I wrote the following short piece for the Minnesota Chapter of the American College of Physicians of which I am privileged to serve as Governor. I edited it a bit for my colleagues – physicians and all others – at Hennepin Healthcare. I offer it to you here.
We will remember these days.
Some day we will remember standing outside a patient room covered head to toe in hair net, mask, plastic face shield, gown, and gloves. We will remember looking at our nurse colleague similarly covered, look into each other’s eyes, take a deep breath, and walk into that room and once again, for the umpteenth time, be face-to-face with a patient. A patient with COVID-19.
Some day we will remember canceling every CME conference, business meeting, family vacation, wedding, funeral, and family gathering for a whole year and wondered how we will ever re-connect.
Some day we will remember how we learned how to care for our patients over a video connection.
Some day we will remember that crazy time when we put our masks in paper bags so that there would be enough for later.
Some day we will remember taking pay cuts and furloughs so that our hospital and clinics could survive.
Some day we will remember the time when our fellow human beings died without their family by their side.
We will remember these days.
But some day, we will also remember feeling closer to our colleagues than we ever have been and realize that these are our lifelong brothers and sisters.
Some day we will remember that people stood on their balconies to applaud what we do every day.
Some day we will remember that during a pandemic there was still kindness and compassion.
Some day we will remember that we were smart and we were brave.
Some day we will remember that what we do still matters.
We will remember these days. And we will remember what a privilege it is to be a caregiver at Hennepin.
How does music – or art in general – relate to health and wellness?
There is a notion in healthcare that I think we need to explore further. In brief, it is likely true that stress in our lives may lead to health problems, probably via some complex inflammatory changes in our bodies. So reducing stress in our lives is probably a good idea. Art can certainly do that.
But beyond that rather nerdy physiologic reason, I think it is vitally important that each of us find beauty in our world. Our national discourse is so ugly and uncivil that it is making us sick. Our daily lives are filled with screen time, busy schedules, bills to pay, and the daily tasks of life. All of this makes music and art and beautiful things all the more important.
I often turn to orchestral music. I spend lots of evenings at Orchestra Hall in downtown Minneapolis and I am privileged to have met some of the talented people at the Minnesota Orchestra. They have graciously published my thoughts on music on the orchestra’s website and I invite you to read it by clicking below.
I also wrote a piece in August 2016 about my trek to Europe with the Orchestra in which I talk about saunas full of naked people, Beethoven, bicycles in Europe and my thoughts on being abroad with a world-class orchestra. Read about all that in “The Finer Things” here.
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I have been steadily moving toward more writing in my career and specifically I’ve been working in an area called “narrative non-fiction.” My writings are mostly based on medicine, health and wellness. Big surprise there – sort of like what I do on this blog. I hope to collect them into a book at some point if I get any good at it.
A venue for publishing narrative non-fiction in the medical field is an online journal called Intima and I had an essay posted there in April. It was called “Don’t worry, at least we will die together!” and it was about my experience with medical students in Jerusalem. If you missed it, you can access the piece in this blog post below.
The editors encourage writers to interact with other writers on the site, and so I wrote a very short post in response to an essay by Margot Hedlin, a newly minted doctor whom I have never met. Her essay was called, “There’s a limit to your love” and it was really thought-provoking. She’s a terrific writer and she masterfully got me thinking about the mundane and the not-so-mundane parts of medicine.
My response to Dr. Hedlin’s piece has now been published in Intima. It is called “Finding the ordinary among the extraordinary.” It has my musings about the need to sometimes find normalcy even in utterly abnormal situations. Like medicine.
I encourage you to read Dr. Hedlin’s piece first in the “Field Notes” section, then my short response in the “Crossroads” section. Maybe as a trio these pieces will pull together some themes that resonate with you.
I’d love to foster dialogue, so please feel free to share these pieces on Facebook, e-mail, Twitter, or wherever you spend your social media time. Or simply share this MyHealthyMatters blog post and let people do their own clicking! (Buttons to share are at the top and bottom of every post I do).
And the editors at Intima encourage a wider conversation, so maybe you could leave a comment on the site with your reaction to any of these pieces.
In this post I simply want to invite you to read an essay I wrote which was recently published in a journal I admire. Called Intima: a journal of narrative medicine, it is a literary place where medicine is explored through story, narrative non-fiction, and art.
My piece is called “Don’t worry, at least we will die together” and is an account of an experience I had back in 2015 while in Jerusalem.
In addition to reading my piece, I hope you will explore Intima and immerse yourself in any of the outstanding works that were submitted. The journal, which originated at Columbia University in 2010, is a treasure that I hope many of you will come to know.
Quick, picture in your head a highly competent physician. What does that person look like?
Does your doctor image look like this?
Or like this?
For the record and the recognition, that’s Dr. Gibson-Hill, a doctor in Bristol, England. You probably know the guy in the top photo.
History has maybe ingrained in us the image of doctors as many things, but first of all they have been men. The reality, even dating back over a hundred years (Elizabeth Blackwell, anyone), is that women have served as physicians for a great long time.
And the reality today is that women are a huge part of the physician workforce in the United States. I remember vividly one moment during the first hour of the first day of my Medical School education at the University of Minnesota some 20 years ago. The Dean stood up in front of the nearly 200 of us eager young medical students and announced that for the first time in that school’s history, more than half the medical students were women. The room erupted in applause that day.
My current practice bears this out. In my group of hospitalist physicians at HCMC, we have 17 women and 14 men. So when you see a doctor in our hospital and I presume at all other hospitals in the country, you are likely to be cared for by a physician who happens to be a woman.
Hi, everybody! For about 2 months I’ve been yammering both in this blog and on the radio broadcast about the current Healthy Matters online book club selection, and it’s time to get to it! As they say in billiards .. “Quit talking and start chalking . . . “
I don’t know about you, but I’ve been reading How Doctors Think by Jerome Groopman. For regular readers of MyHealthyMatters, hopefully you’ve had a chance to check it out. But it’s OK if you didn’t read the book. I’ll bet you’ll have something to add to the conversation even if you didn’t get to read it!
To get you thinking, I’m going to talk about the book in the following format:
My summary and reflections about an aspect of the book, broken into 3 topic sections
A few questions for you to consider in response to my reflections. Hopefully you’ll leave a comment at the bottom with your own thoughts.
I’d rather this be a two-way conversation – an online book discussion – rather than just me talking. (I talk enough). I’m most interested in your thoughts so please join the conversation even if you didn’t get a chance to read the book. (Just like in-person book clubs where half the people didn’t actually read the book! You know who you are.) Continue reading “Book club! How Doctors Think”→
This has been a tough week as too many people have died way too early. I’m going to write a few thoughts about young lives cut short – one from my own life and one from the nation. No links to medical information, no medical advice, nothing funny and probably not too uplifting. I think I just need to make note of these young lives. Sorry it is a sad read. Just some reflections and a poem at the end. Thanks for reading. Continue reading “Dying too young”→
The first time I did a book club selection was after I had read a book and I was really excited to share it with you. That was in March 2016 and the book was When Breath Becomes Airby Paul Kalanithi. If you missed the post about that terrific read, click here.
For the second book in our Healthy Matters book club – and for all future selections – I will post the book before I have read it and hopefully many of you will pick up a copy and read it as well. Then I hope we can have a good discussion about it -here on the blog, on the radio broadcast, and on Twitter. I really value using literature, the arts, the humanities, and so forth to help us all think about the practice of medicine. You can be part of that conversation!
So here’s the book I’d like you to considering reading: How Doctors Think by Jerome Groopman. Then look for a post on this blog in mid-June in which I hope you will give me your feedback – let’s start an interactive discussion!
“I began to realize that coming in such close contact with my own mortality had changed both nothing and everything.”
Paul Kalanithi, from When Life Becomes Air
Welcome to Healthy Matters Book Club! This is the first of what I hope will be many posts in which I will explore a health & medicine book that I have read and found interesting . I’m not a book critic and this is not a thorough book review – just a couple of my thoughts. I hope you will read it and join the conversation by leaving a comment below or perhaps joining me on Twitter @DrDavidHilden. Plus, I’m hoping you will leave me book discussion suggestions in the comments – I’m always looking for a good read!
Today’s Book: When Breath Becomes Air
Re-read the quote at the top of this post. It is a pretty good summary of When Breath Becomes Air, the recent book from Dr. Paul Kalanithi. I strongly recommend the book to you – it is a quick read – just a few hours – but it is gripping.
Dr. Kalanithi died in March 2015 and the book is a memoir of his last months of life. An accomplished neurosurgeon and a rising star in the medical community, Paul Kalanithi learned of a terminal diagnosis when he was just 35 years old. Also a talented writer who was initially torn between a career in medicine or as a writer, he set out to chronicle his life knowing that he would not live a great deal longer. He is a terrific writer and his prose is quite lyrical – almost poetic to the degree that some may find a bit much – and I found it brilliant.
Paul writes with an intimacy rarely seen in books by doctors. Neurosurgeons, fairly or not, are not known for their sensitive sides. But in this case, the surgeon becomes the patient and is faced with what he knows in his mind and in his gut – that he has a disease from which he will certainly die. He knew it the instant he looked at his own CT scan. This unnerved me a bit as I can imagine any of my colleagues facing the same situation in which we look at our own medical results and know a bit too much what it means for us.
When I was reading the book, I couldn’t escape the knowledge that the writer has already died and is really speaking from the grave. Made me pause more than once or twice.
But it is a great read even if you are not a doctor. Maybe even more so, as it gives you an unfiltered glimpse into the mind of a brain surgeon with a soft spot for poetry. You really feel like you get to know him. And just as great is that you get to meet Lucy, his wife, who seems to me an incredible person.
Throughout the reading I couldn’t escape the knowledge that Lucy and their infant daughter are still here – real people, alive and carrying on their lives. To me Lucy is as fascinating as her husband and her epilogue is as poignant as her husband’s writing. Now about one year after his death, she has found herself doing something she probably didn’t imagine just 2-3 years ago – she’s on a book tour for her late husband.
Here’s an interview she did on National Public Radio that I encourage you to listen to:
“Live as if you were to die tomorrow. Learn as if you were to live forever.”
This oft-quoted bit of wisdom by Gandhi was realized by Dr. Kalanithi during his lifetime. After his awful diagnosis, he continued to practice surgery, continued to read, continued to write, continued to love, continued to learn, and continued to reflect on what is important in life. He indeed was acting as if he may well live forever.
But he also acted as if he may die tomorrow which for him was not an abstract concept but a real possibility. One aspect of their lives that gets my thoughts all tied up in knots is their decision to have a baby, knowing that he would not live to see their child grow up. Here is an exchange from the book:
“Will having a newborn distract from the time we have together?” she asked. “Don’t you think saying goodbye to your child will make your death more painful?”
“Wouldn’t it be great if it did?” I said. Lucy and I both felt that life wasn’t about avoiding suffering.”
Can you imagine having such a conversation when thinking about having a child? Holy cow. Listen to the audio clip above to hear Lucy say more about this.
Join the discussion!
What would you do if you knew you had a very limited amount of time to live? Would you continue to work at whatever you do? Would you drop everything and try something new? What would you do if you were Lucy – his spouse? Are you a “live-for-the-moment” type or a “planner for the future” type? Maybe a little of both?
So now it’s your turn. Read the book and leave a comment below with your reactions. I’d love to hear your thoughts!
Also, if you have read a health/wellness/medical book that you’d like to recommend – leave me a comment right here on the blog (in the comments section below). Can be fiction or non-fiction. Maybe we can discuss it on a future post on the Healthy Matters Book Club!
“That it will ever come into general use, notwithstanding its value, is extremely doubtful; because its beneficial application requires much time and gives a good bit of trouble both to the patient and the practitioner; because its hue and character are foreign and opposed to all our habits and associations.”
Such was the opinion of the stethoscope by an English doctor in 1821 named John Forbes. The stethoscope had recently been invented by French physician René-Théophile-Hyacinthe Laënnec in an effort to protect the modesty of his female patients by removing the necessity of placing his ears directly against their chests. The skepticism of Dr. Forbes notwithstanding, the stethoscope is now considered one of the greatest inventions in history. Check out the patient of Dr. Laënnec at the left – head firmly pasted to the chest of this guy with tuberculosis. Oh my! (Since this patient was male, the good doctor did not need to use his new stethoscope invention).
Whether the doctor actually contracted tuberculosis I know not.
But in the year 2016, the stethoscope is so familiar to patients that we probably would wonder what was wrong if the doctor did not have one hanging around his or her shoulders.
So what is the technology that doctors will be using in the future?
Enter the ultrasound
The stethoscope is nearly 200 years old. Although I doubt I’ll ever hang my stethoscope up for good, today we do have some newer tools to help with diagnosis. The ultrasound, though a tool we have had for many years, has now hit the bedside. Today I spent some time with my colleagues (inpatient doctors, or hospitalists) learning how to use portable ultrasound machines in our practice. As a patient, you will likely encounter a doctor with an ultrasound in his or her pocket and you may wonder what the heck this is all about.
So this post is a sort of “mini-Medical School” into the use of ultrasound in clinical diagnosis – a brief look at how clinicians of today can use this tool in medical practice.
Most medical students are repeatedly taught that 80% of the diagnoses they make on their patients will be from the history and physical exam. In other words, fancy blood tests, high-tech imaging (x-rays, CT, MRI . . . ) and other extensive tests are needed much less often than we all may think – perhaps just 20% of the time. So we teach doctors-in-training to learn the skills of talking to patients and laying on of hands by doing a physical exam. Most of us can recall some of our mentors and teachers, patiently and skillfully showing us the tried-and-true physical exam skills.
An anecdote from my training about one of the great ones . . . I remember Dr. Richard Asinger, here at HCMC, putting his stethoscope on the top of a patient’s head. I thought he was messing with me, but he said he could actually hear a heart murmur up there. I was in awe of this pure genius. On the other hand, maybe he really was just messing with me! He’s still at HCMC; I should go ask him. On a side note, he’s also a killer dancer on the dance floor.
But even listening with our stethoscopes to hear abnormalities of the heart (murmurs, for instance, which could mean valve disease) , or of the lungs (like rales, which could mean pneumonia) it is still a bit primitive. Sometimes we want to know how much extra fluid a person has in their body due to heart failure (called hypervolemia). Or we need to know if they have a partially collapsed lung with air around it (called a pneumothorax). Or if they have a blood clot in their legs (called a deep venous thrombosis, or DVT).
So that is where ultrasound comes in.
This is an ultrasound image of a heart.
See the four chambers? Clockwise from upper left: right ventricle, left ventricle, left atrium, right atrium.
See the valves? There are four valves in your heart – you can really see the mitral valve leaflets in this picture – the two white lines that look like a tent at about the 3:00 position.
If the chambers and vessels look big – maybe you have too much fluid in your body. If the valves are not opening and closing correctly, maybe that is what is causing that murmur we hear with our stethoscope. If the heart is not beating strongly, you may have heart failure. So much information can be learned from these pictures!
Ultrasound training with the HCMC Hospitalists
I thought Healthy Matters listeners and blog readers may like to see how we stay competent in the medical profession – so here’s a sneak peek of our group at HCMC learning to use ultrasound in our daily practice. The technology is really neat. The machine is just a bit bigger than your smartphone, so now we can carry them around in our white coat pockets. I think you will see more and more of this when you are a patient – doctors pulling out teeny little ultrasound machines. I have even heard that we will be able to use our smartphones for this purpose at some point.
Here’s my colleague, Dr. Mike Lawson – an HCMC graduate, all-around good guy, and Minnesota Vikings fan – recently returned to Minneapolis after a spell as a doctor in the Seattle VA Medical Center. He’s really good at using ultrasound and one of the best teachers around so he was helping the rest of us become proficient at it.
These pictures are of two of our outstanding clinicians working with the ultrasound machines (Chief Resident Dr. Marissa Durman on the left and Physician Assistant Erica Monroe at right). Look at how tiny the machines are! The doctors and PAs in our group were worried that they were going to have to do ultrasounds on pregnant women. No worries – we have specialists for that! Relief all around.
From putting an ear to a patient’s chest to listening through the tubes of a stethoscope to using sound waves on a portable ultrasound.
The centuries-long attempt to probe the human body continues.