Trust No One

There is a montra that a staff physician taught me on one of my first inpatient hospital rotations as a resident: Trust No One.  (Her other big soap box was: always do a rectal exam, but I wasn't too found of that rule.)  At first "trusting no one" seemed rude and inefficient.  Afterall, we are a team of nurses, doctors, pharmacists, and even patients.  If I can't trust the patient's story, the nurse's evaluation, the ER doctor's opinion, or the pharmacist's recommendation, how can I be a team player?  More importantly, how can I get anything done?

Well, long, long ago, I learned that patient's are not always trustworthy.  "I quit smoking," from the guy who you could smell before you saw.  "I've never had sex," from the pregnant teenage girl.  "No, No.  I would never do drugs," from the patient with pupils the size of dinner plates.  "I've been sober for a long time," from the guy who goes into alcohol withdrawal seizures two nights later.  While, yes, most diagnoses can be made from the patient's history alone, there are still some times you have to take their history with a grain of salt.  So, I guess the montra holds true.

However, when it comes to my own medical community, I am a very trusting person.  It is true that if you treat the nurses well they will make your life easy (and, although I haven't experienced it, they also can make your life miserable if you don't).  There have been so many things I've learned from nurses along the way.  The amount of time they spend with the patients, their personal experience, and their thoroughness are huge helps.  However, there have also been times it has led me astray.  There were a few examples even just this week that I wish I would have asked more questions, gotten more details, and trusted my instincts and training more when the nurses were anxious, stressed, and frantic for the doctor's orders they wanted.  Instead of taking a step back and reigning in the situation, I caved and ordered more tests, started more medications, and skipped steps I should have taken.  Thankfully, the patient's didn't suffer, and it ended up just being a waste of precious healthcare dollars and a blow to my ego.  But, now the montra is a little louder when my pager goes off.

Now, to be fair, the same holds true for people with "Dr." in front of their name.  The number of times is growing where the story from the other doctor is not the same story that I come up with when I go to see the patient myself.  I've gotten a patient with an "anxiety attack" from the emergency room that ended up being a heart attack.  I've gotten someone who "just needs to be watched until a spot in a nurshing home opens up" in rhabdomyolysis.  It wasn't me, but I heard a story about an intern who asked the pharmacist with help changing someone's IV steroids to oral and ended up giving 3x the amount they wanted.  Can you say - 'roid rage.  Montra true once again.

I realize that this might be unintentionally sounding arrogant or elitist.  In all honesty, as much as I try, I haven't always been worthy of that level of trust either.  We all are doing our best, but eventually when I'm the one solely responsible for someone's health, and ultimately someone's life, I don't want to have anyone else to blame.  So, with all due respect, don't mind me if I verify the patient's story, question the nurse's evaluation, reexamine another doctor's patient, or look up a medication dose one more time.  It's just my montra: I trust no one.

Just me?

Hopefully, everyone feels like this sometime.  Hopefully, it isn't just doctors.  Hopefully, it isn't just moms.  Hopefully, it isn't just me?!

Four days ago, I felt... yuck.  I felt like I was a bad doctor.  I felt like I was a bad mom.  I felt inadequate.  Overwhelmed.  Tired.  Attacked.  Insecure.  Unappreciated.  I felt like quitting.  What a terrible day.  What a terrible way to start a very busy four day stretch.  Whew, thankfully, now it's today, and it's over.  That feeling is fading.  It's amazing what trusting your instincts, Diet Coke, and some sleep can do.

Dear Oof-oof,

Here's to my son's little, limp, blonde stuffed best friend.  Who knew that a lifeless toy could have such a personality and such a bond with a boy who has enough life for the both of you.

You began as a gift, and your soft fuzz made for the perfect newborn photo-shoot backdrop.  Then you quietly took your perch on the shelf and kept your dark brown eyes protectively on my baby sleeping in the crib below.

However, it didn't take long for Owen's own brown eyes to spot you on that shelf.  A friendship was born.  Soon after he said the sweet words: "mama" and "dada," "oof-oof" rolled off his tongue.  (It might have come first, but I'm too proud to remember that.)  Unseparable.

As much as you've been through, it's no surprise there is a little less fluff in your stuff.  Your neck has been formed to the shape of Owen's loving elbow.  Your tail is bald from loyal tugs.  Your eyes are scuffed due to a few run-ins with the cement.  And your fur is well worn from being first of the scene to soak up tears, blood, boogers, and other unmentionable bodily fluids.

Thank you for being there for my sweet, soft-hearted little boy.  He turned to you for comfort during his first nap at daycare, when he woke up scared in the middle of the night, and whenever mommy isn't there to kiss his "ouch".  You also provided your undivided attention when our attention was needed for another little boy in our house.  Now, Owen happily shows you off his little brother, but don't worry, he isn't about to let you become a hand-me-down.  You are his.  Always.

Some day you two won't be together.  Maybe Owen will out grow you.  Maybe it will be the washer that is your demise.  Maybe you'll be lost or left.  But until then, keep up the good work.  Owen loves you.  We all love you.

Sincerely,

Owen's Mom

P.S.  You smell much better after your bath today.

Day Light Savings

Seriously.  This daylight savings stuff is not cool.

Ten years ago the extra hour was great because it meant an extra hour of sleep.

Five years ago the extra hour was good because my intension was to have an extra hour of studying.

Today the extra hour was terrible because two people in our house didn't know what they (or their nap schedule) was in for.  This morning lunch, nap, and church all collided on the same hour.  We chose the nap.  God, forgive us.

Maybe in the spring I'll be a little more prepared and break the boys in slowly the few days before.  Or, maybe we should all get together and petition to end this crazy daylight savings crap all together.  I mean really, just pick a time already! 

(But on a positive note... at least I wasn't on call last night.)

Anxiety Disorder

"Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.  And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus."  Philippians 4:6-7

Do not be anxious.  This was the message at church this morning.  Do not be anxious.  It was not the first time I had heard or read this verse, but the conviction was thick today.  And the reason may surprise you; it surprised me.

You might think that having two children under two and a more-than-full-time job would be a good excuse for a case of anxiety, but I can honestly say that isn't usually something I struggle with.  Control.  Pride.  Selfishness.  Those are more me.  Therefore, today's command to "not be anxious" should have been easy.

Instead, the message began with a sentence that resonated in my head (and still is - hence the blog): "Anxiety is not a condition to be managed, it is a sin to be repented of."  Never, and I mean never, have I thought of anxiousness as a sin.  And when this statement landed on my ears this morning, I was sure Scott was wrong.  That can't be.  Afterall, I've been managing people's anxiety as a diseased condition in my clinic nearly every day.

No joke.  Rarely a day goes by where I'm not treating someone for Generalized Anxiety Disorder, or Panic Disorder, or Adjustment Disorder, or Bipolar Disorder, or Post-traumatic Stress Disorder, or Subtance Abuse Disorder, or Social Anxiety Disorder.  There have been so many patients, that I'm getting pretty good at making the diagnosis within moments of walking in the room.  The way they figit.  The way they try to answer questions thoroughly, correctly, quickly.  The way their eyes beg for someone to help them.  Anxiousness seems to ooze out of the pores of those who struggle with it to the point it hangs like a fog clouding the room.  It's hard to miss.

Scott went on to read the verse above, and I found it harder to argue with him.  Just then, he layed on an extra layer and put my profession in the hot seat.  "We turn to doctors [uh eh, me] to numb us, instead of God to heal us."  (I'm paraphrasing.)  Ouch.  Have I been the enabler?  Have I been hindering my patient's true healing?

I'm caught between a rock and a hard place.  Part of me still wants to argue that it is a biologic condition involving the imbalance of neurotransmitters in the brain that can, and should, be treated with medication and therapy.  Yet this new part of me is whispering: it's sin.

I wish all of my patient's knew Jesus and knew the peace which transcends all understanding.  And I wish I knew where to go from here.  What to think.  What to do.

Harnessing the Whirlwind by Jason (the husband)

Susan asked me to guest blog because she's running out of good ideas.  Just kidding!  She's been trying to get me to blog for over a year now and I actually started one last summer but in my mind I knew I would never write at a high enough quality to make it interesting.  The funny thing is, I always enjoyed writing.  In fact, not a lot of people know this about me but I started as a journalism major but couldn't handle the parameters of the job and downright shallow expectations of the profession.  I was worried my personal blog would be filled with KC Royals statistics and random Husker thoughts.  Believe it or not, I will admit Susan might be right.  After all, she is a doctor and she's pretty smart so maybe I do have something interesting to say (or not). 

The real reason I never blog is because I fool myself into thinking I don't have time.  Just the same as I do about reading the Bible daily (working on this), calling my family members (I really am sorry...), and washing the dishes (probably not going to change).  However, I am excited to do this...and I am not a "phase" person who changes their likes/dislikes often, usually I stick with something I am excited about. 

Sometimes, I feel like life goes way too fast - the coach in me likes to use cliches, anecdotes, and comparisons so bear with me.  One minute I have hair on my head (not my back) and driving my 1988 Honda Prelude with a freshly printed license around Omaha and a few minutes later here I am without hair on my head, driving to a real job, and raising two children.  How did it all happen?  Where did the time go?  Often, when people ask how things are going I tell them its been a whirlwind.  Not the answer they want to hear as most people prefer a simple "good" or "fine".  That's right - I compare my life to a blast of wind that's here and gone, sometimes in a few blinks of the eye.  There's nothing you can do to prevent it, but I think maybe you can soak up parts of it while it's present. 

I heard a sermon a few years ago that pleaded with us not to wish our lives away with anxiety and countdowns to the next big thing.  Since hearing that message, I have made a concerted effort to enjoy the little events, big moments, and the beautiful (don't tell anyone I actually said/typed "beautiful") things in life.  Susan is phenomenal at capturing these with the camera, but I capture them in my mind.  

Occasionally, when I am driving to work at 6:15 AM in the pitch dark I think about those moments.  The walks in the evening with Susan and the boys, the smell of firewood burning in the distance as the leaves turn orange (or brown - since I am supposedly color deficient) and crispy, eating chocolate chip ice cream with Susan while the boys sleep in the other room, taking my brothers to the pumpkin patch on a perfect fall day, enjoying Husker games with family who don't mind me complaining and then cheering, and listening to music that doesn't have words (thanks John Williams Pandora website). 

When I look back on this time in my life and feel really busy, I don't want to recall: the nights Susan was on call and I was mad about having to cook (i.e. order pizza and pack the boys in the car), the fact that I ignorantly took 6 graduate hours while starting a new job 25 miles away, getting really frustrated at work, constantly changing diapers...all of which is, a.k.a. the whirlwind.  It's important to slow it down and revel in the things that are actually important that won't always be here (like my hair, the Prelude, and somewhat in-shape body that could complete a triathlon were at one time). 

The historian and man in me is constantly thinking about legacies, particularly what makes people great, remembered, loved and admired.  History tends to remember people who made unpopular decisions, went against the grain, took risks, and made wise/rational decisions, and carved their own path (which probably explains why I am obsessed with Lewis & Clark and the pioneers).  In this busy world, it's easy to get trapped believing there isn't time and you can't enjoy but I will prove you can enjoy life regardless of what is bogging you down.  I am bound to not allow busyness, my job, and other factors out of my control determine my fate.  

I have been convicted to do this, and encourage anyone still with me at this point, to slow life down whenever possible and enjoy the best part...the present...because it's a gift.

Susan - thanks for letting me disrupt your incredible blog with my harangue.  I am not convinced you are right yet about this whole blogging thing but it felt good.  Oh yeah, rest assured I will not bore you in the future with exciting topics I had originally planned, such as: my rationale for dropping David Akers from my fantasy football team in Week 7, why the Royals should sign Alex Gordon to a long-term contract, or why people are way too critical of Taylor Martinez. 

Psalm 3:5

"I lie down and sleep;

I wake again, because the Lord sustains me."

There hasn't been one single, measly occasion in the last three months where my eyes have stayed closed for the entire night.  If it's not one thing, then it's another.  If it's not my pager, it's my baby.  If it's not my baby, it's my toddler.  If it's not my toddler, it's my cough.  And if it's not my cough, it's my mattress.  It's for this reason that I've slipped back to being the caffeine addict I swore I would never be again.  I think coffee in the morning and Diet Coke in the afternoon is a heavenly way for the Lord to sustain me.