A Dream Dies


For only the third time in 4 years, I am not on call for Ethics at Hoag Hospital. The first time was in April when I was on vacation in Tennessee. (I continued to take calls on my other vacations). The second time was after my surgery in August. This time is different. This time it is permanent.

I have been grieving over it for the last week, ever since I sent my letter of resignation to the Chief of Staff. I didn’t want to quit, but circumstances made it impossible for me to continue. I have been responding to consult requests since becoming the Ethics Chairman in 2015. While the volume of calls was only occasionally stressful, when the calls did come they usually resulted in 3-4 hours of work added to my day. Some cases were more demanding, and over the course of a week could result in over 15 hours of work. The reality that a call could come at any time brought additional stress,

I did not want to do the work alone, but my pleas for help were not answered. I labored on, hoping that eventually the quality and impact of my work would generate support. As is often the case, words of support came, but actual help did not.

What saddens me most is not that my efforts were not recognized, or that the help did not come. I grieve for the patients and families who will go without help, for the suffering that will be needlessly prolonged, for the conflicts that will drag on longer than they should, and the belief that I could have made a difference.

A wave of sadness passed over me when I took myself off call this evening, There is so much more I wanted to do. I wanted to have weekly rounds with nurses and physicians so we could identify potential problems earlier and provide more support for families. I hoped to train others in how to perform ethics consults, to train nurses and physicians in how to better communicate with patients and families and to educate community members in how to better communicate with medical providers. I shared these ideas to as many leaders as I could, wrote proposals and gave presentations, all of which were ultimate ignored.

I don’t like to admit defeat, but this was a fight I could not win. For now I will take solace in the knowledge that I did the best I could and the hope that God has other things in store for me to do,



A Doctor Goes Under the Knife


“154/110,” said the admitting nurse. It was the highest blood pressure reading of my life, and tangible evidence that I was more stressed about my rib-removal surgery than I thought I was. I had been anticipating the procedure for months, going from panicked, to confident, and then back to scared again. The blood pressure made it clear that I had not totally conquered my fear.

I was not afraid of the procedure as much as I was of the recovery. The surgeon had gone to great lengths to make sure I was prepared for the agony ahead. “Every breath for the first week will be excruciating,” he had told me in his office. That is a lot of breaths. (at 15 breaths a minute, it’s 151,200 breaths to be exact.)

I worried about how I would get through it. I worried how Lisa was going to get through it. She had been through over a dozen surgeries with me over the last 37 years, from wisdom teeth to hernia repairs to knee surgeries, but I had not been totally incapacitated for any of them. From what the surgeon said I was going to need a lot of help.

The surgeon had performed the procedure over 1000 times before, and I ultimately decided that all of the other patients had somehow gotten through it and that I would too. The thought was comforting, a little. When they wheeled me into the operating room I resorted to joking around with the nurses and residents as they prepared to put me under. “Good night everybody!” I said as they put the mask on my face.

My next memory is of being wheeled into my hospital room. I was hooked up to IV pain medicine, with a button so I could get more whenever I needed it. The doctor had left a catheter inside the wound to drip lidocaine continuously into the area to control the pain. Other than a pain in the muscles in the middle of my back and a terrible sore throat, I wasn’t that uncomfortable. I figured it was because the lidocaine was doing its job.

The pain wasn’t bad through the night. I hit the button a few times out of concern that it might start up, but went through more throat lozenges than I did doses of pain medication. (My uvula had gotten pinched in the surgery, cutting off its blood supply).

I called the nurse a few times in the night to help me get to the bathroom, each time feeling like a wimp and a nuisance. I was a little unsteady on my feet from the meds the first couple of trips and did not want to fall. After a few times to the bathroom with assistance, I was confident enough to go on my own, even disconnecting and reconnecting myself from the oxygen monitor. (No one said anything, so I assumed it was okay…)

I did not sleep all that well because of the throat but felt surprisingly good in the morning. I remember the surgeon had said for me to try and take deep breaths, so I took several, again thinking that the lidocaine was the reason I was not in the excruciating pain I had been told to expect. He had also said I should try to get out of bed, so I grabbed a hold of my IV pole and took a few labs around the floor. The only significant pain I had was when I sneezed while walking. The nurses gave me a few curious looks when I asked if I could walk, but told me that it was okay.

I was fearful that my backside might be hanging out of my gown and asked the nurse if it was okay for me to put my clothes on. He seemed a little leery but said yes then stood nearby as I retrieved my clothes from a bag and put them on. He hooked the bulb of the surgical drain onto my shorts so it wouldn’t dangle.

A little after 9 in the morning the surgical resident and some students came to check on me. With hesitation, he told me that he needed to look at the incision under my arm. “Okay,” I said, raising my arm so he could get a better look. He looked a little puzzled, then looked at my wound.

I told him I was doing well, that it had been over 6 hours since my last pain medication dose, and I asked him when he thought I would go home. (I had been told 2-3 days)

“You can go now, if you want,” he said, “You are doing well.” The nurse came in later to go over discharge instructions. He told me that I was doing really well and that he was surprised that I was not in more pain.

I did not realize how well I was doing until I saw the surgeon for follow up 13 days later. He told me that most patients cannot move their arms at all after the surgery. They hold the arm up against their sides, as even the slightest movement is agonizing. (this explained the resident’s surprise when I raised my arm.)

He told me I could start to drive, then laughed when I told him I had started driving two days after surgery. I then told him that I had only taken a few pain pills and that I had gone back to work three days earlier. Another laugh, with him commenting to Lisa, “This is truly amazing!” He had never seen anyone do anywhere near as well as I had, had never had anyone with so little pain.

At one point in the conversation he started to say, “This is almost miraculous!” but he stopped at the mir- It seemed he did not believe in miracles.

That’s okay. I do.


PS: As is so often the case, being a patient left me with many lessons. I have a much better understanding of the fear that comes with a major surgery. I will be more sensitive to it in the future.

The surgery resulted in trauma to my phrenic nerve, the one that controls the diaphragm. For the last two weeks I have been living on one lung. I thought I understood shortness of breath before, but realize I didn’t. It was frightening to gasp for air after tying my shoes, to feel like I was suffocating every time I tried to lie down, and to need 30 seconds to recover after walking to the living room.

My lung patients will find me a much better doctor going forward!

(Thankfully, this appears to be getting better)

Violence and Choco Tacos


I wanted a Choc Taco yesterday. It was a hot day and I was experiencing some post-operative blues. A delicious ice cream snack from the makers of Klondike bars seemed to be the perfect short-term solution to my problems. With my mission objective thus clearly defined, I got into my car and headed for the nearest 7-Eleven.

I parked near the entrance and walked slowly to the door. (A surgical complication has left me with effectively one functional lung for a while so I can’t walk fast.) I entered, and with my shortness of breath in mind stopped just inside the door to visually scan the interior for the location of the ice cream case. I quickly saw there was a Dippin Dots case a few feet away. I started to move toward it, but hesitated, thinking, “There are probably only Dippin Dots in there…”

My ruminations were interrupted by a man exiting the store. In a condescending tone he said, “Excuse me!” and brushed by me out the door. As he passed by I heard him mutter, “F---ing idiot!” under his breath.

Shocked, I turned around and looked at the man. He did have the appearance of an elitist. Bearded and seemingly in his early 40’s, he wore a plain white t-shirt and carried a skateboard. He looked back at me with obvious disdain, shook his head in disgust, dropped his board and skated away.

As I watched him go I thought, “Did that just happen?” My essential worth as a human being had just been dismissed by a middle-aged skater boy solely because I blocked the exit of a convenience store for a few seconds. My years of education, successful medical practice, work in ethics, and volunteering in church, not to mention my roles as husband, father and grandfather, were not only unknown, but irrelevant to this stranger. None of those things mattered. All he needed to know in order to pass judgment on my human value was that he wanted to walk out of a store and I was in the way. No additional data was needed for him to reach the conclusion that I was below the most basic level of courtesy and kindness. I was not a person, I was a F---ing Idiot.

As I made my way to the ice cream case and retrieved my Choco Taco (which was indeed delicious) I reflected on the way in which Mr. Skateboard illustrates the world in which we live. His hate was easily roused and rapidly dispensed. For him, the fact that he was forced to make an eighteen-inch detour was enough to render me subhuman and deserving of abuse. This is the way of the world today. Hatred is just one political opinion, one religious belief, one lane change or one offensive comment away from rearing its head. When hate arrives, evil can follow.

Recently we have seen the havoc wrought when a society ceases to believe that people have inherent value- People in Wal-Mart shot because of their ethnicity. Men working for ICE shot for doing the jobs they were hired to do. Police officers attacked and mocked by the citizens they were trying to protect. Others killed seemingly on a whim at a nightclub or county fair.

There has been much debate and philosophizing regarding the root causes of the violence that plagues us. Fingers have been pointed at video games, politicians and guns. Those who point to these things are overlooking an important truth. When a person believes that all people are created in the image of God and worthy of love, kindness and respect, no video game, politician or weapon can incite them to violence. When a person loses this belief, violence can be triggered by almost anything.

Even a man just looking for a Choco Taco.




Determining the Loser on the Bachelorette


I almost never open an issue of People magazine, but it has somehow started appearing in our mailbox every week. (No one seems to know how or why). I made the mistake of opening it this last week to read the cover article on the Bachelorette and why she had dumped the man she had “chosen” on the show. The sub headline declared her reason, “I could never marry a man who lied to me.”

In the article Hannah Brown describes her horror when she discovered that her chosen man had, at the beginning of the show, failed to disclose the fact that he was in a relationship with another woman. (She apparently believed that only the most upstanding of men would sign up to compete for the affections of a stranger on national television.) She assails the man’s character in vicious terms.

Any sympathy I might have developed for her flight quickly evaporated as I read more of the article. After describing her sense of betrayal, she went on to say how badly she felt for others judging her about something she had done. That “something” involved her spending the night with another one of her suitors, having sex with him repeatedly, and then announcing that fact on the show! (In spite of the fact that she declares herself to be devout Christian.) How dare anyone, declared the article, judge her for her faith or her sexual choices!

I almost laughed out loud at the absurdity, which was apparently lost on Hannah Brown and the writers and editors at People. In their system of values, it is a mortal sin for a man to go on a TV show and pretend to be interested in someone he had never met, but perfectly acceptable for a woman of professed faith to go on the show and fornicate with a man she barely knows. (Hannah ungraciously used another word beginning with “f” to describe her intimate pairing.)

The problem I see is in the value system Ms. Brown’s words and actions reveal, a value system based on personal convenience. She declares lying as terrible but her sexual immorality as understandable. Her sins are minor, the sins of others are defining. This seems to be the way of our world now. In politics, social media and everyday life, we attack others and defend ourselves.

The end result is that no one changes for the better.