The Wise Whisper of Prudence

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

By Mary O’Brien, M.D

They had second thoughts about it.  Twelve boys and their soccer coach had heard heavy rains were coming, but they went on their excursion anyway.  Tourists looking forward to an outing on a lake in Missouri never imagined how dangerous a storm could be.  The duckboat operators chose to ignore a forecast for thunderstorms.  They thought it would be alright.  Life jackets were considered unnecessary.  After all, they’re such a nuisance.  Two groups of people failed to heed the quiet whisper of prudence.  The first group survived, but only with the immense efforts of over a thousand people and the loss of a brave Thai diver.  The second group suffered catastrophic consequences with 17 deaths including nine members of one family and seven seriously injured.

Prudence would have prevented both disasters.  It’s not a word we hear much today.  In fact, it almost seems arcane.  Prudence sounds like the name of a fussy old maid in an eighteenth century novel.  The New Oxford Dictionary defines prudence as “acting with or showing care and thought for the future.”  Its origins can be traced to the Old French and Latin word “provident,” meaning “foreseeing or attending to.”  Could any reasonable person doubt the need for more prudence at every level of society?  Foreseeing or attending to the future is a tremendously useful virtue.

Many of us have fallen into the trap of wanting too much and, naturally, we want it now.  A flight delayed or cancelled due to bad weather leaves nearly everyone frustrated and upset.  It’s better to cope with temporary disappointment and stay alive.

Every year, people die in cars swept away by raging flood waters.  Thousands die or sustain serious injuries in accidents related to severe storms, blizzards, hurricanes, and tornadoes.  Prudence would have dictated staying off the roads in the first place.  Numerous other situations confirm this vital lesson.  Swimmers, surfers, golfers, hikers, campers, skiers, mountain climbers, and others have ignored prudent warnings and suffered terrible consequences.

Prudence does not shout.  It announces its presence with a whisper.  The next time you feel an uneasy, nagging sense of caution about something, pay attention.  It may just be the wise whisper of prudence.

A Unifying Moment

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

Thousands of people have had one goal for the past two weeks. Included were Navy Seals, professional divers, engineers, rescue specialists, medical personnel, and logistics experts from around the world. These individuals have focused on one objective: saving 12 young boys and their soccer coach from a flooded, underground cave in Thailand. The resulting real-life drama has surpassed any possible storyline in a work of fiction.

The young team set out on June 22, 2018, for soccer practice when torrential rain and flash-flooding stranded them. They were reported missing, but dangerous storms and difficult terrain hampered searches. As the days passed, hope of their survival faded. Undeterred, two British cave divers navigated a 2.5-mile cavernous tunnel one- half mile underground. They were astonished to look up and find the boys and their coach still alive. News of their miraculous find spread across the world.

Intensive planning for the daring and dangerous rescue began with offers of help from around the world. Experts from the United States, Great Britain, Australia, China, Japan, France, Denmark, and other countries converged on the scene with elaborate equipment and supplies. Communication lines, medical supplies, clean water, high-energy food supplements, and oxygen tanks were painstakingly positioned. Deep, murky, filthy water combined with passages only 15 inches in spots complicated efforts. A group of Buddhist monks kept a prayer vigil at the rescue site, and millions of people from around the world prayed for success.

Sadly, during a practice run to position oxygen tanks, a 38-year-old former Thai Navy Seal died when his own oxygen ran out. His heroic efforts were acknowledged with full military honors at his funeral. Heartbroken but determined to succeed, the rescuers pushed onward.

On Sunday, July 8, the threat of monsoon rains, dropping oxygen levels, and rising carbon dioxide levels in the cave forced a decision to proceed. The boys would have to learn how to swim and scuba dive “blind” in a matter of hours. The boys themselves decided who among them would go first. The painstaking rescue plan brought four boys out on day one. Every available oxygen tank along the 2.5-mile trek was used. After a 12-hour interval to replenish and restage oxygen tanks, four more boys were guided to waiting medical teams. Another overnight effort to replenish and restage supplies unfolded.

Finally, on July 10, news that the remaining four boys and their coach had been rescued spread around the globe in minutes. It was a unifying moment of joy and relief for the world. The courage and composure of everyone involved was a testament to the human spirit. When people cooperate for the good of others, personal, political, and cultural differences melt away in pursuit of a noble endeavor. Bravo!

Pearls of Wisdom

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

By Mary O’Brien, M.D.

He was a disciplined thinker, a real-life Mr. Spock, in a world where so many worship emotion.  Dr. Charles Krauthammer died on June 21, 2018, after a battle with cancer and 46 years of paralysis from a diving accident.  He finished medical school at Harvard and trained as a psychiatrist before turning to political journalism.  Early in his career he won a Pulitzer Prize.  The rest is history.

Dr. Krauthammer was an intellectual force of nature.  Facts, reality, logic, and truth served as his compass.  He had an unusually inquisitive mind and was open-minded enough to allow his thinking to evolve.  This stood in stark contrast to so many in the media who idolize notions and emotions.

Always patient and respectful in debate, Dr. Krauthammer was kind, thoughtful, gracious, and dignified.  But those qualities never suppressed a laser-like wit and genuine sense of fun.  He knew what there was to know about baseball and chess. People loved being around him because they always learned something and had a good laugh.  Being confined to a wheelchair did not prevent him from enjoying life.

Most people will remember Dr. Krauthammer for his political analysis and writing.  But as a physician who struggles with multiple illnesses, I have a slightly different focus.  Here are just a few pearls of wisdom I learned from his remarkable example:

  • Resist the temptation to feel sorry for yourself. Bitterness and victimhood will not solve anything.
  • Think about death every day. This is not morbid.  Charles Krauthammer was a wonderfully cheerful, funny man.  Confronting death allows one to appreciate life fully.
  • Keep your focus on others. We live in an age of malignant narcissism.  Krauthammer rarely talked about himself and kept his focus on the needs, problems, hopes, and dreams of other people.
  • Be courageous enough to say what you think but always be measured and civil. Hatred and nastiness abound today. There’s nothing constructive or healthy about it.  Civility, patience, gentleness, and humility will always be the mark of true wisdom.

Dr. Charles Krauthammer could have given up on everything at the bottom of that swimming pool when he was 22 years old.  He chose to fight back, and I’m one of millions who is grateful that he did.

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Note to Self

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

By Mary O’Brien, M.D.

Anthony Bourdain. Kate Spade. Robin Williams. They had what most people dream of having: massive success; fame; money; and a fabulous lifestyle. And yet, on the most profound and intimate level, they were utterly miserable. They couldn’t find a way to love themselves enough to keep living.

They are not alone. Millions of people, known only to a few folks around them, suffer the torment of suicidal thinking. We’ve known for decades that most suicide victims see some sort of health care professional shortly before they die. There is no shortage of studies, articles, committee meetings, and conferences on the subject. But somehow very little seems to change.

Two days ago I heard an “expert” on TV insist we should ask every patient about his or her personal life, marriage, relationships, family and financial problems, and work stress. I’ve been quite ill in recent years, and I’ve seen multiple physicians. No one has ever asked me about any of these matters. Perhaps, since I’m a physician, they feel too uncomfortable to ask. I suspect, however, that the larger issue is our obsession with time and money. Herd ‘em in, herd ‘em out, generate more revenue. A discussion about personal problems can become lengthy and emotionally charged. It’s difficult to get a tearful, distraught patient out of the office. In far too many cases, we’d really rather not know about it. Besides, when someone is crying, it’s tough to stay focused on your computer.

We live in an ever more detached, isolated, dissociated, overstimulated, and under-loved culture. All the “fans,” “likes,” and “followers” in the world cannot take the place of one sincere, sympathetic listener who actually cares.

Morals, Manners and Mindsets

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

By Mary O’Brien, M.D.

Our culture appears to be in free fall.  Movie moguls assault young women.  Campus doctors exploit and molest patients.  Gymnastics coaches and doctors engage in appalling sexual crimes.  The abuse of women and children has occurred for millennia. However, as individuals and as a civilization, we’re supposed to be advancing.

The human person, the human body, must be treated with dignity and respect at all times, at every stage of life.  The notion that we can do whatever we want, whenever we want is wrong.  It always has been, it always will be.

Professional stature is non-existent without self-restraint and honor.  And those in leadership positions who merely look the other way bear just as much guilt as the perpetrators.  It’s shocking to realize how much disgraceful behavior is tolerated out of ineptitude, laziness, greed, or complacency.  Virtually every sector of our society is at fault here.  Until we reach a critical mass of people willing to challenge this horrid behavior, nothing will change.

In our professional realm, there are a few things we can do to restore respectfulness:

  • Call patients or clients by their proper names: , Mrs., Mr., Dr., Reverend, Judge, etc. are all appropriate until someone invites familiarity.  Using first names with a new patient is not “friendly” as we have been led to believe.  It merely signals a sloppy level of unearned familiarity and unprofessional demeanor.  A medical or dental office is not a nail salon.
  • Male professionals should not be alone in an examination room with a female patient. The “expense,” “inefficiency,” or “inconvenience” of having a nurse or assistant present is an unacceptable excuse for this breach of protocol.
  • Manners matter. “Old school” nurses and doctors were taught to ask the patient’s permission before we touched him or her.  “May I listen to your heart?”, “May I examine your abdomen?”  No doubt some youngsters in health care would roll their eyes at this.  But we should never make assumptions about touching anyone (apart from emergencies), and yet it happens routinely today.
  • It’s good to remind ourselves, our colleagues, and our students that decorum and propriety are not old-fashioned and unnecessary. On the contrary, they are critically important, and their absence is palpable.

Morals, manners, and mindsets do not exist in a vacuum.  When someone is disrespectful or unethical in one domain, that vice will eventually metastasize.  Regardless of our age, culture, or profession, we should always try to treat others the way we’d like to be treated.  It’s not corny.  It’s not outdated.  It’s our only path forward.

A Little Reminder

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

By Mary O’Brien. M.D.

Are you a terrorist?  Are you a drug dealer?  Perhaps a criminal of some other variety?  The fact that you are reading this makes any of those possibilities quite unlikely.  And yet, our culture now assumes the worst of nearly everyone.  In an airport, we’re all treated like potential terrorists.  Hand the clerk in a grocery store a hundred dollar bill and she checks it to see if it’s counterfeit.  Anyone needing pseudoephedrine to breathe normally is treated like as if she may be running a crystal meth lab in her garage.  That’s ridiculous.  I don’t have a crystal meth lab in my garage.  It’s in the attic.  These days, too many people can’t recognize humor, much less reality.

Needing to fly somewhere does not make someone a terrorist.  Wanting to pay cash for groceries does not make someone a counterfeiter.  Trying to breathe more easily does not make someone a meth dealer.  Hoping for some pain relief does not make someone an addict.  As a society, we are making some very misguided judgments.  I recall that seven years ago I sought help from another internist when a long list of autoimmune diseases began spiraling out of control.  The “medical assistant” asked me what my main complaint was.  When I explained I had increasingly severe pain in my hands and feet, she quipped, “We don’t do pain management.”  I had to restrain myself.  I was there for a diagnosis, not a prescription.

Pain is the single most common symptom of most malignancies, autoimmune diseases, vascular diseases, and serious infections.  Renal disease, neurological disorders, metabolic diseases, and any inflammatory process can cause agonizing pain.  And we haven’t even touched on trauma.  Most patients who complain of pain are totally genuine and honest.  Some people exaggerate, some are manipulative.  Some, but not most.

Today, we have many veterans suffering constant pain from multiple amputations and other terrible conditions.  In many cases, they cannot obtain a month’s supply of pain meds.  They are forced to endure preposterous “policies” and “protocols” created by sanctimonious idiots.

If we really understood as much as we think we do about pain, pathophysiology, or pharmacology, we would ensure that patients have the pain medications they need to function.  Opioid addiction and overdoses are devastating problems.  But forcing patients with documented causes of severe pain to suffer needlessly is simply wrong.  Everyone who has had a cocktail, a beer, or a glass of wine does not become an alcoholic.  Everyone who needs chronic opioid treatment does not become an “addict.”

The whole point of health care is to relieve pain and suffering.  Perhaps we all need a little reminder.

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The Shock Value of Anything

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

By Mary O’Brien, M.D.

Our culture is in big trouble.  Civility is under assault.  Over the past 20 years, most of us have heard increasing use of vulgar language in public and even professional settings.  Some of us have even heard vulgar language used at funerals, especially when celebrities are involved.  It’s typically done in an effort to lighten the mood.  It doesn’t work.  It’s not appropriate, it’s not funny, it’s not hip, it’s not “cool.”  More of us need to speak up and call people on it.

Rude, crude, vulgar language merely announces to the world a limited vocabulary, emotional immaturity, and a lack of class.  The timid giggles elicited by comedians using crude language is nothing more than the nervous response of an insecure audience.  When a joke is truly funny, people laugh in a genuine, spontaneous manner because they recognize a universal truth.  Really talented people don’t need to rely on incessant efforts to shock an audience.  They actually have a gift for seeing everyday realities in novel, insightful ways. The shock value of anything wears off quickly.  Before long, the whole gig becomes tiresome.

The use of vulgar language often signals a nasty, vicious, vituperative mindset. Unfortunately, most offenders don’t even realize how badly they embarrass themselves.  The disgraceful monologue inflicted on people at the recent White House Correspondents’ Dinner was a case in point.

Cruel attacks on anyone’s appearance, wishing someone would be crushed by a falling tree, and “jokes” about abortion are not funny.  The nonstop use of the “F” word only underscored the pathetic mentality of the “comedienne.”  Some folks had the spine to walk out.  Too many sat there like overdressed lemmings.

Regardless of our age, gender, profession, economic status, political perspective, race, or creed, no one will ever think more highly of us for spewing vulgar language and nastiness.  Two thousand years ago, a very wise person said, “Out of the fullness of the heart, the mouth speaks.”

Truth is timeless.

A Class Act

Posted on Posted in Continuing Education, Elder Care, Psychology, Seminars, Uncategorized

By Mary O’Brien, M.D.

The lady was a class act.  In a sea of loud, silly, and shallow people, Barbara Bush stood like a lighthouse, radiating wisdom and grace.  She demonstrated remarkable equanimity, regardless of circumstance.  Blessed with razor sharp wit and a penchant for fun, she was nonetheless known to her family as “The Enforcer.”  Candid, caring, committed, and tough, Mrs. Bush had a massive impact on everyone around her.  She set the standards high and refused to indulge any twinge of narcissism in herself or others.  It’s a testament to her character that everyone around her succeeded.  She had the longest marriage (73 years) in American presidential history and was the mother of two governors, one of whom (George W. Bush) was also the 43rd president.

There were, however, those who bemoaned the notion that she was “only” a wife and mother.  Those folks ended up looking foolish.  Mrs. Bush had no misgivings about the value of family.  She was fiercely loyal and protective, but she did have boundaries.  When pestered by the media about her role in the political campaigns of family members, she quipped, “I’ll do anything to help.  But I won’t dye my hair, change my wardrobe, or lose weight.”

The reality was that Barbara and George H.W. Bush, in the late 1950s, lost their three-year-old daughter, Robin, to leukemia.  Barbara’s hair turned white shortly after that tragedy.  She refused to hide her age, stress, or heartache by dyeing her hair.  There was nothing coy, contrived, pretentious, or conniving about Mrs. Bush.  She possessed a refreshing candor and confidence that come from authenticity.  It was clear she had no interest in impressing or manipulating others.  As was the case with Billy Graham, she said what she meant and she meant what she said.  This surely must have perplexed the glitterati in Washington.

Historians will write about Mrs. Bush for years to come.  She was a smart, gracious, strong, and virtuous woman.  Countless children learned to read as a result of her efforts.  No doubt her opinions influenced domestic and foreign policy behind the scenes.  However, Mrs. Bush possessed an uncommon degree of humility, maturity, forgiveness, and forbearance that enabled her to rise above conflict and petty partisanship.  As she once explained, “Politics is what we do.  It’s not who we are.”  Have we ever been in greater need of her example?

 

Steady As She Goes

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

By Mary O’Brien, M.D.

Are you afraid to open your financial statements for March? Have the recent market gyrations triggered a sudden interest in Xanax? Nonstop news cycles and social media postings have spawned massive overreactions to every comment made by political or business leaders. Down drafts of 1,000 points can cause even the most seasoned investors to panic. Over the past two months I’ve had to curtail my exposure to the business networks. Watching the Dow Jones Industrial Average plunge 700 points at 2 P.M. can make me feel as if I’m about to go into ventricle fibrillation. I’d rather stay in normal sinus rhythm.

Sadly, that is not a joke. I have a vivid memory of sitting at a stoplight in Little Rock, Arkansas, on October 19, 1987. It was about 5:30 P.M., and I was headed home from my office. Over the car radio I heard, “The Dow Jones Industrials are down 517 points.” I distinctly remember thinking, “Oh, he’s reading that wrong! The DOW couldn’t possibly be down that much.” It was.

Shortly after I arrived home, my beeper went off. One of my favorite patients was in the emergency room (ER) with a massive myocardial infarction. George A. was a 76-year-old gentleman from Hope, Arkansas. He had grown up in poverty but had educated himself and built up several successful businesses. He was bright, witty, charming, dapper, and gracious. But on that day, George A. had lost over a million dollars, at least on paper. He was devastated.

I grabbed my bag and raced back to the hospital. We got George admitted to the cardiac care unit (CCU). His electrocardiogram (EKG) looked awful, and he looked worse. He was utterly convinced that one dreadful day on Wall Street had destroyed his future. Around 8 P.M., George become very ill (coded). We worked on him frantically for over an hour, but we couldn’t bring him back. There was no doubt in my mind that the thought of financial ruin had literally scared George to death. I felt numb.

Later that week, two of my colleagues committed suicide. They had also lost a fortune, at least on paper. Everyone was stunned and afraid that week. One year later, however, the market had recovered nearly all of its losses. Thirty years later I still mourn the loss of three good people. For all intents and purposes, they died from acute financial panic.

I am no financial genius. But forty years of investing have taught me a few lessons that may help someone else:

  • Don’t watch market moves minute to minute. Before long, you’ll need heavy sedation.
  • Don’t dump stocks when everyone is panicking. You’ll almost always miss out on the best part of the recovery phase.
  • Remember the wisdom of the ancient Greeks: Moderation in all things. Balance stocks, mutual funds, bonds, certificates of deposit (CD’s), cash, real estate, and precious metals based on your age, health, family needs, and risk tolerance.
  • Don’t give in to ignorance, laziness, fear, or greed. Sixty-six percent of millennials have nothing stashed away for retirement. Failure to invest is one of the greatest mistakes of all.
  • No matter what happens, avoid the temptation to overreact. You are infinitely more important than your financial statements.

Now take a deep breath and open the statements from March. Steady as she goes. You’ll be fine.

A Bit of Common Sense

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

By Mary O’Brien, M.D.

Do you take care of patients?  Are you in a position to teach students or other caregivers?  These days, everyone in healthcare is simmering in a sea of policies, protocols, rules, regulations, and algorithms.  Some of them are reasonable.  A few even make good sense.  Unfortunately, however, many of them are downright dumb.  Often, by the time someone reaches the lofty position of creating assorted rules and policies, she has lost touch with her sector of the real world.  The results are not good.

In recent years I’ve been sidelined with a growing list of autoimmune diseases. I used to joke with audiences that with red hair, green eyes, and see-through skin, I was a walking collection of recessive genes.  It’s not a joke anymore.  Being in constant pain and steadily losing functional ability is not fun.  However, in my new role as “patient,” I have learned a few things that are not taught in most training programs.

In the hope that it might help a few other folks, here’s some of what I’ve learned:

  • Sunshine is our friend.  Over the years, I’ve spent far too little time outdoors.  I was a sickly little kid and a natural-born bookworm.  From the mid-1980s on, I was afraid of “skin damage.”  Swell.  Now I have decent-looking skin but my musculoskeletal system is so badly compromised I struggle to get in or out of a chair.  Please encourage patients to get some fresh air and sunshine on a regular basis — especially if these patients suffer from any chronic illness.  Vitamin D supplements are fine, but they can’t undo the damage of decades of deficiency.
  • Small comforts matter.  The point of health care is to relieve pain and suffering.  Many of our colleagues have apparently forgotten that.  Computers can provide information.  They cannot provide comfort and consolation.  There is a true art to easing another person’s misery, and it usually involves small, simple measures.  “Hugging” a king-size pillow while lying on your side can ease pressure and strain on shoulders, elbows, and knees.  Massaging a nicely-fragranced body butter into hands, arms, legs, and feet before bed can help ease the achiness that accompanies chronic illness.  It’s not a substitute for proper medication, but these measures can provide a few moments of respite.
  • Being squeaky clean feels good.  I was obsessed with hygiene even as a little kid.  But chronic pain and illness can make taking a shower, washing your hair, and brushing your teeth feel like a triathlon.  Nearly anyone who has had the flu can relate.  The most simple measures can make a difference:
    • Change pillow cases every 12–24 hours.  I did this for patients when I was a nurse’s aide 45 years ago.  I do it for myself now.  If feels nice.
    • Step up oral and dental care after meals and before bed.  This feels nice, too.  And, there are discernible medical benefits.
    • Try a shower in the morning and a warm bath at night (as long as it’s safe).  Baby wipes, facial wipes, and dry shampoo are essential for travel and chronic illness.
  • Never wake a sleeping patient for vital signs.  I can hear nursing instructors screaming right now.  However, if a patient is sound asleep, her vital signs are probably fine.  Despite all of our impressive technology and sophisticated medications, we have found nothing more restorative than good, deep sleep.

If policies and protocols eased misery, everyone would feel fine by now.  Sometimes what we need is a bit of common sense.