Legacy

We all think about what mark, if any, we will leave behind. The simple, straight-forward approach is to think what will be said about me at my funeral? Will everything said during my eulogy be true and honest? I call this the ‘simple’ approach because it’s an easy way to think about the legacy you’ve left behind. The harder (and more exhaustive) way to think about this is to analyze and ask yourself if you’ve lived every moment of your life, treated everyone as if no one is watching. I bring this up because I have come to realize, through my condition, that I hope to be remembered for the kindness I showed others. I have always lived my life according to the Golden Rule[1], but since this tumor resection, I have come to two realizations: 1. without the compassion and empathy I try to bestow on others, my recovery from and coping with my newfound condition would be drastically and negatively different. And 2. My condition has allowed me to see the amazing and beautiful true nature of my fellow man. These two ideas are not exclusive, in fact they are intertwined.

golden-rule

I have always strived to show others true compassion and empathy. I suppose my entrance into medicine was an extension of this ideal; a way to hone and polish these traits. My 30 years on this Earth, before this ordeal, were devoted to this ideal. Little did I know that in an attempt to achieve this I was actually preparing myself for the struggles that lay ahead. The reason I say that my compassion and empathy have been crucial to my recovery, and furthermore that this condition has put the kindness of others on display, is that this compassion towards others has allowed me to appreciate the kindness that others have shown to me. It’s like appreciating a beautiful piece of art: anyone can be mesmerized by a captivating painting, but the person who has studied that painting, the artist, and the story behind the piece of art will appreciate it more. My life has been devoted to this ‘art’, in fact I chose a profession where this ‘art’ can be studied further. My point is that now the proverbial tables have been turned and the empathy and compassion I have worked tirelessly to portray to others is now shown to me; I firmly believe that had I not been so attuned to this trait, my appreciation of it would be diminished.

I understand that there is a difference between pity and empathy; I also understand that while much of this ‘kindness’ from others is actually rooted in pity rather than empathy, this only represents a small portion of these kind acts.

3_7_Legacy

Thus, I return to my original point and the title of this piece: legacy. I have had long conversations with my stepfather surrounding the idea of reincarnation. His response struck me. “Yes, I believe in reincarnation. By touching your life, my spirit lives on in you, and anyone else’s life I affected. So even after I die, my spirit lives on through you, your kids, and your kid’s kids. So in that sense my soul lives on after I die, and so yes, according to that definition, I do believe in reincarnation.” I once mentioned that meeting with old friends who knew me before the discovery of my tumor gave me great angst. But I’ve since come to realize that what my stepfather said is correct: your actions and ultimately your soul lives on through the lives you touch. Now even though part of me is anxious at the thought of seeing friends that I haven’t seen since my surgery, I leave our visit being grateful that this person knew me before my affliction. When I meet new people, I can’t help but remember that this person did not know me before the surgery and thus has no memory of the person I was; thankfully in the former scenario, this person knew me both before and after the surgery and thus doesn’t make any incorrect assumptions about me; at my funeral I wouldn’t want it to be said about me: “Chris, a disabled man, was a kind, loving person.” Instead I hope it is said that, “Chris, who I knew before his surgery during his tennis playing days, lived a life of empathy and compassion.” What do you want said at your funeral? What do you want your legacy to be?

[1] http://www.wisegeek.orgt/what-is-the-golden-rule.htm#didyouknowout

Thinking Ahead

In my current state I have found myself constantly, almost obsessively, contemplating different aspects of a future visit that I had not thought about before. For example, I now always consider the physical entrance and exit to any locale I am headed. I am concerned with details and wonder, “Are there railings there? Are there steps at leading to the house? Where is the bathroom in the residence? How many people will be there? Do I know anyone that will be there?” These are just a few of the thoughts that race through my mind before I even step foot at my destination. Earlier this year, my thoughtful wife surprised me with tickets to a show by one of my favorite comedians Aziz Ansari. Even though I absolutely loved the show and found his performance extremely funny, getting to our seats was my nightmare scenario: we had to park very far away and had to traverse uneven terrain to get there. It was a sold out show with thousands of people attending. To make matters worse, our seats were in the top row of a large theater, and getting to our seats meant ascending up many flights of stairs. Stairs, as long as they have railings, are no problem for me; the trouble was that for these stairs there were no grab rails. Thus I had to go unsteadily and unsupported up multiple flights of stairs. Because we were late and everyone was already seated, I was contemplating having to grab onto one of the unsuspecting audience members in the event I had to steady myself or prevent a fall. Luckily, I made it up the stairs without falling, and we were able to enjoy the show. After the show we were able to find a stairway with railings, thus leaving the show, while still slow, was much easier. Now I tell you this, not because I simply want to recap for you a difficult situation I had to endure, but because I feel it highlights an important point: thinking ahead is very important and a skill that is vital to everyone, not only to those stricken with a brain tumor.

think ahead

If you examine any craft, whether it be music, art, or business, those with success in their craft have an uncanny ability to think ahead. For example, a novice chess player may think 1 or 2 moves ahead; however someone proficient at the game may think between 3-5 moves in advance;[1] a grand master could possibly for see up to 8 moves in the future; the top chess players in the world are known to sometimes map out entire games in their heads before the first move is made. It doesn’t take a statistician to see the trend here: increasing proficiency is directly correlated with how many moves ahead one can predict. This philosophy goes beyond the game of chess. The ability to think ahead leads to success in all fields. In medicine this is especially pertinent, as your physician often has your management plan mapped out in his or her head before even seeing you: okay, this is this patient’s second visit for back pain. Since we’ve tried some NSAIDs (non-steroidal anti-inflammatories), I think it’s time to begin trying some physical therapy. I’ll make sure there are no red flag symptoms[2] and prescribe physical therapy. They might push you for imaging (i.e. x-ray, computed tomography, magnetic resonance imaging), but there is no need for this yet. Imaging now would only result in exposing the patient to unnecessary radiation and increase health care spending. They might also push you for stronger pain relieving medications (i.e. opioids) but unless the pain seems almost unbearable there is no need to prescribe this. Remind them that these medications can have adverse effects, including death. This is not an uncommon thought that runs through a physician’s head before seeing the patient. Like with chess, thinking ahead is vital to the success of any clinician; a more proficient physician will have the ability to remain many steps ahead of the patient. In sports, fans almost believe the player to be prophetic in the amazing plays: does Roger Federer know that if he serves in a particular spot that his opponent will return the serve in this area, at which point he’ll run around his backhand to hit a forehand to win the point? How far ahead does he have the point mapped out?

The point here is that whether we like it or not, we should constantly be pushing ourselves to think further and further ahead. I believe that even in our daily lives the more we can think ahead, the more success we’ll have. For me this means plotting an entrance and exit strategy, for you this may mean planning out your shopping trip to maximize your efficiency.

[1] http://www.angelfire.com/nf/chess/Thought.html

[2] See my earlier post for a definition of red flag symptoms

Pediatrics

One of the aspects of my work that always brightens my day is being able to see children. The only downside of having encounters with children is that they are often in distress (thus the reason for their visit). But many visits are ‘well child’ visits: visits where developmental milestones are assessed and vaccinations are given. These visits are typically filled with a smiling child’s face (that is until ‘the shots’ are given).

These highs come with the occasional low; in fact, since my return, I have only come close to crying once while in a patient room. This came after a six year-old girl told us that her mother’s boyfriend had sexually abused her. I hate seeing a child in any sort of distress- my heart sinks whenever I enter the room of a pediatric patient who is clearly sick.

pediatrics

Why do they give us so much joy? The scientific answer is that we’re designed to feel that way. It benefits our survival to think of children as precious. In evolutionary terms, loving them as we do causes us to protect them from any harm, leading to a propagation of us as a species. My superficial answer is that I see my sons (aged 8 and 2) in every pediatric patient. However, not only did I feel this way before the birth of my children, there are also countless others who do not or will not have children; thus my argument of seeing our children in others is debunked.

When I reflect on it more deeply, I realize it’s the honesty of children that I truly treasure. Kids will tell you what is on their mind; call it naiveté, but unlike us adults, they have yet to go through the long process of becoming an adult and being taught to censor many of their thoughts or words. This honesty can also be thought of as pureness. In philosophy there is a never-ending debate over our inherent values: one side believes us to be virtuous at the core, claiming that we are all born with inherent ‘good’ values. The opposite school of thought labels us as inherently ‘bad’; according to this theory we are all born with these hurtful tendencies. Personally, I subscribe to the former theory. I have never come across a trait that I disliked that couldn’t be traced back to a learned behavior. For example, I’ve yet to come across a racist whose beliefs spontaneously form. I can always trace their misguided beliefs to some experience that led them down this path. But regardless of where you stand on this debate, you’d be hard-pressed to find someone to argue against the pureness of a child’s mind. Whether or not their values are virtuous, they are always honest in what they say.[1]

That brings me to the topic of today’s column. When Linda Frevert (one of the leaders of the Epidermoid Society) told me that many of the EBTS members are parents of children who have been diagnosed with Epidermoid Tumors, my heart sank: deep inside I knew that children were afflicted with this condition just as adults were, but I had been somewhat in denial about this reality. The thought of a child having to endure a surgery of the brain or even the diagnosis of an Epidermoid Tumor is hard to fathom. The good news of diagnosis at a young age is that children’s bodies are incredibly resilient and fantastic at recovery. I’m sure there is a plausible scientific explanation for this, but the conclusion is always the same: kids bounce back from injuries better than adults. I liken it to a sand castle. If a piece of your sand castle is taken (or broken) while you are building it, who cares? You can just get more sand and rebuild the affected area. But, if your sand castle is already completely built and your sibling decides to break off a chunk of it, it can prove very tough to rebuild.

But my despair turns to hope when hearing of children afflicted with this condition. Yes on the one hand it is horrible to think of a child with an Epidermoid Tumor. On the other hand, their diagnosis comes now when they are best equipped to recover. I often wonder how my recovery process would be different if I had been diagnosed at a young age. Thus, this is dedicated to any parents who have to endure this diagnosis in their child: just remember that there is nothing you could have done to prevent this- it is postulated that the tumor begins its formation in the womb. Also know that diagnosis now is better than later as your child’s body is equipped to recover from this, and your child will heal. Sand castles broken while building it can be rebuilt, sometimes better than before.

[1] I am a big fan of stand-up comedy, and Louis CK does a hilarious bit on children learning to lie: https://www.youtube.com/watch?v=msy__Gujljo