Learning to Fly

Imagine you are learning to fly a very large, passenger plane. You aspire to be the captain and make the daily decisions to fly and (hopefully) land the plane. You start with smaller planes and work your way up over time. But imagine after getting your private pilot license in small 2 seat small planes, your instructor, who has never seen you actually fly the plane, hands you the keys to a 747 and says "have a nice day". He assumes you know everything there is to know about flying because you finished entry level pilot school. And assumption that will likely be fatal to you and everyone on board.

I don't want to be dramatic, but that is essentially what often happens in residency training programs where the instructors are as lost as I am. Professional medical educator often make assumptions and are so lazy they can't begin to solve the problems at hand and truly mentoring and training future medical professionals. Now I know they are all not like that. And I know many who are extremely good, but I am dismayed at the number of inferior faculty members in medicine today.

On several occasions I've been "handed the keys" without a word of education, mentoring, direction or anything resembling teaching and told to "start the engines". Nothing quite 747ish, but certainly in a class I've never flown before. Assumptions of my skills, knowledge, education, morals, ethics, decision making, memory of clinical practice guidelines (checklists to the pilot) etc have been largely "assumed" inaccurately and brushed off with a "well you went to medical (flight) school, didn't you?" I've been careful, I've plodded through each situation with care, but not without error and certainly not without trauma (to me especially). The system, at least my part of it, is very broke.

If other industries worked as ours does, the country would be in shambles. Planes would fall out of the skies as pilots, who never practiced on a simulator or in an otherwise safe environment, muddle their way through piloting encounters. Vehicle accidents, caused by police/fire/EMS driving fast to calls, would be common as drivers muddled their way through it without the benefit of an emergency driving course or similar. You get the idea. We gain expertise by mentored practice and infusion of knowledge working first in safe environments with simulators, training courses, etc. Not on people.

This is silly. This is dangerous. It was the best of time, it was the worst of times. And I have to go back to the planes tomorrow. I doubt I'll even be greeted by a hello, let alone meaningful teaching of any kind. But I'll do my best to park the 747 and not hurt anyone. Particularly me.

Public Violence

Another day, glued to CNN, watching a tragedy unfold. A small town. A small elementary school just weeks before Christmas and the New Year. There is not going to be any explanation that will make this event understandable on any level. Certainly not for the parents of one of the many children killed. The grief of the parents can't, won't be understood.

As time begins to reveal the true scope and causes much discussion will ensue about how to protect public buildings in the U.S. from this type of incident. Imagine a mentally unstable individual, dressed in camo or black fatigues, with a bullet proof vest on, armed with several weapons, gaining entry into any public building...determined to do harm. What really must we do to protect many from the one or two? This happens so quickly that even with armed officers on the premises, tragedies like this will happen.

I don't even pretend to have any prevention answers but the answer is not in gun control. We are well beyond that and this is more about people control. The real prevention must come at getting better at hearing and heeding the warning signals that may have preceded this and other tragedies. Threats, notes, comments, texts, tweets and other communications often precede such events and foretell that "something" is going to happen. Prevention is pro-active and requires investing time and resources. But it may be our best hope. Although I realize, there is no real way to totally prevent this from happening ever again. And likely it will. So, so sad.

My "parental" heart goes out to all those families who are grieving the very pre-mature loss of their children as well as those who have lost adult victims in this tragic event. CNN is reporting "closer to 30 killed at school" but it is still unfolding and the victims families are in the process of hearing for the first time that their child won't be coming home.

Brain Food

I wonder if brain food will help me get through this...

1. Fish: Herring, salmon, tuna, mackerel, halibut, anchovies, sardines & other cold-water fish

2. Soy: soy milk, tofu

3. Colorful and citrus fruits: avacado, cantaloupes, watermelon, tomatoes, plums, pineapples, oranges, apples, grapes, kiwi, peaches, cherries

4. Berries: Blueberries, Elderberries, blackberries and raspberries

5. Cruciferous and leafy green vegetables: broccoli, cabbages, kale, turnips, Brussels sprouts, broccoli, collard greens, cauliflowers, radishes, spinach, onions, red peppers, lettuce, carrots, asparagus, okra, mushrooms, broccoli and sprouts

6. Chocolate: Dark chocolate

7. Nuts

8. Whole grains: whole wheat, wheat germ and bran (folate), oatmeal, brown rice, whole-grain breads and cereals, barley and popcorn

9. Peas, lentils, green beans, lima beans, black beans, kidney beans, and a variety of legumes

10. Sage: oils and tablets

11. Spices: curry, tumeric, curcumin

12. Tea: Green and black

13. Eggs

14. Calcium-rich foods: Yogurt, cheese, milk

15. Iron-rich foods: Lean red meats

16. Complex Carbohydrate-rich foods: grains, nuts, sweet potatoes

17. Supplemental: Gingko biloba

18. Water, water, water

Here we go again. I  hope 2013 brings more sanity to this process of learning. That is of course if I survive the Mayan Mayhem and 12-21-12, 12:21:12 am and pm.

And, prayers for our country and the parents of the children killed in Connecticut. So sad.

And So It Begins, Again

I had hoped I awoke post 12-12-12 at 12:12:12 am or pm with the awareness that my world had died and I had been transported to a time and place where peace reigned through the kingdom. Nah! I'm back on a too-cramped airplane to a too-damn-small airport and taking care of patients in residency. I can't think of a more painful experience except maybe having my eyelids pealed back over my forehead. Oh wait, that happened too.

I'm not backward, ignorant or a naive trouble maker. I'm not psychotic, paranoid or anxious. I'm not angry and have no grudges. But the system I return to is broke, bad. And I hope at the end of the day, everyday, I don't hurt someone.

End of Days

End of days?? Yay!! 

The story of the end of the world is fascinating and goes something like this Cliff Note summary.  Apparently the Sumerians of days gone by discovered the planet Nibiru and they surmised it was heading toward Earth. It was supposed to make impact with earth and destroy everything, including the midnight grill at the hospital, back in May 2003 (remember that?). Obviously it never happened and I started medical school and residency. So the owners of that cosmic thought shifted the date to this month.

Why this month? Conveniently the end of days event was linked with the end of one of the cycles in the ancient Mayan calendar and the winter solstice on 12/21/12. And I for one, am thrilled about the possibility of total destruction of residency and the medical system that we know and love as well as obliteration of all past memory of failed relationships, bad meals, even worse instructors, lousy chief residents, lame exams, pimping, aging, passive weight gain, car troubles, parking tickets, famine, pestilence, war and terrible frozen yogurt flavors. We, or at least I, really need a do-over mulligan.

I have absolutely no clue about Nibiru or the end of days. NASA says the planet doesn't exist and I believe the guys who put a remote control vehicle on Mars. But I am very excited to know of the possibility of total destruction or anything that will prevent me from cleaning my bathroom one more time. Peace be with each of you time travelers. May your cosmic journey be a safe one; Because I know who's on call in the ER and it won't be pretty. 

Namaste.