The Rhetoric of -est

As Mother’s Day whizzed by and we race toward Father’s Day I am reminded of one of my favorite Mother’s Day Facebook posts (posted by a fellow Peace Corps volunteer on one of the Mother’s Days we were in Paraguay). She wished her mother a happy day and stated that she didn’t believe she needed to call her mother “best” to tell her how much she loved her.

The post made me think. It is tempting and common to say “the best mom or dad” or the “coolest” or the “kindest” or add “est” to the end of any description we’d like to use for those we love. But, if there is a “best” it implies that there is a worst and that there are many almost bests or not bests.

Ever since my colleague’s post, I’ve actively avoided the description “best” for anyone, even though it is tempting. I don’t think we need to rank humans or suggest a hierarchy as a means of showing someone we love them. I also don’t think there is such a thing as the “best” mom because no two moms are the same.

I believe language shapes our thinking and if we focused more on describing individual’s good traits without comparing them to others we might create a society with fewer divisions based on arbitrary markers and we might be more likely to recognize the good in humans. Is it a stretch to say how we talk about people will change how we view them? Maybe, but I will argue that framing theory supports my hypothesis that the words we use to describe someone shape how we view them. You can test it though. I dare you to change your rhetoric about people in your life and see if it changes how you view them over time. Try a longitudinal study over 3 years. Report back in 2022, I’ll be here.

Q-tips and Time

The road between my father’s house and school had a stretch with small, rolling hills. My father would always speed up the ups so that our stomachs would drop on the downs of the hills. One day, halfway through the hills, we got stuck behind a Q-tip (that’s what we called elderly drivers because all you can see over their car headrest is a white tuft of hair). The elderly driver was going so slowly we didn’t get to enjoy the hills. My sister and I groaned.

My father said, “Do you know why old people drive so slowly?”

“No,” I said, rolling my eyes.

“Because time is moving so fast for them that they feel like they’re moving quickly. Think about it. Each second is a smaller fraction of their life than yours or mine,” he said. “Time seems to go faster as you get older.”

I shrugged then. But, a decade and a half later, I find myself wondering why time runs away from me. I sometimes drive slowly because I feel like I’m rushing even when I have nowhere I need to be. I’ve come to understand what he meant—each second that passes makes every subsequent second a smaller fraction of my life. Funny that time, that constant meter we trust to measure and organize our lives, feels so inconsistent.

Peppermint Patties

When we were young, we usually went grocery shopping with our parents. When my mom took us, we were always allowed to pick out a treat at the end to enjoy on the journey home. My sister and I always mixed up what we got—sometime chocolate, sometimes liquorish, sometimes something completely different. My mom always got a peppermint patty.

Since becoming an adult, I usually grocery shop alone. I almost always get myself a treat for the trip home. I still mix it up, but when I can’t decide I get a peppermint patty.

Not so long ago, I visited my sister in New York City. She’s lived there many years. She and I are still very close, but our lives have taken divergent paths. We grow more different as time passes. We went grocery shopping for snacks during my visit. My sister paid. When we checked out, she grabbed little peppermint patties for each of us. I guess she chooses peppermint patties too. It made me smile. We are different and similar, nothing will change that because we have too many shared roots.   

On Flowers

I love flowers. They are beautiful. They are transitory. You usually can’t eat them and they really have no practical purpose. They brighten a room.

The moment flowers are given to you is always special. The moment you buy your own flowers is a personal reward—a reminder that sometimes it’s okay to just enjoy some color without reason. Giving flowers is like giving someone food…expressing caring without giving them another material burden they’re expected to make room for in their home. Some complain that flowers, because of their short lives and lack of function, are pointless. I disagree.

I’ve found that the best things in life—passing time with family and friends, a hug, a kiss, solving an annoying problem that’s been nagging you, uncovering what is ailing a patient, baking the perfect cake, enjoying a mountaintop view, for example—are all short-lived. There’s something in the requirement to be present or you’ll miss it, to live the moment and know you’ll never get it back, that makes these things special. Flowers make you pause and be there with them for a short time. They require that you make time, even only moments, to see, smell, and feel them. They let you feel appreciation, love, and gratitude for just a fleeting moment. A fleeting moment is better than no moment. In fact, life is made up of fleeting moments. Why not let them include flowers?

The Snowy Paths of the Brain

Imagine a scenario in which there is a steady snow. In this hypothetical, the snow never stops and it has already accumulated several feet on the ground. In this place you have a house, a barn with animals, and a woodshed.

Imagine it is a day filled with the regular chores of a house and barn in Vermont. The first time you trudge out to the barn in the morning it’s hard to blaze the path through the thigh-high snow, but as you go out again and again—to feed the animals, to give them water, to collect eggs, to clean out the stalls—the path becomes more packed and easier to travel with each pass. Even though it’s snowing, the path between your house and the barn stays well-groomed because you travel it so often.

Now, imagine you have to get wood for the woodstove. You start down the well-defined path to the barn and, then, veer off into the snow to go to the woodshed. The first time you go to the woodshed, it’s a tough slog through deep snow. Subsequent trips are easier. You only need to get wood once over the course of the day, even though it took you many trips to get it, so hours after collecting the wood the trail you made is starting to disappear under fresh snow. By bedtime, the path has completely disappeared because you didn’t retravel it that day.

The pathways in your brain are like the trails between the buildings on the snowy property described above (credit for this analogy goes to my anatomy and physiology professor this semester, Dr. Matt). As children, we are building many pathways while at the same time eliminating unused pathways. The amount and rate of forming new pathways and connections in the brain slows with age but, even when we’ve lived long enough to be wise, our brain continues to reshape itself. The formation of new pathways, strengthening of others, and pruning (eliminating) of infrequently used routes in the brain is called “neuroplasticity.”

Neuroplasticity, the resiliency and reshaping of our brain, is one reason researchers worry so much about children who don’t have access to many learning opportunities or live is stressful family situations. These experiences, or lack of experiences, shape the children’s minds for the rest of their lives. It’s easier to be ready for the learning done is school, if before you start your brain is used to hearing stories and practicing words and math. It’s easier to be ready for more school and job responsibility if you were lucky enough to master elementary school. It’s easier to know how to be confident, happy, and kind if you’ve experienced those things many times.

Neuroplasticity is also part of the reason why drug addiction is considered a disease and is so difficult to beat—drugs can change the pathways in our brains. Once someone is addicted to drugs, their brain is literally wired to want, seek, and (even) need the drug to function normally. It’s hard to avoid a path you know well and that has become central to your existence. For example, how often do you change the route you take to work everyday?

Neuroplasticity is also more general in a way I find inspiring. To me, it’s evolution’s way of giving us one more reason to be hopeful. The idea that we can reshape our brains if we’re will to trudge enough times to forge a new connection is awesome. It’s also amazing that if we try hard enough to stop using a pathway, it will weaken. This gives us fantastic opportunity for life-long learning and self-growth. It means we can train ourselves to understand new things, act differently, and even alter our response to specific situations. It means that we can discard habits and build new ones if we are willing to put in the energy to tackle the snow of our mind. Life isn’t static and I find it inspiring that we (individuals) need not be either.

What You Look for Is What You Find: Look for Strengths

Not so long ago a friend and I were discussing our workplace culture, the individuals in it, and how the people scheduled to work on a particular day determined how hard the day will be (because some people work more than others). It was a discussion after too many hard hours; we were tired and burnt out. We started spiraling down the path of complaining about everything. Halfway down the trail, I paused to remember that all things are a matter of perspective.

It is easy to complain about coworkers. To gripe how so-and-so doesn’t do or know enough or how they make our work lives harder. Sometimes all we need to do before we can move on is vent, which is productive, while other times we get caught fixating on what makes a particular person terrible, which solves nothing.

I believe anyone can change, and everyone does, but only when they want to change and only when they’re ready. As such, we each can defend ourselves and what we believe in, but expecting others to bend to our will is futile for enacting change in my view. I have NEVER seen anyone work harder after I wished they did. On the flip side, I have seen people work harder when complimented on what they do well and asked to join in the fray when they were surrounded by good examples. This is where perspective comes in. Before you can complement a peer or ask them to do something you know they’ll do well, you must know their strengths. The only way to notice strengths is to look for them, which requires quite the opposite type of astuteness used to identify weaknesses. 

We can’t avoid noticing when others seem to be slacking while we are working too hard. But, as we muddle along, we can also strive to notice if those same slackers do a particular thing well. Once you notice a strength in a peer, you can look to and rely on that person to step up in situations where their strength is vital. This is particularly helpful if their strength is a weakness of yours or if they like tasks you dislike because it transforms a colleague that you found difficult into a resource. We are stronger when we play off each other’s strengths, rather than focus on each other’s weaknesses. Of course, noticing strengths doesn’t negate the wearisomeness of having to pick up another person’s slack or negate a personality clash, but it does lighten the burden and give us an avenue to find common ground. You will see what you look for, so I strive to look for the good. When I get derailed, I vent and, then, try again. Usually, I can find something wonderful within any human. I bet we all can if we try.  

Why I Go Back for Each Shift

Not long ago, I walked into an emergency department room (a cube defined by some walls but mostly curtains) to place an IV. An elderly man was on the hospital stretcher. He was there with his son. I began my normal banter—introducing myself, explaining why I was there, and narrating what I was doing as I went. The man might have asked me about my name, about 30%-50% of patients do because it’s unique. He might have asked about my necklace, it’s a wolf and about 25% or so of my patients ask about it.

“I’m going to raise the bed so I don’t have to stoop,” I said. “I need my back for many years to come.”

The patient and his son laughed. “You know what you need, music. Do you listen to music?” the patient asked.

“Not here, it’s not the right place. But, I like to dance, so I do listen to music,” I said.

“My wife liked to dance. She died a year and a half ago,” the patient said.

“I’m sorry to for your loss, sir,” I said.

“We were together 60 years,” the patient said.

“That’s amazing! I don’t think I’ll be with anyone for 60 years at this point. Did you take her dancing?” I said. I maintained a jovial tone because he seemed merry when he mentioned his wife and dancing.

“I did,” the patient said. I looked down to find him crying. I paused and put a hand on his forearm. Giving him a squeeze. I’d recently visited my grandmother. A big part of our visit was discussing how my grandfather, who’d died 2 years prior, was still with us.

“How lucky she was to have you take her dancing! How amazing it must have been to have had so many years together,” I said.

“Sorry, I always cry when I think of her,” the patient said. He half-shrugged and looked away.

“It’s okay. She’s with us still and you’ll see her again, sir,” I said.

“I hope so,” the patient said.

“I know you will,” I said.

The patient and his son nodded. The tears ebbed. I placed the IV. All humans have stories. Sometimes they find space to share them when they visit us in the emergency department.   

The Sunny Side

Last week I flew to Chicago for my last (most likely) medical school interview. I had the window seat on the plane and, surprisingly, wasn’t sleeping as we approached Chicago. I was excited to spend 24 hours in the city and get a feel for a place I hardly knew. I gazed out the window as we started our decent.

Before we decreased our altitude, we zipped along above the clouds, through a bright blue sky with sparkling sun. A thick layer of clouds was below us. The view of bright blue above white divided by shining sun rays conjured images of every version of “seeing the light” imaginable—end of the tunnel, heaven’s gates, nirvana…to name a few. The clearness and stark lines between the blue and white were beautiful.

Slowly, the plane’s path dipped so that we began to approach the clouds. We must have been far above them because it took us a while before we got close to the wall of white. I knew the clouds were a penetrable, gaseous/small particle entities, but they looked solid and impassable. We approached them quickly, and soon the sunny view of blue was obscured and the windows were masked in white. We were in the middle of the clouds and there was nothing to see.

Our journey continued rapidly and, in no time, we were below the clouds, a snowy and gray scene was visible below us. The sun seemed to have vanished, leaving a stark winter city scene. There were no leaves on the trees and the buildings added to the gray of the air between the land and the clouds. It looked cold and brooding. If I hadn’t just observed the sunny blue above I wouldn’t have known it could exist in the same place as we now were.

I smiled as I stared at the houses and streets, a bird’s eye view of the cityscape. I guess it’s just a matter of knowing where to look to find the sun. I held the vision of sunlight within me as I caught the train from the airport to where I’d spend the night before my interview and school tour. I’d been nervous before starting my trip, but I wasn’t anymore. I felt lucky.

Mental Health and the Emergency Department

Checking into the ED for a psychological complaint

When a person comes to the emergency department (ED) with suicidal thoughts or another mental health state that could be a threat to themselves or others (ex. extreme paranoia, homicidal thoughts, mania, etc.) the processes is simple. They change into paper scrubs and their clothes and belongs are locked in a secure closest, returned upon their discharge from the hospital. A hospital staff member sits outside of (or just inside) the person’s ED room conducting constant observation—which includes observing the patient at all times and recording their location and general behavior every 15 minutes. The constant observation is to ensure that the patient does not try to hurt themselves, try to leave, or try to hurt anyone else during their ED stay. Many people who check in for psychological evaluation are not allowed to leave the hospital until their mental condition has been cleared by a psychologist, meaning they are forced to stay in the ED until a doctor says that they will be safe returning to society. Patients suffering from psychological conditions that require more treatment than the ED can provide remain in the ED until a bed in a specialize treatment facility (or in the hospital psychology unit) opens.

One way to define “a national mental health crisis” in the US

When I think of a mental health crisis in the US, I think of all the people stuck in the ED waiting for a psych evaluation and then waiting for a bed in a facility that specializes in psychological treatment. I think of the patients who remain on lockdown in the ED for 100s of hours because if they leave they might knowingly or accidentally hurt themselves or someone else. These patients have no other safe place to wait for an in-patient bed. I think of the people who come to the ED and, even under the watchful eye of our staff, try to kill themselves. I think of the people who end up in restraints, literally tied to a bed, because their condition escalates to the point that they try to escape, attack hospital staff, or harm themselves. To me, the mental health crisis in the US is that we don’t have enough 24-7 services and specialized treatment facilities to keep patients with mental health conditions out of the ED. To me, mental health is just like any other aspect of health. We need to bolster our programs to help prevent acute mental health problems, but we also need adequate mental health treatment programs for those struggling with psychological conditions. The crisis, I think, is a lack of preventative care and readily available treatment, not the existence of diseases.

The ED does welcome mental health patients as we do all patients, but the ED is not equipped to find long-term solutions for any health condition. It is true that the ED can help with acute symptoms, which is all some patients need for a short period of time, but we don’t have a calming environment nor do we have the staff to provide intensive treatment for mental health conditions. We serve as a gatekeeper to specialized treatment and as a place to go when there is nowhere else to go. Just like the ED is not an appropriate place to perform and recover from surgery, it is not the right place for those who need in-depth evaluation or long-term treatment. The ED was designed to keep patients for ideally a few hours or, at most, for part of a day before sending them home or to an in-patient facility. But, what happens with some of our gravely ill psychological patients is that they must stay in the ED for days, even weeks, because there are no openings in specialized facilities.

Conclusion

Using the ED as a long-term home for people suffering from psychological conditions is neither therapeutic for them nor is it a cost-efficient design of the health care system. We need more mental health treatment facilities in the US. We need more programs designed to help those coping with mental health conditions manage their symptoms at home. We need more people going into the psychology fields and social work. In summary, we need to dedicate more resources to mental health in the United States. I think to do that we need to start by acknowledging how many people struggle with mental health and how weak or absent our treatment options currently are for those people. Next, we need to make mental health a budget and policy priority at all levels of government and in private health care systems. Right now, EDs are serving as the catch-all. They are not the solution. While the ED might be the right place for folks in any kind of acute health crisis to go initially, the ED only works if there are specialists and specialized facilities to refer our patients to once we’ve identified the sustained medical care they need. It’s times we prioritize mental health as we have heart health, lung health, and cancer-free health so that no patient is held in the ED because they have no other safe place to go.  

Closing 2018, Opening 2019

If I had to pick one word for 2018 it would be “success.” I finally got a job taking care of patients, this officially marked my transition from a communications career to a health care one. With each passing day, I grow more certain that I’m headed in the right career direction. I finished my pre-med requirements, took the MCAT, applied to medical school, and got into several medical schools. I made some awesome new friends and visited some of the best long-term ones. The farthest friend visit was to my beloved Paraguay (I also visited friends in DC and Atlanta).   

This New Year’s finds me at a crossroads. In the coming months, I will decide where I will go to medical school. I feel incredibly lucky to have options, especially because I only applied to schools about which I am excited. The cost of school and if I should move to a new state weigh heavily on me. Starting the next chapter in the doctorhood quests is simultaneously overwhelmingly exciting and completely petrifying. But, change and moving are nothing unusual for me.

Earlier this year, I wrote about “name the fear and conquer it” as my general approach to life. A huge part of that is identifying when I’ve fallen into a mindless routine and, then, breaking that routine. I’m the type who as soon as they learn something new looks for how to become better and how to expand my knowledge. I think this trait will serve me well in medical school. It’s served me well in everything else I’ve tackled. But, as I think about these traits and the exciting goals that are coming to fruition this year, I find myself thinking that my biggest New Year’s resolutions have little to do with my career ambitions and a lot to do with the rest of my life.

I have high expectations and hopes for myself as I begin medical school, but I know I will put my best self forward in pursuing those regardless of my New Year’s reflection. Therefore, as we slide out of 2018, my New Year’s resolutions are to focus more on relationships and adventure. In that vein, here are my top 5 resolutions:

  1. Do a better job of staying in touch with old friends, family, and contacts even in the midst of school mayhem. This may include taking more time to visit friends who live far away, writing letters, texting, emailing, or social media-ing.
  2. Focus on developing new friendships. The challenge for me is always ensuring I leave enough time to spend with friends even when school work crescendos.
  3. Travel outside of the country, to a new place, at least once in 2019.
  4. Travel or visit somewhere new (even if it’s a day/partial day trip) at least once a month.
  5. Join some initiatives/groups that don’t directly relate to my budding career in medicine. Ideas I’ve pondered before or relate to interests I have include: joining a gym (I currently workout at home), ballroom dance classes/club, hiking club, book club (currently in one), or writers’ group; taking a yoga or martial arts class; becoming a youth mentor; and/or joining a choir.

Besides the New Year’s resolutions, I plan to continue my daily struggle to smile more, see the best in people, and be the kindest person I can be. I wish you the best of luck in 2019—I’ll be taking it one day, one week, and one month at a time. Happy New Year!