1) Our personalities are a sum total of our life experiences and the people with whom we surround ourselves.

2) Most of us are more afraid to live than to die.

3) Everyone should experience a death in a public place ( I know this is dark) to witness life leaving this earth is transformational, and forces one to assess the importance of life.

4) Just because I don’t understand you, that does not make you an artist.

5) Stress is not the same to everyone; some individuals apparently have a large bandwidth to tolerate and manage stress

6) We exist throughout our lives as two individuals: the person we are, and the person we are capable of becoming. We should make it our mission to meet the people we encounter on our journey.

7) Sometimes you have to make the wrong choices in life to get you to the right places.

8) Mark Twain once said that two of the most important days in your life are the day that you were born and the day you find out why.

9) If you predict bad things consistently, eventually you will be right.

10) There is no substitute for the truth, no matter how ugly it may be.

1-There is a difference between a performance of strength and exuding strength under pressure.

2-Most stay silent because of fear.

3- Surrendering to injustice is cowardly.

4- The cost of inaction in life is incredibly high.

5-Fear is not an acceptable master.

6-Always choose courage over comfort.

7-Society fears a man who has lost everything but his courage.

8-In most organizations, it is so much easier to endorse disorder than admit corruption.

9- The most significant strength is in being kind to people who have tried to destroy you.

10-Your true character is how you treat others who cannot do anything for you.

–

Who am I??????

I am but a man, I like to write about experiences and observations in life. I could spend a millenium writing about silly things in life, if we can’t laugh at ourselves, then why laugh at all. I have always wanted to write, however always felt that I did not have enough of life experiences to write something of artistic validity. My, how our minds change with life experiences.

We all see and experience life through our own filter, so there is tremendous heterogeneity in how we interpret life experiences. I have never really felt that I push myself in life as much as I have always felt that I was being pulled by a force greater than me.
I believe men have gotten the short end of the stick when it comes to what we do and sacrifice for our children, family and society at large, it’s my mantra to discuss the untold from a man’s perspective.   If you are not open minded do not read any further ……

1) Life is challenging but also beautiful, embrace the difficulties, appreciate its beauty.

2) The world can be gray, not black and white.

3) There is no right way to do something wrong.

4) Stress comes from doing something you do not want to be doing.

5)  We often confuse honesty with bitterness.

6) We do not worry enough about our character and too much about our reputation. Our character is who we really are, our core values, our integrity, our own personal mission statement; it is essentially who we are when no one is looking.  Our reputation is what others think we are. If you have to choose, select character as the most important.

7) If you make a decision for the right reasons… no matter how much it hurts, you have made the right decision.

8) My parents were right, saying thank you, please, excuse me, as well as beginning and ending a sentence with yes, sir, and no, ma’am, will get you extraordinarily far in this world.

9) It’s better to be alone and happy than to be married, lonely, and miserable.

10)   Arrogance and self-awareness rarely go together.

The delivery of medicine is unique, healing can occur almost under any conditions and at any latitude and altitude.

I have to confess that we health professionals have many responses to stress including shouting, crying and most frequently sarcasm, it attenuates the emotional pain and trauma of the unfortunate tragedy of human kind.

I am a frequent air traveler, I have logged over 1.5 million miles on United Airlines alone (that’s 2 1/2 round trips from the earth to the moon). When I was a child if someone would have told me that I would have traveled the world, I would have told them, ” I believe that about as much as butt ugly Chelsea Clinton reproducing”!! In all my travels I have been surprised by how many times I have delivered health care at 30,000 feet.  I have to reveal a conflict of interest in this passage because I have family that has worked as a flight attendant but also another family member whom retired as a pilot from the airlines industry.  I hold an exquist sensitivity to the airlines industry having family members in the business.  Since I was a teenager I heard so much about the travel industry and while in college I even obtained my pilots license.  This exposure has heightened my awareness of not only how difficult the airlines industry is, but also how hard pilots and flight attendants work, yet get little of the appreciation of what they do in the skies to keep us safe.  I am so aware of this that very early in my travel career, I always looked the captain, flight attendants, etc, in the eye and thanked them, ALWAYS! regardless of how little the gesture of kindness. I frequently would tell them  I know you are busy, whenever you find some extra time, just to minimize my burden as a passenger to their very stressful and under appreciated careers.

While on a recent trip from a medical convention, I had the opportunity to be called to use my powers for good rather than for evil (see Spider-Man).  Not yet quite at 30,000 feet I was just getting comfortable as my movie, Zero Dark Thirty was beginning to get interesting.  A movie that chronicles the capture and killing of the planets most wanted terrorist.  The proverbial announcement came over the intercom, “If there is a medical personnel, can you please ring your call button?” I remember thinking, here we go again…. I immediately went back to my medical training days of the term, “slow code”. This was a common term used in my medical training regarding the situation of being a called to a code red.  Residents in training when paged to a situation for a code red would walk very slowly in hopes that the patient would not survive by the time they arrived (This is no longer practiced and considered unethical and could lead to termination of your training by an ethics board). I of course worked under the fear of losing my job so I always ran to code red’s, I have to admit I crawled to code “Browns” (when patients crapped on themselves)

I arrived in the back of the plane and said patient was sweating, I checked for a pulse and it was thready, to a trained cardiologist, this usually implies a blood pressure of a minimum of 80. When you are starting with that as a blood pressure, it usually is a bad sign, things usually get worse before they get better.  The flight attendant helped me obtain history from the matriarch as her husband had just slumped over in his chair toward her and briefly lost consciousness.  I was able to find a blood pressure kit and it was slightly better.

While the attendant obtained history and translated from English to Spanish I was examining him and trying to talk to the family. I informed them that based on what we know , he probably should see a doctor in houston prior to continuation to Panama.  Meanwhile the staff was able to find the first aid medical kit and a heart monitor, while putting the monitor on our patient, another doctor joined my for assistance.  while trying to focus on our patient I was overcome by anger and fear, you see I do not really have any fears, no fear of heights, blood, speaking in public, however my greatest fear is seeing women with red lipstick on their teeth.  Yes, you read right, red lipstick on women’s teeth just creeps the shit out of me.!!!!!! I believe I can trace this back to my childhood, I saw ,”who’s afraid of baby Jane”/  A movie staring Betty Davis as the evil sister, whom is bat crazy, Like hanging from a tree upside down kind of crazy and terrorizes her sister. There is a scene in the movie where she has tons of make-up and the camera is a tight shot on her face and she has lipstick on her teeth!!!!!!!!! I still can’t get that scene out of my head, so when I see women with red lipstick on their teeth, I am like a cat on its hind legs.

So the saga continues, I now have a monitor on his chest and sure enough he has an abnormal heart rhythm.  The diagnosis is clear, his heart pauses for approximately three seconds. The Matriarch of the family now tells the attendant that they don’t have insurance. I guess even in panama they understand how expensive health care in the US can be, Knowing full well in the us a Tylenol in the emergency center requires a platinum American Express, when you absolutely cannot leave home without it!!! The flight attendant told me the issue and I quickly responded, oh,…..nothing to worry about, the US gives everything away for free, including health care! The flight attendant was about as uncomfortable as Adrian Peterson from the Minnesota vikings at a day care center.  Maintaining her professionalism, she turned around and told the matriarch, the doctor insist you must be transported to the emergency center! You have to love the professionalism of flight attendants. .Things began to stablize, I drew up atropine into a syringe ( an agent used to accelerate the heart rate) as a precaution, in case his heart tried to stop again.

The flight attendant asked me if I wanted anything to drink? I told her scotch, make that a double, shaken not stirred!! She looked at me so confused with that “deer in the headlights ” look, (no disrespect to deers).  I had to whisper, “I’m just messin with you, the sarcasm helps to take the stress off this medical situation”.

By now I had my assistant place an IV and he was resting comfortably in the seat, we will be landing soon so I sit behind him, watching the monitor, looking out the window on our descent and holding a syringe of atropine in one hand, the flight attendant was somewhat annoyed with me, because my seat belt was not, “low and tight across my lap”!!!!!!!

So as I walk off the plane behind the ambulance crew, I am handed a brown bag, a token of the attendant’s appreciation???????

The work environment is no longer a safe place, people don’t bring their baggage into the workplace, they bring cargo. As we become a part of a new normal of never telling the truth and the fear of having Human resources perform a TSA style colonoscopy on your every human interaction, I cannot help but wonder how things will be….

I never realized in the work environment that a disagreement with someone or having a different viewpoint is considered an emotional  attack?? Or not having things work out how you may have planned them is considered a violations of one’s rights? (What is the saying?? “if you want to make god laugh, tell him your plans”.) We now live in a work environment where I cherish the “good ole days”!!!!! Things use to be so much more overt, we now live in a covert nature of how we communicate.  When someone is talking to you, it’s the words unsaid that matters most, …. but since I tend to rely more on people’s actions than words I find it very easy to find the truth as our physical manifestations of our behavior are far more honest .  I know individuals whom are absolute believers in what people say. Kind words are interpreted as absolutes truths, as opposed to agenda driven. Very few individuals can reach the  authenticity of being what you say, what you believe and what you do.

We live and work in an environment where the new generation expect results yesterday and promotions as easily as we can obtain a starbucks “Chocolate Mocha Venti”.  Job security is based on, ” I am good and I deserve it”! Rather than the absolute truth, it is based on meritocracy.  I have lived in an academic environment of the practice of medicine throughout my career and my friends in the business world remind me of how absolutely out of touch with reality academic medicine may be, and I whole heartedly believe them.  While visiting having beer and BIO-POLITICAL  rounds with a group of my business friends I started to tell them the idea of academic tenure, at my institution, tenure is a position renewed every seven years, at most academic institutions tenure is a lifetime, “forever”. Yes all for the sake of academic freedom.  They explained to me why and how this has destroyed the academic institutions as we know it…. So as they see it, the cost of an education has gone up exponentially as have administrative salaries within academic centers. Where does the funding come from??? All the junior and mid faculty that kill themselves, do not take care of themselves physically experience divorce rates four times the general population, add in four times the suicide rate, Twice the drug abuse and alcoholism rate and not to their surprise, why specialty of medicine is no longer sustainable. The small people support the “tenure” people.  So as they remind me, why does academia pay some faculty a high salary to sit and think with no output??? Seems like a system that cannot and will not survive in the new affordable care act, decreasing reimbursement and burnout  of our health care providers.

Do we not have a responsibility to contribute to the academic success and financial success of the organization that gives us our check??

The new normal is that women want to be “treated like Men” in the work environment. Really??? is this one of those things of the grass is always greener on the other side?  Perceptions can be very deceiving, women wanting to be treated like men? lets look into this further…..Men in the work environment can be vicious, despite being in the 21st century, you are always considered a ‘weak player” if you leave the office early to pick up your kids from school, take them to the doctors, forget about staying home to take care of your sick child, that is still not acceptable in the corporate world if you want to move up the ladder. What about how difficult we are on each other, do women know how much we tease each other?? talk about hair, fat ass, comb-overs? that is fair game in a mans world.

I can tell you of a recent experience regarding women and men in the work environment, I am a proud believer and supporter of the idea that we need more women in leadership roles in the work environment.  The glass ceiling still exist in the executive suite and few women reach the corner office.  I work in the worlds largest medical center and have relationships with many hospitals.  While trying to build  a similar program at our sister institution, a women was hired to replicate my successful program.  She was hired at exactly twice my salary with the stipulation that she could only work one in four weekends because she has two kids? Moreover, I was requested to cover one of those four weekends, because this was an opportunity to recruit a woman to the position. They said she was excellent as a “multitasker”?  Really us men cannot multitask? I thought I could do a pretty good job at managing a heart attack in the emergency room, giving orders for shock in the intensive care unit, all while making my kids lunch for school.  I declined the offer, not because I do not support her, but on moral principal, I also have two children, the same age as hers, I would like the same benefits to spend time with my children as hers. This event left me asking, are my kids less important than hers? Do I love my kids less because I have to stay to cover her service while she goes home to hug her kids, love them and spend time with them?  A more global question came to mind, what about single men and women and single mom’s with no support from their ex-husbands/Wives?? Ask them how they feel about increasing their work load to support the woman whom needs to leave early to take care of their children, are their lives marginalized??

The story only becomes more interesting, she only lasted several short years, she was never fired, however two highly motivated, bright young cardiologist were hired whom were able to perform at nine times her level.  In the current work climate, you could never tell her about her performance, so what better way to solve the problem than to be eaten up by the competition. That is an example of what it is to be treated “like a man”. Now lets add in the factors of Racism,Nepotism,cronyism, etc,  regardless of ism…. Being treated like a man is far less civil than we all think.

Social scientist  have only known for 15 years that men actually play a very important role in the family, yes only 15 years ago!!!!!!  it appears that women are good at teaching love to children, however men are critical to self-esteem of young boys and young girls.  Quite simply, children can grow up and be great citizens without the love of their parents, although can still have significant risk for drug abuse, violence and time incarcerated, However children cannot be a productive citizen and have normal healthy relationships without self-esteem. Maybe fathers are important after all…..

So what about the socio-politico-Warfare of the work environment and avoiding a visit to the Human Resources office??? Live and work for something greater than yourself.  When issues come up, stay on your own personal mission statement to do great work and deliver a good product, there are still many opportunities for workers like this.  I still live by the mantra that there are two types of individuals in the work place:

1) Come to work on time, Complete more than what you are asked to do.

2) Come to work late regularly, Complete less than what you are asked to do.

Guess whom has the brightest future??????

 Anyone whom deals with children would appreciate this……..

I would not push my children into medicine, it is a decision to be made by them…

This brings me back to the beginning, and the person whom understands this the most, my beloved sister

Full Circle 

Claudia Finkelstein, MDCM1

[+] Author Affiliations

JAMA Intern Med. Published online March 17, 2014. doi:10.1001/jamainternmed.2014.181

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My daughter met her cadaver yesterday. She has begun her own journey of “things that you need to know to be a physician.” Many are taught explicitly, and so many more are implicit. I am in the high desert writing, walking, breathing, recovering from some of these same lessons.

She is surprised that the woman whose body she will begin to slice open tomorrow is of my age and build. When I asked about her cadaver she said, “she’s younger than I expected, a little older than you.” She has already noticed the sharp smell of preservative and the slimy residue on the gloves—part of the price paid for this deeper knowledge. Deep although she has not even broken through the epidermis. Already the urban legends circulate among her classmates. The laboratory is so cold that she wears fleece leggings under her scrubs.

In my personal dissection I have gotten to the skin layer and maybe a bit beyond. I have at least noticed my numb inability to express to her (and maybe even to myself) the depth and complexity of my emotions about her choice of livelihood as a woman in medicine. This numbness, the shutting off of emotions, has served me very well very often over the years. It has also been treacherous in times like these when I am so overwhelmed by emotion that I think I feel nothing.

I have tried sending her “welcome to the profession” texts. I have attempted a heartfelt message of encouragement on a hand-painted card that ended up reading both in sentiment and in penmanship as if it were written by a fourth-grade boy.

I am capable of neither emoting nor communicating at this moment. This moment that matters so much. I want to tell her that it is OK to feel nauseated, creeped out, highly privileged, and excited at once. I want to tell her that she is crossing a line that few humans cross, the line of cutting into one of our own. I want to tell her to be strong although I know that she does not need me to tell her. Crossing this Rubicon may be momentous or may slip by unnoticed—I hope that she will notice and am not sure that I ever did. I cannot even remember whether my cadaver was male or female, but I cannot forget the chemical smell high up in the back of my nose each time my hand neared my face. I prided myself on displaying no emotional or physical reaction to the dissection.

Reflecting on our shared career choice, I examine how we each got there. My choice of career did not really feel like one. Certainly it was not one made with great deliberation. I spent time posing as an existentialist when not cramming for examinations as an undergraduate. I thought about engineering, not medicine, and took advanced physics. But biology came easier and was more interesting. I was sure, however, that becoming a physician was way out of my league until I met a medical student. I found out that you do not need to be a genius to get in. It was a relief to think that I could eventually earn my keep doing something both interesting and useful with my life. I was not aware of any price beyond the stated tuition.

My daughter, on the other hand, is actually an engaged learner, the kind that we all hope to teach one day. She reads the background papers and worries about conceptual integrity instead of what will be on the examination. I do not think that she believed that any career was out of her reach until partway through the nail-biting application process. It was way beyond that point in my application that I had discovered that I even had a chance. I remained distant from the process, feeling as if it was someone else’s life and future. I filled in the application and wrote what I suppose must have been a rather moving essay—if not moving, at least effective.

In my role as her mother, I was careful not to be directive or to sway her toward medicine. We talked about the thrill of basic science, the poor pay of a yoga teacher, the social justice that might be achieved with an MPH degree. We talked about taking time to know her heart. Somewhat deliberately, I did not discuss medicine. After one lunch with her father the radiologist, she came home and brightly announced that she wanted to be a physician. In response to this news, I was less effusive than she may have wished or expected. I did not know what to think or how I felt.

She and I share a solid stomach and tolerance for all manner of fluids, smells, and sights. We love to figure things out. We know how to hunker down and delay gratification almost indefinitely to do what needs to be done. We know how not to wear our hearts on our sleeves and get down to business. We value productive forward motion and are constantly biting off much more than we can comfortably chew. We also share a certain conviction in doing things “the right way.” Lately, I have been working to shed the concept of the one right way to do almost anything.

As I have stripped this and other layers, I have become a better physician. My tears are closer to the surface, my human heart closer to experiencing a depth of feelings. I care deeply for and about my patients. As I have removed some layers, I have become a better mother (I think). I try to listen more and to say less. In both cases I begin to see the limits of my power.

I smile when people ask how I feel about her choice and avoid a straight answer. “You must be so proud.” Yes, and yet there is more to it. Having finally achieved a sense of stability and joy in my professional life, how can I express my deepest feelings about her choice?

I wonder whether her heart will become hardened and immune to the suffering of her patients. I wonder whether her heart will break in the face of the suffering. I wonder whether she will succeed at selective partial hardening—not the all-or-none variety: hard enough to remain objective and effective when necessary and soft enough to cry sometimes.

“I hope it does not kill her soul” rings false when coming from the mouth of one who goes around lecturing medical students about how to “Maintain Morale and Momentum in Medicine.” But deep in my heart, I sincerely wish her a life of ease and joy, not one in which defensive layers are essential for survival. Layers like the fleece can be left at the door of the laboratory. The chain mail on the heart is less easily dislodged. Everything that I could not tell her in a letter I have told her here. She has assured me that she will be fine. May it be so.

ARTICLE INFORMATION

Recent events in the news have really got me thinking about this whole thing of gender,sexuality, etc even Supreme Court Thomas has been “called out” for saying everyone is too sensitive. Strange in life how everyone wants to share their opinion on their beliefs but despise the idea of your sharing your thoughts with them?  I can no longer say Woman in the work environment, I have resorted to a more politically correct term, so I now reference women as Gyn-no-American.  Yes, go ahead and call me a pig, but I have to go a little further and state I have gay friends, etc and that some of my “best friends” know gay people. So I am coming out of the closet to state like the majority of my friends, I am a flaming Heterosexual!!!, Yes I said it, and because I have kids, I am in fact “Pro Vaginal Intercourse”!!!!!!!!!!!With the internet, social media  and such, now everyone can comment on Facebook,twitter, etc on the world-wide web, all of the injustice in the world.

Why do I have to shout these kinds of things?, because I feel left out, I am so busy working to support obamacare, more taxes, 16 trillion in debt, who is going to speak for the “average”, Coffee slurpin, tobacco chewin, skoal spittin, Dunkin Donut eatin, Gun toting, “Duck Dynasty” watching  Guy?. Why is It getting harder than viagra to get a fair shake in humanity? Speaking of some women….. The new normal has been to recruit women into the work place which I agree,   we are all tired of Pale, male and stale, however the question in my mind becomes should there be equal pay for equal work? so to rephrase this, with so much effort to have women in the work place, does that mean we should have a sacrificial worsening of the work day for single men and single women in the work place so married women can get home to take care of and be with their kids? So with that in mind, I guess single people should stay single and never go home so that we can all support the women recruits with higher salaries in the workplace? Why worry about Single fathers, divorced mothers and for that matter married men whom love their children and despite what society thinks, we love our children and cherish every moment with them,as far as I know there is no gender that deserves to enjoy their kids more than the other, “N’est Pas”? Are my children less important than the new recruit? And when the great recruit goes home early, what about all us schmucks working so late at night when we get home, our kids are asleep in bed.? What about us?…..Why don’t we just be honest… It’s not about gender, sexual orientation, or religion, it’s about color, the color green.  Those whom generate green in great quantities, are always welcome, do you think the college football player whom just came out of the closet  will be an issue for the owners if he runs a 4.4 forty time and does 225lb bench press 40 times?  I doubt it, he is a physical beast that will fill seats, how dysfunctional a society are we? could he be compared to all the issues heterosexual males in pro sports get into? Murder, Mayhem, drugs, infidelities, child support, do I need to go on….that is well tolerated and accepted by our society and some guy has the courage to come out and he is the exception??? I encourage GLBT (Gay/Lesbian/Bisexual/Transgender) As I have always said, the community should not be denied the right to come home to nagging,lazy,dysfunctional spouse, or experience the emotional turmoil of divorce, an angry ex, no payments for child support or alimony? why should all the heterosexuals have all the misery, does it not love company?

This past weekend I again experienced the inequality of equality.  My children’s school had the first, “parent/child” dance.  This was to replace the father/daughter dance.  Apparently in the new normal of politically correct society the school based on the recommendations of the parents decided to be inclusive and include mothers so that they do not feel left out.  Well, I was very disappointed by this decision, most households with two working parents, one parent takes the more full-time job that pays the best and the other works the lesser paying job, usually the parent of the  lesser paying job has more of the home responsibility, but also has the greater experience of spending more time with the kids. In the US population, men usually but not always end up with the higher paying job and therefore are home less frequently and spend less time with the children, however it does not imply that the father would not want to spend more time with his children, in other words we value every moment, memory and time we can hold our child’s hand, wipe away their tears, or help them understand their homework.  The dance this past weekend was a success!!!! So many fathers were there, dressed with coat and tie and beaming with pride as they danced with their daughter, including yours truly. Nothing can possibly explain the joy, emotional fulfillment of having your daughters small hands grab yours and tell you, “lets dance daddy”! Despite the fairness, I felt that the men  had their moment diluted and in some ways marginalized.  I believe that most of us are honored to dance with our daughters and look at the smile on their faces as the music and rhythm moved our feet. This was the moment we all want to share and share privately with our brethren in our time, in our space…..