Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do
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Showing posts with label children. Show all posts
Showing posts with label children. Show all posts

Thursday, May 5, 2011

Homecoming-Parenting Again

Zanzibar!

October 14, 2011 my son departed for the African continent.  More than 6 months later, he will soon return and my life will be changed, in ways I cannot yet predict.  Like many young adults, my son needed time to figure out where he wanted to take his life.  Together, we opted for time volunteering in Africa as a way for him to "get away" while giving back something.  His first 3 months were spent building civic projects in the hills of Eastern Ghana.  I know only a little of his time there but he lived with no electricity or running water in a place that was equatorial hot.  He met volunteers from all over the world and seemed to have his eyes opened to many things about himself, being American, and regarding world politics.  It seems work was easy as the Ghanaians are soooo friendly but not sooo hard working. He then traveled east to Tanzania where he lived in finer accommodations but had to struggle to teach English and math to students in an orphanage.  Again he met many people and gained insight into how hard teaching is, the impact of a tourist economy, and the beauty of Mt. Kilimanjaro.  Of course, it wasn't all hard work and no play-he did treat himself to a short but impressive (his experience) safari and a week on the spectacular beaches of Zanzibar-a place of which most of us can only dream.
His path home took him through England where he traveled to see family, family-friends, fellow volunteers from Africa and to pay tribute to his deceased grandparents.  During his time there, I know he has been scrubbed clean and obtained some fresh clothes-slowly shedding the layers of Africa from his ski, hair and cloth.  But I suspect even when he stands back on American soil, that Africa will not leave his system so easily.  How this experience will change him, our (and others) relationship, and his dreams and future plans, will only emerge slowly over time.  I will do what I can to support his re-entry but I too have learned things during his time away-I know I can never return to how we co-existed in past years, that I need not completely sacrifice my health and happiness to accommodate an "angry young man".  I know that being a good parent (mother) means more than opening a wallet, preparing a meal, lending the car, or greasing the way.  It is also letting go, allowing them to fall, forcing them to confront, refusing to lower standards, and holding your head high.  Parenting-the hardest work I have ever done and ever expect to do.
Wish me luck!

Monday, March 28, 2011

The Apple Doesn't Fall...


As a woman neurosurgeon, I wear the simultaneous hats of surgeon, mother and wife (along with chef, businessperson, volunteer, leader...) so I am thrilled to announce that my daughter has started her own blog called College Kitchen.  Even if you are well beyond college, she has a great insight into cooking healthy, fast and inexpensive meals-just what every college kids needs but also what so many of us that juggle hectic lives need too.
It will be very interesting for me to watch her evolution as a blogger.  I have already shared with her the few "tricks" I have learned during my time in the blogosphere but more importantly, I have shared with her how my own blogging has transformed the way I think about each day and each encounter.  I wonder if it will have the same impact for her.  Perhaps her blog will catapult her to fame and fortune-like Julia (and Julia), maybe it will help others learn how easy it is to prepare fast but healthy food, perchance she may gain insight into a new part of herself or her future...all I know as  mother is that I am so proud of her, and specifically tickled that she now also has a blogspot address.

Monday, March 7, 2011

Birthday Mom


Once a year, I have a week in which I celebrate the birth of both of my children.  They had the same due date, just one year apart and ultimately just a year and four days separate my oldest and youngest.  So when the last week of February nears, I am taken back to those challenging days-the end of pregnancy when the anticipation and anxiety of childbirth (especially the first time) are nearly overwhelming.  I worked full-time up until the very end with both and I think that actually helped distract me but it also meant I was utterly exhausted.
Fast forward 21 years and I am relaxing on Amtrak traveling from New York to Washington, DC-a far cry from the 13 plus hours of labor.  Wand then on Saturday a lovely jaunt to the Phillips Collection in Dupont Circle on and then a special dinner at Citronelle.  I think every parent-daughter relationship has its good and bad moments-right now we are all in a nice place and the time shared was a joyous celebration for all.
Somewhat in contrast, my son turned 20 on the day we left DC.  He is currently on a volunteer project in Tanzania, after 3 months of work in Ghana, and we were not able to reach him in any way around the time of his birthday. Mail takes 3-4 weeks to arrive (and succeeds only about 75% of the time), his nearest internet cafe seems on-line about half the time when he gets there (infrequently), and he lost his phone...Finally a week letter, we did make contact and were able to extend him a "virtual" hug.
For me, it is always a week of introspection, thinking about the early years of my marriage, the decision to have kids, the financial struggles intrinsic to most young families, and the many, many challenges of raising children simultaneous with building a career in neurosurgery.  Despite the challenges, I have found both to be extremely rewarding.  I look forward to many years of reaping the rewards of both of these essential parts of my life.
Happy Birthday Dina and Daniel!
Love,
Mom

Friday, February 11, 2011

Exciting Progress

This week there was exciting news published in the New England Journal of Medicine about the potential benefits of intrauterine surgery on a fetus with spina bifida (see also Spina Bifida Association).  In the past, similar approaches have resulted in unacceptable risks to the mother and complications of the pregnancy.  With advances in technology and technique, these risks have been limited and in fact no additional risk to the mothers were found.  Dramatic positive results included (full text at NEJM link above):

  • The first primary outcome, fetal or neonatal death or the need for a cerebrospinal fluid shunt by the age of 12 months, occurred in 68% of infants in the prenatal-surgery group and in 98% in the postnatal-surgery group (relative risk, 0.70; 97.7% confidence interval [CI], 0.58 to 0.84; P<0.001) 
  • The second primary outcome — a score derived from the Bayley Mental Development Index and the difference between the functional and the anatomical level of the lesion at 30 months — was significantly better in the prenatal-surgery group than in the postnatal-surgery group (P=0.007). 
  • In post hoc analyses, infants in the prenatal-surgery group were more likely to have a level of function that was two or more levels better than expected according to the anatomical level (32% vs. 12%, P=0.005) and less likely to have a level of function that was two or more levels worse than the expected level (13% vs. 28%, P=0.03) than were infants in the postnatal-surgery group. 



The New York Times hailed the research as opening the door to the great potential for fetal surgery.  Many days I have happy to be a neurosurgeon, some days I feel GREAT to be a neurosurgeon.  Reading the results of this study, as someone who has spent many hours with these patients and their families, I am thrilled!

Monday, December 13, 2010

Journey Back-Poland (Germany) 7 (Halberstadt)

Streets of Halberstadt
We don't know why my grandmother's family left Poland when she was three and moved to Halberstadt (200 km southwest of Berlin near to Magdeberg).  It may have been motivated by a particularly gruesome pogrom (there is historical evidence for this), by the need for better employment opportunity (there is the suggestion that my great-grandfather had trouble finding work), by the growing and thriving Jewish intellectual community, or my some combination of all of these.  What we do know is they were not the only family to make this move so they had a number of contacts and perhaps friends among from Smigrod among the community in Halberstadt. So perhaps it was fitting that when my mother and I arrived for our visit, we were greeted not only by our guide but by a visitor from Israel who was originally from Smigrod but who had grown up in Halberstadt (knew my great-grandmother) before fleeing the Nazi's as my family had done.  
Mom getting oral history
And so we settled in not only for lunch among resettled Russian Jews (who are the only current Jews inhabiting this city) but for tales of life in Halberstadt, including ones about our family.  A culinary and emotional treat!  I learned that my great-grandmother was known for her baking-the neighborhood children would gather outside her home when they knew she was baking in hopes of catching a morsel or two.  She also confirmed where my family lived so we were able to visit not only the street but see the actual home!  We had left a relatively short time to visit Halberstadt on our way from Poland to Berlin and after meeting this woman, I regretted our plan.  Here was a slice of history and our opportunity limited.  Fortunately, we also learned that in Israel, she lived near to our relatives ther and through the wonders of modern technology, she has now met them and has continued to relate her oral history and memories to us through them.  So the world may indeed be flat!
"Silk Bag"-my family's street
Mom in front of our family's home

One of our priorities in Halberstadt was to visit the grave of my great-grandfather.  For some reason, the Jewish cemeteries in Germany were sometimes left alone (I have previously written about the desecration of most of the ones in Poland) and we knew with advanced arrangements, we would be able to pay our respects.  Our guide first showed us around the remains of the synagogue, a lone wall standing in a semi-arranged garden as silent memorial to Nazi devastation.
Synagogue in Halberstadt-silent memorial
We then traveled through the other limited remains of what was once a thriving, prosperous intellectual center for Jews including a Mikva.  One of the former synagogues (Berend Lehman) has become the Moses Mendelssohn Academy serving as community center, gallery and overseer of Jewish history.  We then made the short trip to the large cemetery where we located Joshua's grave and said I said a silent Kaddish.  Here, more than anywhere else I had been on this trip, I felt inexorably connected to my ancestors.  I guess there is something to be said about gravestones as a palpable way to honor our past.

Soon after, we said goodbye-we had one final stop to make before returning home.  Following my grandmother's path, we pointed ourselves toward Berlin-where she traveled after marrying my grandfather.

Friday, November 12, 2010

Creating Balance

I recently addressed a group of enthusiastic medical students considering neurosurgery as a career.  I spoke on creating balance between a demanding career and home/life/family.  The following is a distillation of that address.

My mother told me I couldn't be a "superwoman", the somewhat pejorative term used for early generations of working women who were also moms and more.  Fortunately, I lived in a different era than my mother and my options for lifestyle choices were greater.  Those of you entering the workforce 20+ years later have even greater options.
Achieving balance requires:

  • Hardwork
  • Dedication
  • Creativity
  • Constant re-assessment
  • A little bit of luck
There are so many variables in every confluence of work/home/family that there is no one answer that will work for everyone.  That being said, those entering this world now need not re-invent the wheel-there are now many who have blazed the path and found creative solutions that may apply to others situations.  There is no magic, just real life people who have found there way in the brave, new world.

What are some of the greatest challenges/questions to those who wish to enter a career such as neurosurgery?

  1. If I become a neurosurgeon, who will take care of my children?  You have many options:you, your spouse, friends, nanny, au pair, or day care.  I chose to place my children in day care though when I completed residency and moved to NY, I found I needed to supplement that with a caregiver who collected the kids from daycare and started their dinner.  Of course, they soon became much more independent and soon needed more taxidriver than babysitter!
  2. If I am a neurosurgeon and have a family, how can I exercise and live healthy?  This can be a challenge but certainly eating healthy (packing your lunch, for example) takes no more time than the alternative and actually saves money.  Consider just walking 15-20 minutes a day until family life stabilizes and permits more.  We started walking with our children at a young age so the fitness of hiking became an important family activity!
  3. If I am a neurosurgeon and my spouse also works, can we find jobs together? Sure, this is a challenge and you may have limits on your choices but employers like stability and if two of you are connected to a job (or region/city) that is a big plus.  These days, many jobs (though not neurosurgery) allow work from home for all or part of the week.  There are many options.
Just a few more myths/truths:

  1. You can't have it all-TRUE! Even in an ice cream shop one must make choices!
  2. There is never a good time to have children-TRUE! But we try to choose better times and know that for generations, we have survived this challenge, too.
  3. Few go to their grave wishing they worked more/earned more money-TRUE.  I do know many who have regretted missing that school play, the birthday party, or sitting by the bedside of a loved one who will soon die.
  4. There is one right way for...marriage/parenting/career development-FALSE.  There are as many options and paths as there are stars in the sky!
  5. Working longer hours increasing productivity-FALSE.  Many studies show that those that structure their day and leave the office at a reasonably scheduled time outperform colleagues whose days stretch on for many additional hours.
Don't be afraid of change! Inertia can be your enemy in life.  Live, love, and follow your dreams!

Saturday, October 23, 2010

Going, Going, Gone

Last Thursday my husband drove both my son and me to JFK airport.  I was leaving on a routine flight west to San Francisco for a neurosurgery meeting.  My son was departing on a bit more of adventure.  Early that evening,  Daniel would begin his full day journey to Accra, Ghana and then on to the remote village of Akropong where he will live with a Ghanian family and work on building projects (schools, community buildings) for three months.  Like many late teenagers, Daniel had been been nothing short of challenging for much of the last few years and I had long anticipated the day he would depart for Africa-a chance to gain a little corner of peace and quiet.  So I was unprepared for the emotions that flooded through me when I had to finally hug him and say goodbye.  I spent much of the first part of the journey to California completely unable to complete any of the work I desperately needed to do.
A week has passed and we have received a very brief communication that he arrived safely and another with some very rudimentary details about his placement (he is an hour from the nearest internet cafe and cell phone reception is inconsistent and very expensive).  We do know it is very hot and that the work proceeds slowly as a result.  He has met many other volunteers and in one of those amazing coincidences, one grew up in the same town as his British father!  Perhaps he will make his way to an internet site this weekend and we can see some photos and hear more about his existence there. For now, I have made the decision-for reasons I can't really explain-that I will only communicate with him via hand-written letters.  Perhaps I think he will enjoy getting mail and perhaps it seems more personal and appropriate given where he is living.  It is strang being 2010 and having a loved one be away for a really extended period of time (7 months total) with little means of communication.  It takes me back to when I was growing up and even long-distance phone calls were unusual and very short.  It also reminds me how dramatically communications have changed in a relatively short period of time!
Daniel wanted to get away and to do something completely different that also helped mankind.  It seems he has accomplished that geographically.  I hope the emotional change will also be all that he seeks.  For me, I will be in New York waiting...yes enjoying the lack of mess, late nights, and overly boisterous behavior but also wondering what will great me when we reunite in May 2011.
Daniel leaving home for Ghana

Monday, October 11, 2010

My Oxford Challenge


My son is going to do volunteer work in Africa for 6 months and was prescribed malerone to protect him against malaria.  He obtained the prescription, took it to the pharmacy AND...we were told it would cost nearly $2000, even though my health insurance policy carries an expensive prescription drug benefit.  Thus began my odessey with Oxford.
First Call: (32 minutes): Informed it was not a covered medication because it was for travel.  They agreed that there was no such provision in my policy but that was "Oxford's general policy".  Informed I could ask for an APPEAL OF COVERAGE, expedited with an answer in 48 hours.  Great.
Wrote appeal, sent to provided address with registered mail.
Second Call: (48 minutes): Requested response on appeal, informed after some time that in fact medication was covered and what I needed was a QUANTITY LIMIT OVERRIDE APPEAL since he had 6 months of pills ordered and was only entitled to one.  Again told an expedited appeal would be answered in 48 hours.
Faxed appeal as instructed.
Third Call: (32 minutes) Couldn't find my appeal, couldn't find anyone who could tell status of appeal, tried to get through to a medical department and was told they weren't answering their phones I could continue to hold or call back later...as I had to go back into the operating room, I concluded the call.
Fourth Call: (36 minutes) Got lovely woman who apologized profusely for all the calls and trouble but after invetigating informed me in fact malerone was NOT a covered medication! After I got a little angry, she put me on hold, and ultimately agreed I needed a QUANTITY LIMIT OVERRIDE APPEAL and gave me a different fax number and instructions how to use the facesheet to prompt a definite response.
Re-faxed appeal as instructed.
Fifth Call: (49 minutes) Kind man said the pharmacy stated I could only get 2 months worth-I tried to remain calm and ask why the appeal had been rejected and who could I speak with as the whole point of the appeal was to OVERRIDE this limit and I though as he would be far from a real pharmacy and even a reliable postal service I had good grounds to request this.  I was put on hold again and when he returned he apologized profusely and said I was misinformed...what I needed was as VACATION OVERRIDE APPEAL-this process means I have to purchase the medication out of pocket and then after I complete 5 pages of paperwork (without leaving out a single crucial item), Oxford will decide if I am entitled to reimbursement that they can send me at their leisure.

And we wonder if our health insurance system is broken?
Bon Voyage!

Friday, September 24, 2010

Robert Glick-Neurosurgeon

The following is reproduced from Heart of a Lion, Hands of Woman: What Women Neurosurgeons Do .  With the holidays approaching, I thought you might enjoy!
Thanksgiving from hell…Almost! (1996)


Roberta Glick, M.D.
Roberta Glick

I am eight months pregnant. I am 43 years old. My husband invited 20 guests, “his family” for the “second night” of Thanksgiving. Need I say more.
Let me give you some background. Several Jewish Holidays have traditional second nights, including Passover, Rosh Hashanah and Hanukkah (which has 7). In this era of “post-modernism”, we’ve created a new tradition of “second night” of Thanksgiving at our house. Friday night following the usual Thanksgiving celebration, we invite my husband’s brothers and their families who have come into town for the grand Thanksgiving party held at my step-mother-in-law’s house. We also invite several of his relatives from the side of the family we don’t see on Thursday, and other friends.
Our party was originally for 10 to 12 people and I was told, by my husband, “Don’t worry, you won’t have to do anything”. By Tuesday before Thanksgiving, the count was up to 16 people. By Thursday, Thanksgiving Day, it was 17. And by 3 p.m. Friday, it was 20. Our “traditional “second night” meal is spaghetti. The recipe is one my husband’s mother used to make for the kids some 25 to 30 years ago. She was an artist who died of breast cancer, and her legacy includes her 3 sons, her paintings, and her spaghetti sauce recipe. We still have the original one written on disintegrating paper.
My 5 year old son and I spent much of Wednesday and Thursday evenings decorating the house for Thanksgiving and Hanukkah (which was one week after Thanksgiving) and setting the table. Because it was Friday night, the Jewish Sabbath, we light candles and say blessings over wine and bread, challah. The table must be set so that all of the woman have a set of candlesticks to bless, all the men have prayer caps (yamalkes) and everyone has a special Kiddush wine glass and prayer book. This is in addition to all the usual silverware, dishes, drinking glasses, and wine glasses.
I am going to reveal one of the very guarded secrets of marriage that no one ever talks about. That is, before a party, there are tremendous tensions and “discussions” between spouses. Something like this. I, of course, am the one with great expectations who wants to make a “perfect party” with matching cloth napkins, lovely polished silverware, glistening crystal, fresh cut flowers, and candles. But I’m no Martha Stewart, nor do I know who Martha Stewart really is. I’m a working pregnant mother, with grand illusions and with morning sickness for 8 months.
My husband on the other hand, believes that good food and good friends are all you need for a great party, and don’t worry about the rest. “We can use paper plates and paper napkins,” he says, as I cringe, appalled. So after two days of “setting up”, as my son calls it, I thought everything was under control, especially since my husband (Don’t worry, you won’t have to do anything but rest and relax) had ordered flowers, chickens, all kinds of salads, fruits, cakes, pies, and other desserts from a wonderful local caterer.
So feeling confident, we went to the circus. On the Friday morning of the dinner party, we decided to take 12 brothers, sisters, nephews, and nieces to the 3-ring Barnum and Bailey Greatest Show on Earth. It was a great time.
After the circus, at 2 in the afternoon, we went to pick up the food at the caterer’s shop. But the caterer was closed. No one answered the phone or the pager number that we had been given. Because we had used their services often in the past, we totally trusted the chef (a 450+ pound guy who was always sitting down when we saw him). He was obviously a great cook. We had even faxed our order 2 weeks in advance and received a return fax message earlier in the week. So why worry. I kept telling my husband, “Let’s give them another hour, they’ll show up”. Always the eternal optimist, I am.
At 3 p.m. we had to reset the table from 17 to 20. Actually, we had to add a third table for the kids and rearrange all the furniture in the living room to accommodate it. At 4 p.m., still no word from the caterer. Dinner was called for 6 p.m., and all we had so far was spaghetti and spaghetti sauce. My husband said, “I better go shopping””.
“What about the flowers?” I asked.
“I’ll pick some up,” he said.
“Find a bakery and use the health food store for fruit and chicken,” I said.
“I will,” he answered.
“Stop and Chop” became our mantra because at 5 p.m. we started making green salads and fruit salads and chicken for 20 people. In the meantime, maybe it was hormonal (which translates as the unknown “woman” factor), maybe it was my way of dealing with reality and insanity all at once, maybe it was because I was 8 months pregnant, but as I was getting out more silverware to reset the table, I sat down on the kitchen floor and started shedding tears and having bouts of laughter in succession.
A race to the finish. The first guests begin to arrive. I handed them knives, cutting boards, bowls, and plates to help prepare the food. Finally dinner was ready and we all sat down. Just as I was sitting down and finally relaxing, the phone rang.
It was a friend whose father, a university professor with some recent visual and mental changes, had just been diagnosed with a malignant brain tumor. He called to tell me that he had been doing some reading and found out that this tumor, called “Glioblastoma Multiforme”, was the worst tumor one could have and that his father may have only a few months to live. He was shocked, and severely upset and angry all at once. Portable phone in hand, I left the table and wobbled back to the kitchen to talk to him.
When I returned to the table 15 minutes later, I realized that a Thanksgiving party that nearly went off track, one that I knew I would laugh about later, in the years to come, was not the life drama or tragedy I saw it as just minutes ago. My perspective on life at that moment was like looking through a telescope as I refocused the lens. As I looked around the table, I was thankful for all the good friends and family, joy and good health, and good times we were able to share that night.
And I thought of my friend.

Note: About one hour into the dinner, we received another phone call. It was one of the partners of the catering service apologizing and letting us know that they went out of business that very day. Something about taxes. They didn’t even offer a cake.

Friday, September 3, 2010

Happy Birthday Randy!

This weekend I had the distinct pleasure of celebrating my sister's 50th birthday.  When Randy was born, just 9 1/2 months after I arrived, my parents were told many sad things about Down's Syndrome children.  To their credit, my parents decided to raise her (not place her in an institution) and to fully integrate her into our family.  Though they were told she was "uneducatable and only partially trainable" she now reads on a 4th grade level, can do simple math, cooks a spectrum of foods, and can challenge most people on tv trivia!  When I was young, I had to cope with the notion that her probable life expectancy was only 20 years (at that point, most Down's Syndrome children were institutionalized and died of institutional diseases, not their Down's).  During college, she would come to visit me at Brown and while I went to classes, she would befriend everyone in the dorm, even some I barely knew.  Her charm and congeniality was infectious.
For nearly 25 years, Randy has lived semi-independently in a group home and worked steadily.
There is no doubt, having Randy as part of my family has influenced much of who I am.  My career in medicine is probably related as well.  If so, that's one more reason I have to thank her, as it has been a wonderful and rewarding career.
What lies in Randy's future is unknown.  Statistically, she has a high chance of early Alzheimer's but otherwise, her longevity and well being is probably very similar to others her age.  I look forward to celebrating many more landmark birthday's with my very special, "baby" sister!



Monday, August 23, 2010

Fool me Once

Fooled me
Last summer, all summer
Out late
Many lies
Wasted work
The graduate! Ha!

Fooled me
Freshman blues
More lies
Wasted time
Opportunity lost

Fooled me
Said you blundered
Wanted help
Change would come
Had ideas

Fooled me
Summer home
Big plans
Getting it right
Taking control

Fooled me
Deceit everywhere
Where to turn?
What to do?
Is it too late?

Fooled me
Once, twice
Again, again
Fooled me
Me Fool


George Bush: Fool Me Gaff (must watch!)

Friday, August 6, 2010

This Boy, A Memorial

This boy came into the world not fully closed
And his mother gave him to me
And I closed him

This boy came into the world with too much fluid
And his other entrusted him to me
And I drained him

Then the years passed and this boy grew
His mind expanded though his feet hung still
And together they were happy

As the years passed, I watched this boy
I marveled at his spirit and his family
And he made me smile

One day, this boy got dizzy and his head ached
He told his mother to come see me
And I knew he was sick

This boy came to my hospital
His mother gave him to me again
And I fixed his drain

The next day, this boy was happy
I saw his spirit return the ache disappear
And we all smiled

At home, this boy played and ate ice cream
He laughed and read books
Then he went to sleep and never woke up


To J, 
I hope you are running in heaven.  Tell the angels to send your mother, father and all your brothers and sisters strength-we all miss you.

Saturday, July 3, 2010

Coming Soon

Been traveling and teaching for two weeks then the requisite hell week catching up on return but have some wonderful things to share and know that life has begun to return to a "normal" rhythm so the blogs will soon flow again.  Look for:
Travels with Mom I: Roots in Polish villages
Travels with Mom II: A Sobering Visit to Auschwitz-Birkenau
Return of the children: It's summer and the kids are back in town
Worldwide medical community: the beauty of coming together


MarianPlatz, Munich June 2010

Friday, May 21, 2010

My Kids Told Me


With their usual candor, my two college-age kids have told me that the current rage on campus (beyond the usual alcohol and marijuana) are...various prescription drugs.  Everything from adderall for academic performance enhancement to percocet for Saturday night buzz-college students across the country are transforming legal medicines into recreational tools.  As a physician who writes many prescriptions for narcotic pain medications (there is little a painful as a multi-level spinal fusion), I have gained a new appreciation for the potential impact I may be having on our young adults.  



The way I see it, these drugs are getting to campuses in one of a few ways:
  1. Kids are stealing them directly from their parent's medicine cabinets (for use or sale),
  2. Patients are selling all or a portion of the Rx that doctors write them,
  3. Doctors are getting paid for Rx writing mills (more than one physician in my community has been caught red handed in this scenario), or
  4. Drugs are being stolen from pharmacies or similar.
Some of you may be saying, so what? In every generation, the youth will find a way-in my college years the drugs were quaaludes and cocaine, for a while ecstasy and meth were all the rage (and still are in some places), why should the current fad prick up my skin? I guess as a physician who is committed to healing, I loath the idea that I may be contributing to addiction and ill-health.  Is there anything we, as conscientious physicians and/or parents can do?  I would recommend the following:
  1. Mandatory directed education on narcotics, particularly on setting strong office policies that help prevent abuse,
  2. Public awareness campaign regarding protecting medicine cabinets,
  3. Accelerate reporting to physicians of patients receiving prescriptions from multiple physicians,
  4. Provide greater incentive for physicians services related to drug detox/withdrawal (currently no specialty takes this on as their responsibility outside the extremes of inpatient drug addition facilities).
If you have other ideas, I would love to hear them-it is time we as physicians gain an increased awareness of how we may be inadvertently contributing to "unhealth", not part of our Hippocratic Oath.