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Month: November 2018

#ThisIsOurLane–It’s Time We Talk About Gun Violence

Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself

–Anonymous

 

She was 38 years old. She was innocently walking into her shift at the hospital on a Monday afternoon. An ex-fiancé approached her, they fought, he shot her in the hospital parking lot SIX times before he entered the hospital and shot three more people. The hospital where she worked tried to revive her, her colleagues performed CPR and life-saving measures to prevent her death, but to no avail.

She was an Emergency Medicine Doctor. Although I did not know her, I feel as though she is like a sister, she recently became an attending, she was working in a busy urban ED. She is remembered as being extremely kind and compassionate. She could have been me. Her name was Dr. Tamara O’Neal, and she was taken too soon from a profession that needed her.

We as a country have become so extremely divided on this issue of gun violence. We can’t even talk about it. It’s as if there is a difference in our thought processes as wide as the Grand Canyon. But. People keep dying. Families keep losing loved ones. Yet we haven’t found a way to have real honest and open discussions about the problem.

The death of Dr. O’Neal came soon after an article was written about gun violence in The Annals of Internal Medicine. A non-partisan, thoughtful and extensive position paper about how we as a society can implement change to try and curb the public health crisis that is gun violence. It is an example of what we do as physicians, we care about the health of society, we want all to lead happy, thriving lives.

The NRA (National Rifle Association) tweeted a rebuke of the article, telling doctors to ‘stay in their lane.’

What the NRA didn’t expect from their tweet was an outpouring of physicians who responded #ThisISOurLane. These doctors came from all different specialties, some gun owners, some not. Some who actively try to save patients on a daily basis, some who tell families their loved ones have died, some who do autopsies, some who manage the aftermath, of mental heath, PTSD, and suicidality that follows senseless death. Doctors all over the country responded and started a significant national conversation about gun violence. It is one of the most collective and vocal conversations we as physicians have been able to get on this topic.

It has created a dialogue, which is exactly what we need, people on both sides of the issue recognizing that each of us is operating from our own biases but also being willing to look at those biases and being prepared to be wrong.

I admittedly don’t know a lot about guns. I’ve seen a real one, I have touched one. I do not know what it is like to shoot one. I have been very anti-gun for as long as I can remember. Likely it has to do with my job as a pediatrician and knowing the risks of having guns in the home, and the number of deaths that occur when a small child accidently gets ahold of one, or the danger of the teenager who is having a depressing week and knows the combination to the gun safe.

I work in a non-trauma pediatric ER, so my first-hand experience on the daily is non-existent. However, I did train in a place where gun violence was common. I learned a lot during my trauma rotation about the tragedy that is gun violence and often the feeling of despair when there is too much damage to fix, like what happened with Dr. O’Neal.

I learned that we always count bullet holes as soon as they come in…you can then start to predict where the damage might be.

A bullet, when entering the body is so hot it is essentially sterile, so if it lodges in a place where it won’t do any harm, like muscle tissue, we do not go and get it, as we can cause more damage that way.

If a bullet enters the chest or abdomen, you hope it quickly leaves (entrance AND exit wound) because if not, the likelihood it has richocheted internally is high, and these wounds are much more damaging.

Gun-shot victims die of blood loss. So the time it takes to get them from the scene to a hospital that can treat them is precious. The faster they get to the OR, the better chance at survival.

If there is a mass casualty event, where there are multiple victims, there are more deaths. This is due to fact that the hospitals and the trauma surgeons fixing these bullet holes become overwhelmed, patients then have to wait to get treated, and many can die waiting.

My experience is so one-dimensional. I realized this with a mild form of horror as I listened to a lecture at a conference I was at recently. At FIX18, two brilliant female physicians each from either side of the gun issue (one pro, one against) came together to talk about the things we haven’t been able to discuss as a society. Drs. Megan Ranney and Torree McGowan had an excellent lecture, they listened to each other and subsequently were able to recognize knowledge gaps, perception gaps and actually landed on the same page. They are also now leaders in researching ways to better contain and understand this major societal issue.

I learned that I actually know nothing about guns. However, I also learned from the example of these two women that I have the capacity to listen. Others have the capacity to listen, even if it seems we are on opposite continents with our ideas. The sooner we start having real conversations about how we want our children to stop dying, our friends in their place of worship stop dying, our sister colleagues outside of their place of work stop dying, the closer we will get to a real solution that can actually benefit our entire society. We need to not only start being willing to have the conversations, we also need as a society to be willing to see gun violence as the public health crisis it is.

We can research it like we research car accidents and drownings, and infectious disease outbreaks. We can do so in a non-partisan way, truly looking for commonalities and patterns so then we can try and make safe laws to help our vulnerable while maintaining rights for those who want it.

We need to befriend those on the other side, listen, try to get to a place of understanding.

Rest In Peace, Dr. O’Neal. I believe that change is coming.

My Grandfather Was An Immigrant–Embracing Diversity

“The bosom of America is open to receive not only the Opulent and respected Stranger, but the oppressed and persecuted of all Nations and Religions; whom we shall welcome to a participation of all our rights and privileges…”
–George Washington

 

My grandfather moved to the United States when he was 15. He was seeking a better life, and when he got here, lied about his age to enter the army. Eventually, he met my grandmother and they settled down in a small town in central Washington. One of his most proud accomplishments was sending all of his six children to college.

In my own personal experience, my family moved to the island of Oahu in the state of Hawaii when I was 8. We moved from a small town in Idaho when my father, a Presbyterian minister, got a job at a church in Honolulu.

You would think that the cultural change was massive. It was, for my parents, but for my 8-year old self, I remember landing at the airport and being met by people who put more leis on our family than our shoulders could accommodate. I remember staying in a hotel, I remember that our first rental house had a stream running through it with a bridge over, and I remember that the kids at school didn’t wear shoes. I didn’t want to wear shoes either. The warm weather was a nice change, and I loved wearing shorts during the holidays. By the time my birthday arrived, I had made enough friends for a small party. I recall my parents commenting that there were no Caucasian (haole) girls at my party. I dismissed the comment, there was only one other haole girl in my class, and I didn’t really like her.

Growing up in this uncommon mixture of cultures and being forced to do so at the age I was has forever changed how I think about diversity. How I perceive our differences, and how important it is to have the child-like innocence of being oblivious to the differences of culture and skin. I tried seaweed for the first tine not long after we moved there. I thought it was gross. But when all of my friends were eating seaweed and rice together in musubi—I learned quickly to like it. I even began taking my shoes off when I got to school.

Life changed when middle school started, and we and my classmates graduated to a much larger school. I was twelve. All of a sudden, things were different. My best friend from elementary school stopped talking to me. We were in different classes, but her skin color was darker, and she was also born on the island. She was way more interesting and cool than I would ever be. Suddenly I wasn’t worth her time. My skin color became a liability. At the time I would have done anything to not be white, which also equated to boring.

We moved back to the mainland right before I started my freshman year of high school to St. Louis, Missouri. This time, I did experience culture shock. We entered a largely white town, whose high school had inner city African American students bussed in, still apart of the desegregation efforts implemented in 1954. I struggled to understand the divide, why when you went into the lunch room it looked as though someone had drawn an invisible line, keeping the kids who grew up in different parts of town, and had different skin colors, separate.

I now live in Seattle, which is more culturally diverse than St. Louis, less than Hawaii. I believe it was my formative years in the islands that shaped me. I feel fortunate that although I know I still have my own implicit biases, I am as not susceptible to the fear many have developed around immigrants. I think diversity is vital to our society, it helps us to be kinder and more compassionate. It helps us to be forced to put ourselves in someone else’s shoes, to try to see the world from their perspective.

In thinking about diversity and immigration and where I live, I realized that I rely on a lot of immigrant women to help make my life better. I need them, and it would be so tragic if they were not in my life.

I have Isabel, my Chinese masseuse who helped me when I was trying to get pregnant to ease my mind, but also relieve my stress. I have Nancy, my Vietnamese nail manicurist who invariably always asks me how my mother is doing, even though the last time she came in with me was over a year ago. Raj, an immigrant from India who owns the wax salon I go to, always shows me pictures of her daughter, who has about 10 times as much hair as my son!! Then there is my tailor, who is an immigrant from the Philippines, who I hadn’t seen in a few years, but when I brought her my latest request, she insisted I bring my son when I came to pick the item up because she really wanted to meet him. I think I probably unconsciously chose these women to be in my life, possibly because of our differences or maybe they just felt trustworthy.

They are all excellent at the jobs they do, and I know my life would be less rich without them.

We need as a society to reject this narrative of ‘otherness,’ that because someone was born in a different country, or may have a different color of skin or religion, they are dangerous or ‘less than,’ or not deserving. We should instead be embracing the mindset of our forefathers, that America was made for you, and for me, that it is a place where those seeking asylum can rest.

We are fortunate to live in a country where we are free. I am enjoying my freedoms, but I know I didn’t do anything special to deserve them. I am fortunate that my grandfather made a choice to leave his country and settle here. It was luck that he came and was able to make a life. We have to embrace our inner empathy. We are all just people, after all, trying to keep ourselves and our children safe, and that when we show each other love and compassion, we all benefit.

What I am truly afraid of is the hate that we are sowing. I am afraid of unrestricted gun access that could hurt me in my place of employment or my children when they are old enough to go to school. I’m afraid of the rhetoric that has consumed our society declaring people seeking refuge as ‘dangerous’ and family separations as acceptable. I am scared that one day my cute, silly, fun-loving son will treat another person with hatred due to the color of their skin. Those are the things we all should be very afraid of.

After all, most of our ancestors were immigrants at one time.

Please vote. And if you can, try to imagine what it must be like to travel far and long in order to try and make a life in another country, because the one you were born into is too dangerous. Try to find compassion for those who are different than you.

Lessons Learned–How My Experience as a Patient Made Me a Better Doctor

“The good physician treats the disease; the great physician treats the patient who has the disease”

–William Osler

 

I was 37 weeks pregnant with my son when I started bleeding. I had finished a long day in the ER and was home with my husband, who was putting together the crib. I went to the bathroom and saw blood in the toilet. At first, I honestly wasn’t sure what to do. There was no pain, and everything else had been going well that day. But I quickly realized that bleeding while pregnant, especially this far along, wasn’t normal.

I called my doctor and we were instructed to go to the hospital. We thought we would be going home after a few hours, but the baby continued to have a very high heart rate and an ultrasound didn’t tell us much so we were told I needed to stay the night on monitors.

There was no room in labor and delivery, so we were stuck in a small back closet area. My husband was in what appeared to be an uncomfortable chair. Fortunately, I didn’t continue to bleed, but JP’s heart rate remained above 200 during the night. In the morning, we were counseled by the maternal fetal medicine physicians (the high risk OBGYNs) and I was transferred in an ambulance to the main hospital which had a level IV NICU. The doctor informed me I was not going home without a baby. This was unexpected, as I hadn’t even packed a bag! I also had over 10 shifts left until I was ‘supposed’ to deliver, so I felt totally unprepared.

Over the next few days, I had a different doctor every 24 hours and a different nurse every 12. We were in the hospital for a total of 5 days. This was the first time I really felt what it was like to be a patient. It didn’t matter that I was a doctor, and had been on a OB rotation during medical school, I still didn’t really know what was happening. I began to feel and understand the fear, frustration, and helplessness so common for patients in the hospital. I was scared. Things were said outside the room, decisions and conversations were had without my input, and I really hated how many different people were involved in my care. I also recognized that I didn’t appreciate when my nurses and doctors talked to me as though I was just a number, a presentation– ‘37 y/o G3P0 female here with bleeding and fetal tachycardia.’

I felt alone and without an advocate.

Initially, we tried to have JP vaginally, but I did not progress. After about 48 hours of pitocin, balloon dilators, and hoping that things would move along, unfortunately they did not.

The doctor that came on next was the one I will always remember. She sat on my bed. She told me that she knew it had been hard to be there, and that she thought it was time to make a decision about having a C-Section. She shared her thoughts on timing, we discussed anesthesia methods and she listened to my concerns. She saw me as a person, and I could feel for the first time since I arrived in the hospital that I had someone caring for ME, looking out for ME. She promised me ‘We will get this baby out while I am on shift. We have 24 hours to do it.”

I realized that in my own life, I have definitely come to the hospital to just work my 8 hours, to care for patients, but in a much more sterilized way. Sometimes life gets the best of me, and in those moments I struggle with hearing my patients, trying to do the best and what is right for them, and making sure compassion enters each of my interactions.

As a patient, it finally clicked. I realized sitting in a hospital bed that my patients invariably know where my head is at based on how I treat them, whether I sit, whether I look them in the eye, whether I talk to them in layman’s terms, whether they felt I was listening.

I recently read a book that put all of these thoughts I was having into words, In Shock, by Rana Awdish, a female physician who herself has had multiple harrowing experiences as a patient. She currently works in critical care, and with her writing has been changing the conversation about how we as physicians care for our patients.

After my experience, and reading this book, I came to the conclusion that I need to make it a point to do better. We as physicians need to do better. This last week #Doctorsaredickheads was trending on Twitter. It was very interesting to see patients describe their terrible experiences, but also fascinating to see physicians responding. There was a lot of anger over the fact this was trending, physicians defending themselves and our profession, rejecting the words, rejecting the notion that this phrase, albiet crass, could apply to any one of us at any given time.

I think the real lesson is that we as physicians are people too. We have bad days, and misbehaving children, and health scares, and working too much or too long. Sometimes we let our lives dictate how we show up to work. Sometimes that means we aren’t as compassionate as we should be, we don’t listen as much as we want to, and we don’t honor the sacredness of our profession. There are times when I am certain we are all ‘dickheads.’

I learned so much from being a patient. I’ll tell my full story at a later date, but since my experience, it has forever changed the way I come to work. I know that every family can tell if I am mentally there or not. They know if I am there to take care of their child, or if I am just punching the clock. Every family in the emergency department needs and wants to be heard, and navigating the system can be really challenging. Sometimes the only option a family has is to come to the ER, because it feels as if no one else is listening. It is my responsibility to then become the one that does listen.

Prior to every shift I make a true and concerted effort to leave my ego at the door. The work that I do is not about me, it is about trying to make sure that each of my patients get exactly what they need. Sometimes that is complicated care, sometimes it is to listen and create a plan to move forward.

I want every family to know that it is my job to take care of their child, so I will do my best to do that very thing. I also have learned that often, a parent knows way more than I do, and it always helps me to listen and to take their perspective into serious consideration.

I understand why we as a profession get the reputation we do, but don’t think it is because we don’t care, it is because we are still just people, with our own challenges and lives and families. Sometimes the things outside of our control affect us more than we would like them to. Sometimes we forget how to be compassionate and to put our patients first.

Do you have a story, of how you changed the way you practice based on an experience? Or as a patient you felt by the way a physician treated you? I’d love to hear it.