La Casa de Salud

"Hormiga," said the young Guatemalan girl as she grabbed my finger and pointed to an ant on the ground.  "Yerba," she said, pointing to the grass. Having recently arrived in the country, I was wet behind the ears and scared to death.  Only 19 years old, I decided to serve a mission for my church for two years.  It was my first Sunday in the country and though I studied Spanish in school for 5 years and intensively for eight weeks prior to my arrival, being in Guatemala seemed to be a whole new game.  Everything came much quicker, words seemed to be all joined together and I was having a hard time understanding what was being said.  While my companion, Elder Castellanos (a guatemalan himself) was speaking to the leader of the congregation, the bishop's eight year old daughter tenderly took me by the hand and taught me words in Spanish.  Her acceptance of me, a foreigner in her land, warmed my heart.  I immediately grew to love the people of Guatemala.  I later had the opportunity of working with Mexicans, Dominicans, Puerto Ricans and others.  It was during these two years as a missionary that I knew that I wanted to pursue a career as a physician.

Having done well in school and loving the challenge of solving problems, I Initially studied to be an engineer in college.  During my mission years I came to desire to be in a field where I could interact with and bless the lives of others as well.  There were many times when we would visit people in hospitals who were sick and I enjoyed my efforts to be of help.  I began to think of being a doctor and on returning home, I changed my course of study and pursued medicine as my career.  After completing my residency training at Barnes Hospital here in St. Louis, a friend of mine introduced me to a fledgling Spanish speaking medical clinic called, "La Clinica."  It was held in the bottom of a Methodist church.  Though primitive, it grew into a respectable organization.  Unfortunately when the economy took a nose dive in 2007 the funding dried up and the "La Clinica" was no longer viable.  In its place came "Casa de Salud" (translated Home of Health).  St. Louis University has been a generous sponsor and I have continued to be a volunteer physician as before.

I view these efforts as essential to my overall development as a person, as an essential part of my health, really.  I don't really give that much.  I am only there, a few hours, once a month, and I share the knowledge that I have been blessed to acquire.  In return, I am showered with appreciation, compassion and care.  I can see in the patient's eyes gratitude for my efforts.  I feel wanted and that perhaps I am making a small difference in another's life.  Doing so without being payed monetarily changes the interaction dramatically.  I find that as I give of myself, I leave with more than I had before.  Sure there are days when I am already exhausted and I don't relish the thought of driving down and extending my day  but once there, my spirits rise and I leave refreshed.  At some point in my life when my children have all left the house, I will probably increase the time I spend at the clinic but for now I keep it simple, I try to stay balanced.

The image of that sweet Guatemalan girl is never far from my mind.  Last week, I put my daughter on a plane as she begins a journey to Brazil.  She too has decided to be a missionary.  We are so proud of her and I know that by dedicating her life in serving others, she will come to know the beautiful person that she is even better than she does now.  She will find her own little girls that will reach out to her, taking her by the hand and bless her life.  A life of giving brings out the best in all of us.

Touching Lives

"A mensch, do you know what a mensch is?"  I had to admit that I had no clue but it didn't sound good.  With the ever present twinkle in his eye, Aaron declared that my education was insufficient and that he would take it upon himself to teach me the important words to know in Yiddish.  It was the least that this good old Jewish boy could do for his "mormon" doctor.  Through the next few years we grew closer together as he overcame lung cancer, struggled to control gout and progressively deteriorated as his emphysema progressively sapped his body of strength.  Knowing he could not live forever, we discussed his goals for the end of his life.  He did not want to linger on machines but he was certainly not wanting to give up on life either.  At the end it was a massive heart attack that took his life.  He was rushed to the hospital, the cardiologists tried to open up the blockage but his frail body could not take the damage and he did not make it back up to the intensive care unit.  Not knowing these details at the time, I was on my way to see him and happened to meet his family in the lobby of the hospital and learned that they had been called urgently to come up to the ICU.  I ran up the stairs before them, only to learn of his demise.  It broke my heart to turn and notify his loving family of his passing.  Tears were shed together.  As I told his daughter how much I cared for him, she responded, "he loved you, you were such a mensch."  To what seemed to be harsh sounding consonants those years before, now rang with sweet praise.  What an honor!

A few short days prior to saying goodbye to Aaron, I had to also say goodby to Thomas.  I dare say that was not his given name, having been born in China, being a soldier in the Japanese War many years ago.  He and his wife have lived in St. Louis for a very long time.  Though they hold on to their beloved Chinese traditions, they have readily embraced America and love being here.  He worked as a Chinese cook.  We made it through a severe staph pneumonia together, managed his diabetes but watched him slowly decline in strength the last six months or more of his life.  We tried physical therapy, adjusted his medication but at the end it was a simple fall that sealed his fate.  It resulted in a fractured hip and then a devastating stroke that left him partially paralyzed and unable to safely swallow.  He had previously made his wife promise him that she would not let him "rot in a nursing home" but now she was being told that he must have a feeding tube placed and that he would have to be cared for in a facility.  Together we had heart felt discussion about end of life care.  We agreed that his care should be tailored to making his last days as comfortable as possible, not making those days last as long as possible.  Hospice services were arranged and he was able to pass relatively peacefully at home.  On my shelf in my office sits a jade colored plaque inscribed with Chinese characters.  It sits as a reminder of the sweet spirit of that noble man.  He gave it to me about a year prior to his passing.  When I asked him what it means he said, "Good Doctor."  I call it my doctor trophy.

The last farewell that I will share started with Shirley and ended with Millard.  Having dealt with repeated lung issues, Shirley was declining and was adamant that she did not want to go back to the hospital ever again.  Her family called me in a panic on a weekend, as her breathing had become worse and she was struggling to breath.  They wanted desperately to do something for her but did not want to go against her wishes.  I told them that I would meet them at her house and arrange for nurses to come by.  I then called the hospice team and arranged for them to meet me there.  My wife was out of town, so I brought my boys with me to the visit.  I calmed the family's fears and promised that their wife and mother would not be allowed to suffer.  The hospice nurses did a wonderful job and she was allowed to stay at home until the end.  That night as we turned to leave their home, her husband, Millard, turned to my boys and told them how grateful he was to me, their "angel" father.  His kind words to my sons deeply touched my soul.  Over the next 5-6 years, Millard himself slowly declined.  Once an avid cyclist, he was discouraged by his inability to get around as he would have liked.  He had to give up his beloved home.  He made the best of his situation, taking up his oil paint brushes which had long laid dormant.  In the last few years of his life he completed portraits of his dear wife, his two children and of himself.  I saw him regularly, keeping an eye on his kidney function but in the end his old body just started to give out.  He developed Parkinson's which made it difficult to move around.  I received a call from his daughter who told me he had become too weak to even go downstairs to eat.  I told her I would stop by.  He knew it was the end.  We arranged for the hospice nurses to come again.  He did not last long, passing quietly at home.

It is hard to say goodbye to these friends I have made, patients of mine.  My whole goal as a physician is to keep people healthy but at the right time, my job is to relieve suffering, to minimize pain as well.  Success is often measured in the quantity of life but one's quality is equally as important.  I view my interaction with my patients as a wholly satisfying experience.  Each one touches my life for good.  I certainly feel that I receive more than I could ever give.  I wanted to pay tribute to all of my patients, those who have left us and those still living.  To touch a life is a sacred experience, a solemn honor that I take seriously.

Give it a Rest!

We are all busy with work, home life and everything in between.  We don’t have time to get sick.  It is such a nuisance.  We tend to slog on; catching some extra rest when we can, hoping to recover quick enough that our daily routine is not interrupted.  You may be like me and subconsciously consider the lack of days missed at work as a badge of honor, a symbol of toughness or even superiority.  Most of the time this strategy works well and we get back to health fairly quickly.  The human body has an amazing capacity to regenerate and recover from illness.  There are times, though, that it is time to shut it down, stay home, and rest.

There are two reasons to stay home when ill.  The first is to prevent the spread of disease to others.  This is especially true if we work around those who are very young or very old.  As much as your boss wants you at work, if you infect five coworkers, it will make the situation exponentially worse.  Your exercise buddies at the gym will appreciate not being exposed as well.  Most viruses are infective within the first 4-5 days from the time that symptoms occurred.  If a fever is present and has resolved, that is usually a good sign that the immune system has the infection under control and the person is no longer infectious.  Apart from Chicken Pox or Tuberculosis which can be transmitted through airborne particles, most diseases require contact with mucous.  Good hand washing is essential to prevent spread.  Make sure to avoid coughing in your hand.  Use your elbow or an handkerchief. 

The second reason to stay home is to allow your body the rest that it needs to recover.  A high fever above 101.5 degrees, dizziness, vomiting, diarrhea and shortness of breath are all signs that indicate a more severe illness.  It is important to not only rest but especially to stay well hydrated.  Dehydration makes muscles more likely to cramp and will slow the recovery.  A simple way to judge hydration is to look at your urine.  If it is not a pale yellow, more water is needed.  Going to the gym in this phase of illness is likely to make it all worse.  Listen to your body.  Give it a chance to work its magic.  When the illness starts to turn for the better, increasing your activity is good but it must be done gently.  A gentle fifteen minute walk on the treadmill will stimulate the flow of blood and lymph, the circulation of which will speed recovery by delivering your white blood cells where they need to go and flushing out the toxins that are building up from the disease.  An hour of hard core spinning will deplete your energy stores, exacerbate dehydration and likely trigger a relapse. 

Illness always occurs at a bad time.  There is never a convenient time to be sick.  Hopefully the suggestions above will help guide you to a quick recovery as well as keeping those around you free from disease as well.  Remember, the next time your body cries out, “Give it a rest!,” listen up.

The Road to Success

Is it quitting smoking?  Losing weight?  Giving up ice cream?  Starting an exercise program?  What is your new year's resolution?  We all want to improve but the lack of results can be frustrating. "The road to hell is paved with good intentions."  This was apparently penned in 1855 by Henry G. Bohn.  If you are like me, the list of things in your life that need improving is rather daunting and yet every year we try again to improve.  How can we make lasting change?  How do we keep our latest resolution from adding to the cobblestones on the road to failure?

You may have noticed that this is not being posted on January 1st.  My resolution this year is to update my blog once a month.  What can I say?  At least it is not January 31st.  The first key to lasting change is to pick a reasonable and achievable goal.  Planning to exercise every single day for an hour would be ideal for all of us....but achievable for almost none.  Make sure there is enough flexibility to achieve the desired outcome.  I have resolved in the past to not eat any ice cream.  Those resolutions clearly failed but I found a way that works for me (see my post "Earning My Ice Cream").  It is also important to tackle our shortcomings one step at a time.  Choose just one and work on it first (see "Make Every Step Count").  Take a bite out of it and chew it one day or week or month at a time.  There are many people who need to lose fifty pounds to be healthy.  That is a big number and seems so unattainable that most will not even try.  Breaking down the goal helps to realize how to achieve it.  Over a year, losing one pound a week will result in a fifty pound weight loss.  That is even giving you two weeks of no weight loss!  To lose one pound a week requires a 500 calorie change each and every day.  That means eating less or exercising more but the difference needs to be 500 calories.  Setting the goal to lose fifty pounds is admirable but it is doomed to failure if one does not start each and every day with, "How can I get to get rid of 500 calories today?"

Broadcasting your resolution is another way to aid in your success.  Tell everyone around you what you are doing.  Yes, it is scary but it holds us accountable.  Not being willing to share your resolutions is the first sign of failure. In fact, it is planning to fail before you even begin.  Instead of shaking in fear that you might disappoint a loved one, use them for support.  They will encourage you, be more patient with you and help you.  In fact, finding a resolutions that can be done with a partner will increase your chance of success (see "The Buddy System").  I am grateful to my patients who have said, "We miss reading your blog."  It has given me the encouragement to make the time to start writing again.

Ultimately, if lasting change is going to be implemented, the resolutions have to be meaningful enough to change who we are.  The resolution must invoke a revolution.  Temporary change will not suffice.  We need make the leap of faith from saying, "I want to quit smoking," to "I am a nonsmoker," or from "I want to exercise more" to looking in the mirror and affirming, "I am an exerciser."  For me, it is changing my mindset from being a doctor that occasionally writes in a blog to being "A blogger." This does not happen over night and requires persistence.  Failure will happen; we will stumble and fall.  Falling is not failing.  Quitting is failing.  Those on the road to success have one thing in common, they have all gotten up after having fallen and continued the race.