A Thousand Acts of Compassion

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars
credit: 10tv

By Mary O’Brien, M.D.

Millions of people around the world were stunned by the horror of the Las Vegas massacre.  The magnitude of the attack was staggering.  However, it was the cold, cruel, calculating mindset of the shooter that left us speechless.  Normal, decent human beings are not capable of grasping that degree of unmitigated evil.  And yet, as the days passed, stories of stunning courage, heroism, and compassion emerged.

Police officers stood up amidst crouching civilians trying to discern the shooter’s location, making themselves targets. At least two men were shot while performing cardiopulmonary resuscitation (CPR).  Scores of people used their own bodies as shields to protect loved ones and even strangers.  And quick-thinking, brave people fashioned splits, tourniquets, and stretchers from anything these people could find.

Several victims survived, in part, because combat veterans inserted their fingers into bullet wounds to slow blood loss.

Many individuals demonstrated compassion, courage, and creative thinking, transporting victims to hospitals.  An Iraq war veteran “borrowed” a truck with the key in the ignition and shuttled 30 people to the emergency room (ER).  A cab driver passing by scooped up a young woman with severe wounds.  In the back seat, his passengers cradled her as they raced to the nearest hospital.  In a moving demonstration of selflessness, many of those injured or wounded declined ambulance transport or emergency care in deference to those in even more serious condition.  As one of the ER triage physicians said, “I’ve never had such wonderful patients!”

All of these stories are remarkably reminiscent of the kindness and heroism displayed by people in the aftermath of the Boston Marathon bombing.  Countless people donated blood, water, food, accommodations, time, and money to assist victims, family members, first responders, and medical personnel.

Truly evil people always want to aggrandize themselves, often through unspeakable violence.  But violence has always been the last refuge of the coward.  And, as we’ve witnessed in Las Vegas, one cowardly act by a monster inspired a thousand acts of compassion and courage.  May God heal and protect all the good people who endured so much and helped so many.

Anger, News and The Brain

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

By Mary O’Brien, M.D.

Have you reached the point where you’re afraid to watch the news?  I have.  The sight of one human being kicking another sickens me and every other sane person. However, anger, hatred, and violence are not new.  They are as old as mankind because they stem from primitive, tribal, and “us versus them” thinking.  And lest we think we’re above it all, primitive, tribal thinking occurs daily in neighborhoods, businesses, offices, universities, and political and religious entities around the globe.  No one starts out that way. As a poignant lyric from the World War II musical “South Pacific” reminds us, “You’ve got to be taught to hate and fear, you’ve got to be carefully taught.”

Perhaps more people in the under-50 crowd can relate to a line spoken by Yoda in the “Star Wars” saga.  Cautioning Luke Skywalker about the true enemy, Yoda warns against fear:  “Fear leads to anger, anger leads to hatred, and hatred leads to the dark side.”

That’s not merely a memorable line from a movie.  That is profound.  Wherever we see evil, darkness, or violence, there is almost always some measure of fear.  People fear the loss of their money, their power, their identities, their rights, their beliefs, and their version of “truth.”  All of this sounds like a philosophical discussion until we consider the underlying physiology.

Appropriate fear, as part of the fight-or-flight response, is a survival mechanism.  It has helped humans and other species to endure for many millennia.  Learned fear originates in the amygdala.  Repeated, fearful stimuli, if unchecked by higher centers in the frontal and pre-frontal cortices, can rapidly lead to anger and aggression.  Simply put, a person can literally develop an angry brain.*  The result is an individual who becomes angry too easily and too often.  These people overreact to angry feelings, become aggressive whenever upset, and have great difficulty calming down.  Allowing oneself to simmer in a sea of angry thoughts, feelings, hormones, and neurotransmitters can rapidly lead to some horrible behavior.  We see it every night on the news.

Human physiology is such that anger and empathy are mutually exclusive.  Empathy, being a far more highly-evolved emotion, tends to inhibit anger and aggression.  And calmness is a pre-requisite for empathy.  Long, long ago, in our very own galaxy, someone even wiser than Yoda said, “Perfect love casts out fear.”  Perhaps someday the human race will catch on.  Until then, don’t go overboard watching the news.

After The Storm

Posted on Posted in Brain Science, Elder Care, Homestudy, Psychology

By Mary O’Brien, M.D

A week of frightening forecasts.  Days of hectic, worried preparations.  Hours of terrifying wind and torrential rain.  Now nearly seven million Floridians are without power.  They, along with millions of other people, will begin the long process of recovery.  Despite their exhaustion and stress, they will follow in the footsteps of so many Texans and help one another.  People in Florida are not strangers to disasters.  They know how to re-build.

And who, among the rest of us, does not know someone in Texas or Florida?  Nearly every individual I know has family members, friends, colleagues, or acquaintances in one of these disaster-ravaged areas.  We are all interconnected whether we realize it or not.  Those of us in health care who are well-acquainted with suffering have an opportunity to set a good example for others.  Whatever each of us can do to help, now would be a good time.

Why Humans Need to Cry

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

By Mary O’Brien, M.D.

“Stop that crying, young lady, or I’ll give you something to cry about!”  Most of us heard something similar growing up.  Certainly, there is a time and a place for tears.  However, what most of our parents, teachers, or coaches did not understand was how complex and profound crying can be.  The neurophysiology of crying is far more intricate than most of us realize.

Crying, to oversimplify greatly, involves the autonomic nervous system, the frontal and prefrontal cortices, the brainstem, hypothalamus, basal ganglia, amygdalae, vagus and trigeminal nerves, heart, lungs, facial muscles, larynx, pharynx, eyes, nose, and throat — as well as a host of neurotransmitters.  Anthropologists believe that, in humans, crying developed long before speech.  As tears begin to flow, we become choked up and speechless.  This may explain why crying reveals emotional states that are nearly impossible to express in words.

Clearly, tears can be shed in response to pain and physical distress, as well as to fear and anger.  All mammals experience fear largely as the result of having a limbic system.  Given certain circumstances, most mammals can express anger.  Grief, mourning, and bereavement can move people to tears at any age and in every culture.  Some animals such as dogs, elephants, and primates can manifest behaviors suggestive of loss or grief, but these animals’ ability to shed tears in response to grief has not been scientifically verified.  Grief and mourning have a cognitive component.

Human beings are social creatures.  Barring neurologic anomalies, humans can cry from the moment of birth onward.  The tears, vocalizations, and facial expressions of crying signal a universal plea for help and empathy.  Tears elicit a change in the mindset and behavior of the person who cries and in those who witness the crying.  It’s not rare for someone to “feel better” after a “good cry.”

The ability of humans to feel empathy and compassion for others has had a profound effect on culture and civilization.  Without these emotions, there would be no such thing as hospitals, orphanages, disaster relief, or volunteers of any sort.  The capacity for compassion is not present to the same extent in everyone.  Some individuals have no empathy or compassion at all.  Others are veritable saints.  The next time you feel moved to tears, don’t fight it.  It may just mean your humanity is still intact.


Trimble, Michael, Why Humans Like to Cry, Tragedy, Evolution, and the Brian.  Oxford, UK, University Press, 2012.

To Our Friends And Colleagues In Texas

Posted on Posted in Elder Care, Psychology
credit CNN

How do you cope with a year’s worth of rain in a few hours? It’s like anything else in life: Until you’ve been through it yourself, you don’t know. Some of us scattered across the country have vivid memories of Superstorm Sandy or hurricanes like Andrew, Hugo, or Katrina. I remember all too well what Hurricane Floyd, in the late 1990’s, did to my house in coastal North Carolina. Water poured into my kitchen and living room, ruining my furniture and morale. I was on call at the time. At one point, all I could do was cry. That was a result of 22 inches of rain in 24 hours. How anyone copes with 50 inches of rain is beyond my comprehension.

The days, weeks, and months ahead of you will be brutal. At some point, nearly everyone will feel overwhelmed with exhaustion, anguish, anger, and frustration. Many of you will wear yourselves out while helping others. That’s what good people do in a crisis.

Throughout the U.S. and Canada, there are many good people who frequent INR (Institute for Natural Resources) and Biomed seminars. Perhaps it will give you a miniscule measure of comfort to know that you are in our thoughts and hearts and prayers. Across the country, the number of people in schools, businesses, religious groups, and civic organizations contributing to relief efforts is growing. One day all of this will be behind you. Until then, may you all be blessed with the safety of your loved ones, compassion for one another, and Texas-sized resolve.

Random Acts Of Coolness

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

by Mary O’Brien, M.D.

I live in Myrtle Beach, South Carolina.  In the dead of winter, I’m grateful for that.  Right now (during mid-summer), however, it’s the dead of “awful.”  The temperature has been in the mid to high nineties for several weeks, and I suspect there may be lower humidity in a steam shower.  For that added touch, traffic is terrible.  Tourists are tripping over one another, and everyone is cranky.  I’ve thought about moving to Alaska.

Yesterday, on the way home from the grocery store, I drove by a utility crew digging a huge ditch.  For a split second, I caught the glance of a very large, burly man crawling out of a hole.  He was covered with dirt and sweat.  I thought he was about to collapse.  In a heartbeat, the “do something” physician-part of me began to debate with the shy, introverted, aging woman part of me:

“This man is on the verge of heat exhaustion.  I should stop and offer help.  But with what?   A trunk full of cereal, paper towels, and cat food?  It’s really none of my business.  This is their job.  Besides, it’s probably not safe to pull over. Blah, blah, blah…”  Perhaps you know the routine.  I can debate myself for hours.

A mile down the road, I turned into my driveway — still conflicted.  Then it dawned on me. “I am an idiot.  This is not a difficult decision.”  I dumped my groceries in the kitchen and grabbed what I could from the fridge:  bottles of water; Coke; lemonade; and Hawaiian Punch.  I know, I know — I have the taste buds of a ten-year old.  Then, I raided my stash of ice cream bars from the freezer and headed back out.  As I pulled up to the work site and got out, the crew looked baffled.  I suspect the crew thought some fussy woman was about to start complaining about the mess or the congestion.  It happens.

I explained I had driven by ten minutes earlier and was worried about them.  When I pulled out the cold drinks and ice cream bars, their jaws dropped.  They still looked as if they were about to fall over, but this time it was from shock.  By the way, I’m not the only one with the taste buds of a ten-year old.

If you’re ever in a similar situation and you feel conflicted, choose the “random act of coolness.”  You’ll feel better about everything all day long.

Little Charlie

Posted on Posted in Brain Science, Continuing Education, Pain, Psychology

By Mary O’Brien, M.D.

Do you know what “Mitochondrial Deficiency Syndrome” is?  Most people don’t.  Unfortunately, that doesn’t stop them from weighing in on the case of little Charlie Gard.  Charlie is an 11-month old baby with a rare and devastating genetic disorder that precludes normal functioning of mitochondria.  Mitochondria are intracellular organelles that generate ATP (adenosine triphosphate).  In essence, ATP represents energy at the cellular level.  Without ATP, cells, especially brain and muscle cells, cannot function.  The most sensitive and vulnerable cells in the body are those of the cerebral cortex.  Little Charlie cannot see or hear or move or swallow or vocalize or think.  No one can know with absolute certainty, but he probably cannot “feel” anything at this point.  The word tragic is utterly inadequate.

The global media frenzy surrounding this heartbreaking situation is revealing and deeply disturbing.  Controversy sells, and unfortunately, the less people know, the more adamant and emotional they often become.  Those of us who have dealt with life and death situations for decades can help by elevating the level of conversation.  Some timeless principles are useful:

  • Embrace humility.  Never be afraid to say “I don’t know enough about this situation to have a well-informed opinion.” That would be refreshing.
  • Exercise the intellectual discipline to learn the facts involved.  In medicine, every patient is unique.  Arguments for or against life support or experimental treatments are pointless absent actual knowledge.
  • Resist the temptation to become emotional.  Unbridled emotions cause far more problems than they solve.  Try to be the voice of reason.
  • Try not to confuse or conflate the issues.  People in nearly every media outlet have tried to make the case about socialized medicine, cost control, parental rights, the British court system, the European Union, or theology.  The case of Charles Gard is about medical ethics.
  • Focus on principles, not personalities.  There is a colossal difference between saving life and prolonging death.  Remember, there is never a moral imperative to render futile care.

Primum non nocere.  (First, do no harm.)  There’s a reason that Solomon prayed for wisdom.

Photo Source

Minimizing Summertime Maladies

Posted on Posted in Continuing Education, Homestudy, Psychology, Webinars

By Mary O’Brien, M.D.

Triple-digit temperatures.  Devastating storms.  Disease-carrying insects.  Rip currents.  Shark attacks.  Jelly fish stings.  Fireworks accidents.  Food poisoning.

This list of problems only scratches the surface of serious summertime challenges.  But an ounce of prevention really is worth a pound of cure.  With that in mind, let’s consider some tips for minimizing summertime maladies:

  • Never leave an infant, child, adult, or pet in an unattended car.  Temperatures can soar past 120 F within minutes, even with the windows cracked.  Within 20 minutes, temperatures can exceed 140 F.  Every summer, mere carelessness leads to terrible tragedies. Please educate the people around you.
  • If a storm is close enough for you to hear thunder, it is close enough for you to be struck by lightning. Get inside a car or building.  Do not seek shelter under a tree that could turn you into a veritable lightning rod.
  • Most hurricane-related deaths occur as a result of drowning. People who are out and about can face dangerous flash floods.  Never attempt to drive through standing water.  It takes only six inches of water to move a vehicle.  Unless you are a first responder, please stay put in the immediate aftermath of a severe storm.
  • These days, mosquitoes are more than a nuisance. The West Nile virus is already active in many states and the Zika virus remains a threat to pregnant women in particular.  Eliminating standing water such as bird baths, planters, or backed up gutters where mosquitoes can breed can help.  Avoiding outside activity at dawn and dusk when mosquitoes are out in full force would also help.  Spraying protocols and insect zappers or traps may be worthwhile.
  • Be prudent at the beach. Warnings about rip currents, sharks, jellyfish, contaminants, or other dangers are not issued to ruin everyone’s fun.  Every summer, needless tragedies occur because people do foolish things.  Be the voice of reason for younger people around you.
  • Drink alcohol sparingly, if at all.  The vast majority of fatal boating accidents involve alcohol.  Even on shore, alcohol and high temperatures can be a disastrous combination.
  • Let professionals handle the fireworks. No one ever imagines they could be horribly burned or blinded by an accident with a firecracker.  Sadly, that is not rare.
  • Keep any meats or side dishes made with mayonnaise at proper temperatures — hot or cold. Food poisoning can have consequences far beyond an upset stomach.  When in doubt, throw it out.

Summertime is supposed to be fun.  With a little prudence and common sense, it can be precisely that.

The Healing Power of Touch

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

By Mary O’Brien, M.D.

Seasoned politicians understand it.  Talented athletes get it.  Even newborn babies are “all in.”  Unfortunately, too many professionals in health care seem to need a reminder.  We’re slightly distracted by gadgets these days.  Actually, touching patients has become, well, “yucky.”

Savvy politicians realized long ago that patting another person’s shoulder as they shook hands elicited more support and cooperation.  Players in the National Basketball Association who engage in more high-fives, fist bumps, and “guy hugs,” are apt to play better as individuals and as a united team.  (Believe it or not, psychologists have actually studied this.)

The landmark research on positive touch dates back many decades, revealing that newborns deprived of caring, gentle, living touch resulted in failure to thrive despite adequate nutrition.

Research into the neurophysiology of touch demonstrates remarkable conditions between pleasant, soothing sensations and social connectedness.  In a nutshell, “A-beta” nerve fibers conduct impulses related to touch.  These touches are triggered by– displacement or movement of long hairs on the skin — by vibration, movement, indentation, and stretch.  “A-beta” fibers enable us to detect a wobbly table, a greasy dish slipping out of our hands, the weight of a puppy curled up against us, or the wind blowing through our hair.

Another type of fiber, “A-delta,” carries information about the movement of short hairs on our face or body.  These sensations are decidedly unpleasant like walking into a spider web or feeling a bug crawling up our arms or legs.  Assorted other fibers carry pain impulses at a very rapid rate so that we can react and hopefully survive.

However, the newest nerve fibers to be discovered are part of the emotional or affective touch system.  They are called CT or “C-tactile” afferents.  These fibers transmit impulses associated with gentle, pleasant, nurturing sensations — an affectionate pat, a warm hug, or a loving caress.  Compared to pain fibers, “C-tactile” fibers are slower to respond, perhaps encouraging the pleasant interaction to linger a little longer.

Gentle touch fosters human interactions, togetherness, and nurturing for survival.  It’s fascinating that touch is the first to develop in utero and the most highly developed one at birth.

Clinical research is underway to study the effects of gentle, pleasant touch on conditions including autism, neuropathic pain, depression, and spinal-cord damage.  Why wait?  Let’s put the gadgets aside for a minute and touch the patient.  You’ll both feel better.

References
— Denworth, L. The Social Power of Touch.  Scientific American Mind.  July-August 2015, pp. 30-39.
— Voos, A.C. Periphery, K.A., and Kaiser, M.D., Autistic Traits Are Associated with Diminished Neural Response to Affective Touch.  Social Cognitive and Affective Neuroscience, Vol. 8, No. 4, pp. 378-386, April 2013.

The Sounds of Silence

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

By Mary O’Brien, M.D.

Paul Simon and Art Garfunkel had a huge hit with “The Sounds of Silence” about 50 years ago.  It resonated with millions of people.  Back in the late 60’s and early 70’s, excessive noise was considered a form of pollution, and that was long before anyone knew what a cell phone is.

Today, the scourge of excessive noise defies description.  Unfortunately, it has metastasized, with some devastating consequences, into every nook and cranny of health care.

People in medical and dental practices, hospitals, pharmacies, nursing homes, and every other patient-care area are bombarded by incessant noise.  Blaring TV’s, radios, “ patient-education” videos, cell-phone conversations, and shrill chatters continuously assault people who are sick and in pain.  Some are them are even patients.

What exactly are the consequences of noise pollution in healthcare?  For starters, staff members become increasingly edgy, irritable, and distracted.  Burnout is rarely far behind.  Patients and family members are often restless and annoyed.  Patients in hospitals and nursing homes cannot rest or sleep.  The resulting physiologic cascade can be staggering:  1) blood pressure and pulse increase; 2) glucose levels rise; 3) adrenaline, noradrenalin, insulin, and cortisol levels rise; 4) lymphocyte counts fall;  5) pain thresholds drop; and 6) tempers flare.  Rarely, however, does anyone make the connection.  What should we do?  Let’s take better care of ourselves in order to take better care of our patients.  Turn the sound down, or, better yet, turn it off (at least for a little while).  The sounds of silence are long overdue.