A Story I Have to Tell

Fernando Botero's: After Velazquez

On the intake sheet it only said "second opinion" so I had no idea when i walked into the examination room and was greeted by my patient and her mother.  She was a lovely young woman complaining of more than 10 years of back pain with debilitating progression.  This woman was also coping with psychotic schizophrenia (on three controlling medications) and suffering from morbid obesity (5'4" an 310 lbs).  Her exam showed no significant neurological impairment.  However, her MRI revealed a large ruptured disc and also the ravages of degeneration from the extra stress of her body habitus.
I began my usual explanation about ruptured discs and treatment options but had to conclude by informing her I would not consider surgery for a number of reasons all related to her obesity (the high rate of surgical complications, the likelihood of significant residual pain related to the widespread deterioration of her spine, her inability to exercise and adequately mobilize after surgery just a few of many).  I went on guardedly to make sure she understood that it wasn't that I didn't want to help her or that I was prejudiced about her weight and then moved on to my recommendation that she strongly consider surgical treatment for her obesity. I finished, so I thought, on a positive note saying that with the rapid weight loss one could expect, we might be able to consider surgical treatment for her back in less than a year.
I stopped talking after inviting any questions and there was absolute silence.  It took great restraint to let her speak next-the pause was so prolonged.  Her mother took my cue and also waited.
"It won't work," she finally blurted out,"I am a compulsive eater and so I know I will fail any surgical intervention because I don't have any control." Gratefully, her mother took up the conversation with her own story of surgical weight loss and subsequent reversal of the ravages of uncontrolled diabetes.  My patient responded again with a plaintive, "Won't work, I am psychologically impaired and I like to eat too much."
I smiled, it was time for me to end my silence. Gently I offered that many of US were compulsive eaters who loved to eat and that her weight issues were separate fro her other problems.  I realized that she had always linked the two and knew (rightly) that she would never conquer her mental illness, only keep it controlled (mostly with strong medications) for periods of time.  Thus she had come to think of her eating has a fait accompli, too.
I doubt I will see her in my operating room any time soon but I knew by her and her mother's beaming smiles that I had offered them something even better-perhaps a fresh start.  And they had given me something-the intangible gift of a patient helping you to understand something about the world and yourself that otherwise would have remained elusive.

No Hair Shave

I used to love the feel
The straight blade gently caressing
Strands falling away
Skin baby soft
A perfect palette to start
Wrapped tightly in white when done

No more
No more

Now I do parts and braids
Tediously planning the cut
And then the surgery done
More work to restore clean and tangle-free
Smiles reflected in the mirror
Change is good.

Journey Back-Poland 1

MarianPlatz, Munich

After four rainy, cold days of a professional meeting in Munich, I piled my mother and our luggage into a rental card and headed north and east towards my family roots in Poland.  For many years, I had shared with my mother an exploration of our family roots-searching out clues to their lives, digging to find more remote relatives, and to solidifying our family tree as far back as possible.  For me, part of this journey of discovery was the desire to "walk in their footsteps" and as such had looked for an opportunity for my mother and I to find time to spend in Germany and Poland.  Finally that time had come.

Krakow Streets

So we sped north on the marvelous Autobahn passing rapidly from Bavaria into the heart of what was East Germany though nothing about the road or the cities/villages betrayed significant evidence of this recent history. Another welcome surprise was the easy transition from Germany to Poland-both are now members of the EU so there was really no border patrol-just a short stretch of highway that narrowed to 1 lane with a 30 miles/kilometer speed restriction (all the police I saw were busier drinking coffee than watching the passing traffic).  The clear benefit of EU membership was in clear evidence as the excellent highway continued through the western entrance to southern Poland. Slowly the flatlands gave way to rolling hills as we neared our first destination, Krakow.  Despite imposing (and traffic stopping) roadworks on the periphery of the city and the challenges of navigating the narrow, confusing medieval streets of the city center, we parked the car right in front of our hotel right on schedule. After a full day of driving, we were more than ready to check in and then stretch our legs, explore the streets of Krakow and find some authentic Polish vodka and grub. This we did, ultimately relaxing to a flight of Polish vodkas (who knew?) with amazingly tasty food with direct views of the impressive central square.

Night in Krakow's Central Square

Next up: Jewish Life in Krakow and Auschwitz/Birkenau.

Rage Against Golf

This is not a knock on Tiger Woods, nor a complaint about being an "orphan" to a husband addicted.  This is not even a rail against the environmental impact of creating and maintaining all those acres of pristine fairways and greens.  No this is frustration at the continual role that golf plays in the "business of medicine".  Each year I am confounded by the obligatory (or many) GOLF TOURNAMENT BENEFITS when many of my male colleagues take the day or afternoon off to drink, socialize, and hit a little white ball toward a small hole with a flag. This week I was further assaulted by a hospital trustee who will host about 15 males (mostly surgeons) at a very expensive/prestigious local golf course along with the requisite luncheon before and cokctails after.  Again, these partners will take much of the day "off" but it will count toward work.

Now I fully realize that many women also love the game of golf (though they are rarely fully included in the activities described) and that I am fully free to take an afternoon off if I choose BUT...it is not the same and we all know it.  Penciling in a Benefit Golf Game into one's schedule rings completely different than-taking 1/2 day off for R and R!!!

So here is my call to ACTION:

Would some hospital administrator, hospital Board Member or Trustee step forward and offer at least some equivalent non-traditional alternative the Boys on the Links???  Here are a few suggestions:

Spa for a Cause (half day full spa treatment in exchange for a defined contribution to the cause)

Art Day (some activity for profit, education or just fun that revolves around painting, photography, dance, music, etc.) 

Wellness Rewards (yoga, Tai Chi, massage, stress reduction, cooking instruction for fun or profit)

I know thee is someone out there listening...

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

My Dinner Conversation

The Place and Time: Lyon, May 2010
Setting: Dinner Meeting at Brassier Nord, a Michelin star chef's local digs
Players: Neurosurgeons from France, England, German, and me (USA)
Theme: Medical systems: What works and doesn't
(Preliminary Info: All sitting at the table are pretty tops in field)

On a recent lecture tour in France, I sat back and listened to a remarkable discussion revealing the mixed assessments of physicians of mixed how successful their own medical delivery system worked-for both themselves (physicians) and themselves (patients).  Highlights:

Germany: Two tiered system.  Everyone must have insurance, responsibility is on individual (not employee), if you can't pay you get it anyhow, and if you earn enough you can opt out and get "private insurance."  Biggest catch for patient:  Once you opt for private, there is no going back!  Biggest catch physician: Little motivation for innovation, working hard, etc when on straight salary.

France:  Subtle two tiered system, everyone insured by state, private insurance allowed for upgraded service.  Increasing numbers opt private leaving the public system in tailspin.  Biggest perceived challenge: "fraternity" not fair that some have better than others! For doctors-the allure of the dollar is strong so they would rather spend their time in the private sector.

UK: Once the quintessential socialized system, now two-tiered and highly regulated.  Also crunched by work hour restrictions on house staff resulting in both workforce and competency issues.  Patient challenge:  wait times.  Physician challenge: highly regulated and little opportunity for creativity.  Leading edge of outcomes/quality assessment that I've encountered.

The US is entering a period of transition for our medical system.  There is so much propaganda flying around about the failings of other systems.  This dinner conversation proved many important things to me.  First, certainly no medical delivery system is perfect and effecting positive change in any system is excruciatingly slow.  Delivery of medicine is ever more complex, time consuming and less remunerative for physicians.  However, no one will argue that maintaining the status quo is just not a viable option.

Another Positive Review

Frances Conley, M.D.

Frances Conley, M.D., who wrote an award winning book Walking Out on the Boys, reviewed Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do in the Journal of Neurosurgery, May 2010. Dr. Conley was one of the first women neurosurgeons in the US ( details here and here) so I knew she would pull no punches, especially given her own literary (in addition to professional) success.  So I was thrilled by her overwhelmingly positive review.  She even challenged us to write Volume II in another 20 years!  Thank you Fran for all your positive words-they mean so much to me that you enjoyed our efforts.