Patriot Day

Posted on Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

It’s hard to believe, but it happened 18 years ago.  The horrific events of Sept. 11, 2001 (9/11), shocked the nation and the rest of the civilized world.  We now have an entire generation of young people who know of 9/11 only through video images.  They have no actual memories of that day.  Those of us who do will never be the same.

This coming Wednesday, 9/11, is Patriot Day. Many people across the nation are honoring those who sacrificed themselves for others by performing an act of kindness.  Wouldn’t it be great if kindness became our second nature, our default mode?  We would wake up thinking, “Whom could I help today?”  Sadly, we do not think this way.

Instead, we are focused on getting “likes” on Facebook and/or other forms of social media.  As a result, far too many people are literally addicted to attention.  Getting “likes” on Facebook actually stimulate dopamine release in the reward pathways of the brain.   However, did you know performing or witnessing an act of kindness also stimulates release of serotonin and boosts “Immunoglobulin A” (IgA) production?  IgA is our first line of defense against infection.  It is most concentrated in tears, nasal secretions, and saliva.  This could be helpful as we head into cold and flu season.  And, heaven knows, millions of us are worried sick about horrible headlines and hurricanes.

Given this reality, performing acts of kindness truly becomes therapeutic.  Maybe this year on 9/11 we could:

  • Take the time and interest to compliment someone — especially someone who probably hasn’t received a compliment lately.
  • Pay for the driver in the car behind us at a toll booth or drive-thru.
  • Donate clothes or household items in good condition to Goodwill, the Salvation Army, or a shelter.
  • Take a box of donuts, muffins, or chocolates to the people at the bank, pharmacy, fire station, or police station.
  • Leave a basket of treats on the doorstep of a single mother or elderly neighbor.
  • Send a greeting card (a real one) to someone who has had a rough year.
  • Donate blood.
  • Send flowers anonymously to someone in a nursing home.
  • Give a donation to the American Red Cross for disaster relief.

There has been a battle between good and evil since the beginning of time.  Two thousand years ago someone told us to overcome evil with good.  So far, no one has come up with a better plan.

A Precious, Healing Balm

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

It’s not on Amazon.com.  None of the brick and mortar stores have it.  You won’t find it in a catalogue.  It’s not available at a bank or hospital.  This elixir is so rare and valuable you couldn’t even talk your doctor into giving you a prescription for it.  That’s just as well because no pharmacist would know how to fill it.  This vanishing and precious healing balm is silence.

We are addicted to noise.  It’s nearly impossible to escape.  Incessant noise bombards us in the workplace, the grocery store, the drug store, airports, waiting rooms, and neighborhoods.  People bring their own noise with them everywhere they go — just in case there might not be enough ambient noise.  People can’t even go for a walk without portable noise.  Years ago, Max Picard wrote, “Nothing has changed the nature of man so much as the loss of silence.”

He was right.  Silence gives rise to the very rhythm and harmony of life.  Without silence, there is no calm, comforting stability.  Chaos is, by its very nature, noisy.  Consider the floor of any stock exchange.  Everything is noisy and chaotic, and yet markets crave stability.  Most people crave stability whether they recognize it or not.  Perhaps we use noise to avoid facing the deepest truths about ourselves.

Many of us are familiar with Henry David Thoreau’s quote, “Most men lead lives of quiet desperation.”  The American writer James Thurber tweaked that sentiment in 1956, writing, “Most men lead lives of noisy desperation.”  Given our current culture, that’s probably more accurate.  Anyone who has lost electrical power for even 20 minutes knows that feeling of desperate frustration.  We want our gadgets to function.  We want our noise.

Oddly enough, when we’re sick or in pain, we usually want peace and quiet.  Could it be that silence is therapeutic?  That concept seems foreign to many people today, but it’s worth considering.  Silence is indeed a precious, healing balm.  It lies at both the center of the universe and the human heart.  Maybe, one day we’ll catch on.

The Root of the Problem

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars
(Photo credit MARK RALSTON/AFP/Getty Images)

By Mary O’Brien, M.D.

Dozens of people are dead.  Dozens more are wounded.  Grief and shock have gripped the citizens of El Paso, Dayton, and the rest of the nation.  Politicians, as usual, will blame their opponents and insist more legislation is the answer.  They are misguided.  The answer begins with understanding the real root of the problem.  And the real root of the problem is complex.

We must ask a forbidden question:  What is normal?  Is normal defined by centuries of acceptable behavior?  Is normal that which enables individuals to form a stable, productive society?  Over the past 50 years, we have tossed aside our ideas of normal:  traditional marriage; nuclear families; the sanctity of life; respect for elders, authority, and other people.  We have ridiculed religion and tradition as old-fashioned, useless burdens.  We now worship fame and outrageous antics.  Young people lead virtual lives online, often devoid of any actual friends.  Hyped-up, exaggerated, and downright fictitious lifestyles are posted nonstop in a frantic effort to achieve celebrity status.  Many young people are desperate for attention.  Their behavior, however, often leads to rejection and isolation.  Everyone experiences rejection and isolation, but normal people gradually mature and learn how to cope.  They adjust their behavior in an acceptable, productive manner.

Unfortunately, when time-tested values and institutions are stripped away and replaced by whatever is bizarre, nasty, violent, vulgar, or self-indulgent, the results are disastrous.  Unstable, angry, young men with fragile psyches cannot spend endless hours playing “first person shooter games” without consequences.  Many of us over the age of 40 are completely unaware of how realistic and gruesome many video games have become.  We’re not talking about cartoon characters.  Virtual people and real people blend into one another.  Combine this with mental illness, anger, hatred, drugs, and a complete lack of any moral compass, and the results can be horrific.

Angry, unstable, amoral people should not have access to guns.  But sooner or later, we need to address the real root of the problem.  There is such a thing as “normal.”  Most of us are still sane enough to recognize its absence.

The Wonders All Around Us

Posted on Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

I was startled recenty at 5 A.M.  A strange, golden light was shining on my bedroom wall.  It was not a familiar pattern.  Grabbing my robe, I went to the window and pulled back the curtains.  A massive, misty, yellow sphere was glowing just above the tree line on the horizon.  I went outside.

Was it a search light?  Was some group starting construction at 5 A.M.?  The air was heavy and still with a level of humidity that was oppressive.  The birds were beginning to chirp, but there were no typical sounds of annoying human activity.

The sphere of light was larger than any natural phenomenon that I had ever seen.  It was bright yellow and appeared to be expanding as I watched in perplexed amazement.  Trying not to trip in the dark of my backyard, I stood at the edge of the tree line. Clouds on the horizon started to part.  I gasped out loud as I realized a full moon was setting in the most spectacular fashion I had ever witnessed.

I wanted to call my neighbors to come see this miraculous spectacle.  But then, not everyone appreciates exquisite beauty at 5 A.M.

It occurred to me that 50 years earlier, Neil Armstrong, Buzz Aldrin, and Michael Collins were blasting off on Apollo 11 for man’s first trip to that magnificent yellow sphere.

Now I understand.  “Tranquility Base:  The Eagle has landed.”  On July 20, 1969, anyone on earth who had access to a TV was glued to it.  The entire world paused for a time, united in hopeful, anxious awe at what we were watching on grainy black and white images.  Most people under the age of 57 or so don’t understand.  We were spellbound in our pride and joy at being Americans and citizens of the good earth.  No one watching that glorious event had a dry eye.  It was literally hard to breathe.

July 20, 1969, was one of the most important days in human history.  It happened because President Kennedy set the goal, and 400,000 people worked around the clock for nearly a decade to achieve it.

Most of us will never be part of something as tremendous as the space program.  But we can choose to notice the wonders all around us.  Sometimes, I wonder how many extraordinary sights we all miss because we’re sleeping or busy or distracted.  Getting up at 5 A.M. has its rewards.

You Never Know Who Might Be Listening

Posted on Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Are you well-spoken?  Would other people agree?  There are many aspects of professional behavior, and speaking is one of the most important. Unfortunately, as a culture, our speech patterns, vocabulary, and grammar are deteriorating badly.

Incessant use of e-mail and texting has had a negative impact on speaking skills and vocal quality.  Parents, teachers, and bosses seem reluctant to correct anyone.  Someone might get upset.  People often confuse correction with criticism.  That’s misguided and it can undermine success.  Part of being an effective health-care professional involves conveying knowledge and inspiring confidence among patients and colleagues.  Bearing that in mind, here’s a little checklist to help polish your speaking skills:

  • Watch out for verbal crutches (um, uh, well, like, you know). Better yet, eliminate them.
  • Don’t start or end a sentence with the word “so.” So, we’ve had a lot of turnover lately, so.
  • Learn the correct use of the words “fewer” and “less.” Skim milk has fewer calories than whole milk.
  • Try not to begin or end a sentence with a preposition (to, of, with, for, on).
    • Incorrect: He doesn’t have any place to go to.
    • Correct: He doesn’t have any place to go.
    • Incorrect: We have many medications to choose from.
    • Correct: We have many medications from which to choose.
  • Learn when to use the subjunctive case.
    • Incorrect: I wish it was true.
    • Correct: I wish it were true.
  • Review the proper use of pronouns: Attention, Southerners.
    • Incorrect: Her and her husband went to the seminar.
    • Correct: She and her husband went to the seminar.
  • Recall the use of past perfect tense: Attention, Midwesterners.
    • Incorrect: Ordinarily I would have went home.
    • Correct: Ordinarily I would have gone home.
  • Eliminate redundant adjectives: Attention entire country.
    • Incorrect: The patient had a small, little bruise.
    • Correct: The patient had a small bruise.
  • Pay attention to singular or plural agreement between nouns and verbs.
    • Incorrect: There’s lots of options.
    • Correct: There is a lot of options.
  • Avoid constant self-reference.
    • “For me, this is not helpful.”  It’s not about you, but this phrase is ubiquitous.
  • Check your vocal quality. Is your voice loud, shrill, strident, or frenetic?
  • Watch out for bad habits in the cadence of your speech. Refrain from “sing-song” phrasing and “up-talking” at the end of a sentence.  It makes anyone sound like a silly school girl.
  • Slow down. Smart people often speak quickly, but you don’t want to sound like a toy machine gun or a cartoon character on amphetamines.
  • Diction is a crucial part of effective speaking.  It requires effort.
  • Guard against “whiny girl” or “lazy girl” voice. Irritating sound emanates from the posterior pharynx with inadequate volume.  The speaker comes across as bored and boring.  Modulate your voice to sound like a competent, knowledgeable adult.
  • Be careful with gestures. Many people overuse hand gestures.  It’s distracting and undermines the real message.  Excessive gestures can make someone look desperate.  Politicians take note.

We work hard to develop our careers.  Don’t allow poor speaking habits to sabotage your future.  You never know who might be listening.

We Can Do Better

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

The pendulum has swung too far.  Fifty years ago there were psychiatric hospitals full of mentally ill patients who were poorly treated and even abused.  “One Flew Over the Cuckoo’s Nest” was required reading.  National outrage peaked and psychiatric hospitals closed leaving thousands of patients unequipped to face the outside world.  Alcoholism, drug addiction, and homelessness began to spiral out of control.

Today major cities like New York, Seattle, Portland, Los Angeles, San Francisco, and others have homeless populations overwhelming local resources.  Los Angeles County now has over 60,000 homeless people, and San Francisco publishes a map to help visitors avoid piles of human feces and used syringes.  Police officers are becoming ill as a result of contact with infected people.  Tuberculosis, Typhus, Typhoid fever, Hepatitis A, and scabies are only a few of the conditions smoldering on the streets.  Rape and violent assault are routine.  California now accounts for one-fifth of the homeless population of the entire country.

The two largest contributors to homelessness are mental illness and addiction.  Most cities have laws against sleeping on the streets, but often those laws are not enforced.  Decriminalizing bad or problematic behavior does not make it go away, and permitting squalor is not compassionate.  Homeless people do not represent a big voting block, but government officials have a responsibility to protect public health and safety.  Experience over the last 40 years has taught me something about caring for homeless patients and starting free clinics, so here are a few thoughts:

  • Commit to addressing the problem. If inaction, complacency, and blame solved problems, we wouldn’t have any problems left.
  • Enforce existing laws and give the police the support and back up they need. That is not being “mean.”
  • Triage people in tent cities. Most need help from social services, many need treatment for addiction and mental illness, some may respond to help from church organizations, and some probably need to be arrested.
  • Organize a volunteer force (the local equivalent of the Peace Corps or the Job Corps). Those not in need of acute treatment for mental illness or addiction might be salvaged with a program that teaches basic living skills.  Such programs already exist in some areas.  College and graduate students could volunteer and earn “credits” toward paying off some school loans.  Colleges and universities would need to cooperate, but at some point you have to put your money where your mouth is.  Tax credits could be given to non-student volunteers.
  • Organize mobile free clinics to vaccinate, screen for infectious diseases, and begin basic treatment. Invite nursing and medical students as well as retired professionals to help.  Sometimes people simply need to be asked.  They would need legal protection from malpractice.  Non-controlled drug samples and old medical equipment could be donated.  I know whereof I speak here.
  • Create transitional housing facilities (like senior life care in reverse). Old warehouses and military style barracks could be refitted. California has the largest percentage of billionaires in the country.  Ask them for help.  No one becomes massively successful because he or she has a dearth of ideas.

Fifty years ago some people were abused in mental hospitals.  Now we allow them to abuse themselves and one another on the streets.  This is a massive, complex, and expensive problem.  But failing to address it will have catastrophic consequences for everyone.  We can do better.

An Idea Whose Time Has Come

Posted on Posted in Brain Science, Continuing Education, Homestudy, Seminars, Webinars

By Mary O’Brien, M.D.

Are you an adult?  Are you sure?  Young people today are taking longer and longer to grow up.  Throughout history people worked hard and started families in their teens.  Only a privileged few could afford the time or money for an education.  Even a mere century ago, finishing high school was a relative luxury.

A few weeks ago, during the 75th anniversary of D-Day, we heard remarkable stories of 18- and 19-year-old boys fighting for freedom and civilization.  These boys grew up very fast.  They had no choice.  Mommy and Daddy could not indulge every whim of their sons.

Growing numbers of people now realize we have a problem.  Young people are graduating from high school and even college with minimal practical skills.  Changing a tire, cooking a real meal, or opening a bank account can overwhelm them.  This is not good.  Many of us were required to take shop class or home economics in high school.  Then, the “geniuses” in education had their way.  The results speak for themselves.

Happily, there is hope.  A young teacher at Fern Creek High School in Kentucky has begun three-day workshops called “Adulting 101.”  Sarah Wilson Abell has been instructing students in real-life skills:  how to handle basic food preparation and cooking; how to change a tire; how acquire the fundamentals of money management; how to read a map (in case Siri is sick); how to behave on a job interview; how to have basic table manners and etiquette; and how to tie a tie.

Parents used to teach these skills, but the days of June and Ward Cleaver and Ben Cartwright are long gone.  This timely idea is spreading.  More and more people in their thirties and forties realize they need these skills.  I recently encountered a 31-year-old woman who didn’t know how to sign her full name because, “We didn’t learn cursive.”  You can’t make up things like this.

Someone reading this is probably not a high school teacher, but many of our readers teach students in the health-care professions.  Starting your own “Adulting 101” class could be tremendously helpful.  In addition to the topics listed above, a few more are worth considering:

  • Good, old-fashioned people skills. Professional etiquette when dealing with patients and colleagues must be taught.  Translation:  Put down your cell phone and look up from your computer.
  • Principles of personal hygiene and dress. Don’t act outraged.  Most of us realize standards couldn’t have sunk much lower.  Our failure to teach and maintain such professional standards has compromised patient care and the career advancement of many students and trainees.
  • Essentials of appropriate speech and behavior in the workplace. As is the case with appearance and manners, there are boundaries that separate work, play, and personal life.  This comes as a shock to many young people.  We do them a great disservice when we fail to correct the situation.

“Adulting 101:” It’s an idea whose time has come.  It should have never gone away in the first place.

Memorial Day, D-Day and Cicero

Posted on Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Traffic Delays.  Slow Wi-Fi.  Dead phone batteries.  Forgetting a password.  Insufficient “likes.”  These are among the top stressors listed by millennials in a recent survey.  Contrast this with the real stresses endured by similarly aged men storming the beaches of Normandy in World War II and the absurdity of current culture becomes painful.

I’ve always been baffled by the number of people who confuse Memorial Day and Labor Day.  They’re not even embarrassed.  Ask nearly anyone much under the age of 50 what he knows about June 6, 1944, and prepare for a blank stare.  Twenty- and thirty-somethings may well scrunch up their faces in annoyed perplexity as only they can do.  People today lead frenetic, cluttered lives that leave little room for history.  But as Cicero wrote in 46 B.C., “To be ignorant of what occurred before you were born is to remain always a child.”

Memorial Day commemorates those who died in active military service.  Originally, it was called Decoration Day and was observed on May 30th.  Eventually, it was changed to the last Monday in May mostly as an excuse for another three-day holiday weekend.  This year Memorial Day falls on May 27th.  People will have barbecues, picnics, and parades. They will open neighborhood swimming pools and proclaim the unofficial start of summer.  A few thoughtful people will attend memorial services and place flowers on the graves of those who sacrificed all.  But millions will remain clueless as they consume hot dogs and beer.

This year, on June 6th, those of us fortunate enough to live in the free world will observe the 75th anniversary of D-Day (June 6, 1944).  The planning, hope, courage, determination, perseverance, and sacrifice of the Allied Forces on that momentous day cannot be overstated.  The unwavering commitment of thousands of men to stopping the onslaught of the Nazis despite the terror, horror, and agony of it all is beyond our grasp.  What those men endured makes our worries laughable.

The next time you find yourself upset by traffic delays, slow Wi-Fi, or a dead phone battery, remember Memorial Day, D-Day, and Cicero.  Some of us need to stop thinking like children.

Guidance and A Good Example

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Do you teach students? Do you manage employees? Are you setting a good example for those who will come after you? Last week, I heard Jamie Dimon, the chief executive of J.P. Morgan, discuss the importance of cultivating a bench of good people from which the board of directors could select a worthy successor. A truly wise leader in any organization thinks like that. Of course, in order to think and plan on that level, one needs tremendous maturity, discipline, humility, and prudence.

Many people today are too insecure and self-obsessed to train their own replacements. They’re more worried about who might threaten their power and position. But history is a good teacher. Socrates trained Plato, and Plato trained Aristotle. Jesus picked 12 apostles and numerous disciples. Sir William Osler trained an elite cadre of young physicians to follow in his footsteps at Johns Hopkins.

Superior leaders surround themselves with first-rate people, and these leaders cultivate several key attributes and skills. Whether you are a senior partner, a professor, or a parent, here are some of the qualities that are essential to your ultimate success as you pass the baton:

  • A deeply ingrained sense of right and wrong. Many people focus on what they can get away with. Moral relativism is not the secret to greatness or even long-lasting success.
  • A willingness to accept personal responsibility for success or failure. Expressions like “It’s not my fault,” “It’s not my job,” do not make for an acceptable mindset.
  • The ability to speak and act with courage. This one is tough in the age of social media nonsense and nastiness. The vast majority of people in board rooms and conference halls are afraid of what someone might say, so they hide behind the commonplace and comfortable. There is no honor in cowardice.
  • The wisdom to encourage and inspire others. Mediocre-management types make excuses. Top notch people bring out the best in others. When you have a great parent, teacher, coach, or boss, you can’t bear the thought of disappointing your hero.
  • The capacity to engage in independent thought and creative problem solving. The world is full of lemmings, parrots, copycats, and complainers. It takes a secure, confident leader to inspire real leadership in others.

Whether you work in a huge medical center, a small office, a corner pharmacy, or at home, someone is looking to you for guidance and a good example. Don’t be afraid to set the bar high.

Pop Quiz!

Posted on Posted in Brain Science, Continuing Education, Seminars, Webinars

By Mary O’Brien, M.D.

Quick!  What illness can cause fatal pneumonia, bacterial superinfection, meningitis, myelitis, encephalitis, acute thrombocytopenic purpura, transient hepatitis, or subacute sclerosing panencephalitis?  The answer is measles.  Each year nearly 20 million people are infected worldwide.  There are 200,000 deaths, most of which occur in children.  The anti-vaxxers are utterly unaware of these facts, but there has never been a shortage of ignorance in the world.

Measles is a highly contagious viral illness that typically strikes children. Unfortunately, more than 90 percent of susceptible people who are exposed will contract it.  Measles spreads mostly by aerosolized droplets from the nose, throat, and mouth during coughing.  The virus can survive airborne for two hours in closed areas like a classroom.  The vast majority of measles cases in the U.S. are transmitted by travelers and immigrants, with subsequent transmission to unvaccinated children and teens.

Measles has a 7 to 14-day incubation period.  The prodrome begins with fever, sneezing, watery eyes, conjunctivitis, and a hacking cough.  Koplik spots develop on the oral mucosa, opposite the first and second upper molars — before the rash develops.  Dental professionals take note.

A sore throat typically develops shortly before the rash, which is maculo-papular.  Macules erupt just in front of and below the ears, then migrate down the sides of the neck.  Papules begin to emerge as the rash spreads down to the trunk and extremities, including the palms and soles.

Peak severity is often marked by a fever above 40⁰C.  Many children have periorbital edema, photophobia, irritability, pruritis, and a hacking cough. These kids look and feel very sick for 3 to 5 days, at which point the fever subsides and the rash fades and desquamates.  Immunocompromised patients may be profoundly ill with severe, progressive pneumonia but no rash.

Mortality in measles is about 2 in 1000 cases in the U.S. and much higher in developing nations.  In the year 2000, measles was officially declared eradicated in the U.S. by virtue of the tremendously effective MMR (measles, mumps, rubella) vaccine.  Unfortunately, multiple outbreaks have recently occurred in California, Washington, Oregon, Utah, and New York.  Many outbreaks have been linked to unvaccinated children in Amish and Orthodox Jewish communities.  Currently, an outbreak of measles in Brooklyn, New York, has been declared.  There were 285 cases, a public health emergency.  Nationally, the figure stands at 465 cases documented in 15 states.

Scientific ignorance and paranoia on the part of some parents and stunning misinformation on the internet has led to clusters of unvaccinated children and rapid spread.  The original “study” claiming that vaccines cause autism was entirely fraudulent.  It involved 12 patients and was thoroughly debunked.  The author lost his medical license.  Legitimate studies of over two million children have demonstrated absolutely no relationship between vaccines and autism.  Autism has been linked to over 100 genetic mutations.  Many people today do not like to hear the word “genetic.”

A landmark study published several years ago in the New England Journal of Medicine revealed disrupted stratification of multiple cellular layers in the cerebral cortex early on in fetal development.  The stage for autism seems to be established before birth.

Making decisions based on misguided notions and emotions can be catastrophic.  Those of us in health care and education need to set the record straight.