Communication

In medicine, we are constantly trying to make progress in the field. We achieve this through various mediums: new methods to teach medical students and residents, innovative technological procedures, and even what we call “M and M” (Morbidity and Mortality, a conference during which a case is presented and there is a discussion about what went wrong—usually a negative outcome for a patient). In these M and M’s a misstep in the typical sequence of events occurs, resulting in a poor outcome. People spend hours at these M and M’s in an attempt to decipher where this ‘misstep’ occurred. 95% of the time, mistakes can be traced back to a breakdown in communication. I recently attended a lecture at which the tragic story of Jose Martinez was shared.[1] I will attempt to give you a brief summary of the unfortunate events that led to Jose’s death (although I encourage you to read the article if you can): after being diagnosed with a heart condition, Jose underwent surgery in an attempt to help his ailments. In his recovery, a medication called Digoxin was to be administered. While the Digoxin dose is standardized for adults, it is a medication rarely used in pediatrics. Through a calculation error that was reviewed multiple times prior to administration Jose was accidentally given a dose of digoxin over 10x the typical dose. The immediate knee jerk reaction is to try and ascertain who is at fault. Who can I blame for this? The answer is not so simple. Even though the initial dosing error was made by the physician, the numerous checks in place after the initial mistake should have prevented and caught this error. The bottom line is that an improvement in communication could have averted this tragedy. Improved communication is a vague idea: perhaps if the nurse and physician discussed this dose further the mistake could have been avoided. Or if communication between the pharmacist who dispensed the medication and the receiving nurse were better, Jose would be alive today. Determining the crucial point at which this communication broke down could result in endless hours of speculation. Ultimately, it is miscommunication that led to Jose’s premature demise.

Now, this is not a novel idea: improving communication is a notion that has been prevalent for centuries. What does this idea have to do with my situation? Ironically, even though some of my communication skills were strong before this ordeal, I now realize that I have long depended on verbal communication as my sole means of communication. In today’s age there are countless ways to communicate: e-mails, texts, (snail) mail, telephone, and even Facebook. There are also more classical ways to communicate: face-to-face exchanges, interpreting of body language, and perhaps most importantly, listening. Even though my verbal communication has been hampered, this deficit has allowed me to focus on and strengthen other modes of communication. It is akin to someone who has lost their sight; in most of these cases their other senses become heightened. I hope that in my case that this ‘loss’ of verbal communication has enhanced my other modes of communication. In many ways, I consider myself lucky to have the deficits I have at this time in history. I say ‘in many ways’ because I often imagine my fate if this were to occur even 100 years ago. First off, medicine would not have been at its current stage, and if I went to my doctor with the complaint of double vision, a good doctor might have said, “Well, it’s probably a brain tumor, but there really is no way to treat it even if it is.” His (or her) empathy wouldn’t allow him (or her) to tell me that I’d simply have to wait to determine if there is progression; in essence I would be forced to await death. Let’s say for this hypothetical situation, my condition was somehow treated but left me with these current deficits; remember this is before the advent of luxuries like Internet, or even – gasp – smartphones excluding e-mails, texts, and Facebook. Even though I realize that I have suffered an unfortunate fate, part of me feels incredibly fortunate for this to have happened when it did.

I know that one article may not be able to prevent all consequences of miscommunications, however, I believe today technology should serve to bring us closer together and allow us to communicate more clearly. Even with these advances, it seems intuitive that we should become closer to our fellow man, but in reality we have become more distant from each other.  In my mind, I imagine a couple at dinner engaged not in conversation, but with their phones, sending e-mails and texts—perhaps checking their Twitter feed. Is this now the only way to communicate?

[1] http://www.nytimes.com/1997/06/15/magazine/how-can-we-save-the-next-victim.html

Juggling

This article is dedicated to a dear friend of mine, Kyle Snell. Kyle is one of my closest friends and visited me every day I was in the hospital. Ironically, Kyle is an amazing athlete, completing the Boston Marathon, twice. I call this ironic because, even though athletics used to be a major part of my life, I now even struggle to walk. Kyle is now completing a fellowship in Sports Medicine, but was once a resident physician in our program. I had hoped to practice with him. I dedicate this article to him because I often think of his situation and this analogy.

 

In life we are constantly trying to juggle. What we juggle and how much we juggle varies from person to person; for example, there are some of us that are juggling light handkerchiefs. On the other hand there are some of us who try to juggle flaming bowling pins; some of us juggle two things at a time, while others try to juggle five or six items at a time. There is no right or wrong way to juggle. For some, juggling lighter items makes life bearable, for others juggling many things at a time is the way to go. The key, like everything else in life, is to find the right balance; you need to figure out what works for you, what you can handle.

This topic is apropos due to both my recent change in situation and in giving advice to a good friend of mine. In the latter situation, my friend, who had entered into a new relationship was at a crossroads and wondered if taking the next step (i.e. marriage and children) was prudent. I gave his question much thought and came to the conclusion that adding more to his plate now may cause him to neglect something else in his life. I then gave him the analogy of juggling, which I’ll share with you; for me, this ordeal has highlighted the idea of juggling and ultimately the limits with which we ought to give ourselves when trying to undertake something new (or perhaps something old). In my specific case, ‘the balls’ I juggled were family, friends, medicine, and exercise. I did not realize this, but before my surgery, medicine was a very large, heavy ball while family (even though at the time I thought it to be a ‘large ball’) was in fact more like a tennis ball. Since the surgery I have become increasingly focused on my family; and by this analogy it would be represented by a basketball now.  

For my friend, I warned him that adding another ball to his juggling act (or more accurately adding more weight to what he is juggling) could produce disastrous results, for he may neglect something he was keeping in the air and inadvertently ‘drop it’. I had decided that for him, his juggling act was already in delicate balance and I feared that adding anything else would end up in a ‘dropped ball. I knew that for him, he always gave everything he has (and more) to whatever he decided to ‘juggle’ and that adding yet another item to juggle wasn’t a good idea. Thankfully, he took my advice and did not pursue anything further. I recently saw him and he seems happier than ever, and content with his decision.

I’ve come to the realization, however, that this juggling analogy not only pertains to both his situation and mine, but to everyone’s. We all have issues that we are metaphorically juggling. Knowing what you are juggling can help you to make decisions whether to undertake something new. That by no means implies you should stay away from new activities; just know that this juggling act is a delicate balance—as I was told “only you know what it’s like to walk in your shoes.” Only you truly know this balance and what you are capable of juggling.