Intelligence and capability are not enough . . .

. . . There must be the joy of doing something beautiful
– Dr. Venkataswamy, founder of Aravind Eye Hospital in India

This is an ophthalmologist who realized the vision to apply McDonald’s model of efficiency to eye care by founding one of the most profitable eye hospitals in the world that restores vision to 1.4 million people a year. Its an amazing story from a book I am reading these days called “Fortune at the Bottom” by CK Prahalad which I highly recommend. It really debunks the idea that caring cannot also be profitable or that innovation in business models and high technology should be reserved for developed markets.

Medicine that makes you go “wow”

You know that feeling in life when you watch something so amazing, you get goose bumps? Like an artist painting an image, a musician playing a sad song. Today, I saw something truly beautiful in medicine.

During our team meeting, my attending psychiatrist, Dr. C interviewed a patient. The patient, Fred was a small but intimidating guy who looked like his job as a logger suited him perfectly with the stocky build, coarse dark skin, dull grey eyes and a rugged black beard. The interview with Fred started pretty regularly, “how have you been sleeping? are you feeling safe?” but then Dr. C asked about what stopped him from hurting himself the last time, then asked about his family, his wife and child in California . . . After a few exchanges about his son, Fred paused for a minute and looked down. He looked choked up. “You got choked up for a minute there Fred, are you thinking about your son?” He nodded. “Do you miss him?” He nodded again. “You want to be a good father to him don’t you?” Now there were tears in the corners of Fred’s eyes. “I know how hard it is not to be with your son” Dr. C said. “I want you to know how much I appreciate your willingness to talk to us. Its not easy coming into a roomful of people and being able to show your emotions. Thank you Fred” And with that, the interview was over.

And just like that, the interview was over. No more than 10 minutes had elapsed. Not a pill nor shot had been administered, nor a drop of blood taken for a test, and yet the entire room fell silent as Fred walked out of the door and back onto the unit. For Fred, the healing process had begun . . . and I was getting goosebumps . . .

back from greece!

Good to be back home!

Btw, www.millhouses.gr is like the best hotel I’ve stayed at

Gorham pics

Of course, a couple months late, pics of northern NH. Beautiful place . . . considering its in the boonies

So boonies here, they can’t even spell Hillbilly right

On the border with Maine at sunset, its not the ocean but ain’t it beautiful?

Mt Washington . . . I climbed that sucker . . . in my car :)

Gorham, not much there but at least its green and pretty.

Judgement

Just woke up from a fun night on Thursday my last call night on Surgery. Had a full day in the OR, still working on tying those knots under Dr. Liu’s watchful eye. Made it to Dr Z’s guest lecturer talk by Ross Jaffe, another one of those guys that one could perceive to “have it all”. He’s an MD/MBA, was an internist and founded Versant Ventures which now has $1B under management (with 11 other GPs, this means he probably pulls in $1mil a year in salary plus 2% carry so probably gets a payday of $50-70mil every 10 yrs). Dr. Jaffe said something that really resonated with me. He said that people ultimately get paid for 3 things 1) Skills 2) Analysis 3) Judgement of which judgement is the most important thing (and what he iterated to me that should be a reason for me to pursue residency instead of stopping at the intern year.

As I left with those words for my last call night at DHMC, I saw again how judgement makes a big difference in the ED. A 30yo guy who was partially ejected in an MVC came in with what turned out to be a really bad laceration in his spleen and was bleeding to death in his belly. We took him to the OR and as soon as we opened his fascia, he started gushing blood out of his abdomen. We ended up sucking 4L of blood out but fortunately found the lac in his splenic and short gastric arteries and tied them off (I hope he makes it). The other fortunate thing was that Dr. Burchard (one of the best teachers I’ve met here incidentally) was on call and was able to make the right judgement to take him to the OR immediately after the FAST scan (ultrasound) of his belly showed fluid for immediate exlap. In this age of testing and data overload, another physician may have wanted to waste precious minutes by taking him to CT scan risking the possibility that he would bleed out.

I guess the moral of the story is really that in an age where “evidence based medicine”, hard sciences and technology seem to rule the day, the truth is that the soft squishy qualities like good judgement, common sense and deciphering what is important and relevant are MORE not less important.

Positive Override!

Malcolm Gladwell’s Blink talks about a couple of states of mind. Positive override vs negative override. Positive Override is where you are generally happy and anything negative is just a fluke that you roll with and Negative is the opposite where you are generally miserable and anything good that happens is just a temporary run of dumb luck that probably will go away.

Today I find myself DEFINITELY in positive override! I won’t overanalyze but I think its a combination of things most important of which is that I am REALLY loving it at Dartmouth these days especially after being back from my “away” rotation at Children’s Hospital of Orange County in California and seeing what it is like in the real world of medicine where interns are too busy to learn and told to spend LESS time with patients to be more efficient and doctors generally are rewarded for efficiency, not critical thought or patient care. The management and rewards system there is definitely messed up!

Contrast that with Dartmouth where we spent a whole day on talking and reflecting about Death and Dying with our Associate Dean who happens to be a practicing oncologist trained at MGH with 30+ years of experience talking with patients. And today got to watch Hillary Clinton come to DHMC and give an excellent talk on healthcare (btw, I think she won my confidence today for candidate most informed and capable on improving healthcare in this country). Then proceeded to interview a former drug user who has turned her life around as part of our substance abuse discussion today. Btw, I think I am going to be really good at psychiatry.

Anyway, besides that, I am really happy to be around my classmates and friends who love and support me. Just found out that one (and probably another one) of my classmates is sticking around for an extra year and will probably be graduating with Jane and I which will be great!

Today I feel like I am learning, growing as a person and feeling very happy with my life and relationships. Its a great feeling!

Hope everyone else is doing well too!

From the top of Mt. Washington to the Block at Orange

I am such a city kid. Just spent the day walking around with Jane at the local mall here in Orange County, CA. Its not a great mall even but just walking around, buying churros from the food court, seeing what movies were playing and people watching was so much more comfortable and fun than being at top of whats considered one of the finest sites in the Northeast, Mt Washington where I was last week before I left Gorham, NH. Definitely tells me I will be coming back to Cali one day.

Not much has changed except everything

Crazy, just saw Nacho who went to Taipei American School with me for the first time since graduation in 1996. Its been 11 years! It was great to see him but just amazing to me how time can really stand still for 10 years. Its crazy how you can have an intense shared experience like going to high school with someone then lead totally different and mutually exclusive lives and when you see that person again, it can be just the same as it was before. Anyway, cheers Nacho to your kid and life in the suburbs.

Oh yea, it was good to see Monica and Max too (but I’ve seen you guys more recently than 10 years) :)

Contemporary Chinese Art?

Pretty funny. I went to an opening of Wenda Gu’s Exhibit (www.wendagu.com) at the Hood museum today. Basically this guy who calls himself one of the original contemporary artists to come out of China (was even banned by the Chinese government) took Tang poems and translated them to English, retranslated them into Chinese again except incorrectly so the strokes were backwards and extra radicals added etc. The point is that in the process of “bridging cultures” nothing can be precisely interpretted and authenticity is lost/created/recreated. Not particularly creative in my mind and not as interesting as actually talking to the artist who was pretty vague about modernity, postmodernity and culture but lucid about markets, which markets are more developed for art, who his leading competitors are and how many studios he had. He even compared himself to Walmart saying that his production base is in China (low cost and better craftsmanship) and his “creative center” in New York.

What was funny to me was that while his art was contemporary, the business of buying and selling is as ancient a tradition and as authentically Chinese as can be.

Freedom and Belonging

Just got back from a Sonny Rollins concert. Seriously, one of the best parts of being here are the $5 concerts with legends like this man.

Its special. I want to be doing something I love at 77.

Anyway, its amazing how good music can really help you let go of the day to day stresses and worries and remind you of the real good stuff. For me, it really comes down to freedom and belonging. Freedom, like walking along Ocean Beach from the bottom of the alphabet up toward the tip of Golden Gate park and going along PCH to the Sutro baths to watch the sunset. Belonging that feeling of camraderie of being out with the guys driving on the highway with the windows down on a cool summer day. Damn I love the ocean.

Note to self: figure out how to get closer to the ocean! :)