Little Miracles

“There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” Albert Einstein

“Miracles happen everyday; change your perception of what a miracle is, and you’ll see them all around you.” — Jon Bon Jovi

“The miracle is this: The more we share the more we have.” — Leonard Nimoy

IMG_0393

Sand and Sky, Summer, Ocean Park Beach, Maine

It is amazing when things in medicine work just the way they are supposed to —  it’s like a miracle.

When I take an antihistamine, I can breathe, and all the itching and sneezing stops. When I get an injection of local anesthetic, I can touch and poke and pinch to test that it is working — and it is. When I had an operation on my knee, an ACL repair, my knee stability was noticeably restored almost immediately, despite the post-op pain and swelling. I know these things work on patients, because books, observations, and experiences have shown me so. As a surgeon I get a kick out of operating on acute appendicitis, where often even in the recovery room immediately after surgery, the patient already feels better.

Yet I still marvel when I notice that this stuff is working on me.

I used to worry that as I entered the world of science, and then medicine, I would lose the ability to see beauty, to appreciate and be amazed and awed by the world around me. I worried that the more I knew about the details of how things worked, that I would not be able to see the glorious whole, the big picture, whatever that big picture might be.  Would the biology and chemistry and biochemistry and physics become like a filter on a camera lens, changing the way I would see these things? As I got deeper into this world of science and medicine, and then surgery, I was concerned that the experiences around me might overwhelm or blunt my humanity,  become mundane. Would I  become callous, detached, dispassionate? Would I still feel? Would I lose my faith, whether in people and humanity, or even more? Continue reading

Muted

Smitty greets Sully as they meet to head to work, “Hey there, Sully! How’s your wife?” Sully answers, “Oh, geez. She’s up in bed with laryngitis.” Then Smitty says, “Laryngitis?! That damned Greek!”

IMG_1488

First cone of the season, West Boxford, MA

As you may have guessed, I am nursing a case of laryngitis, my voice muted and strained. This time, it has not stopped me from attending to my work responsibilities or other activities. It has required some adjustments though, as I squeak and growl and cough and sputter, my voice robbed of inflection and tone, and even volume control. It is an irony to have to strain my voice to repeat myself because of my strained voice.

I have had more severe laryngitis twice, one time a couple of months ago, another time several years ago. These were so bad, my voice so completely silenced, that I had to change both my operative and office schedules, not just to recover, but because it made my job impossible. We wear masks in the operating room which obscure our expressions and hide our mouths, muffling our voices just a bit; it can be difficult to hear and be heard even with functioning vocal cords. It is impossible if you can’t even manage a whisper.

It is true that learning to (or being forced to) mute your own words and listen more to patients — and colleagues and staff — is not a bad exercise in attention and communication. But in day-to-day practice, there is an expectation of bi-directional conversation, two-way discourse. The doctor is expected to voice opinion, advice, orders. That cannot happen while mute.

In medicine and healthcare we often think about, and talk about, physician-patient communication, but in the abstract. We consider principles and philosophies, we argue the the importance and the need to protect and enhance physician-patient communication. We frame it as a component of the physician-patient relationship, or patient empowerment, or patient-centered care, or patient education, or even informed consent. It will probably be an important piece of the new precision, personalized medicine buzz. Physician-patient communication is the foundation for much in healthcare, whether new hot topics and ideas, or old traditions and approaches.

There are lots of little things we tend to overlook though, in these lofty discussions, that turn out to be no less important when considering the big picture of physician-patient communication, and the big important overarching principles and approaches. Think for a minute about the old saying about trying to sleep with a mosquito in the room, and you will start to understand about small things having great importance, great impact.

These are the small, day-to-day, practical and concrete challenges and barriers to communication, to care. The little things that will tank the most cutting edge and sophisticated solutions and approaches. They could be episodic, like a surgeon with laryngitis, a power failure, downed cell tower or phone line, crashed computer network or server. Or they could be more insidious, lurking continuously in the background, like scheduling protocols that cut time short, technology mismatch when the patient may only have an analog phone, or no phone at all, outdated computer software or no computer at all, no car or transportation, no family. Even language itself may be a barrier rather than a bridge, whether a function of nationality, education, or med-speak jargon.

These little things are potent, despite being small; they are common, nearly ubiquitous. If not accounted for, and certainly if not acknowledged, they may well allow our new solutions to enhance rather than alleviate the disparities and vulnerabilities among those who are most susceptible. We must keep them in mind as we debate our philosophies and principles, as we race towards new technologies and systems.

Disrupting and hacking the systems are popular concepts that are catching our attention and imagination. But if we aren’t careful, the disruption we seek will not be the disruption we get. Remember unintended consequences. Remember that if we aren’t mindful to craft solutions that will include and work for the most challenged and vulnerable among us, the solutions will not likely work well for any of us, and the whole enterprise crashes down, grinds to a halt.

Just like my schedule on the day I am mute from laryngitis.