Wednesday, December 25, 2013
Livin' in a lonely world.
It's funny how your mind can be in two places at once. The boat is bouncing up and down off the coast of Puerto Vallarta. The music blares from the speaker above my head. My daughter is face down on a towel. She writhes back and forth complaining about her stomach and the rocking motion of the ocean.
I am a world away. Sitting in my brother's room on a brown bean bag listening to the Journey album that he just purchased. It's the eighties, and I probably am no more than ten years old. We listen to the song over and over again as I commit the words to memory.
She took the midnight train goin' anywhere.
It would be the first song that I memorized all the way through. I daydreamed that I was on stage singing to a crowd of adoring fans (mostly girls). Of course, my dreams never came true. I never became famous. Yet the song stuck with me through all those years.
Just a city boy.
My daughter looks up at me quizzically. She no longer has the grimace of discomfort on her face. Daddy, you used to sing this song to me! Indeed, she is right. When she was two years old she had so much trouble falling asleep. So I would sing to her. Horribly out of tune since I have no sense of tempo or melody. And this was one of the few songs that I knew all the words to. This is the first time that she is hearing the original version instead off my warped, poorly executed warble.
All of the sudden, I feel such a strange sense of wholeness. In a foreign land in the middle of the ocean. My daydreams of singing this song to an adoring audience in a sense came true. The lines of my life have twisted and turned but somehow tied these moments together over the decades.
And my dreams are nothing like what I had imagined when I was just a few years older than my daughter is now. Yet I can't help but feel that everything happened exactly the way it was supposed to. That indeed all those disparate and disconnected moments somehow have been woven into the pattern of my life.
Looking down into the soft sparkling eyes of my daughter, I feel great calm. And I try so hard to hold on to the feeling,
because I know, in a moment or two, that it will dissipate.
Posted by Jordan Grumet at 4:49 PM
Monday, December 23, 2013
The kids have left a half finished virgin strawberry daiquiri on the small lounge table next to us on the beach. I sit with a book lilting in my hands in the mid afternoon sun. The bugs come and go. A bee sniffs around the opening of the glass. He hovers ever so gently above the sugary brew unaware that he is about to falter. He lands nonchalantly on the froth but flutters his wings frantically when he realizes that he is stuck.
And I think that this death.
One moment you are parading your freedom in search of what ever drives a little bee's mind and the next you have cancer, are in a car wreck, or tangled in death's grip disguised as a froo froo girly drink sin alcohol.
My brother is a little less jaded than I. He reaches over, grabs a straw, and gently lifts the debilitated creature from the quicksand. He places it on the table. Although its wings are fluttering maniacally, the hind legs are weighed down by cherry red globs of liquid delight. He limps along forward unable to take off, unable to escape the horror that has befallen him. My brother, chiropractor turned surgeon, dips the straw in a glass of water and holds his thumb over the top. He sprinkles the sticky stuff off the bee's legs delicately with his make shift dropper careful not to inundate the poor creature.
Slowly but surely, his nursing pays off. The limping evolves into tentative walking. The bee crawls past me leaving a trail of red stuff on the table cloth that reminds me of blood. Eventually he makes his way back to the daiquiri cup, and I'll be damned if he doesn't start to climb back up. He inches past the base and heaves himself forward over the thickest portion in the middle. His strength is building, his confidence is growing.
And then he flies away.
But in my world, in my world he hoists himself up with his last bit of strength and falls over the ledge to certain peril.
In my world, the temptation is just too great.
Posted by Jordan Grumet at 4:07 PM
Saturday, December 21, 2013
But once the wheels have left the ground, once a comfortable cruising altitude is reached, a transition takes place. Now the journey has indeed started. The initial gusto gives way to a much calmer period. The view from ten thousand feet is grand and distant. Feet haven't hit the soil. Our mind creates and modifies a future that is not yet reality. Although there is no turning back, the eyes strain to see the shimmering land below.
There is a moment in every journey, however, as the plane breaks through the clouds. There is a jarring of turbulence and then suddenly the horizon appears. After all this time, details become clear. Below are cars and building, people and roads. It is our first view of what the destination really looks like. We had an inkling before, but is was a mere apparition of a hopeful mind.
I announced almost one year ago that I was leaving my current position to start a home based concierge medical practice. The original surge of inspiration gave way to a long period of planning. And indeed, I was cruising above the clouds for so long that I often wondered if I would ever land. I broke through the clouds today. I always thought I knew what the future looked like. Now I am watching the ground rapidly approach as I begin my descent.
I will go back to the beginning. Doctor and patient. One human being trying to connect with another.
The landing gear has engaged. The flight attendants are in position.
It's time to land this bird.
Posted by Jordan Grumet at 8:08 PM
Sunday, December 15, 2013
The wheels of my car struggle to grip the powdery snow of the unplowed highway. The sun's absence attests to the premature beginning of my Saturday morning. My wife and children are asleep quietly in their beds. Most of the world is in fact sleeping. Already, my dance card is full. Between two hospitals and three nursing homes, a number of crises are brewing. By the mornings end, I will sit by the bedside as one patient dies. I will have family meetings, make critical decisions, review labs and talk to specialists.
Unlike many of my colleagues, I still practice in the office, nursing home, and hospital. Even on the weekend. Whether on call or not. I will wake up in the middle of the night. I will go to sleep too late and rise far to early. My fatigue will be interrupted by flashes of wondrous energy. Day in and day out. I have found no other way.
I consider myself a modern man.
My wife and children form the nucleus of my daily activities. I try to be as involved as possible. Dinners at home, violin practice, nightly homework all interrupted by the nagging mistress hanging on my belt loop, the wanting mobile infidel.
I write, I blog, I tweet. I use the latest in EMR technology.
I don't know how to weather the changes that are coming quickly upon us. Once I bowed at the alter of diagnostic accuracy. Now, I realize that there are many parts to effective doctoring. Shared experience, understanding, and lasting bonds are often what I think most are in search of. These things take time. Time often given during nontraditional hours. Time when one should be with their family, sleeping, or even having fun.
I don't know how to choose the way forward. I don't know how to be a guide down roads that I have never travelled. For now I will continue to make my early morning trips, my tires trampling through the unplowed snow...
Making paths where none yet exist.
Posted by Jordan Grumet at 6:53 PM
Thursday, December 12, 2013
Soni pushed her mother quickly into the building from the parking lot, she wore a strained look on her face. The wheel chair appeared preposterously large for the aged figure cowering under the haggle of blankets. They were enjoying the brisk air, taking a walk around the facility, when the elderly woman called out. Her lips curled and she moaned deeply.
Now Soni's mother had stopped talking months ago, but the devoted daughter had become adept and interpreting the grunts and groans. The sound her mother was presently making, however, was different, alarming. Her one arm was dead, lifeless from the stroke, but her other hand clenched her abdomen. She winced in pain.
Soni had a bad feeling. Something horrible was happening. She beckoned to a CNA who helped her mother into bed. I walked in moments later, completing my rounds at the nursing home. I bent over the bedside and examined my patient. Her abdomen was rock hard. Her brow was furrowed. Her breath left her mouth guardedly and fluttered before escaping. She was suffering.
I explained that indeed, something catastrophic had happened: a bad appendix, a perforated bowl, a ruptured aneurysm. Soni nodded at me as she held her mother's hand. There would be no hospital. There would be no emergency room huddle. Soni wanted her mom to die quietly in her nursing home bed. The years post stroke had been difficult and fraught with misery and dementia. Nature was asserting itself, taking back what had been forfeited prematurely.
And this was something that I was trained to do. I ordered a sublingual form of morphine, called roxanol. But of course the nurse and I both knew that it was not that simple. The miracle drug meant to keep people like Soni's mom comfortable, can no longer be given just by doctor's order. Even though the vial was sitting in the lock box at the nursing station, the dying woman writhing in pain had to wait. First a prescription had to be written and signed by hand, faxed to the pharmacy, the pharmacist than had to release the medication and issue an authorization number. It took ten minutes in all. Ten wasted minutes while someone suffered.
When confused, agitated, and in pain, the poor woman started to clench her teeth. I knew that my only choice was to go to an Intravenous formulation. An IV was already in place. But again a new prescription needed to be written, faxed, processed by the pharmacist, and a new authorization given. This time, unfortunately, I delineated the number of milligrams instead of milliliters of solution. The pharmacist made me rewrite the prescription and start the process all over again. Another half an hour was lost.
Agonizing over the unnecessary pain my patient was suffering, I begged the pharmacist to hurry up. He responded the way they always respond now a days...sorry, federal regulation!
Soni's mother died quietly in bed a few hours later. Once the medicine was released, I was able to bring her the comfort she so desperately needed at the end of her life. I wish I could have been even faster.
There is a troubling trend in the regulatory atmosphere of healthcare. Nonsensical rules are binding the hands of caregivers. We are facing ever steeper barriers to basic common sense care. Regulations meant to protect the populace are becoming an agent of harm.
Unintended consequences of silly rules, made by naive administrators, living in ivory towers.
Posted by Jordan Grumet at 5:53 PM
Saturday, December 7, 2013
@berci opened with his talk on medical futurism. He, of course, wowed the crowds with examples of mind boggling technology. What struck me, however, was between the the cracks of his technospeak was a fervent wish to enhance the experience of students and patients alike. In his own measured and careful way, his passion clearly shone through. For various reasons, he describes himself as "in the process" of becoming a medical futurist. Maybe the thing that keeps him in the present, is that age old wish to use one's talents to ease the suffering and solve the problems of others. Sounds anything but futuristic to me.
@amcunningham followed with a discussion of the benefits of twitter. Obviously, when talking of the other speakers, she was preaching to the crowd. But what her lecture really showed me is how social media allows some of us to not only amplify our content but also our personalities into the ether. In real life, Ann Marie is every bit as bubbly, sparkly, confrontational, and intelligent as her twitter feed would suggest. This ability to digitize her essence means that people around the world benefit from her kindness and knowledge. And they also consider her a friend. I certainly do.
@alancorbett8 and Mahmood Mirza teamed up to talk about social media and the doctor in training. Again, they didn't have to do much convincing from my view point. In many ways, they represent the changing of the guard. Us "old guys" who grew up in a world without twitter and blogging had to adapt. This new generation has come of age already having acquired these skills natively. Yet the changes they will face in the future will probably mirror ours. No one really knows what disruption is lurking around the corner. Interacting with these two at the conference, I had no doubt that their generation is smarter and more prepared than I was.
My one sadness of the conference was that @lucienengelen was prohibited by weather from coming. Of course, we were able to conference him in. His talk went nicely with @Berci's. He stunned the crowd by using google glass technology to take a picture of the conference room. I hope to meet him in person one day.
I was lucky enough to spend some time with @Doctor_V. Brian talked of the emergence of the public physician. What I loved about his talk was not only is he a world class speaker (in terms of style and technique) but he is truly a "thought leader". He takes disparate and underdeveloped ideas that have been swirling around my head disjointedly, and pulls them together in a coherent and clean package. I get the feeling that he is often a few blocks ahead of me in his thought process, yet he is always kind enough to wait for me to catch up.
@ArtsPractica is unique. A non clinician by trade, she devotes her time to helping physicians deal with misdiagnosis and burn out by studying art work. Her lecture had the crowd riveted for the full hour (which is no small feet since she was the second to last speaker). And believe it or not, I think most of us were just getting started. We wanted more. None of this surprises me. Alexa, in real life, is much like her lecture. As you get to know her, each layer pulled back reveals something even more interesting. I feel lucky to have met her.
There are no words to describe Ed Gavagan's talk. I suggest you look it up on YouTube or TedMed. My description wouldn't do it justice. What I can say is that he has a warm personality and a beautiful family. And one more thing. We tend to attribute his abilities and talents to the horrific and tragic events that befell him. On the contrary, I suspect Ed was always super talented. These events just happened to bring him to us.
In conclusion, I got so much from #DOTMED13. While sometimes we spoke of different subjects: technology, social media, art, and story telling. We all were trying to use our unique passions to bridge the gap with our fellow humans, to take better care of each other.
I can't think of a better way to spend a Friday afternoon.
I have tons to say about @RonanTKavanagh and @muirishouston who hosted the event but I fear it would take to long. I will have to save it for another blog post.
Posted by Jordan Grumet at 11:04 AM