoms and emotions aren't worth the heartache they cause--but it's a perfect example that life to the full doesn't mean life without suffering, and even if you take all suffering away, it won't bring happiness.

The Invention of Wings (Sue Monk Kidd, 2014)--This book was an incredibly engaging look at slavery in the South shortly before the Civil War. It details the relationship between an idealistic young Charleston woman and her brash waiting maid, as well as the cultural barriers they both face growing up. It's stark, often very hard to read, but hopeful and thought-provoking as well. Any fans of historical fiction, strong characters, or just a good story should add this to their list.

The Spirit Catches You and You Fall Down (Anne Fadiman, 1997)--as I've already mentioned, this book is a must read for anyone in healthcare or that deals with other cultures, but really, for everybody. This book riled me up more than any other book I read this year, and has changed the way I approach medicine (at least a little bit, at least I hope).

5 Other Great Reads
Clear and Present Danger (Tom Clancy)--an intricate spy novel, detailed but engaging
Leaving Van Gogh (Carol Wallace)--a beautiful look at art, mental illness, friendship, and family
Saint John Paul the Great: His Five Loves (Jason Evert)--the latest on JPII, a wonderfully personable portrayal
Station Eleven (Emily St John Mandel)--a science fiction novel of sorts, wonderful characters and a moving story
The Tiger's Wife (Tea Obreht)--lots to think about in this fantastical tale of a young doctor dealing with the death of her grandfather

As always, I'm up for discussions and book recommendations. Here's hoping for more library card use from all of us in the new year.

This Year, Next Year

Inspired by a friend's post, I present a year-in-review/new-year's-resolution brainstorming session. Goals for next year are subject to change.

14 Things I Did in 2014

1. Played camp doctor for Camp Wojtyla for almost 2 weeks.

2. First (and second) adventure race

3. Learned how to make kale chips

4. Diagnosed leukemia and diabetes

5. Was a High Roller in the Bike MS

6. Read over 40 books

7. Gave speed dating a shot

8. Certified as a Wilderness First Responder

9. Became the education liaison for one of our sites

10. House reunion with all 7 of us (albeit some were Face Timed in)

11. Toured Ireland—SO many other things could fall under this. Let’s just say amazing trip.

12. Trap shooting

13. 2 time flag football champion

14. Spiritual Exercises silent retreat

15 Things I Want To Do in 2015

1. Play in a basketball league for the first time in 12 years.

2. Repeat stint as Camp Doctor, this time for 4 weeks, and become an expert hammock camper

3. Three Colorado sporting events

4. Trip to the Outer Banks

5. Complete my first skiing 4 pack

6. Send a “just because” card once a month

7. Try out a new recipe once a month

8. Attend New Faculty Development Workshop

9. Clean my bathroom every 2 weeks (this one might last about 2 weeks)

10. Take a class

11. Do something that makes me sweat 4 days a week

12. Make progress as part of the Faculty Resilience Council

13. Book the El Camino Trip

14. Finish “Time for God” by Jacques Phillipe

15. Refresh my intubation skills in the OR

A year to live

What would top your Bucket List if you had a year to live?

This was the topic of our conversation at dinner last week. Not because any of us are dying (well, we’re all dying), but it came up while discussing the book I just finished, “Being Mortal” by surgeon Atul Gawande. The book discusses, among other things, how priorities changed for people depending on how much time they thought they had left.

Those who thought they were near the end focused more on family, friends, and comfort, while those with their entire lives in front of them were more likely to explore new connections, pursue long-term achievements, and ignore their family.

I was encouraged to think that I wouldn’t be doing things a whole lot differently than I am now. The main thing is I would push forward some trips that have been in planning for a while. I would return to Kansas City to visit friends, I would embark on one last big adventure (Long’s Peak, el Camino, the Incan trail, etc), and I would keep doing what I’m doing. Working at a job I love, playing sports, being with family, volunteering with camp, enjoying creation.

I will admit that in the little things, I could do a much better job of making the most of each day. After all, no one wants to think back in their final moments about how much time they wasted surfing the internet or doing Sudoku. So perhaps one of my resolutions in the new year could be to spend less time on things I might regret and more time on things that make my life more full.

Life to the full. That should be on everyone's Bucket List.

Some days are worse than others

This week I had to tell a mom her daughter had cancer.

It did not go well.

When the patient checked in, I thought that “Fever, cough” indicated yet another flu victim. But as I heard the story and progressed through my exam, my suspicions grew. And as I left the room to put orders in, I told the nurse, “She has leukemia.” Twenty minutes later when I had the first of the lab results back, I got a sinking feeling in the pit of my stomach knowing that I would have to break the news. The worst news. The news no parent wants to hear.

There is no way to predict how someone will respond. I expected tears. I didn’t expect what actually happened. It’s probably one of the most disconcerting things I’ve ever experienced to be the cause of that kind of reaction—screaming, fist-pounding, falling to the floor, more screaming. Top of the lungs screaming. Heart-rending screaming. Agony. I hated being the cause—even indirectly—of that level of anguish. I could do nothing to make it all okay, to make it all go away. In that moment, I was powerless.

Maybe that’s what I hate. Being helpless. At least when I’m suffering, I participate in the struggle, I have a role, I fight. But watching someone else grieve, watching someone else ache—I can’t fight her battle. It breaks me. So I pray. Because God knows what He’s doing. He holds that toddler and her mom just as He holds me. I’m trying to convince myself of that even as I type it. That I don’t have to have all the answers. I don’t have to be perfect. I have to present, and I have to be faithful. He will do the rest.

God has created me to do Him some definite service. He has committed some work to me which He has not committed to another. I have my mission. I may never know it in this life, but I shall be told it in the next. I am a link in a chain, a bond of connection between persons. He has not created me for naught. I shall do good; I shall do His work. I shall be an angel of peace, a preacher of truth in my own place, while not intending it if I do but keep His commandments. Therefore, I will trust Him, whatever I am, I can never be thrown away. If I am in sickness, my sickness may serve Him, in perplexity, my perplexity may serve Him. If I am in sorrow, my sorrow may serve Him. He does nothing in vain. He knows what He is about. He may take away my friends. He may throw me among strangers. He may make me feel desolate, make my spirits sink, hide my future from me. Still, He knows what He is about.                                       -John Cardinal Henry Newman

A Gratitude Manifesto

For true freedom, freedom to love because He first loved us. For salvation. For a God who stands by my side every moment of every day, who daily blesses me beyond what I deserve or expect. For knowing I will never be alone. For the truth and beauty of the Catholic Church, in her liturgies, her saints, her guidance and wisdom.

For a family that chooses life. For an example of sacrifice in marriage from my parents. For sisters who are also friends. For memories of laughter, hugs, tears, adventure. For all of us being safe, healthy, and together today.

For friends that have walked with me through many challenges and celebrations. For love that is unconditional, for my everybody committee, for being able to be my weird self. For those who have known me for a long time and have grown with me. For those who have allowed me to share their lives and who have been willing to share mine.

For the opportunity to be a pediatrician. For my training and education, my teachers, my mentors, my patients, my coworkers. For the families that let me in to a vulnerable time and trust me with their most precious gift. For the ability to see kids get better. For the heartache of watching kids die, because it reminds me how precious life is. For a job that I love, because I know how rare that is.

For my health and the ability to enjoy leisure. For the grace to appreciate literature, music, art, food, sports, and nature. For all things, big and small, that enrich my life, from a barrel-aged quad to a Colorado sunset to a book that makes me laugh out loud.

For the chance to give back, both financially and personally, for all that I have been given. For the challenge of giving more, for the knowledge that my life is not my own, and this is not our home.

I am grateful.

Looking back

Today Mass was celebrated for a doctor who changed the life of a priest—Fr. Riley was one step from abandoning the Midwest misery of Notre Dame for the glamour of Hollywood, but typewritten letters from a friend convinced him to stick it out and here he is. Quite the legacy. It made me think of a priest who changed the life of a doctor…

Apprehension filled my heart as I sat in the stiff chair, clutching my test results. What if he couldn’t tell me what my career path was? What if I answered some of the questions wrong? What if he told me something I didn’t want to hear? I almost laugh looking back at it now, how anyone could be fearful of meeting with a soft-spoken five-foot jolly caricature of a Jesuit. 

As freshmen at Creighton, I’m sure there were many opportunities for career advice, but the only one anyone took seriously was Fr. Schloemer. (Reverently picture a garden gnome. In a collar. That's him.) His formal title escapes me, but he worked in academic counseling, and the general sentiment was that he was the one to tell you what to do with your life. There was a prerequisite personality and skills inventory whose results I carried to my appointment that day, but I was still skeptical.

The structure of the meeting was informal. We mapped out a sample course schedule based on my chosen major (biology) and I don’t even think he looked at the test. Near the end of the discussion, he set the course for my vocation as a physician. With his dulled pencil in hand, he humbly asked, “May I make a suggestion?” I nodded somewhat hesitantly. He scrawled “MCAT” on my schedule between the column of my prospective sophomore and junior year. I cringed.

“I don’t want to take the MCAT. I don’t think I want to go to medical school.”

“You’ll have all your prerequisites done. It’s better to do it before you forget. It doesn’t mean you have to apply to medical school.”

He had a point there. So I resigned myself to this new development and left feeling somewhat unfulfilled. I still didn’t have an answer. Or so I thought.

From that moment on though, I could see God chipping away at my wall. I wasn’t confident enough, or smart enough, or dedicated enough to be a doctor. But I started to want it. I would see a cluster of short white coats shuffling through our science building and I began to tell myself, “That could be me.” I began to see myself in medical school, taking care of people, studying for the long haul, and I was at peace with it, even excited about it. Within a few months, it was as if there had never even been another choice. This was what I was meant to do.

From the beginning of this long journey, I knew this was God’s plan for me, obviously not something I came to on my own. And every time I hit a road bump (from a failing grade—yes, those happened—to being belittled by a surgeon to staying up 30 hours straight), I knew I wasn’t doing this by my strength. I knew I wasn’t alone. God had foreseen this when I was a scared little freshman, and He knew I could it.

So thank you, Fr. Schloemer, for those four letters and your humble “suggestion”. It changed my life.

PSA for MIA parents

Imagine this. You finally get a vacation. With your spouse. Away from the kids. Hooray for Grandma and Grandpa! You hope they have everything they need, but really all you can think about is that king bed next to the window overlooking the beach. And sunshine. And quiet. You promise you'll check in every night...maybe.

Now imagine this. While you're gone, your slightly clumsy 4-year-old walks straight into a door, splits her head open, and gets taken to the wonderful pediatric urgent care down the road. Only they can't treat her. Because you are unreachable (darn cell reception on the beach), it's not a life-threatening emergency, and you forgot to give power of medical decision making to Grandma and Grandpa. Whoops.

This actually happened to me last week (well, I wasn't the one on vacation, obvi. I was the treating doctor). Mom and Dad were on a plane over the Atlantic and Grandma had one traumatized little girl and her restless older brother with no way to consent for medical care. Thankfully the plane landed and we got phone consent in time to get the patient the stitches she needed and home to bed, but there's an easier way.

If you are going to be out of town, unreachable, or leaving your kids in someone else's care for a prolonged period of time (in my mind, that's a couple of hours, given that you never know what kids will do), it's a good idea to give the caregivers medical power of attorney (MPOA) for your kids. Every state is different, but from what I know, here's the basics.

1. The MPOA does not ever supersede your rights as a parent, nor does it allow the temporary guardian the ability to let your child be adopted or get married (I know, we were all worried Grandma might go a little crazy, right?)
2. The MPOA is good for up to a year and allows a designated guardian the ability to make medical decisions for your children.
3. An MPOA is not necessary for emergency treatment. This qualifies as life- or limb-saving measures that any reasonable person would agree to for their children. This does not apply to cosmetic or non-emergent issues, even including facial stitches or broken bones (which can be set a few days later with good outcome).
4. The MPOA should be a signed document designating specific (named) people to care for your (named) children (include date of birth) during a specific period of time and should be signed and dated by the parent.
5. Our hospital (as far as I know) does not require a notarized form, and Kaiser's form says notary is optional, but for water-tight agreements, notary is preferred. Here is an example of the form for Colorado. Every state may have their own requirements.

So, next time you flee the madness of your offspring for sandy beaches (or if you know someone planning to do so), make sure an MPOA gets filled out so that we can take better care of all those kiddos.

Burnout and what to do about it

Physicians have the highest rate of suicide of any profession.

I told this to a friend of mine the other day and she was shocked. And I was shocked that she was shocked. To me, it seems obvious—we have high stress jobs, high rates of depression, and knowledge of as well as access to lethal drugs. We take on the suffering of the world without training in how to deal with burnout, loss, abuse, and failure. Residency is only possible for those who become, as Dike Drummond notes on The Happy MD blog, lone-ranger-superhero-emotionless-workaholics. How else are you supposed to survive being solo on an overnight call with the sickest patients in the hospital? So that’s how we cope. But that’s not the answer. In one study, 40% of interns (first-year residents) met criteria for major depressive disorder.¹ Forty percent!

I was discussing this with a colleague recently, lamenting the fact that we have to turn off our compassion in order to survive difficult situations. If you get too close to the teenager dying from cancer, it’s too hard to do your job. So you create distance. “You have to!” I said, meaning it. She looked at me sadly. “No, you don’t.”

I’m not sure I completely believe her, but I think that’s because I was trained (as we all were) to become a lone-ranger-superhero-emotionless-workaholic. Thankfully my faith and my amazing support system have kept me from going too far over the edge, but what if there was another way? One that didn’t involve having to always be right or never being able to ask for help? Medicine will always be difficult (especially in today’s world with its constant fight for reimbursement, poor access to care, and patients who diagnose themselves with Dr. Google and get their vaccine advice from celebrities) but we don’t have to get burned out.

General estimates among practicing providers are that anywhere from one-third to over half suffer from symptoms of burnout (defined as depersonalization, emotional exhaustion, and decreased sense of accomplishment). So what do we do?

There has been a lot of promising research in the areas of mindfulness and positive psychology, and I’m starting to immerse myself more in it as I take on the task of improving wellness and reducing burnout within our section (not a small challenge, with some 100 providers and the lowest employee satisfaction rates within the hospital).

I’m not under the impression that things will change quickly, or by great percentages, but I’m going to try to do something. I have to. Because the alternative is to accept the unreasonably high rates of depression, burnout, and suicide in my colleagues and friends. And we were made for more.

To finish, I’m going to borrow an exercise from the Positive Psychology department at Penn to challenge you, dear reader (and myself). It has been shown to improve wellbeing and to have lasting effects even 6 months down the road. It’s called “What Went Well”.²

Here’s how it works:

            For 2 weeks, at the end of every day, write down 3 things that went well that day. Doesn’t have to be big things. Then write down why those things went well.

            Example: I was able to work out today because I was disciplined and had the time to commit to exercise.

            Another example: My best friend called me to catch up because she cares about me and wants to know how I am doing.

            That’s it. That’s all you have to do. You don’t have to show it to anyone or make it eloquent. Just give it two weeks.

Here’s to wellbeing. For all of us.

1. Guille, C., et al. (2010) in Journal of Graduate Medical Education.

2. For more exercises and resources, visit www.authentichappiness.org

American Tradition

Whenever I see the richness of cultural traditions in other countries, I lament the fact that Americans have nothing. We’re such a melting pot that our one claim of cultural identity is to sit on the couch on a Sunday in late January with piles and piles of food and beer and scream at the TV while 22 grown men attempt to demolish each other. Oh, and the commercials. Yes, American tradition consists of Super Bowl commercials. I suppose you should add baseball to the list. After being tied to the Fall Classic this year because of my time in Kansas City, and seeing the entire city rally behind their boys in blue, we definitely claim baseball. But when you compare that to the elaborate costumes, recipes, liturgies, dances of almost every other culture in the world, you realize that we care much more about capitalism than tradition.

However, I’ve come to realize lately that there is one thing we should claim proudly. S’mores. Hear me out. Regardless of how often your family camped growing up, chances are you are well versed in the art of browning (or burning) marshmallows over a fire, carefully balancing the chocolate and graham cracker on your knee, or a tree stump, or picnic table, and then gooing up your fingers to complete the masterpiece. Everyone has their own style—finding the perfect s’mores stick, one or two mallows, the cracker to chocolate ratio, the technique (I’m a slow and even, golden-brown kind of girl. Michelle is definitely a scorch and run).

It’s something so innate that I’ve never thought about the fact that it’s a uniquely American practice. Michelle went to Nicaragua this summer and the group made their hosts an “American” dinner (think Thanksgiving, which I suppose is another tally in the win column) complete with s’mores. Padre Simon was incredulous…“You mean you light a fire for no reason? In the summer? Just for fun?” After being introduced to this shining example of American culture, he promptly ate five.

Fire just for fun

I also had the chance this summer to take this tradition to the limit—s’mores more abundant. At Camp Wojtyla, John 10:10 stands as a reminder that Christ came for us to live life to the full, every aspect of life. Even s’mores. So one night during the week, we traipse up to the fire pit with boxes and boxes of candy bars—Twix, Reese’s, Snickers, of course Hershey, even Starburst—and spend the night taxing our pancreases.

So someone remind me, the next time I lament of our tradition-poor consumeristic American lives, of Padre Simon and Twix-marshmallow heaven, and standing under the stars, with a fire “just for fun”, living life to the full.

Perfection

Omaha! Omaha!

509 is a big number this week. Manning etched his name on another page of the history books as he passed Brett Favre’s career TD passing record. The media has been appropriately slack-jawed. Some brief stats for the math nerds among us:

            Average passing TD per team per game last season: 1.54

            Therefore, average passing TDs per 16-game season: 24.6

            Number of seasons you would need to play to hit 509 throwing the average: 21.2

            Average years a QB plays in the NFL: 4.4 (a far cry from 21.2)

            Number of NFL players who have played more than 20 seasons: 6

            Number of those players who were not a kicker or punter: 0 (although one was a QB and a kicker, not sure how that happens)

In other words, statistically it’s highly improbable to get anywhere close to 500 touchdown passes. Favre had to come out of retirement about 7 times to reach that milestone. And Manning isn’t done yet.

But the stats tell only half the story. What’s amazing to me is that Manning has done this year in and year out, no matter who his receivers are or who the opponent is, and it’s because of his work ethic. He’s notorious for being the one who spends the most time preparing, watching film, studying the playbook, coaching the receivers, practicing and practicing and practicing. He’s respectful, intelligent, humble, and generous. In a world where million dollar fines for childish behavior are routine, Peyton’s been fined all of once for a grand total of $8628. Instead, his millions go to support the communities that have supported him, helping underprivileged kids through the PeyBack Foundation.

I believe it’s why he makes everyone around him a better player, why Elway made such a gamble on the unknown, and why the Broncos are now America’s favorite team. Who knows where the touchdown record will finally stand, or how many other records Manning will pass on his road to Canton. He has the numbers to pave the way, but his legacy will be much more than that, and for good reason.  

The Great

One of the marks of the great events of human history is that you remember where you were when they happened. JFK's assassination, the moon landing, 9/11. When John Paul II died, I was at Walmart picking up (Sister) Susan's glasses. We had been watching CNN for days as he lay dying, praying for him, knowing we were witnessing history. After he died, a friend called to express her condolences. Not a Catholic, she nonetheless knew that losing the leader of our Church would have affected me. It wasn't until then that I really had a chance to reflect on what he had meant to me. I told her he was a spiritual father to me, and I meant it.

I remember Mom telling me once that since JPII was the only pope we had ever known, we couldn't understand that this wasn't the way it always was. The pope wasn't always so visible, so magnetic, so prolific. Yet, as one of the JPII generation, I grew up reading his writings, seeing him in the news, studying his teachings. The second time I saw him in person, in Toronto (maybe the third, if you count WYD 1993, where we barely were close enough to see screens of his face), we were packed in along the barricades, awaiting his arrival. Cheers rang out as the helicopter passed overhead, circling closer. Somehow, I found myself balanced atop a folding sports chair, three rows back, clutching my disposable camera (my real camera's batteries had died the day before. Of course.).

As the popemobile got closer, you could feel his presence. I can't really explain it. It wasn't necessarily a visible thing, but it was tangible, this wave of grace that flowed over the crowd as he passed them by. Even as distracted as I was by trying to snap a picture without falling off my chair, I noticed it. It was like a gentle shock wave, or a bath of warm water. It was the Holy Spirit and the presence of a Saint.

There are other memories I have ("You are young. The pope is old."), and numerous writings and teachings of his that have changed my life. I think what it all came down to, why I'm proud to be a member of his generation, is that as a philosopher and anthropologist, he knew what the human person was created for and how he or she would find fulfillment; and as a pastor, he lovingly demanded that we rise to the challenge. He believed in us, as a race and as individuals. He knew that God would finish what He started in us, and he believed that the time was now. He knew we were made for greatness and wouldn't settle for anything less, especially in his own life. That is truly the Gospel lived.

Saint John Paul II, on your very first official canonized feast day, PRAY FOR US.

Make a wish

The book club decided to read "The Fault in Our Stars" this month. (Whether or not we actually discuss it during the gathering is anyone's guess.) There are countless worthy topics triggered by reading this book: facing one's mortality and leaving a legacy, friendship, the value of suffering, the importance of literature, how to care for the terminally ill. But I've been thinking about something a little different. I think I can safely say, without ruining the plot, that a major portion of the story involves one of the characters' Make-a-Wish trips.

Don't worry, I do not have a life-threatening disease, and even if I did, I'm pretty sure I'm too old to get a Wish. Still, it's an interesting question: what would you do if you could do anything?

It has to be something I couldn't do for myself. Something that requires more than just money or time, because I have both of those (although conceivably I wouldn't if I were dying). So I'll have to make the Camino happen of my own accord. No, the Wish requires a little bit of pull, some connection, some influence, some outstanding rule-bending circumstance that makes it the chance of a lifetime. I lament that I have now missed out on what would have been the two ultimate Wish experiences (for me) because I didn't get sick sooner: a private audience with Saint John Paul II, or (a distant second) a cameo in one of the Harry Potter films with at least a week on set during filming.

The problem is that as I've gotten older, I've become significantly less attached to worldly things. I'm not saying this in a prideful way, but I have no desire now to plaster my bedroom walls in autographed "Buffy the Vampire Slayer" posters or be front row at a Hanson concert (although it was surreal seeing them at The Tavern and getting high-fives from 2 out of 3). Even famous people are just people, and stuff is just stuff, and my most-cherished memories have been doing normal things with my friends and family: watching the Kristen Bell sloth video with Brandi in Scaggs, playing computer Jeopardy a hundred years ago in Hilary's basement, hearing Uncle Dave tell his crazy stories, singing the sun down at youth choir practice, going out for a drink with a friend.

So, I've now pretty much talked myself into not needing a wish. But I do not want to let you, dear reader, down, and I do not want to live a life devoid of big dreams, so I will put forth the following Wish, hoping that someday I will be able to make it happen before I'm dying of an incurable illness.

I would like to found the Saint Gianna Scholarship fund, to put young, faithful, dynamic Catholics through medical school. I will always be grateful that the great cost of medical school was not a factor in my choice of career paths, that I was able to follow where I felt the Lord was leading me without wondering how I would ever make it work. And I was disheartened by the lack of strong Catholics in medicine despite the obvious deep need. We are desperate now more than ever for compassionate care that sees each life as valuable without fearing suffering, that makes the most of God-given talents and scientific breakthroughs to protect the dignity of the human person without compromising. But it's also harder than ever for Catholics to be on the front lines, when euthanasia and abortion are legal, when IVF and the Pill are the "gold standard" against which other methods are stacked, when psychiatric care is an afterthought, when even the American Academy of Pediatrics advocates promoting birth control for all teens. Case in point. I think it's enough to make a faithful Catholic re-consider their options, especially knowing the financial implications of medical school. So my goal would be to establish a foundation that could off-set that, maybe for one person, hopefully for more. I would need a lot of help in the finer points of non-profits and scholarship management, not to mention raising the funds. Not to mention that it wouldn't begin to counter the ethical challenges or the intensity of training, but if it could get us more of the right kind of doctor, I think it would be worth it. So if any Wish-granting fairies are out there, I've made my decision.

Beauty in the city

If you're like me, you have a hard time dropping $15 to go wander the Botanic Gardens when a few extra minutes of driving can put you in the middle of equally beautiful wilderness.

Case in point #1

#2

And #3--all less than 90 min from my house

However, I have always been a fan of what I've seen of Dale Chihuly, beginning with the massive entryway sculpture at the Joslyn in Omaha. The colors and shapes are arresting, especially when you consider it's all blown glass.

Inside and Out. Photo courtesy of the Joslyn. Stunning, right?

And we just happen to have a huge collection of his outdoor work at the Botanic Gardens right now. I was chatting it over with a friend of mine, who lamented that it seems pointless to go look at all these sculptures when even more beautiful creations are all around in the flora that normally inhabits the gardens. It's true; sorry, Dale, but you can't beat the Master at His own game. Never the less, I think it is absolutely worth a visit for a few reasons.

1) Gets you outside in the beautiful Colorado fall.
2) Gives you a reason to drop the money to take in the best of creation (especially the alpine collection, the birds and bees walk, and the rose garden), and because you spent the money, you might actually stop to enjoy it, instead of passing it by like we do every day.
3) Tons of beautiful sculptures will make you feel cultured without feeling cooped up in a museum.

#nofilter (I don't really know what that means, but I've always wanted to write it)

So if you haven't yet seen the exhibit, it's worth it. And if you'd rather instead head up to the mountains to see the changing fall colors, fine by me. Bottom line, there's a lot of beauty out there to be seen. Get off the computer and go see it!

Comments on the Synod "Relatio"

The interim summary of discussions from the Synod on the Family has been released. I'm not presuming to have a firm grasp on all the nuances, or a definitive critique, but I thought I would put forward some general points and my commentary. (Disclaimer: this is long and academic, but still shorter than reading the full document, although you should do that too)

The document divides itself into 3 parts, saying that the Church must first 1) listen to the challenges for the family in the modern world, then 2) look to Christ for His revelation about the beauty and truth of the family, then 3) discuss how these two converge.

In the first part, the document examines a (non-exhaustive) list of the challenges that the Christian family faces today, cognizant of the cultural differences and economic barriers: polygamy, taxation, violence, single-parent homes, mixed-religion couples, and the emotional desires for intimacy and growth. From a pastoral standpoint, addressing these challenges "requires that the doctrine of the faith, the basic content of which should be made increasingly better known, be proposed alongside with mercy." (11)

At the beginning of part two, we encounter what I think is the major "controversy", if you will, that the media has latched onto. The document sites this "law of gradualness" referenced in JPII's Famililaris Consortio and says that this means "interpreting the nuptial covenant in terms of continuity and novelty"(13). I think many people see this as a concession that the Church needs to re-interpret things in light of today's culture. I wonder if this is even the intent of some of the bishops, despite the fact that right after this, we are reminded of Jesus' caution that while Moses gave a law of divorce because of the hardness of the Israelites' hearts, "from the beginning it was not so" (14, cf Mt 19:8). Allowances for a practice of sin are not the fullness of God's plan for us, and should be no more than a temporary stop-gap while we continue to convert those hard hearts, not a concession to the culture. This is in fact what JPII meant when he first mentioned the "law of gradualness" in his writings on the Christian family in the modern world:

[Man] knows, loves, and accomplishes moral good by stages of growth..."And so what is known as 'the law of gradualness' or step-by-step advance cannot be identified with 'gradualness of the law,' as if there were different degrees or forms of precept in God's law for different individuals and situations"... It will be easier for married people to make progress if, with respect for the Church's teaching and with trust in the grace of Christ, and with the help and support of the pastors of souls and the entire ecclesial community, they are able to discover and experience the liberating and inspiring value of the authentic love that is offered by the Gospel and set before us by the Lord's commandment.(Fam. Cons. 34, emphasis mine)

 In other words, we convert in stages, by teaching authentic love and allowing people to progress towards acceptance of the Gospel gradually, not with judgement, but with understanding. It certainly does not mean that gradually we change the Gospel to accommodate the culture's whims and individualistic hedonism. 

The current document reaffirms this further along in part two: that in difficult circumstances, "the value and consistency of natural marriage must first be emphasized"(18). Somehow the media ignores this (are you surprised?) and jumps straight to the next point. Namely, that "with regard to cohabitation, civil marriages and divorced and remarried persons,...the Church turns respectfully to those who participate in her life in an incomplete and imperfect way, appreciating the positive values they contain rather than their limitations and shortcomings"(20). Many people will see part two as a confirmation that cohabitation and civil unions are morally good, and think that the Church is finally admitting that Her teachings were behind the times. But there is a far cry from "accepting the reality" of a situation, and condoning it as morally permissible or the greatest good. Taken in context, it's clear that the Church recognizes that incomplete participation in the sacramental fullness of marriage still has some merit, insofar as it embraces the family as necessary and fruitful, but that we hope for all people to progress towards something better.

Part three starts with an exhortation to families and couples to participate in the joyful evangelization of the culture and announcement of the good news of the Church's teaching on the family. The document mentions the importance of helping young couples adequately prepare for marriage and navigate the difficult early years of marriage with support from experienced couples and the parish.

The section on separated and divorced couples starts out really beautifully, recognizing the suffering of these men, women, and especially children, and encouraging us to walk with them. The document makes clear that there is concern of alienating from the sacraments those most in need of their graces. It does support access to the Eucharist for divorced persons (45), and encourages dialogue surrounding remarried persons coming to the sacraments as well.

There are also comments on welcoming homosexual persons and their gifts into the Church and affirming the rights of children of same-sex couples. The comments regarding same-sex unions and the "precious support" of such in the lives of the couples gets dangerously close to that "gradualness of the law" in my mind and has enormous potential to be misconstrued by the media (52).

I was glad to see comments reaffirming that marriage at its heart requires an openness to life and that the social and economic realities of the world do not override this (53-55).

Ultimately, it's important to recognize that this document is merely a summary of the discussions had so far, "not decisions that have been made nor simply points of view"(58). We still have the second half of the extraordinary synod, then a year of work, then the ordinary synod to go. Overall, I think the discussions have been positive and necessary, and as usual, the media is taking its own agenda to heart. But there's really not much here that represents a change in Church teaching or doctrine.
 

There could be love

I'm re-reading "The Giver". Not only in preparation for watching the movie, but because even though I remembered the concept from 6th grade, something in me knew that I would appreciate it more now. That something was right.

There are elements of the community in the book that are startlingly real: regulating birth, euthanasia, sacrificing differences and love and choice for the sake of order, predictability, safety, and sameness. Those stand in stark contrast with the vivid memories that are passed on to Jonas--memories of pain, destruction, exhilaration, happiness, loneliness. And the Giver's favorite memory: love. Lois Lowry chose Christmas as the depiction of love--three generations of a family wrapped in the warmth of candles and a fire, gleaming tree and piles of presents.

What would I choose to pass on as a memory of love? It's a big concept, which even Jonas' father recognizes. When Jonas asks his parents, "Do you love me?" they chide him for impreciseness of language (a serious offense in their community, which is almost comical). Do they enjoy him? Certainly. Are they proud of him? Of course. But don't ask if they love him.

Such is the difficulty of choosing a memory of love. It's too big. I have memories of belonging (my final dinner party in KC--smoked pork and cookie cake and yard jenga and hugs), enjoyment (bonfire at Camp Wojtyla with Scott shouting "Victory victory!" at the top of his lungs and the drinking-song-version of "At Camp Wojtyla"), comfort (Calie holding my hand during a difficult meeting, saying volumes without saying anything), and many other facets of love, but I'm having a hard time coming up with one that encompasses it all. Maybe it says more about the vastness of love than the inadequacy of my recall. Yeah, we'll go with that. But it's interesting to ponder just the same.

Even in a society where "love" as a word and a concept is derided for its impreciseness, Jonas is able to recognize how powerful it is. He whispers in awe to the young child staying with his family, "Gabe, there could be love!"

I don't have a solid memory of it, but I know I've felt it, and I know it exists, and that's enough.

Unplugged

Trust me, I realize the irony of writing about digital overload in an online forum. But seeing as how I have no print media willing to publish my rants, this is what we're stuck with. The latest "Outside" magazine featured an article by a (supposedly) well-known tweeter and blogger who unplugged for a year (he could do Google maps and online searches, but no "daily news cycles or social media...I would not blog, tweet, share, pin, like, star, favorite, or forward anything.") Holy buckets, I can barely go without checking facebook at a red light.

But I can put at least some of the blame for my digital addiction on the neurobiology of something called variable intermittent reinforcement. Compulsive behavior is built by varying the timing and size of rewards, leading to increased dopamine release in the brain. It's why slot machines are so successful. "One time you check your inbox and there's a single new message, from LinkedIn, which reminds you that you can't figure out how to delete your LinkedIn account. Sad face. The next time you check, you have five new messages, including one from an old friend and another from a potential employer. Happy face! So you check, check, check."

There's also a deeply ingrained response from childhood where we are rewarded when "a signal sent gets a signal back." At 2 months of age, a baby learns that when they smile, they are rewarded with loads of positive attention. Toddlers will repeat a behavior (good or bad) over and over if it continues to get a response. And we carefully word our facebook posts to garner the most likes--signal sent, signal back.

A 2012 study by two Boston University psychologists found that Facebook use is driven by two "primary needs"--the "need for self-presentation" and the "need to belong." Broadcast and be acknowledged: that's a ping. Each one affirms our existence as efficacious agents in the world and prompts a squirt of reinforcing hormones from the brain's reward center. "That is why people will respond to a text while driving a two-ton vehicle." (sound familiar?)

That constant leak of dopamine in our brains is why we sit around a table all staring at our smartphones. Why I constantly check my phone to see if anyone loves me. Yes, that's the way my reward-addicted mind phrases it. As if a lack of text messages during a shift at work or a paucity of likes on a status update somehow diminishes the reality of my relationships.

So, what's an addict to do? Bottom line: improve mindfulness. Recognize those impulses as a legitimate chemical reaction in your brain and make a conscious effort to replace the impulse with something else. Engage in what you are actually doing. Recognize the beauty around you. Connect with a friend, listen to a song, exercise, smile. Meditation is one of the most well-established ways to improve mindfulness. Conscious presence actually does cause changes in brain chemistry and activity. Bottom line? We have to find other ways of activating those same reward pathways. Otherwise we end up like the rats in early experiments that die because they push the "reward" button in their cage to the exclusion of everything else, including eating.

If you've never been exposed to mindfulness training or are unsure where to start, I recommend a short little book by mindfulness guru Jon Kabat-Zinn called "Wherever You Go, There You Are." It introduced me to meditation in a whole new way, helping me to recognize my thought patterns and be present more fully.

Now here's hoping that I can practice what I preach and stop reaching for my phone every time there's a lull in the constant stimulation of my day-to-day.

Gifted

"Since we have gifts that differ according to the grace given to us, let us exercise them: if prophecy, in proportion to the faith; if ministry, in ministering; if one is a teacher, in teaching; if one exhorts, in exhortation; if one contributes, in generosity; if one is over others, with diligence; if one does acts of mercy, with cheerfulness." -Romans 12:6-8

In the Christian faith, we know, at least on an intellectual level, that we each have unique gifts given to us by God to further His kingdom. On an emotional level, we often feel quite lacking when confronted with the likes of Blessed Teresa of Calcutta or Saint John Paul the Great, who many of us have had the chance to see and study within our lifetimes. Even more personally, there are people in all of our lives who radiate various charisms, the name given to the spiritual gifts each of us are given. Those people seem to have been especially blessed, filled with the Spirit, and on a higher plane; we attribute it to some sort of spiritual favoritism.

In reality, each of us have been given charisms (I'm convincing myself of this truth in my life as I write, don't worry), but many, I dare say most, of us have not spent the time discerning and developing these gifts. Just like someone given incredible athletic talent spends untold hours refining their skills, so, too, we must put the same effort into our charisms. We spend so many hours and days (at least I do) begging God to show us His plan for our lives, to tell us what to do, and yet we don't recognize the tools He has placed in our bag as a clue.

At the St. Mary's Young Adult Group last night, Scott discussed that in baptism, we share in the mission of Christ. His mission--namely, to bring about the Kingdom of God on earth--is our mission. Determining and strengthening our charisms is the best way to engage in our mission. Many people have written about the charisms. Sherry Weddell's "The Catholic Spiritual Gifts Inventory" is perhaps the most well-known and widespread for Catholics, certainly the one I've heard the most about. Thanks to my compulsive-online-shopping sister, we now have a copy of the Inventory, Workbook, and Workshop DVD in our (her) possession.

Administration, celibacy, craftsmanship, discernment of spirits, encouragement, evangelism, faith, giving, healing, helps, hospitality, intercessory prayer, knowledge, leadership, mercy, missionary, music, pastoring, prophecy, service, teaching, voluntary poverty, wisdom, writing.

I admit I was surprised by my results, both to realize that certain things I've taken for granted in my life (powerful experiences of intercessory prayer, for example) are actually gifts to help further the kingdom, and to see that many of the things I regret not being better at (hospitality, music) aren't really the things that God is calling me to do anyways. The book explains that "charisms shouldn't be a penance", that we should enjoy using our gifts for His glory. Not only that, but your gifts should be effective, that is, bear fruit; and should be affirmed by others.

There are full-length parish workshops devoted to identifying and developing your charisms, but I think the first step is to know they exist, to pray about them, and to look for confirmation in your own life of how God already uses you. And if anyone wants to complete the Inventory, come on over.

Nashville music and other musings

Broadway was out of a movie--fiddles and bass lines spilling out into the street every time the doors swung open. Blissfully, the bars were non-smoking, and without a cover you could wander in and out on a whim. Miller Lites and Michelob Ultras abounded, much to the chagrin of my craft beer palate. But it wasn't about the drinks; more than a few were left unfinished on the table if the band wasn't up to snuff. It's all about the music. The pop-country-by-demand of Tootsies ($20 will buy whatever song your heart desires, even if they have to look it up--thank goodness for smart phones) seemed to be the most popular (and lucrative) of styles. But there was old-time honky-tonk, bluegrass, and plenty of electric riffs as well. The talent was incredible. Even when they were reading lyrics and chords from said smart phones, there was no mistaking that these were professionals.

Even more so at the famed Bluebird Cafe, where we were fortunate enough to see a "Songwriters in the Round" concert. These guys were in. cred. i. ble. They took turns playing their own songs, which the others had never heard before; but just by knowing the key and watching the leader play, the others were able to join in, playing harmonies and solos and even backing up the vocals. I wish I could explain it better. It was a treat to watch. I think a smile was plastered on my face the entire time, just watching their faces and fingers as they, too, just enjoyed good music.

As I write this, I'm listening to Michelle's second guitar lesson unfold in the family room. And it all resonates so well with the book I'm reading by acclaimed neurologist Oliver Sacks. "Musicophilia" explores the science and medicine behind our experience of music. From the preface--"What an odd thing it is to see an entire species playing with, listening to, meaningless tonal patterns, occupied and preoccupied for much of their time by what they call 'music.'" Music is a part of us from infancy, for nearly every culture and era in our history, and yet, as I mentioned in the last post, it serves absolutely no evolutionary purpose, has no immediately recognizable benefits for humanity.

I still don't have answers. What is it about music that moves us, challenges us, excites us, touches us? What is it that makes singing praying twice? (or once if you're JPII or me) That makes even atheist Nietzsche say "Without music, life would be a mistake"? To me, it's poignant evidence of a God who wants to speak to our hearts, who delights in our creative exploits, who created us to live life to the fullest. Not merely to our evolutionary potential, but to the FULL.

Cause it's a musical

My latest literary endeavor details the science of music--how our brains react to it, why some people have perfect pitch, etc. The prologue explores the curiosity of music, the fact that it has no easily discernible evolutionary value, yet is so ubiquitous and even necessary for humanity. Why do we love music? Why does it move us so profoundly? Don't expect me to have the answers; I just think it's interesting to ponder.

I'm grateful for music. As much as anyone, it has shaped my life. Many of my most vivid memories are centered around songs. Waking up to Dolly Parton and running downstairs to dance in our pajamas before school. Learning Bible stories while Mom sang the verses of "God Loves a Cheerful Giver". Screaming "na na na na" at the top of my lungs with Tom Duckett at Servant Leadership Weekend. Skillet's "Comatose" album blasting in the car while I drove with tears streaming down my face (on multiple occasions...it's my go-to emotional release). There are songs that will always be associated with specific events in my life, that can make me smile or bring tears to my eyes with just a few notes. Those are some powerful neural connections in the brain that can do that.

When we were introducing ourselves at the beginning of my Wilderness First Responder course, in addition to name, credentials, and why we were there, we had to share our guilty pleasure song--the one we sing at the top of our lungs when no one else is around to laugh at us. Seeing all these hulking EMTs proudly claim Disney songs, Taylor Swift, and One Direction proved that music speaks to us in a way that words alone do not. I can't explain it, but I love it.

Woofer

This last week, I suffered a rib fracture with a pneumothorax, lumbar spinal cord injury with paralysis, dislocated shoulder, hyponatremia and heat exhaustion, an intracranial bleed, and an ectopic pregnancy. Sorry, I mean I simulated suffering from those things. They were fake (phew about the pregnancy, right?). Makeup bruises, imagined pain, lots of drama, but I did manage some real tears for the paralysis scenario. Although when you're lying on your back on a rock in the rain, not allowed to move your legs, the tears aren't that hard.

I spent the last five days in a special wilderness first responder (WFR) course for medical professionals, during which we all got to play rescuers and patients to the point that I was dreaming about it by the last night. My last CME course definitely did not find me building traction splints from hiking poles. Or traipsing through waist-high grass in White Ranch Park looking for "victims" of a lightning strike, and then waiting in the dark for a litter team to arrive so we could evacuate her safely. Or experiencing first-hand the ear-popping pressure change inside a Gamow bag, which can treat high-altitude pulmonary edema. (My last CME course did get me to pass boards, so there's that...)

We were 29 plus our fabulous instructors (oh, one of them is the NOLS director of education, you say? he wrote the textbook, you say? and we get access to his brain all week? yes, please). EMTs, paramedics, RNs, and MDs from all walks of life, from psychiatry to FBI (yup, FBI!). And most of these people practice pre-hospital medicine every day. You know, the stuff before they come to the ER all pre-packaged and stable? The part without the lab and the radiology suite and the pharmacist? The hard part? Yeah, they do that. I felt super under-qualified.

But that's why we learn. And boy howdy, did I learn. Practical hands-on things like knot-tying and ankle-taping and one-person log rolls, as well as teamwork skills, planning skills, ideas for a first-aid and survival kit, and plenty of wilderness medicine (did you know you don't do CPR in severe hypothermia because of the risk of V-fib? me neither. Now I do). So now maybe I don't have to feel quite so worthless without all my technology and fancy hospital things when something happens in the wilderness, and people are like "Oh, you're a doctor? Great!" Cause, yeah, my MD means nothing out there. But now I got some extra letters and stuff, so I guess I'll be okay.

Checkin' the mail

Michelle teases me that I am so diligent about checking the mailbox every day. She laments that fact that all she sees are ads and bills. For the most part, that's all I get too. (Although I have subscriptions to a few magazines that occasionally make it worth the trip down the driveway.) But once a week or so, I can count on a hand-written letter from Omaha, and that is the primary reason for my checking.

The letters come from my friend John, a retired banker and alum who is a faithful member of the Creighton 5 pm daily Mass community. As a regular attendee myself, especially during my last two years, I would often see him there, and we progressed from the casual nod hello to friendship. John enjoys getting to know the students and keeping up on Creighton sports, and we often enjoyed chatting about the latest campus news, pop culture happenings, or vacations. Once I moved off campus, he would offer me or the roomies rides back to the House after Mass, especially if the weather was bad. And when I graduated, he asked if I would keep in touch every now and then during medical school, "even if you just write a quick 'hi' on the Church bulletin and throw it in the mail so I know you're surviving."

The thing about medical school (and residency, and perhaps life in general) is that it's busy, but also isolating. People marveled that I found time to write to John a couple times a month, but the truth was I looked forward to it. It was a chance to decompress, to process everything that was going on. I stored up stories to tell, about anatomy lab or powderpuff football or my crazy patients, waiting to put them in the next letter. I wrote in anticipation of the next day off, or my next trip, or the next family birthday, and that helped me to keep things in perspective as well. Knowing that I had someone to share my experiences with (a real someone, not the ubiquitous facebook post) somehow made them more vivid. I would be in the midst of something and think, "I'll have to share that with John later." Sometimes I even made lists so I wouldn't forget to include anything.

In residency too, the letters were a lifeline to someone outside the medical field. I could describe the horrors of an 80-hour call and know that he would be appropriately astonished at the schedule we kept. Or I could brag about our notorious post-Owl Team breakfasts and know that he would marvel at our camaraderie and delicious food choices. In return I am kept abreast of Creighton basketball, changes on campus, news items I missed, interesting stories from students, and his or his brother's trips to Okoboji, Guadalupe, and everywhere in between. We exchange thoughts on book and movie reviews, culinary delights, and of course the weather.

Now eight years later, I still save up stories for John, giving him a little window into the life of a young pediatrician and outdoor enthusiast. I of course select the things that will make my life seem thrilling and worthy of documentation and leave out the boring routine, which is most of life. But it reminds me of a simpler time. A time when everyone had to wait two days or more to hear from their loved ones, and letters lagged behind the present just a bit, as conversations were carried on over weeks instead of minutes. It makes you think about what is really important enough to share, and how much should be shared. It requires intentionality, and I think that's what I love about the trip down to the mailbox. It's the opposite of the false transparency of social media and online friendships. It's tangible and personal, sometimes whimsical but sometimes weighty. It makes me live a life examined, because I know someone is waiting on my report (not that he necessarily watches for the mailman like I do, but I know he enjoys the updates).

Because I know my own joy at the handwritten word, I try to be more conscious of sending along cards and notes to the rest of my friends as well, something that might brighten their day (I encourage you to try it as well). And if anyone ever wants a pen pal, I've got some pretty good practice, and a nice supply of stamps.

The Way of the Cross

Saturday I ran the Rugged Maniac, one of the endless "adventure races" cropping up around the country where participants pay a premium to crawl through mud for "free" beer. Or at least that's kind of how it seemed on race day. Having never done an adventure race, and wanting a trial run under my belt before the Warrior Dash next month, I was pretty much ready for whatever. Oh, except a broken toe. Coming down from rock climbing with the boys last week at Camp W left me with bruising and buddy tape and a little bit of apprehension, but I was going to go for it anyways. Don't worry, on the second of 25 obstacles, I kicked a rock and went down, mimicking the original injury and sending shooting pains down my foot. But maniacs press on.

Muddy water can't stop me. Broken toe can't stop me.

The group that I was supposed to be running with, a motley crew of South Campus nurses and SO's, was, let's just say a lot less into physical activity than I was. I pretty quickly left them in the mud by that second disastrous obstacle and found myself running alone. Throughout the race, I lamented that I had no cheering section, no partner in misery/triumph, no one to balance me as I nearly ate it on those narrow beams (but I did have a guy high-five me at the end for my last-minute save). I thought how much better the Warrior Dash with the wombmate would be, and how I even wanted to encourage random strangers as they walked hunched-over, knowing how important it is to feel that support.

Blame it on spending two weeks this month at Camp W, where everything is a metaphor for the Christian Life, but as I was praying the Stations yesterday in the dry, clean comfort of my living room, I thought back to the course as I pictured Jesus walking Calvary on His own. Yes, he met the women of Jerusalem, and His Mother, and reluctant Simon, much as I occasionally struck up conversation while in line for obstacles, but the walk, the burden, the suffering, was borne alone. How much would He have given for a companion to whisper encouraging words, or just to share the journey! Fr. Gaitley, based on the revelations to St. Faustina, talks about offering to Jesus our presence at the cross, loving Him and being with Him in His suffering. And now I have a concrete experience of the value of this. Our God who transcends time was also fully human, and ached for a friend for the journey just as much as we do.

I don't really have a metaphor for the muddy water, or the fire pits, or the free beer. Sorry.

Fire pit--check!

Health

People often ask me, as a healthcare professional, what I think about "the healthcare system". I'm not sure how to encompass all of my thoughts in a succinct answer, but a medical student asked me about it a few weeks ago, and I realized that a lot of my ranting could potentially be quelled with a change in the philosophy of medical education (which in my mind, is much more doable than, say, getting Medicaid to change their reimbursement policies). I'm too lazy to look up the research behind this, though I'm pretty sure it would support me--but I'm convinced that if we took a giant step backwards in history, we would actually come out ahead.

In 1946, the World Health Organization published a document that stated, "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

In 1946! Pretty sure we've long been ignoring that truth.

I would posit that if we, as doctors--and with the support of the rest of the healthcare system, including insurance reimbursement--could focus on promoting physical, mental and social well-being, rather than trying to "cure" disease or infirmity, we could make great strides in healthcare costs, patient satisfaction, and overall health outcomes.

Let me give you a few examples. In residency, we dealt a lot with what I called the bane of my existence, but what ICD-9 calls functional abdominal pain. Usually preteen girls with Type-A moms who manifest stress in their GI track, and despite 100% normal workups have disruption of their daily activities due to pain. If there was such a ratio as healthcare dollars spent per improvement in quality of life, functional abdominal pain would be among the highest. We did literally million dollar workups on these patients--sometimes including surgeries like gall-bladder removal, central line placement, and gastric tube insertion--all to prove to the parents and patient what we knew from spending 5 minutes in the room: they needed a therapist and patience, not a hospital. Rather than trying to find a physiologic cause for functional pain (which doesn't exist), if we had spent our efforts to promote overall well-being (ie: managing stress, teaching coping skills, reassuring the family, identifying and removing triggers), I'm convinced we would have been much more successful. But it's easier to "consult surgery" than to spend an hour with the family telling them what they don't want to hear: that there is no quick fix and that it's going to take time and effort rather than a simple prescription.

A much more common example is the plethora of viruses for which parents want a cure. While I do my best to reassure parents and rely on a thorough history and physical exam rather than tests, there are inevitably dozens of strep tests, urine tests, chest x-rays, lab draws, viral swabs, and--gasp--antibiotic prescriptions every week ordered because the parents and patients expect a quick fix. How about instead we focus public health efforts on hand-washing, hydration, symptom care, and keeping immune systems healthy by proper nutrition, vaccination, and not creating super bugs by overusing antibiotics? Not a quick fix, but ultimately better. Think of how many kids we could save from radiation, swabs, blood draws, catheters, and antibiotic-induced diarrhea! Take it a step further to incorporate the social well-being mentioned above--what if workplaces allowed parents of sick kids to work from home a handful of days a year rather than taking sick leave, or if schools didn't require antibiotics or negative tests to allow kids back in school, or if you could use HSA money for pedialyte and hand sanitizer and fresh produce (not saying that's the right answer, but just imagine if society could support well-being from the front end like this).

The adult world has even more examples--throwing expensive imaging tests and narcotics at chronic pain instead of teaching meditation or coping skills; using antacids and antianxiety meds to mask symptoms instead of dealing with stress; knee replacements and bariatric surgery years later instead of addressing childhood obesity.

It's a big system to change overnight, but if medical students and doctors had more training in talking with patients about overall wellness and felt equipped to resist unnecessary and even harmful interventions, then maybe patients would stop expecting a strep test every time they had a sore throat, or a narcotic every time they had pain. And then maybe insurance companies, hospitals, therapists, pharmacies, lawyers, policy-makers, etc. would get on board as well, promoting well-being instead of simply trying to cure disease.

Life to the full

It is extremely daunting to try to put into (less than 3,000) words the experience I had up at Camp Wojtyla this past week. For those of you that don’t know (pretty sure everyone who reads this knows), Camp Wojtyla is a Catholic outdoor adventure camp for middle school and high school youth, where young people learn how to restore and strengthen their relationships with God, themselves, others, and nature through rock climbing, archery, rafting, hiking, camping, etc. I have been on call as their medical consultant for staff training and the middle school camps, but this week was able to be a part of the high school girls camp. Almost 60 girls from across the state and country were captive for 8 days in Teepee Village (or out backpacking), along with the 34 counselors and staff, the camp directors, and me, Doctor Laura.

 

I had NO idea what to expect when I got there Sunday around lunch time. I knew that I would be sleeping in a tent and that was about it. My tent was christened the “Siena Sick Tent” and had an easily identifiable sign complete with a red cross, although on occasion I was asked to sleep elsewhere to help with staffing shortages and sick campers. I had no idea that the person who has been doing my job for the last few years would be departing Monday morning with the backpacking crew, leaving me by myself to deal with camper medications, injuries, illness, HAFE (high-altitude flatulence), etc. By “etc” I mean that I also got roped into driving a 12-passenger van through mountain dirt roads to take the girls rock climbing, finding my way into town to prescribe and fill meds for the staff and campers, getting up at 3 o’clock in the morning to head out on a summit hike, meeting up with an injured hiker on the trail and being part of an evacuation and then sitting in the ER waiting room all afternoon, and participating in “Silly Songs with Sherpa” version of “His Cheeseburger” (yes, I was on my hands and knees in the dirt).

Home Sweet Home

It was slightly overwhelming to be at the beck and call of the camp at all hours, especially since no one seemed to remember that I had never been at camp before (they forgot to give me a schedule and a walkie-talkie, tell me when meals were so I could give meds, and wake me up in the mornings when we had to leave early for excursions) and considering that they had never had a doctor before, so most of the time no one knew quite what to do with me.

 

But it was also incredible to witness the love that the counselors had for each other, for God, for the campers, and for me, who just showed up and was thrown into the middle of things. The girls were welcoming and selfless and encouraging and so invested in their mission. The boys (who spent all week as behind-the-scenes “sherpas”—filling water tanks, cleaning bathrooms, cooking food, driving vans, setting up for Mass) were so humble and genuine in their service of us, and so encouraging of the girls. I have truly never been a part of such an incredible group of young witnesses of the power of our faith and of our God. They were able to handle with grace the unexpected challenges of camper meltdowns, bus breakdowns, flat tires, missing food shipments, late nights and early mornings, hail storms, no showers, and physical discomfort; and because of that, the girls were able to handle it as well, along with the challenges of rock climbing, difficult hikes, being uncomfortable and in pain and out of their elements. Through all of that, they were able to grow in friendship and unity with each other, trust in God, and confidence in themselves. It was an extremely convincing demonstration of the mission and pedagogy of the camp.

 

We also had a ton of fun—watching sherpas painted like trolls tramping through the woods throwing “stun powder” at the girls, Kelly Clarkson sing-alongs during breakfast dishes, song parodies and skits, the best campfire party you could imagine, extreme s’mores (because having life to the full should not exclude culinary experiences), and Italian night complete with checkered tablecloths, serenading, and life-sized Mario Kart races. There were also a few tears—as one of the staff told me, “Welcome to Camp Wojtyla, where you can’t hide from your feelings”—but they were accompanied by hugs and fervent prayers and were definitely outnumbered by laughter.

Sing along time with the sherpas

Meanwhile, I was able to remember that I don’t have to compare myself to others to affirm my worth, that I need to depend on others for support, that it’s important for me to do things that scare me, that my God loves me beyond all belief, and that I am the crown of creation (still having a hard time believing that last one after being surrounded by the beauty of the created world). I am so grateful for the challenge and the opportunity, and I look forward to being a part of high school boys week, which will be very different I’m sure.

This absolutely scared me