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

True freedom

Wisdom from one of the greats of Russian literature:

"The world has proclaimed the reign of freedom, especially of late, but what do we see in this freedom of theirs? Nothing but slavery and self-destruction! For the world says: 'You have desires and so satisfy them...Don't be afraid of satisfying them and even multiply your desires.' And what follows from this right of multiplication of desires? In the rich, isolation and spiritual suicide; in the poor, envy and murder...

Obedience, fasting and prayer are laughed at, yet only through them lies the way to real, true freedom. I cut off my superfluous and unnecessary desires, I subdue my proud and wanton will and chastise it with obedience, and with God's help I attain freedom of spirit and with it spiritual joy."

First published in 1879-1880, still pretty relevant, don't you think?

Summer lovin'

Although I don't think I'm going to make it up Mt. Massive this year, and though I'm pretty sure the Rockies' slide is due to my lack of attendance at games, and although Jazz in the Park hasn't even made it on to my radar (okay, enough, stop!), I've still had a pretty good Colorado summer. In the last week and a half alone, I've done camping, the Colorado trail, the Bike MS, Staunton State Park, and tomorrow I head out for a week at Camp Wojtyla (and yes, I do work sometimes). Who knows the fun that will be had!? I'm the "medical consultant" for the camp--basically the school nurse up there on a free ride. My own tent, someone to cook me food and perhaps let me tag along on adventures (rock climbing, Mass on a mountain, ropes courses), all in God's country...sign me up! Hopefully I'll have some worthy stories when I get back. I'm assuming so, because in the 8 hours I was up there during staff training, I got homemade camp pizza, beer on the porch with Fr. Peter, a brief class in salvation history, recertified my safe environment training, and I got to do an I&D, a nail trephination, and examine two other staffers for mild illness. It was a pretty packed day! Not that I wish anyone ill, but I do hope I can be of some use while I'm up there. But if not, I'm considering it a much needed retreat for myself. And an excuse to use my camp cookware and headlamp.

P.S. Still to come this summer--Ft. Collins brewery trip, another go at camping, Twin Sisters, Rugged Maniac, and Warrior Dash.