Medicine: The Science and the People

The Quad, UChicago

Friends, have I told you all lately how much I love my work?

Nerding out over the science is just so fun, even more so because I don’t have to be the one doing the research. I just get to benefit from it! That we can know the chemical mechanism of how hemoglobin’s oxygen affinity changes with altitude, how sodium and calcium channels work in kidney and muscle cells, and how caffeine and adenosine affect the brain–how amazing is that? And that neuroscientists like Adrian Owen have figured out how to communicate with locked in folks by putting them in a functional MRI machine, asking them yes or no questions, and having them answer by imagining either playing tennis or walking through their house–I mean how crazy awesome is that?? And did you know the father of modern scientific surgery started out as a body snatching anatomist? 

OH the science, I just get giddy about it–pretty much daily!

And in the end, it’s still about helping people–helping the person in front of me right now. The best way to do that is to apply all of that vast knowledge and expertise to the human I’m with today, in their current circumstances, phase of life, and psychophysiologic state. I get to take all of the science I can possibly comprehend and use it to help you, the unique individual. *sigh* *gawk*

I cannot do any of this without knowing you. How do I know you? I query and observe. I attune and attend. I stay quiet, I listen, watch, feel. I try not to interrupt. I ask open, honest questions, and I wait for you, your whole self, to emerge. I look and listen to understand your experience from your own point of view. I do my best to self-regulate, and not project my own judgments and prejudices onto you. It’s so much all at once–I have to be slow and quick at the same time, hearing, seeing, retaining both your output and my own processing, holding it all to let out with appropriate filters and timing–and I love it all!

You know your body and mind (to the extent that you can). I know the body, some of the mind, and a lot of science (as well as I can). You know some of your own patterns, I know some patterns from thousands of patients seen over twenty years. We can, together, apply our collective and collaborative knowledge and awareness to your current context, in service of moving you toward your goals. Only you can decide what actions are worthy of your time, energy, and resources; only you can reassess and alter those equations.

My wish for you is to have the fewest possible regrets at the end of your life, whenever and however it happens. How can I help? How can the science help? How can it not? How can science actually make it worse? 

Medicine is the practice and discipline of lifelong learning of the science, yes. And its core is about caring for people. We make the journey together, my patients and I. What do we share? Here’s my list:
Information
Interpretation
Responsibility
Respect
Privacy
Relationship
Power
Agency
Decision making

We are humans in relationship–with ourselves, with one another, with our environments. It’s all so much, so dense and complex. And yet in the room with you, talking with you, examining you, I can usually distill to one or two central concerns and objectives, for now and the future. It’s gratifying for us both, and it keeps us connected, strengthening our relationship over time and shared experience.

I can hardly think of a better way to spend my professional life.

“What’s Your O-Ring?”

I grew up with this image on the wall.

Preventable disaster.

Space Shuttle Challenger has been on my mind lately. Last week Hector Carrillo did a live recording from Florida, experiencing cold temperatures there like the rest of the country. I attended six nightly online creativity workshops organized by Erin Mallon, narrator, writer, and podcast host. I now feel a familiar, swelling creative energy akin, in my metaphorical mind, to that housed in solid rocket boosters. Talking animatedly with Friend Donna the other day, I brought up Challenger and she asked me why, for such joyous and productive excitement, I choose a metaphor that’s one of the greatest tragedies of a generation?

Huh. Fascinating.

At first I thought it was just because Challenger was such a quintessential and iconic image of the space program in general, and growing up with rocket images all over the house [Ba worked for Lockheed Martin on the Shuttle Payload Integration Contract, he told me tonight when I requested a photo of the photo from home], I just pulled on those memories as convenient analogy. I had not ascribed any conscious meaning or relationship to the shuttle’s ultimate demise. I was ready to shrug off Donna’s question as peripheral to my creative journey. She prodded me gently, though, to engage some cosmic curiosity and explore further. Speaking of comic: Today, January 28, is the 38th anniversary of the Challenger explosion in 1986. 

For those too young to remember, the night before Challenger launched from Cape Canaveral that January day, temperatures dipped far below freezing. Engineers at Morton Thiokol, manufacturer of the O-rings that served essentially as gasket seals for the rocket boosters, advocated strenuously to delay the launch. They knew that temperatures that low would stiffen the rings, making them contract and fail, causing fuel leakage, uncontrolled combustion, and inevitable disaster. Bob Ebeling sounded the alarm first. Despite his and his colleagues’ presentations and advocacy, NASA elected to launch, and seven amazing people lost their lives.

Eventually Donna and I got to the bottom line Challenger question for my creativity and writing: ”What’s your O-ring?” OH, SO fascinating! I spent the next 24 hours and a good portion of my morning pages (21 consecutive days as of today) yesterday processing… I bet more insights emerge this week and beyond. Thus far it’s mostly more questions and a few vaguely related ideas, that apply to more than just my book project:

Where is there vulnerability where stability is assumed and taken for granted?
How can I detect it? Where are alarms sounding that I ignore because I don’t want to delay something that I want or expect? What realities am I denying to advance an agenda, but that put that very agenda at risk for abject failure because I deny them?

Booster energy as book energy: What happens when it leaks or emits inappropriately, and under which circumstances? What would that look like? Is it already happening?

Conditions and consequences: The parameters for normal function in the body are remarkably narrow. I have always marveled at how a person can not only survive, but function highly for prolonged periods, with multiple systems operating wildly outside of those parameters. Nature compensates automatically, elegantly. But there is always some cost, and compensatory mechanisms can only last so long before the system crashes. So for my writing, what are ideal and acceptable conditions for creative work to occur and thrive? How can I establish and maintain those conditions, monitor for derangement, and adjust accordingly? What costs are worth paying, for what reward and value, for how long? How can I know when I need to delay or even abort? 

The O-rings were only one part of a highly complex and integrated machine. Each part of any system has its own unique parameters of function, and is also inextricably linked to every other part. Derangement and compensation in one part inevitably affects the whole of parts in predictable and yet nuanced ways. How elastic is each part’s accommodation capacity, within and outside of its normal functional range? When function is impaired, what complex domino effect does that create, with what consequences for the whole system?

This post feels oddly satisfying in its total lack of conclusion. Truly, I can live the quesiton(s), as Rilke admonishes so eloquently. I look forward to what insights emerge in time, especially as I continue to release streams of consciousness in writing each morning. This week I will practice letting go of attachment to outcomes, and attend to habits that make my desired outcomes of high creativity and connection more likely: bedtime, morning light and writing, regular exercise, sitting with uncertainty.

Let’s see what happens!

Bit Post: How to Get Me There

The loving space

OH how I hate these conditioning workouts.

And yet here I am, on the other side of another one, feeling *AWESOME* in spirit and absolutely spent in body.

I sign up only partially wanting to come. I still have the “I should” voice, which I appreciate and continue to reframe as “I know I will thank myself later. I will be glad that I did it. STRONG OLD LADY!!”

But the catalyst that gets me past the activation energy is the people. I know the coaches; I know they are here to encourage, to keep me safe, and never to judge. I may or may not know my classmates, but they are reliably friendly and welcoming, and we all follow the coaches’ lead, leaving any and all judgments at the door.

They say that how we treat ourselves underlies how we treat others, and we are generally kinder to others than to ourselves. So being in this space, where others are so kind to me, coming here regularly, teaches me to strengthen my body and soften my self-talk.

Melissa taught me the five factors that keep kids in sports; they are the same factors that keep adults in an exercise program:

1. It’s FUN
2. Our friends are doing it
3. We feel like we fit in
4. We feel competent, like we know what we’re doing
5. We feel we are making or can make progress

Generally I think if we have three or more at any given time, it may be enough to keep us going.

At Ethos I have all five. Well, today not the first one. But the other four, absolutely, no question, in spades.

There are simply not enough words for the gratitude.