TED talks for the win

I have taken to downloading TED Talks for the commute to Broomfield (or random jaunts to the grocery store; I'm not picky). I can't remember how it first started. I've been doing Lanky Guys and Catholic Stuff podcasts and decided that I should figure out this phenomenon.

The idea behind TED is to share ideas.

There are conferences all around the world dedicated to just sharing ideas.

Isn't that wonderful?

In today's world that is so bent on productivity and one-upmanship and success and money and comparing yourself to the fake version of someone else that they decide to broadcast to the world, there are whole conferences where people sit and listen to other people share ideas.

There may be nothing more that comes of a talk than an interesting conversation. And that is okay.

Blame it on my introvert nature, or my melancholic longing for something better, but I hate small talk. Hate. I would rather stand in the corner for an entire evening--awkward as that is--than spend time gossiping about co-workers or trying to out-do each other for craziest work story or just rehash some pop culture news item. I want to talk about REAL THINGS. Science and philosophy and history and human experience.

Apparently there are other people who share this desire. Or else why TED talks? The beauty of this, if you can find ones worth listening to (and ones presented by speakers with understandable accents), is that someone else has already done the reading, the studying, the learning--and you get to benefit. You get the bullet-point, sound-byte-sized revelations that are interesting. That are worth sharing.

For example--
The power of games to increase resilience
One really important reason why we need sleep
Apparently my standards aren't high enough

TED talks obviously aren't the only way to get us beyond small talk. I'm just excited that I can slowly expand my universe during my drive. And I'd like to encourage you to do the same. Let me know if you find good ones.

Learning medicine

Last night I attended an awards banquet at the School of Medicine for physicians who volunteer as preceptors, taking on a student one half day a week for their first two years of medical school and part of their third, teaching them about clinical medicine in the real world. When the program was founded 30 years ago, most teaching was done in a university hospital, where less than 1% of those who sought medical care would eventually be treated.

I remember my Wednesday afternoons with my preceptor in medical school, me always feeling nervous beforehand, but excited to get out of the classroom and actually see patients. I left every evening grateful for the learning, but wondering how in the world would I ever know enough to practice medicine?

I remember my own student's first day, me still wondering if I knew enough--this time to teach it to someone else. And I guess it's going okay, because she nominated me for Best Pediatric Preceptor, which if you knew some of the others who were nominated, you'd know was a huge honor.

But there's a lot more than just imparting medical knowledge, and that was the takeaway for me yesterday. The best preceptors also invest in the relationship, becoming a role model for communication, empathy, integrity, balance, and perseverance. We have the opportunity to remind these students why they went into medicine, when they spend most of their days memorizing the Krebs cycle. We can show them the incredible gift it is to take care of patients. And in doing so remind ourselves of that very thing.

I am a writer

Today was Day 1 of Introduction to Creative Writing, an online class I enrolled in through the local community college. I have been wanting to take a class (in anything) for a while now, and wanting to improve my writing always, so this seemed like a perfect step. Not sure why it took me so long.

Day 1, for those of you who have never taken Introduction to Creative Writing in an online format, involves reading a brief lesson (which consisted mostly of encouragement that we are already writers, even if we aren't published--or even good--and that we just need to practice) and then practicing free writing. Free writing is an exercise in futility for the perfectionist. Or so I'm told. One simply takes a pen in hand (or a keyboard on the lap) and writes for a set amount of time. Whatever comes into your head. Some call it "stream of consciousness writing". No planning. No restructuring. No editing. No even fixing typos. Gah! I may not make it to Day 2.

Our class is composed of at least 2 dozen aspiring writers from around the globe (apparently Introduction to Creative Writing is very popular in Australia. Not kidding.) ranging in age from 14 to 73. We have students, teachers, mothers, grandmothers, military brats, and me. I'm sure the experience, talent, and attention to grammar is going to be vastly different among us. I'm told we'll each work on a piece throughout the 8 weeks that should be completed by the end. A finished creative work. You may even get to read it, if you're lucky.

For now, I'm excited to be a student again. After all, doing it for 24 years, I've gotten pretty good at it.

Cultural legacy

I just finished Malcolm Gladwell's "Outliers: The Story of Success"--a thought-provoking read on why we should reconsider what leads to success and how we might be able to increase opportunities for more people to be successful. One of the intriguing points he makes is about cultural legacy. He focuses on two major populations--Korean pilots, who because of their culture of deference to authority have a hard time speaking up to prevent plane accidents; and Southerners, who because of the defensive and suspicious culture that surrounded the settling of the less-than-fertile land are still to this day more likely to react violently to situations. He's careful to say that these are not all-encompassing legacies, but asserts that if you want to change behavior, you have to at least acknowledge them.

It got me thinking about my own legacy. By many accounts (not necessarily our own), my immediate family is considered successful. Parents married almost 38 years, financially stable yet generous, involved in the community. Four kids, all college graduates (assuming the last one doesn't screw up something in the next 6 weeks) and two doctorates among them; hard workers, athletes, volunteers, and faith-filled disciples. What was in about growing up a Zapapas near the turn of the millenium that set us up for success?

Our cultural legacy is built on a combination of Greek entrepreneurship and German blue-collar work. My great-grandfather came over from Greece on a boat as a teenager and opened a candy kitchen that is still churning out homemade confections. His son (my dad's dad) saw the value of hard work and obtained a degree in pharmaceuticals, traveling the world and sending all six of his children to college. On my mom’s side, my German grandfather was a partner in an electrical company, who worked hard until the day he died but never settled into financial security. My mom grew up into expectations of pulling your weight, but she wanted more. She studied hard, graduated college with straight A's and a business degree, making sure she would always be able to provide for her family. Between these two legacies, college was an expectation for us growing up. School was first (well, God and family were really first—another legacy, stemming from two Catholic matriarchs who were both married for over 50 years and had their priorities straight), and everything else was second. You never gave less than your best. Summer time was for playing outside, but also for doing math workbooks and reading. We watched my parents both work full-time jobs so we could play sports year-round and go to a Catholic grade-school. We just never thought about doing anything differently.

Had any of us been born into a family whose legacy was farming, or ranching, or holding down minimum-wage jobs, things would have been different. Had we come from a series of broken families, things would have been different. Instead we were raised in an environment that cultivated our curiosities and strengths, buoyed by expectations of generations before us. Our culture legacy didn't do all the work, nor should it limit us, but I think it's interesting and important to consider. I, for one, am extremely grateful for mine.

Top 5 Ways Hollywood Medicine Fails

I realize that all of Hollywood is fake. And that creative license exists to further the storyline. But I'm pretty sure the "medical consultants" on all major TV shows and movies are from "The Doctors" and don't actually know what they are doing. Or else everyone ignores them. Here are the biggest offenders.  

1.      The biggest flub no matter who you talk to: We don’t shock asystole.

 Nearly every code depicted on TV involves a patient suddenly flat-lining (that dramatic long beep where there is no heart beat, also known in medical speak as “asystole”) and someone yelling “clear!” just prior to the body dramatically jumping off the bed. So you all know, patients rarely just flat-line. When you start circling the drain, adrenaline kicks in and your heart rate speeds up to try to match the demands of infection, injury, stress, what-have-you. The heart tries its best to keep up, its internal pacemaker keeping things going even when the rest of the body is shutting down. Sometimes it works so hard and fast that it can’t beat in rhythm anymore, a condition known as ventricular fibrillation (or V fib).

This is very scary

If that word sounds familiar, it’s because those infamous paddles belong to a device called a de-FIBRILLATOR. Meaning “to stop fibrillation”. In other words the electricity stops that crazy rhythm and allows the heart to restart its own pacemaker. Guys, the paddles STOP THE HEART. Which makes no sense if the heart is already stopped. So shocking asystole is just bad medicine, and every one who’s ever taken an advanced life-support class knows it. Even the automatic defibrillator machines know that. If there is no heart beat, we instead make the heart beat by doing chest compressions and trying to restart it with epinephrine. Which I guess is just not as dramatic as “CLEAR!” But really, how hard would it be to put V fib on that monitor instead of asystole. Seriously.

2.      Medicine is boring. I realize it wouldn’t make for the most compelling story lines, but can we talk for a second about how much of my shifts are spent typing notes, putting in orders, reviewing results, or waiting on hold for a consultant? They’ve done studies about how much of a doctor’s day is actually spent in patient care, and it’s not much. Besides that, most of the cases are routine things like telling parents that their kid’s cough will go away on its own, or telling that adult patient (again) to take their blood pressure medicine. Fascinating, I know. Believe me, I know. So sure, glam it up, script writers, but at least on cop shows they talk about all the paperwork and leg work leading up to the dramatic show-stealing chase scene/shoot-out. Yes, that one helicopter flight to the ICU is what we talk about all week, but it’s a small percentage of what I actually do, and the paperwork from it takes almost more time than the case itself.

3.      Pen tracheostomies aren’t the norm. Speaking of over-dramatizing, I just want to make sure you all know that when someone drops dead in a restaurant/subway station/playground/their kitchen, doctors (especially medical examiners) do not come out of the woodwork to put in tracheostomies or remove bullets or perform emergency surgery with a bottle of vodka and a pocket knife. 80% of the job is having the right tools, which does not include a ball-point pen ever. We all still call 911, and then start CPR. The end.

Never gonna happen

4.      One doctor doesn’t do everything. “House” made it standard, but every show is guilty of expanding the lead character’s expertise to a convenient, but unrealistic scope. We aren’t usually the ones drawing blood, giving meds, hooking up the ventilator, running the CT scanner, and doing surgery. In fact, most of us don’t do any of those things. Medicine is a team affair, and yes, that would involve paying a lot of extras, or having the docs do the more mundane parts of their job on-screen (see #2), so I understand why Hollywood does it. Just don’t expect your doctor to.

5.      Michelle would like to add an honorable mention regarding TV pharmacists: When asked “Do you know what fentanyl is?” The correct answer is not “oh, synthetic heroin?” Everyone knows what fentanyl is.

Fighting the good fight

Had a dream last night that I lost it on the wiffleball court. Lost. It. My team was short on players, the other team kept finding holes in our defense (in fact, I don’t remember us even batting; the Mercy Rule must not exist in dreams), and I dropped three fly balls. I screamed about the teams being stacked, wiffleball being stupid, and other such nonsense, and then stormed out.

I woke up grateful that I didn’t have to go to confession for such shameful behavior. But not surprised. Because I get that worked up playing recreational sports. Or pretty much anything else. I don’t know if it has to do with being the oldest, or a twin, or Type A, or some mutant combination of the three, but I hate losing.
I could try to dance around it, saying that I’m passionate, or dedicated, or that I see things through. But really I’m just competitive. I want to be the best. I want to win.

It’s almost embarrassing to be honest. Sometimes I’d rather just be the person who didn’t care, who was happy just to play, who laughed off mistakes. And while I know it’s good for me to be humbled, I still hate it. But here’s the good news: God is always victorious, and He’s on my side.

Romans 8 reminds us that we “conquer overwhelmingly” in Christ. “If God is for us, who can be against us?” We are on the winning side. Raise the banners, take a bow. God made me just the way I am, competitiveness and all, because He made me to conquer. So it shouldn’t matter that I drop a pass in football (at least it shouldn’t ruin my day) or get yelled at in the OR during an anesthesia day because I didn’t intubate on the first try (I can’t be the best at everything. Dang it!). Because those are just little battles in a bigger war, which we have already won. So I continue trying to funnel this passion towards greater goals, to humbly accept the losses, and to let the victories be His.

A doctor's tools

I like to think of myself as a minimalist when it comes to running tests and ordering medications in the urgent care. The nurses love it. My mother hates it. “You mean all you do is give them Motrin and a popsicle? That’s it?????” Yes, mom, that’s it. That’s all they need. Most pediatric disease is self-limited, either caused by a virus, or idiopathic (that wonderful term for “we don’t know what causes it”). Most pediatric injuries heal without major intervention. And so running a bunch of expensive, sometimes invasive tests that will most likely be normal seems like a waste in every sense of the word.

Plus, there’s a reason I went to 4 years of extra school and 3 years of indentured servitude residency. It’s called making a clinical diagnosis. You know, what doctors used to have to do for every patient, based on a good history and a thorough exam. They had to know how different heart murmurs sounded, because there was no same-day echocardiogram. They had to learn the signs of heart failure, because measuring brain natriuretic peptide hadn’t been discovered yet. And yes, they had to do a rectal exam on patients instead of getting xrays to diagnose constipation (which is still a more effective diagnostic tool, by the way). Call me crazy, but I like being a clinician instead of merely an interpreter of lab results and imaging. I pride myself on it most of the time. I spend a lot of time convincing parents that it’s a better way to go.

But if you want to make me doubt my clinical skills, if you want me to long for the ability to check a quick BMP or grab a chest x-ray, frankly, if you want to make me feel helpless, then take it all away. Put me in a teepee on the side of a mountain trying to tease out post-surgical abdominal pain in a teenage girl. Or on the phone with a worried friend who doesn’t want to make an unnecessary ER visit for her child. Or on the flag football field when someone goes down with a “pop” in one of his joints. My calm reassuring voice becomes laden with doubt, and I forget all of my training. Or at least that’s how it feels. At least for a moment. Then reason kicks in and I start to work through the problem, ruling badness in or out, looking for red flags, gathering as much information as I can.

The few physicians in my Wilderness First Responder course were sick of being outside the hospital, without any of our normal comforting resources (labs, radiology, even monitors) and not knowing what to do. We all needed a reminder that we are, in fact, clinicians first. We can use our eyes, our hands, and our brains instead of machines. I try to remind students of this when they rotate through the urgent care. It’s what I try to practice on a daily basis, even when I don’t have to, because it makes me a better doctor when I do have to.

And in reality, a popsicle is sometimes all the tool we need.