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Grand Rounds 2.47

August 15th, 2006

Many of you know that we had our first child just 2 months ago. We've taken lots of pictures, and here's one worth sharing.


This one of those photos that just "happen." Besides the perfect trajectory arc and the strategically placed foot, I just love the expression on his face.

So for this edition of grand rounds, I wanted to write a letter to my new son, Timothy. One day, when he is old enough, I hope he'll read this and learn about how healthcare used to be way back in 2006. I don't know what it is about letters, but somehow I just enjoy writing them. If you missed my hospital-janitor-to-hospital-CEO letter from Grand Rounds 2.05, definitely check it out.

Dear Timothy,

Well, you can't read this, nor can you really even recognize me yet, but nonetheless, this letter is for you. I want to tell you a little bit about something I'm quite passionate about: hospitals and healthcare. Did you know that you were born in a hospital? Did you also know that your daddy dressed up as a pregnant woman to propose to your OBGYN mommy in a labor & delivery room? (that's another story for another time) Well, even if you don't follow in our footsteps to become a healthcare professional (no pressure!), there are some lessons I hope you can learn from this amazing world of healthcare.

Timmy, first off, I want to tell you that I'm going to try hard for you not to be a poor little rich kid. When I give you periods of boredom, just remember - those may very well become your most creative moments.

I also have to tell you that I haven't been sleeping very well with you around. Don't worry - I don't mind, I actually still like being woken up by your sweet cries for high-fat breastmilk. Nonetheless, seems like a lot of folks these days have sleep problems. Sounds like just a lot of those poor little rich kids from above are running around as overscheduled, unconnected adults?

You know, it's amazing. I look at you and I am humbled, honored, and scared that you trust me with your life. I guess you really don't have a choice. I heard from a doc that it's pretty humbling and amazing that patients (who actually have a choice) completely trust their doc.

One of the most valuable lessons I've learned in healthcare is the value of being a good communicator, and a big part of that is being a good storyteller. People remember stories. Did you hear about the one about this family that decided to abort their baby because of a rare birth defect? Not really uncommon, except that if the fetus was a boy, they would've kept it. Or how about the 17-year diabetic who cried when her first insulin pump arrived in a FedEx box. Or the patient dealing with the notion of officially becoming "chronically ill?" How about the volunteer hospital chaplain who tells us about what healthcare providers should never say: "Okay, now I’m staining your cervix with vinegar! The vinegar makes the abnormal cells turn white under this special light we’re using! Oh, look! There are so many abnormal cells that your cervix looks like a glazed donut!” Or what about the guy who was using a blowtorch to try to get rid of his warts?

On the more serious side, lots of stories are tough stories. When you face these, I hope you don't grow cynical, but you become more compassionate. Sometimes compassion is as simple as a few words of empathy, while other times it's anything but straightforward. One doc told me of the last helicopter run of his shift, and how those never quite seem to end well. Physicians face death every day, but sometimes, letting a patient die can be the physician's finest hour. And also remember that compassion givers need compassion, too - successful physicians get depressed and successful physician's parents get really sick, too. Also, take time to appreciate people and what they do. Appreciate nurses, and be careful not to cross them.

And by the way, in your storytelling (as well as when you schedule surgery), timing can make or break you.

Besides becoming a compassionate person and a great storyteller, become a man of action. Get things done. Here, a patient's daughter describes her positive hospital experience only after she decided to write out a "directive" to the nurses, doctors, and all staff. Or follow the example of one little physician who used blogger to start a hospitalist website for the Cleveland Clinic. Sometimes you just gotta do it. One day you may become a soldier (or a doctor). Especially with the world going the way it is with all these impending wars, who knows? You may need some quick practical survival "how-tos": packing an external trauma wound and dealing with the psychological effects of trauma.

Sometimes you've got to learn things the hard way, but with quite a few things, it's better to learn from the mistakes of others. One lady bought some pharmaceuticals on-line - she saved a few bucks and lost her eyesight. Another guy found that breaking his arm meant breaking his bank. On a different level, a few big pharma behemoths lost the chief jewel in their crown because they were too arrogant to think through how to deal with the little guys trying to break through. Also, if you want avoid freak finger injuries/amputations, never use those crazy fake nails and never attack an crazed woman with a fork.

Finally, I know this letter must seem somewhat negative. My last piece of advice - never stop being a kid - always be amazed at life. Isn't it amazing that we have our hands in people's chest walls to treat them? You know I've got some blogging friends blogging at the International AIDS conference in Toronto. When your kids are born, maybe this conference will be about a 2nd generation MMRA (measles, mumps, rubella, aids) vaccine. Maybe the vaccine will also include protection against West Nile Virus, too (apparently there's an unsettling number of squirrels are getting West Nile this summer. What about all those things that we have no idea how to treat today, like Medical Unexplained Symptoms, that will be so easily treatable when you're my age? Things do seem to come full circle, huh? I hear that horse tranquilizing club drug ketamine is making a comeback, treating depression. And get this, nicotine may slow Parkinson's. There will always things to marvel at and sometimes us grown-ups are too busy being grown-ups to see it.

Anyway, writing this letter has been sorta strange and enlightening for two reasons. The juxtaposition of your innocence with all of this sarcasm, death, and disease is odd. But I guess sometimes it's in disease that we appreciate health, it's at funerals that we love life the most. Secondly, it's made me double-think about the things we blog about and the way we do so. What are we writing about today that will actually be even remotely relevant even just a few years down the line? What kind of blog would make our children say proudly, 'that's my daddy's blog!' Why is it so uncool to blog about something happy?

Anyway, I'll save all these lessons for you when you grow up. For now, I'm content with you teaching me to enjoy every moment and not take myself too seriously. Hope you (and I) get some good sleep tonight.


Next week, head over to Dr. Charles for the 100th edition of Grand Rounds.


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