The Economy and Healthcare

Much is said about the economy these days-is it rebounding?  Is unemployment down? Who is responsible for the massive debt? How can we save Medicare?  Into this setting, a little reality slips in to my office on a frequent basis.  Today I saw a middle aged man who has a significant lumbar (lower) spine problem.  He has a ruptured (herniated) disc with nerve compression causing severe pain, numbness and weakness.  Together we have tried many treatments to heal this problem which have given him temporary relief but the symptoms soon return, usually worse than before.  The time has come when he should seriously consider surgical intervention BUT he can't.  Here is his story.
This hard working man has spent the last 18 months out of work, made redundant in the heat of the recession.  Just two months ago he finally landed a great, competitive job which he loves (and his evaluations have been outstanding to date) and is finally beginning to right his personal economic boat.  Taking the necessary time off of work, he feels, would jeopardize his job-there are 30 or more talented individuals who would gladly snap his position up.  Bad timing all around.
I find it really difficult at times like these to remain a dispassionate neurosurgeon.  This man is suffering great pain and disability.  He has taken no time off of work and even refuses most medicines because he wants to perform well every minute at work.  Firing him because of having surgery would be wrong and probably illegal but as a large company, I suspect they could find some way to handle that.  Being ill is hard enough, having those issues compounded by fear and financial insecurity has to aggravate the problem considerably.  Of course, I understand that the company needs him at work-that is why they hired him-and what good alternative do they have?
No one plans to have a medical problem and this many has done all the right "health" things (not overweight, exercises, goes to the doctor regularly, etc.) but nature can get in the way.  I am glad that I help many patients in my practice because when faced with this patient, I felt largely helpless.  I just hope the time I took to talk with him, reassure him, adjust his medications to try and get some relief will help in some small way.

Black and White and Yellow

It is like they took a black and white photo

And someone had just one paintbrush

And began to touch it all up with

The color yellow.

As I drive along the road

My eye is invariably drawn

To these audacious highlights

Signaling spring.

The wind still howls on many days

The rain can lash cold against the face

But nights draw longer inexorably

Seasons change.

Why yellow in all that is touched?

Whether sun-stroked bush

Or multitudinous erupting bulbs

April's color.

Yellow, breathing life back into

The slumbering world of black and white

Assaults the eyes and senses

Brings a smile.

Just Two

Brilliant purple they stand alone

Two welcome beacons of

Warmth, light and color

That will soon infuse the day

Saffron threads peek out

From beneath regal robes

Huddled close to ground

Beneath still barren trunk

Oh, how just two

Can raise my smile

Cause heart to swell

Lift shackles of winter.

Patient Wisdom

Sometimes my patients utter wisdom that I feel blessed to share with others.  Here is a recent representation from just one day in the office:

• As to my children, I don't worry about the first 10 years (of their lives), it is the second 10 I lose sleep over.
• Parental wisdom comes in waves.  At first children think their parents the wisest humans in the world.  Then there comes a time when they know absolutely nothing.  This may last for 10 years or more.  Then the next generation arrives and suddenly the parents regain their rightful place as all knowing and wonderful.
• You may have been taking care of these types of patients for years but I have been dealing with my mother for more than 40-I think I know her well.
• If you ask the wrong question, you may get an answer you don't need nor want.
• I realize there is a price to pay for everything.
• I can only ask that you do your best and that you are honest.  No one is perfect.

Everyday, my patients share themselves with me.  I am eternally honored by their trust and the wisdom they share with me-it has enriched my life.

Journey Back Poland (Germany)-Final Berlin

Berlin Wall Remnants

Berlin was ultimately the perfect place to conclude our Mother-daughter "Roots" journey for a variety of reasons.  In planning the trip, it was natural to end in a city with an international airport and Berlin was also where my grandmother and grandfather last lived in Europe before fleeing to Haifa and then on to New York.  Berlin also offered a broader view of the history of Germany/Eastern Europe/the Jews than the smaller cities and villages where we had spent most of our time. Finally, Berlin today most definitely is looking forward and this energy, enthusiasm and optimism was the perfect balm to the grief and sadness that inevitably suffused much of our looking back and connecting with our personal and ethnic history.
After driving through primarily remote regions, our approach to Berlin served as an abrupt return to the 21st century with congested, interlacing roads with the requisite confusing signs-at least when keeping up with the pace of the Autobahn.  We found our hotel, perfectly located within walking distance of nearly all the important East Berlin sites with several convenient transportation hubs available to allow more expansive exploration.  My first great surprise was learning the hotel would arrange to have my rental car returned-that I would not have to negotiate the Friday evening rush hour traffic in central Berlin after all.  With my new found freedom,  I had time to set off to stretch my legs and explore our immediate neighborhood.  Mom rested and we made arrangements to enjoy a nearby Turkish restaurant for dinner.

Alexanderplatz

The next morning we took the U-bahn to Alexanderplatz-the meeting point for our guided tour on Jewish life in Berlin.  As much as I like exploring on my own, the right guide can really unveil the heart and soul of a city and that's just what happened. We saw smaller and larger memorials to the Holocaust and to the small but meaningful efforts at resistance-hearing stories little known of bravery but also of brutality.

In the heart of the old Jewish quarter, we also saw the Hackescher Hofe which have largely been rebuilt (gentrified) since the fall of the Wall and may be one of the ultimate representations of the rebirth of what was once a bleak East Berlin.  The tour culminated at the New Synagogue-a spectacular building completely renovated to serve as tribute to the once thriving Jewish community of Berlin.

New Synagogue

Hackescher Hofe

We said goodbye to our guide, hopped on another U-Bahn and headed to (Charlottenburg), the center of my grandparent's life during their married years.  The lovely Platz (square) was ringed with inviting cafes-just what we needed.  Then we set off up Knesebeckstrasse in search of my grandfather's store.  We easily found the first address and were lucky to get inside the lovely iron doors to look around.  It was an amazing feeling to think of my grandparents selling furs right on this spot to support the family.  We then wandered on to the second address.  This one was less obvious, especially as we had one photography of my Grandpa Henry standing in front of the store so we were trying to match not only the address but the door frame.  In the end, we linked them all and felt this confirmed when we walked around the corner and found a fire station-Mom immediately recalled her brothers talking about this.  We had been to their places of birth and to places where they were raised but somehow, this felt so much more tangible-like I could reach back through time and touch the lives of my ancestors.

Knesebeckstrasse

Knesebeckstrasse

We had paid our respects to our family and now we paid homage to history.  Though we were both exhausted-physically and emotionally-we headed to Checkpoint Charlie then wandered back along the remnants of the Berlin Wall.  While little remains of the physical structure-art, poetry and historical placards remind all of another challenging time in German history.  I deposited Mom at the hotel and with just a little time left, walked up to Berlin's monument to Jewish martyrs.  An entire large city block has been given over to this memorial which is both simple and moving.  I love the fact that tourists and Berliner's alike perch on the stark stone blocks to rest and remember-with signs of a rebuilt Berlin bursting forth in all directions.  I concluded by foot wearing day walking to, through and around the Brandenburg Gate.

Berlin's Memorial to Jewish Martyrs

Now, Mom and I could share a final meal together and celebrate all that is Scharf, Benzil, and Kranzer.  After donning our best attire, we headed to one of Berlin's restaurant stars: Rutz.  There we luxuriated over a spectacular 5 course meals accompanied by the best of German wines.  Certainly a fitting end to a very special adventure.

Naomi at our final meal at Rutz

Anniversary

I was surprised to learn that I had missed the first anniversary of my blog (December 4).  Perhaps that is in part because I started out so slowwwww and really note the start more to January than December.  I have remarked before that my goal when starting the blog was to generate excitement about a book: Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do but it has become my "therapy"-a way catharsis for the stresses of being a neurosurgeon, mother, wife and all that comes with those "jobs" and responsibilities.  Writing on a regular basis again has given me a new view of the world and my daily experiences in medicine.  I have thrilled to see that people from most corners of the globe have at least opened my blog (and perhaps read it) and that some of my pieces have seemed to strike a note in the hearts of some of my readers.  I have particularly enjoyed the opportunity to resume writing poetry and sharing my travelogue from my "Roots Adventure" in Poland/Germany.  Thanks for tuning in-hopefully 2011 will be even bigger, better and more rewarding for all.

Relief

He took himself to Ghana
To search his inner soul
Or so he told us,
When he clearly failed all else.

At first the stories flowed
Through Internet Cafes
New friends, new loves, new life
The experience of a life!

But then the current stopped
No calls or otherwise
A few days then weeks flew by
I imagined so very much

And just like that it came
A call from another shore
All fine, not even aware
Of a mother's eternal woe


Note:  Thanksgiving may be past but today I am thankful all over that all is well.

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!

Autumn High

The cool air assaults me as I step outside

The dogs lope gracefully in anticipation

The sun glints against the coloring leaves

Some trees already ablaze in glory

The trail is firm and welcoming

The dogs throw caution and romp

Light filters and flickers through thinning leaves

Our feet crunch on already fallen

Apples crisp and pears, too

Cider bracing and sweet every morning

Still produce in great abundance

Meals a treasure like no other time

My autumn high