Gary Michael Rose is a devoted 69-year-old husband, father, and grandfather. Many people in Huntsville, Alabama, know him from his commitment to multiple volunteer projects. For decades he has served as a Knight of Columbus, helped at a soup kitchen, and repaired broken appliances for the sick and elderly. That’s only a partial list.
Only a handful of people knew that Gary Michael Rose was a war hero of the highest caliber because for 40 years he never said one word about it. Not one word. On October 23, 2017, Captain Rose received the Congressional Medal of Honor. Now the whole world has a real hero to emulate and honor.
“Mike,” as people call him, trained as a Special Forces medic during the Vietnam War. His second assignment involved a top secret mission into Laos to stem the flow of weapons to enemy fighters. It wasn’t long before all hell broke loose.
The men in Mike’s unit sustained heavy casualties. Desperate to save them, Mike raced into small-weapons and machine-gun fire, tending to the wounded as he shielded them with his own body. One by one, Mike used one hand to hoist a wounded soldier over his back and held a gun in his other hand to return enemy fire.
Eventually, Mike sustained multiple wounds himself, but that didn’t deter him. When a chopper finally arrived to evacuate the wounded, it was unable to land and was forced to hover above the ground. Mike lifted and pushed his wounded buddies into the helicopter in the midst of gunfire. As the chopper began to lift up, the gunner was struck in the neck by a bullet. Mike fashioned a pressure dressing with several bandanas to contain the bleeding. But the helicopter was badly damaged and crash- landed. In an unbelievable display of courage and fortitude, Mike raced in and out of the smoldering chopper to save the wounded before everything exploded.
After four days and nights of constant combat, no food or sleep, and nonstop efforts to save others despite his own injuries, Mike and his men were evacuated. The Army believed that Captain Gary Michael Rose saved between 60 to 70 men, including the man who was shot in the neck.
All of this happened in 1970. Mike never discussed it with anyone because the mission was classified. His men talked about it though — through channels at the Pentagon. For 47 years his men campaigned to get Mike the medal he deserved. Mike finally received his medal, and many of men witnessed the ceremony at the White House.
If someone had written a screenplay detailing the heroism of Gary Michael Rose in combat, it would have been rejected as “unrealistic.” Fortunately for the world, Captain Rose is very realistic. After a ceremony at the Pentagon, he’s going home to Alabama with his family. He still has people to help.
Making that assumption is human nature. Tragically, as people in London, Manchester, Brussels, and Berlin have witnessed, ordinary assumptions can be deadly.
Survival requires alertness. It always has. It always will. There has never been a shortage of danger in the world. The nature and complexity of threats have evolved over the millennia, but certain principles of survival endure. Being mindful of your surroundings is one important principle.
Mindfulness is not new. Nor is it merely a pleasant pastime. “Being in the moment” is a good way to slow down, enjoy a meal, or notice a full moon. It may, with practice, help reduce blood pressure and stress. That’s nice. However, in an age when deranged fanatics and terrorists can wreak massive devastation in minutes, mindfulness can save lives.
An off-duty police officer is still a police officer. The same is true for health-care professionals. The next time you’re out in public, be it in a classroom, a café, or a concert hall, practice some mindfulness that really matters:
Be alert, be vigilant — pay attention to people and things around you — not your devices. Do not “zone out.”
Scan the area for possible exits. It is human nature to leave a place the same way you entered. This can be a fatal mistake in a fire, a terrorist attack, or any catastrophe.
Resist the temptation to follow the crowd. Panic-stricken people can be exceedingly dangerous. Be mindful of alternate options for escape. Being trampled to death is not a good option.
Cultivate enough silence in your daily life to foster good instincts and intuition. When seconds matter, this can save lives.
The principles of mindfulness have been practiced and promoted by some very wise people over the centuries. It is curious that a step on the path to enlightenment may be the most crucial survival skill of all.
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.
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.
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.
“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.
A basic human emotion, anxiety is the sensation of worry, fear, apprehension, panic, tension, or unease that occurs in response to situations that seem overwhelming, dangerous, threatening, or distressing. Manifesting in such forms as worry prior to a major test, nervous anticipation of a social occasion or business event, or heightened alertness in the face of apparent peril, anxiety is an intuitive recognition that action of some kind should be taken.
Anxiety that prompts appropriate action is a normal, adaptive response to temporary stress or uncertainty. Detrimental anxiety overwhelms the individual experiencing it, preventing appropriate action or producing counterproductive responses. Prolonged, intense, or inappropriate worry that interferes with normal function or that is a source of significant emotional or physical distress may signal the presence of an anxiety disorder. Free-floating anxiety that occurs in the absence of an external threat and is pronounced enough to impair daily function may also be symptomatic of an anxiety disorder.
An estimated 40 million Americans over 18 years of age — about 18 percent of the adult population of the United States — experience anxiety disorders. In contrast to relatively mild transient anxiety induced by a stressful event like public speaking or a first date, anxiety disorders persist for six months or longer and can worsen without treatment (NIMH). According to the National Comorbidity Survey Replication, overall lifetime prevalence of anxiety disorders in the U.S. is 28.8 percent, meaning that more than one out of every four adults experiences at least one anxiety disorder during his or her lifetime. Anxiety disorders are approximately twice as common in women as in men. Most people who are affected by anxiety disorder have more than one, and nearly 75 percent of those who have an anxiety disorder experience their first episode by the time they reach 21.5 years of age.
Although anxiety disorders are highly treatable, only about one third of those with these disorders receive treatment.
Coping with Anxiety
Although evidence indicates that early treatment of anxiety disorders can prevent such complications as depression and severe phobic avoidance, only about one victim in four ever seeks medical help. Recommended self-help strategies for anxiety management include:
having a positive outlook.
creating a social network.
seeking help when necessary.
When personal anxiety management proves ineffective, a family physician can help determine if symptoms are caused by an anxiety disorder, another medical condition, or combined factors. Coexisting medical conditions may have to be treated or brought under control before the anxiety disorder can be addressed, by a psychologist, psychiatrist, social worker, or counselor. Some people with anxiety disorders must try several treatments or combinations of treatments before finding one that relieves their distress. Medications do not cure anxiety disorders, but antidepressants, anti-anxiety drugs, and beta-blockers may control some physical symptoms while the patient receives psychotherapy.
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.
Occurring in men and women with comparable frequency, obsessive-compulsive disorder (OCD) affects about 2.2 million Americans 18 years or age and older — one percent of the adult population of the United States. Initial symptoms usually manifest themselves in childhood, adolescence, or early adulthood, and median symptom onset is 19 years of age. One third of adults with OCD experience their first symptoms as children.
OCD is characterized by repetitive, intrusive, unwanted, and disturbing thoughts known as obsessions and by the performance of rituals known as compulsions — in an urgent attempt to control the anxiety that the obsessions generate.
Fear of social embarrassment, for example, could prompt someone with OCD to comb his or her hair so compulsively that the individual becomes unable to look away from the mirror. Thoughts of engaging in violence, bringing harm to loved ones, and having a persistent preoccupation with performing distasteful sexual acts or violating one’s religious beliefs are common obsessions. Common rituals include repeated hand-washing, counting, or touching objects (especially in a particular sequence).
People who have OCD may be preoccupied with order and symmetry, have trouble discarding things, and accumulate or hoard things they don’t need. Healthy people perform such rituals as repeatedly making sure the stove is off before leaving the house. People with OCD perform rituals that distress them, interfere with daily life, and provide no more than a temporary respite from their obsession-induced anxiety. Most people who have OCD are eventually enslaved by their own compulsions.
Research indicates that OCD may be a familial disorder. Many adults who have OCD recognize the futility of their actions, but children and some adults who have OCD are unaware that their behavior is unusual. The course of OCD can vary. Symptoms may emerge and disappear, ease or intensify, or prevent the individual from carrying out his or her responsibilities. Many people with OCD try to control their disorder by avoiding circumstances that trigger their obsessions or by self-medicating with alcohol or drugs.
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.
— 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.