Trust

People often tell me I seem very patient and ‘laid back’. In fact, I devoted a whole article to the subject of patience and the importance of this virtue to my recovery. I do find myself becoming impatient. At times I find myself wishing I would awaken tomorrow with a normal gait and speech. I’ve come to the conclusion, however, that patience is the result of trust. When I am in a long line at the grocery store, it may seem to an observer that I am patiently waiting my turn, but it is actually trust that I am exhibiting. In this instance, I trust that the grocery store cashier is working the best he/she can. In my recovery, I trust that the team I chose (including surgeons, therapists, neurologists, and physiologists) is working to the best of their abilities, and have my interests at heart. Conversely, an impatient person may distrust the grocery store cashier or their physician believing their experience could (and should) be in more capable hands. The question then becomes, ‘What have these people done to earn your trust?’ I have no good answer to this, with my only rebuttal being that I trust in the system that has placed this person in their current position.

There is an economic theory called the Peter Principle. In essence, it postulates that in any company, people receive promotions until they are no longer effective at their position (thus no longer receiving promotions). The theory claims that this results in inefficiency in the company, claiming that all people are elevated within a company until it is deemed that he/she is no longer worthy of elevation, meaning we are all in a sub-optimal place in this company.[1] Why would I even mention this theory in an article telling you of the value of trust? Doesn’t this theory argue against trusting others? Besides finding this theory fascinating and wanting to share it with you, I also feel that in order to convince you of anything, all sides must be presented. Even though I find this theory intriguing, I believe that the promotions stop when it is deemed that someone is not only proficient at their position, but also that a change to this job would result in detriment to both the company as well as the individual themselves. Thus resulting in efficiency. In essence, unlike the Peter Principle, I believe that promotions stop because it is decided that these workers are doing a good job and that a change to their position would be detrimental.

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Is trust like this genetic or learned? It is likely a combination of the two factors: a baby seems to trust everyone, making a case for the learned argument. However, this same baby might go through a phase of separation anxiety, showing his/her mistrust of anyone but their parent (usually mother), arguing for the inborn or genetic component of our mistrust. I would be delusional if I thought I could solve the centuries-old debate of genetic versus learned; but regardless of the origin of trust, I do believe we can make the conscious decision to think positively and optimistically of others. I am imploring you to trust more than you do. Realize that if you wish yourself to exhibit more patience, what you are actually asking of yourself is to trust more.

[1] http://pespmc1.vub.ac.be/PETERPR.html

Friends

This past weekend I was lucky enough to be visited by two close friends from college, Ben Hall and Chuck Howe. I had not seen them since my surgery. In fact, the last I saw Ben was in 2007 during a trip to Puerto Rico, and the last time I had seen Chuck was before then at my wedding in New Zealand in 2005. Part of me was anxious at the thought of seeing my old friends and what they would think of my current condition. Yet there was another part of me that was so excited to see them again. Their visit was an uneventful, filled with retelling of old stories and updating of the whereabouts of former college classmates. While “uneventful” might connote “boring” to some, my ideal day is an uneventful one.

Even though part of me was anxious at the thought of seeing them, their visit reminded me of the importance of having such close friends. While this ordeal has clearly highlighted the value of family, it has also made me realize that I have underappreciated the value of close friends.

I realize that part of their reaction upon seeing me brought about thoughts like, “Wow, he’s worse than I thought.” These are people who would be frequent visitors to my tennis matches in college, and now, only 10 years later, I could not jog. Even standing upright proves to be a task. But I’d like to think after the initial shock of seeing my condition, they simply enjoyed seeing a friend.

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Regardless of their thoughts I have come to appreciate the importance of having friends like them in my life. It’s unfortunate that it has taken a debilitating brain tumor for me to come to this realization. But I implore you, do not make the same mistake I have made. Don’t take your friendships for granted. Appreciate every friendship you have and nurture them. Friends love you for who you are. For them, your well-being is their first priority. Sometimes this means agreeing with the most irrational of explanations, but to them if this agreement results in an improvement (or maintenance) of your well being then this is what they will do. For example, if you’re friend said to you, “my dad’s idea makes absolutely no sense!” Even if you saw the logic behind this decision, you might agree with your friend, because he/she is, well your friend.  Your friend can also ground you, and will not hesitate to call you out any of your hair-brained ideas. “That makes no sense, Chris,” I’ve been told(in college after giving my roommates a bad explanation); even though a comment like that may hurt at the time, it could serve to stop you from making a decision or saying something that you regret for the rest of your life.

Cherish each and every friendship you have. When you find yourself trapped in a pit in the road it is your friends that will pull you out.

Journey

My return to the clinic has been separated into phases. The first phase of my return has involved my shadowing[1] different clinicians in the clinic. While all the clinicians that work there are extremely intelligent and have a fantastic rapport with patients, they each have their own particular strengths. As a resident physician, we are each assigned a mentor. These advisors meet with us about our test results, patient satisfaction ratings, and senior projects. When I was in recovery in the hospital, my advisor was in the process of changing positions at Michigan State University, thus I had to choose a new advisor. During my time in residency I had developed a close relationship with Dr. Kenneth Thompson, making him an easy choice as a new advisor. More importantly, even though he came across as gruff, I knew inside he had a big heart. I have been lucky enough to be able to shadow him during my return to clinic. Besides imparting his vast medical knowledge on me, he also often gives me his philosophical insight regarding my condition. On many occasions he has said, “Chris, if you step back and look at the situation, you have to appreciate the journey you’re going through.” I had never thought of it as a journey before. I began to reflect on what defines a journey.

Merriam-Webster’s dictionary defines journey as “something suggesting travel or passage from one place to another.”[2] By this definition, I have definitely been on quite a journey, at least figuratively. But we all go through our own journeys. Who is to say my journey is somehow more arduous than another’s. Life is a journey: someone who wakes up every day at 7:00 am to go to work then comes home to his/her children, eats dinner, watches the news, then goes to sleep is going through a journey, albeit different than mine. A journey results in you being in a different place than you started. Just as I am being put through a journey via my health, this hypothetical person also is going through a journey ending up somewhere other than where he/she started.

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Our journeys make us who we are. Thinking our ending position is all that matters would be short-sighted, our paths to this position cannot be forgotten, and are as vital to us and our makeup as the end result. There is an old adage, “trust the process.”[3] It’s important where you end up, but what’s more important are the experiences that get you there.

[1] Essentially following and observing

[2] http://www.merriam-webster.com/dictionary/journey

[3] http://media-cache-ec0.pinimg.com/736x/bc/21/f0/bc21f02a471d3d8c11d49d78ad53f5ff.jpg

Partnership

When I was applying for medical school, the interviewers often posed the same question: do you see the patient-physician relationship as more akin to a parent-child dynamic or to a partnership? While it was always clear which answer the interviewer sought to hear, I have come to realize the importance of this idea.

Medicine, as old as it is, would cease to function if it were treated as anything but a partnership. Yes, the management opinions of the clinicians are rooted in years of medical training and knowledge, but in the end the plan of action only comes to fruition after deliberation from both parties.

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Late last year I began working as a writer/medical consultant for a fantastic group called the Epidermoid Brain Tumor Society (EBTS).  One of the perks of this job is that I’m often consulted in cases where my medical knowledge is needed. Several months ago I was introduced to ‘Erica’.[1] Erica had undergone surgery to remove an Epidermoid Tumor. Unfortunately, she was experiencing several post-operative symptoms, one of which was fever with headache.[2] In medicine, there are certain symptoms called ‘red flags’; these are symptoms that clue the clinician in that something worse is going on (for example, if someone were to tell you that they have chest pain that feels like ‘tearing into the back’; this is a red flag for a condition where your aorta is literally splitting). In Erica’s case, fever with headache following brain surgery was a red flag for meningitis (an infection of the central nervous system). As was prudent, she promptly called her Neurosurgeon who advised that she go to the Emergency Department (ED). She went to the ED where the physician deemed that she did not have an infection, and subsequently discharged her home with instructions to see her primary care physician (PCP) in the coming days. Her PCP obtained some further testing and suggested she return after several weeks. Here is the problem (and why I was consulted): she was still having fever with headache. Was the diagnosis of meningitis missed by her physicians? She questioned the knowledge and decisions of her clinicians so much so, that she even considered returning to the ED at a time that she knew that her previous ED physician wouldn’t be there. She also considered seeing a different PCP for treatment. I was asked what her next step should be. My response (via e-mail) is one I’ve pasted below:

Hi Erica!

These are all legitimate concerns that I’m glad you brought up.  

The bottom line is this: I agree that accepting care without question is not the optimal way to practice or receive medicine. It is a partnership where each party has at least some trust in the other party.  If this balance is shifted too far in either direction the result is a negative outcome for the patient.  Why is this relevant to you?  In your case we should believe, to a certain extent, that your physicians are acting in your best interest.  This is by no means a blind approval of care, but in order for this relationship to persevere a certain level of trust must be maintained.  If you do not trust your caregivers then you should sever ties with each of them.

We each have roles in this situation: both Marcie[3] and I are to serve as objective observers for your sake, and interject with our clinical knowledge when we see fit. I tend to look at situations as a group of alternatives: for you this is what I see: option 1. Continue the current path, meaning doing nothing, option 2. Stop seeing your current physicians and find new caregivers, perhaps getting a different outcome.  And 3. Openly question your current path to your caregivers in hopes of forging a new one.  Personally I would still go with option 3 but one of the great aspects of medicine is that you have the choice.  

 Best,

Chris

Medicine is a partnership, a partnership with the goal of achieving optimal health for the patient. When this partnership struggles mistakes occur. This ‘struggle’ could be (and usually is) the result of poor communication from one or both parties. If, for example, you either do not trust or blindly follow the opinions of your physician, then this ceases to be a partnership and you will ultimately be dissatisfied with your care. If the clinician does not trust the patient in any way, or he/she does not effectively communicate the rationale behind his/her decisions, then misjudgments inevitably ensue.

Even though this began in my life as a rehearsed interview answer, it means so much more to me personally, and I hope for you too.

[1] For the purposes of this article, I will conceal her true name.

[2] For anyone involved in medicine, alarm bells screaming ‘meningitis!’ are ringing.

[3] ‘Marcie’ is a neurosurgery Physician’s Assistant that was also consulted on the case