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One of the interesting things about being in medicine is that friends and family consult you with all kinds of medical questions at any time. The questions span speciality (I was asked about a brain tumor, cramping and a bad cough in the same week!) Honestly, I enjoy it: it’s like an unplanned case of the day, and it’s a chance to be helpful. In many cases, I can simply put someone at ease. The movie “Dead Poet’s Socity” spoke about two kinds of professions, the “life sustaining” ones like medicine and engineering and the “life enriching” ones like literature, music and the fine arts. My reward in Acting was to (ideally) give my audiences a meaningful emotional experience by the end of the play through the life of my character, that is enrichment. In medicine, my reward is to use medical knowledge and skills to help patients feel better, sustainment. So, I appreciate the inquiring phone calls and texts and I would like to take you back to one in particular . . .

Last week, my sister texted me, concerned that her daughter (my ridiculously cute niece:) had a high fever and a cough. As I gathered the history and started working through the mental algorithms for what could be wrong, I happened to catch my niece’s voice in the background. She simply asked “What is that?” I think I have may have gotten more information from that audio signal than almost anything else in her story. Why? People who feel very sick are not curious. One of the things we learned in evaluating pediatric fever is that the exact tempertature is not as important as how the child appears. That takes observation, attention. I appreciate that because it feels clinical. A computer can work through algorithms but a only a clinician can be a medical Sherlock Holmes and notice personal, intangible atrributes that crack the “case.”

Paying attention matters not only in diagnosis but treatment. While on a neurosurgery service last year, I encountered a patient who required an operation to remove a brain tumor. Due to the tumor size and location, the patient had a devastating choice, to either lose the ability to read or to hear on that side, depending on which surgical approach was taken. Losing hearing or reading is more than a medical choice, it is a human one. One must ask the difficult question of which option would reduce one’s sense of self more profoundly. This question is approached by a patient who pays real attention to who she is, as well as family members and yes, doctors, who have done the same. No matter our profession, we will learn the same algorithms: law students learn the law, pharmacy students learn the drug mechanisms, but effective decision making in the grey areas seems to reward those who pay close attention to the nuances that no curriculum can adequately capture. Even in the enrichment professions, the actor who not only knows the lines but pays attention to the demands of the performance moment will respond with that spontaneous artistic choice that we recognize as brilliance . . .

By the way, I think we made the right call on my niece. She is doing well . . .

 

 

Body Team 12

Garmei Sumo, Body Team 12, Monrovia, Liberia [image source: mountainfilm.org]

Listening to these stories was hard. The first was the accounting of Garmei , the only female member of the one of the teams charged with picking up the bodies of Ebola victims in Liberia during the height of the epidemic. The second story featured Saba, an 18 year old woman shot in the face by her father as part of an attempted honor killing in Pakistan. While still recovering from these two, I heard about Manny Bobbit, executed in California in 1999 for a 1982 murder, a case complicated by his history of PTSD and a bungled defense. I left the theater drained having experienced three of the short documentaries nominated for the Oscars in 4 weeks . . . and all three stories left me with tough questions . . .

What is the point of us in Ann Arbor, far removed from the cultural contexts of all three stories, witnessing these tales? Is it so we can shake our heads somberly and say “That’s terrible” Surely, there is more to hearing such stories than well-meaning sympathy . . .

Are such stories a call to action? Should we engage in an educational effort in communities like those in Monrovia, Liberia where Garmei was deserted by her friends for taking on the gruesome but necessary task of collecting victims’ bodies? Perhaps join an activist group to draw attention to the ongoing issue of honor killings in Pakistan? Take a Criminal Justice course to learn more about the flaws within the system in securing justice for the vulnerable?

I will admit I am susceptible to the call for action interpretation. Such stories are so harrowing and so heartbreaking, that my natural inclination is to want to “fix.” It’s hard to sit with pain. But perhaps such stories are asking us to do something even more challenging. To examine afresh our own experiences and relationships where we are in light of these seemingly “foreign” experiences. Before we jump on a plane to Liberia to volunteer, or join that campus activist group to draw attention to honor killings, what about an internal taking stock? Garmei talked about joining the body team because many men were afraid to confront death. How well do we confront end of life issues here? How can we, like brave Garmei, walk into dark, hurtful places where people are afraid? Her daughter called Garmei the “Ebola hero” each day when she came home. She was willing to confront the unpopular, the uncomfortable and yes, the dangerous. Perhaps, we don’t need to be on a plane to Liberia yet. There is enough around us to confront that is unpopular, uncomfortable, and perhaps even dangerous. Will we do it?

Saba was shot in the face by her father for marrying outside the family without permission, as part of an attempted honor killing. She survived after being dumped in a  river and somehow managing to emerge for help. The incident tore her family apart as her mother and sisters were caught in the middle. She was estranged from her mother and didn’t talk to her for months. Are there not many families in disarray right here in the USA or where you may be in the world? If a mother and child are not talking to each other, do the specifics of the conflict really matter? The end result is the same, a lost relationship. Can we really categorize the pain of the mother whose son’s body was picked up by Germai, or Saba’s mother when she first saw her daughter’s disfigured face, or Manny Babbit’s mother when she got the phonecall confirming her son’s death by lethal injection? Or our own?

Stories don’t need to have an agenda, but they should provoke reflection. The tears I witnessed on those three faces today whether in Monrovia, Lahore or Sacramento all looked exactly the same . . .

 

 

 

 

It’s that time of year again, the time when we take a moment to reflect on the past year and look forward to self-improvement in the next year. The usual suspects are trotted out: nutrition, exercise, spirituality, finances and family with ambitious goals articulated for each. Anecdotal evidence suggests that the success rate for this bold list is less than ideal. But the alternative, an unexamined stroll into the next year is just as unpalatable. So, perhaps a shift in approach is needed . . .

What if we pick ONE substantial target? Sounds reasonable. But how do we make that choice when there are many things we would like to change? I’d like to share a process I went through recently and propose that it may provide a model for you to frame that choice.

My family and I had an extraordinary experience during a family visit this Christmas. One of my favorite cousins visited us for Christmas with her husband and three children and the usual pleasant visit became much more. Toward the end of the visit, we gathered together and asked the kids to share school tips with each other (my two boys, aged 7 and 13 and her 3 kids, two boys aged 12,15, and a 19 year old woman). So the college student (my niece) shared her insights with the  high schooler who then shared his tips with the middle schooler (my older son) who then shared with the elementary children (my nephew and other son). These tips provoked some questions from us, the adults, which led to much more personal revelations about their individual challenges with school. I was blown away by how much more complicated their school lives are because of social media, cyberbullying, fitting in, skewed perceptions of female beauty and more. I learned more about my nieces and nephews in that one session than in all previous visits combined. No therapy could have yielded the rich insights and sharing facilitated by having cousins who looked and sounded like each other share their struggles and victories. It was the kind of moment that was both frustrating and beautiful. Frustrating because these moments are so hard to consciously reproduce but beautiful because you KNOW they are transformative when they happen. I saw the power of relationships firsthand and knew what my focus would be in 2016: building richer relationships.

A few days later, I watched a TED talk focusing on the most comprehensive study on happiness in history. Several men were followed for as long as 75 years and the data revealed that the single strongest predictor of health and longevity was satisfaction with personal relationships. And so building stronger relationships has become the entirety of my “list.” Perhaps, resolutions should not be a list of “ought to’s” but a single “have to”. There should be both an urgency and timeliness to what we pick . . . I think that leads both to a greater chance of success and meaningfulness to the accomplishment. And so, as we all enter 2016, I will leave you with that question, what is your “thing”? May you reach it.

Happy New Year!

 

 

Toys R Us GallowayCole Galloway with a rehabilitation patient and her recently modified car.

A couple of blog posts ago, I introduced the Maker Movement, a growing community centered on the idea that we can build physical solutions ourselves. Today, I want to introduce you to one of the best examples of Making in action, and that is Cole Galloway and his Go Baby Go campaign.

Galloway works in physical therapy to get children with physical disabilities mobile. The problem? Motorized vehicles for rehabilitating children’s mobility can cost as much as $20,000 and often involve long waiting periods. Galloway got inspired through trips to “Toy R Us” to try something different. He now modifies toy cars such as those you can pick up at a toy store to become vehicles for these children. The cost: $89 and most modifications can be done in an hour with his team. Children who could barely get around can now do what children naturally want to do, move!

Galloway’s case illustrates some important principles of making: First, that the best solutions are often conceived by those on the front lines, who know best the contours of the problem. Second, making is impatient in a healthy way. Making challenges the assumption that meaningful solutions must be expensive and take a great deal of time. Third, and perhaps most important, the solution is carried out in a community, patient centered way. The modifications to the cars are carried out by clinicians but also by parents and community members.

So if making is so wonderful why don’t we see more of it? Why aren’t all of us creating great physical solutions like this everyday? I think we are conditioned by the notion of expertise, the idea that we can only be good at one thing and must be consumers of everything else.There is also a certain inertia that must be overcome to create, but those who overcome this inertia are always struck by the possibilities. And word is getting around . . .

Making can in fact become a way of life. This occurred to me through an unusual path, an online karaoke app! Going back to my musical theatre days, I love to sing and discovering this app has been a revelation. The goal of this application is to promote online musical collaboration across the world. You can sing one part of a song with full accompaniment and leave the other part to be filled in by anyone else on the app, anywhere in world. One night, I recorded half a duet and woke up to find 10 new complete duets from singers who joined in from China, England and Mexico. Aside from the variety, I have never encountered such a unique blend of talent. Music made for mass media consumption must, I think, make certain stylistic concessions to be broadly palatable. But this music can be as creative, raw, spontaneous and yet high quality as it aspires to be. I don’t know if I can call this Making, because it is not strictly speaking tactile and may not be solving a pressing physical need, but the philosophy of making seems to be at work. Recording music is democratized, lack of proximity is eliminated as a limiting factor, and there is a genuine sense of community. Something beautiful can be created every day.

Where else could this go? Well, I’d like to leave you with some resources as you consider ways  you can discover your own potential for making:

  1. Parents may want to check out MakerKids.com which describes itself this way:

    “We are one of the first and only makerspaces for kids in the world.We run programs and camps on topics like Minecraft, 3D Printing, Videogame Programming with Scratch, Robotics Inventions using Arduino, Electronics and Remote Control Robotics.”

    2. The organization Maker Faire holds maker events across North America. One of the best ways to start getting into making is simply to get inspired, to see what people are doing to trigger your own ideas. For more information on maker events and ideas, you can check out, MakerFaire.com which includes event information, a magazine and further resources.

    I think one of the most important questions that Making asks is “What are you waiting for?” And it doesn’t ask this question in a sensationalized, infomercial kind of way but as a question with real tension, that makes us challenge assumptions about perceived obstacles. How do we justify NOT doing anything? The big three reasons are:  I don’t have enough time. I don’t have enough money. I don’t have enough expertise. Making proposes that all three of our grandest excuses are, in fact, hackable.

     

 

DJSanta

Photo Credit: Mp3Jam.org

I’m a sucker for Christmas. There I’ve said it. I tried not to start singing Christmas songs this early, but failed. The result is this duet (click below) that I recorded with a wonderful singer by the name of Niecy, whom I have never met (by the magic of technology, we recorded this duet, 1000 miles apart!). My Kenyan blood is revolting against the descending temperatures, but there is always song . . . Enjoy!

 “Baby It’s Cold Outside” via Smule Listen to my cover of “Baby It’s Cold Outside” via Smule: http://www.smule.com/p/431427151_199190488

Embrace

Photo Credit: EmbraceGlobal.org

I have never considered myself a DIY, use my hands to fix stuff sort of guy. I have always assumed that inclination was part of a different personality type. I am more naturally drawn to ideas, language, music, abstract science concepts and other things you can’t hammer a nail into. But in coming home this week from an interesting event called #wemakehealth I was forced to challenge some of my assumptions. #wemakehealth is an example of the “maker movement” a growing group of people from professions as diverse as medicine, business, design, and technology united by a common purpose, to make everyone into a maker.

So, what is a maker?

I understand it to be anyone who decides that she will not wait for a solution to handed down, but will get her hands dirty and build one now. And that is physically build it.  One speaker referred to it as “democratizing engineering”; an example would be the people who helped develop a warming blanket (known as Embrace) for premature babies in developing countries; this simple device is saving multiple lives where incubators are not available. The idea for this blanket emerged from a graduate school class assignment . . .

So what assumptions does this movement challenge?

That most of us can only be consumers of something someone else has made.

That if you’re not naturally “crafty”, building things is not really for you.

That you need tremendous background in design and engineering to build something from scratch with your hands.

I think we can agree that most things are more interesting to do than to watch. Yet, we somehow accept that other people who are more talented, educated etc must do all our building for us. This doesn’t mean that we suddenly have to try building complex computers. In fact, many incredibly useful objects are quite simple in their design (that warming blanket). I feel like the perfect messenger for this message precisely because I didn’t grow up trying to fix things and build stuff. And yet, in medicine, I was strongly drawn to surgery. There is something undeniably fulfilling about physically fixing a problem and being able to look upon your work. When I was given the chance to close incisions on the babies we were operating on in Kenya, I would look over my work the next day on rounds and if the wound was “clean, dry and intact” it was a tremendous source of pride. I often side with those who argue that we are born creative but have creativity educated out of us, and conclude falsely that it is the reserve of a select few. Now, I also wonder whether if there is something fundamentally human about building, making physical creations. The creation may be a meal, a painting, a creative blood pressure monitor, but it’s something. Perhaps, we were not made only to consume or roam the halls of the abstract, however enticing. Making is also key to progress in healthcare where so many structures, devices, procedures and processes remain opaque. Can we make something better ourselves? Can we stop waiting? Incidentally, #wearenotwaiting is the hashtag for the NightScout project, comprising a group of parents who came up with a creative way to remotely monitor their diabetic childrens’ blood glucose levels on cellphones . . .

So, to explore these ideas further, I am starting a brief blog series on making. I’ll bring in voices from the maker movement as well as practical ways to explore your own potential as a maker. If can I do this, trust me, anyone can!

Teenage Brain

Photo Credit: KindredMedia.org

I am still learning to decipher “Teenage-ese”

A widely spoken dialect, worldwide

Yet unique to those who have roamed the earth

For 13 to 19 years.

The first mystery is the vocabulary of this ancient tongue

It seems that there are only 7 words: “Uh-huh” “Nothing”

“Good” “Not” “Much” “Video” and “Games.”

As for tone, there appear to be two notes: low mumble and mid-range mumble

Excitement is hard to detect, shrouded in ambiguous grunts and mutterings

Unless a wrong is perceived, and then suddenly

This language acquires profound expressiveness

Through the boldly and repeatedly expressed phrase “Come on!”

Flowing conversations are not a traditional part

Of Teenage-ese oral traditions.

Long

Silences

And

Pauses

Seem integral to the communication style,

Creating regular tension with

Parent-ese, a language that insists

On constantly clear and emotionally appropriate communication.

And so, it is tempting to give up on Teenage-ese.

Grunts, groans and monotones

Fall prey to suggesting apathy.

But every so often, like the King in

“The King and I” who constantly exasperates his wife,

Teenage-ese succumbs to “something wonderful”

A single vulnerable phrase slips out despite

The best efforts of the native speaker.

An “I love you” evades the security system and tunnels underneath

The protective barbed wire of the teenage psyche.

If you are blessed

To catch this moment, grab it.

Security will soon catch up with the errant words.

And incarcerate them once again in the teenage brain.

And the mystery of Teenage-ese begins once again . . .