I WILL NOT BE DECIEVED.


I could feel the heat of the morning sun sneaking through the crack in the heavy curtains keeping my room dark and cool. As I tried to hide from the heat the cacophony of bird chirps irritated my ears. I was usually an early riser but I had a little too much fun before going to bed. I dragged myself out of bed and pulled the curtains open and my eyes were assaulted by the brightness of the early morning sun. Ben was still asleep, neither the light nor the audio assault of the many birds stirred him. I could not sleep anymore. It was time to start my day. There was only one problem. My head was paying the price for the excessive of the night before. It came on slowly but I was definitely nauseous and the room was spinning faster and faster the longer I stood. My stomach felt like it was lodged in the back of my throat. My salivary glands oozed increasing quantities of fluid. I had not felt this poorly in many years.
I slowly backed up and rolled back into bed. I closed my eyes tightly, but there was no relief. Suddenly my stomach blew up like a tense balloon followed closely by the release of its contents up my esophagus and through my oropharynx and out my mouth onto the floor. The taste was not as bad as I thought it would have been. The back of my throat relived the bitter taste of the IPA I had had too much of the night before followed by the saltiness of the fries. I was happy not to locate the taste of the fish, it was not that good. It was a very fast review of my last meal followed by another quick reminder. After the third time I had had enough reminders. The bed had collected the last two explosions and the smell had gone from beer to unbearable.

The room was spinning and the light of the sunrise was burning my cornea. I closed my eyes tightly and remained still. I was not rewarded. The room continued to spin and the volcanic activity in my stomach continued. I lost count of the explosions, but the worsening taste did not escape me. I was certain that my stomach was empty but the expulsions continued. It seemed as if my duodenum was collapsing under the force of the attempts to pull the fluids from my small intestine. Closing my eyes did not stop my world from spiraling down the drain. Ben did not move a muscle. I felt as if I were dying a long slow death. I was too weak to get up and was now laying in foul-smelling cold vomit. All I could remember was my grandma, Mama, quoting the bible “Wine is a mocker, he so deceived is a fool”.
Next time, I will not deceived.

WE ARE WITHOUT SANCTUARY.


I am happy to be living in a country that affords me the opportunity to succeed. As a parent I am happy that my children will have more opportunities open to them than I did. My job is to guide them into success. As I look around America I am worried for my children in spite of all the opportunity that exists. The recent string of killings of men and women of color has helped to refocus my attention on the details. I, like many people of color in this great country have been lolled into a false sense of achievement. Worst is that we have allowed the wider society to accept the fallacy that racial justice as arrived. We have failed in teaching our children the important details.

As a parent of girls of color I have focused on making sure they are confident and well-educated, that is not enough. Over the last few months I have had to re-evaluate everything I have come to believe about equity in America. The history of people of color in this country is one of brutality and subjugation. There has not been enough change in our situation. In the last several month several studies have shown the depth and pervasiveness of our disenfranchisement. Our girls are 6 times more likely to be harshly punished in school compared to white girls. Americans of African heritage with master degrees are paid the same as whites with bachelors degrees and even doctors of African heritage are paid about 10 % less than similarly educated white doctors. Why is this so? I have come a conclusion, that question is not relevant. It is not relevant because those in power do not care to fix the problem. I have given up on the idea of equity in my country. The continued inequity makes me angry and concerns me for the future of my girls. I am angry but I will not be deceived into violence. Protesting does no good. Voting does almost as little.

So, in my quest to find a better answer I have looked around and think I have found the only viable route in the Jewish experience of World War 2. No one is allowed to forget the Jewish Holocaust and so too no one should be allowed to forget American Slavery and Jim Crow. The end of the Jewish Holocaust is celebrated but the brutality of it is what is referenced most often. This is what we all are reminded of daily. As people of color we need to teach our children about the brutality of the American enslavement of out ancestors and the continued brutality of Jim Crow America and the current discrimination. We need to have them understand that the current celebration of Martin Luther King Jr is fake and serves only to assuage the guilty. It is not a sign of contrition, it is hollow and designed to distract from the ever-present and pervasive discrimination against people of color. Our children need to know about the Martin Luther King Jr struggle before they can appreciated his success. They need to know and see the pictures of America brutality to their ancestors. They need to know the name Emmet Louis TIll along with Martin Luther King Jr. The goal is not anger, it is empowerment. Our children need to understand that things have changed and that we have many opportunities, but they also need to understand that they need to succeed in spite of the many race based road blocks. They need to succeed to honor their ancestors.

Violence is not the answer, it is only a way to continue to enslave us in the prison complex which is designed to strip us of the rights our ancestor died to attain. Our children need to understand the context of their lives in this land of opportunity. We need them to take the opportunities and make progress while making sure no one forgets the brutal treatment of our ancestors. We should honor our ancestors for their willingness to stand up for their rights and we should build on their success by taking the opportunities available and making the most of them. We know that we will not be treated fairly nor paid equitably because this is the current state of America. There is no real hope of progress beyond the eventual death of the merchants of death. As parents of children of color we need to prepare them to survive and thrive until that day of Martin Luther King Jr’s dream arrives. Don’t get violent, get angry and achieve.

AMERICAN SWEAT SHOP.


There is a curse that inhabits the American work place. We have become slaves to profitability and not to best outcomes. The primacy of profits has led us to misunderstand the nature of work and the importance of worker satisfaction. Making ever-increasing profits is the goal but how we get there makes a difference. Some employers have lost their focus. Sustained profitability is about worker satisfaction. In many fields lip service is paid to the worker, while they are trapped under inhumane work conditions. Fortunately work conditions in the developed world are better than they were. However, we still have a way to go before we can claim victory over poor working conditions. The severity of the impact of poor conditions is dependent on your industry. In health care the impact can be life threatening.

Our culture for too long as valued hard work over smart work. We seem to believe that the worker that workers longer hours is more noble and deserving of praise. This misplaced praise has led to continued poor choices and has led to the misery and burn out of the American middle class. The depth of the problem continues to go unnoticed and unacknowledged. Poor outcomes continue to be placed at the feet of poor training and individuals are blamed. I too have a tendency to blame the individual. The truth is that sometimes the individual is to be blamed, but we too often neglect to evaluated the conditions under which mistakes are made. The systems under which most of us work are archaic, inefficient and are undermining our ability to be the best we can be.

I will be attacked for my stand but the truth needs be told. I love my work because it gives me the opportunity to help my fellow humans at a time when they are most in need. From my limited experience that help is best delivered when I am well rested. Some may consider me weak for insisting that adequate rest is required for best productivity and patient safety. I, however, would rather follow the evidence that suggests that efficiency and safety are best attained with a well rested and optimally trained work force. The conditions of many operating rooms where staff can work full daytime shift and take overnight call then work a full day shift is putting our patients at risk.

The unfortunate problem is that when a staff member makes a mistake that harms a patient she alone is blamed. The idea that she needs to take personal responsibility for her mistake is commendable , but essentially is a cop-out. Her bosses are just as culpable, because they have put in place a system that does not allow her to work at her best. The continued scapegoating of individuals is a sickness in our system that needs to be driven into the grave. Our success is dependent on the balance and efficiency of the systems we construct. Spending money on technology is commendable and necessary but alone will not improve patient outcomes.

Better pay is a great place to start, but is a poor quality band-aid when one works under mentally oppressive conditions. Improving the system starts by focusing on the best assets of the system. Our human capital is our best asset and must be treated as such. We are not robots, we are better. We may not be able to work as long hours and we get bored easily; but until robots can think intuitively and problem solve on the fly we will continue to be the best part of the workflow equation. Functioning at maximum efficiency must be out foremost goal. For humans to be focused and efficient we must have adequate rest and distraction. If we would focus on those areas many of our problems would be resolved without the need for expensive investments in equipment.

Let us invest in our best and most productive assets, our people.

THE NEW YEAR IS COMING.


This is the time for resolutions. It is almost the new year. Have you met your goals this year? If you have not, there is nothing to be worried about. There is still time. If you have run out of time you are not alone. Most of us are too busy living life to focus on our resolutions. I would suggest that we all use this time to look back over our year and be thankful for all that we have accomplished. We all have come a long way and are on the brink of a new year. Let us be happy.

The new year will bring new challenges that will give us more opportunities to grow. Let us take hold of our challenges and continue to succeed in spite of the opposition. All our challenges should be viewed as a means to success. It is only by confronting and overcoming that we can advance. Wipe clean the slate, start anew and conquer. The only person standing in our path is ourselves. Set that goal, make a plan, hold yourself accountable and make it so.

Have a wonderful and successful 2015.

WHERE IS THE CHECKLIST?


I have loved health care for as long as I can remember. I cannot imagine doing anything but providing care . What I have learned in the trenches is that the love of providing care is not enough. Over time i have realized that a fundamental problem with health care is not in the expensive of it but in the nature of the people in it. We want to provide care, but we bring into the system our biases. Those biases allow for less attention to be paid to some patients because of their language or skin color. We may say that we provide the same care to all patients, but as a black physician I see otherwise. My experience of the system at institutions where I am not known by members of staff is vastly different. The consequence of this uneven care is a system where those that can afford care and are the correction completion receive care that is more compassionate and timely.

How do we overcome the inherent bias in the system? The answer is not more training nor necessarily more diversity. The answer will be in the wide-spread use of evidence based payment structures. Our medical systems are complicated and expensive but are systems in name only. We have a complex string of components. All the parts are mostly well-trained and competent. However the results we obtain are not commensurate with the level of training nor the level of expense. The incongruity of expense and quality of results continues because those attempting to improve the system have not acknowledged or do not recognize the biases of the system. The gap in quality of outcome is most obvious in communities of color. The often given excuses are truly just that. Recognizing that there is a problem is the first step to a solution.

Paying for quality work is the only avenue to improved results. The question as to how we get better care for all patients is simple and complicated, but we have a great example in the aviation sector. My brother is an airline pilot and his training is extremity rigorous, but he starts his day with a checklist. He does not feel that his autonomy is being challenged, but that he is making sure that he does not kill himself. We in health care do not have any real skin in the game. Until the decision makers have some skin in the game we will not embrace what is necessary to make our constellation of components into a functioning system. Let us start delivering quality care by implementing checklists. Checklists are reminders of the quality in our options. The checklist is not for you it is for your parents and friends. That checklist is not for you, it is for that provider that is on her sixth surgery of the day. It is a nudge because she is tired. A checklist is for every one of us. It helps us by removing silly mistakes from our systems. For me the checklist is my hope that I will be treated like a patient deserving of care on the off-chance that I am a patient in a strange place where all that can be seen is the color of my skin.

DO NOT GIVE THEM AN EXCUSE TO KILL YOU.


Once more our country is focused on the aftermath of the death of a young black man. The frequency with which this scenario occurs is alarming, disgraceful and is not likely to change in my life time. I am a 40-year-old physician without a criminal record. I have a brother who is a Veterinarian and another an Airline pilot. Neither has a criminal record, but we all have experienced the brutality of American racism. We do not often talk about it. We live it and pray that our children will have a better experience. We want them to get a good education and not be killed by the police. That is our American dream.

The truth of what happened in Ferguson is irreverent to us because we live the brutally of knowing that at any moment we could be killed for no reason. As black Americans we have come a far way, but the fundamental problem for us has changed very little. We are not seen as humans, we are seen as murderers waiting for an opportunity. We are determined to survive so we try standing up for ourselves. However, standing up for yourself as a black man is seen as threatening. Success for us is about surviving the constant attempt to institutional us. If that can be avoided material success is possible, but only if you are not convinced to give up before you have had a chance to try. Material success is about picking your battles.

As a Physician I see the contempt patients show towards me at times, I swallow and still provide them the best care possible. I love taking care of patients and that care is not about anything but my pride in doing the best job I can. Because I provide you with care supported by the best evidence I am comfortable. In spite of providing excellent care I am challenged but nurses and patients. I often wonder what I am doing wrong, but it does not matter. I am of the wrong completion, so my care is subject to review. I need to justify my decisions with evidence, while others provide poor care and are not challenged. This is my life as a black physician.

I am strong enough because I was brought up in a culture that expected me to succeed. My early years in Jamaica has given me a belief in myself that is difficult to shake. It has been shaken, but I have recovered. Unfortunately my girls are growing up in a society that does not expect them to succeed. I will push them hard because their mistakes, no matter how insignificant, will be judged and punished harshly. I need to build in them confidence that is based on competence because our country will not give them the chances they deserve. I will teach them about how not to get killed.

The sad story is that my girls and my nieces and nephews will be at risk from violence from all sides. There is more violence in black communities both from cops and criminals alike. There is nowhere to hide, there is only learning how to manage the risk. Our treatment as black Americans is dependent on the complexion of our company. While out with my brothers and nephews we are treated like predators and undesirables. The excuses for treating us like monsters are varied but none are credible. In spite of the despicable treatment I often experience, I will still treat you well. I will still give you the best health care, although I will not be given the same treatment.

Rioting will not help nor will talking. Sorry Martin, I no longer have a dream, just a reality, ” Do Not Give Them an Excuse To Kill You”.

Be safe America.

LET THEM FLY.


As a parent I believe that there is no greater task than making sure your children are successful. The obvious next question must be asked, what is your definition of success? I would define success as “knowing what you don’t know”, simply I need them to be self-aware. I have a philosophy about how to get them there. Many disagree with me, but I have my parents to thank for their great example. One of the great things my parents did was the gentle subliminal push toward and appreciation of education as the route to achievement. I remember the extra lessons in grade school, and going to the clinic with my mother. I remember helping sterilize the supplies in her delivery bag. What I don’t remember is any discussion of college or which college or even getting better grades.

My parents were very generous with opportunity. They allowed my brothers and I the freedom to decide our interests. Expectations were high but were not overtly discussed. We were required to read aloud at daily devotion. We were not allowed to work outside of the home. Our only responsibility was to complete chores and go to school. We filled our down time by dreaming of the world that could be and taking control of what was around us. We learned to cook, hand wash and iron our clothes. I learned to tailor and one brother learned upholstery. We learned to manage our money, by managing our daily school money. This collection of activities may not seem very significant, but my brothers and I have extraordinarily similar outlook on the world. We believe that our children must be allowed the chance to attain the highest pinnacle of education because they can, not because they must. We believe that our responsibility to our children is paramount and no one comes before them. We may live far apart, but would give the same general answer to 9 out of 10 questions.

We learned from out parents that living the example is more important that showing it. We saw our parents reading and watching the news. We saw their drive to continue their education. We watched them solve problems creatively. They allowed us to explore the world freely but the boundaries were clear.

My view of the world is shaped by my family. My parents and grandparents created an outlook on the world that as given us a never give in attitude. I want to give my girls that same attitude. I will never clip their wings. I will allow them to fly. I will always be there to catch them if needed. I will be supportive. I will provide the means for them to have a platform for success. I will always support my girls, because they are equal to the challenge no matter what it may be.

I thank my village for giving me the strength to allow my princesses to fly.

WHAT DO WE OWE OUR CHILDREN?


Our children are our most important investment and their well-being is our primary responsibility. How we get them from helpless to confident and self-sufficient is our primary task. I am currently on that journey with my two beautiful daughters and hope I am doing the correct things to create wonderful members of society. These are my guide posts:

1. Create confidence
Give them confidence by allowing them to succeed and fail early. There is nothing like accomplishing physical tasks to give confidence. My girls have never been restricted by age guides. We have allowed them to challenge and master anything they would like to attempt. Many times they fail but it is only in failure that we learn how to succeed.

2. Make learning fun
We strive to make every experience a learning opportunity. I hate structured learning, that is not where most of our learning occurs. Most importantly, answer all their questions (much easier said then done).

3. No baby talk please
When my girls speak others are often amazed at the depth of their vocabulary and general language skills. Those skills are not coincidental. We talk to them in adult language and provide definitions as needed so that they have early exposure and reinforcement of appropriate language.

4. Early introduction to technology and science
My girls are 3 and 4 and both know their way around a computer. They both have been introduced to programming. The 4-year-old gets it and is an intuitive problem solver. The 3-year-old is not there yet but she is learning about computers and always want to program. They love seeing the effects of their work. They remind me daily that they need to program. We are on code.org most days and I am the one limiting their time.

5. Respect others and the planet
Letting them see us showing respect to others and nature gives them a sense of their place in the universe. We are here to take care of the planet which is not limited to our fellow primates.

Our child are willing and able to learn and accomplish so much more that we give them credit for. We need to unleash them. In the rapidly changing world we live in, the only skill that will guarantee success is adaptability. Exposing our children to as many learning opportunities as we can will prepare them well for the challenges ahead.

 

I HAVE A DREAM.


I have big dreams and I am sure you do too. Those dreams are what we all live for. We work hard and push to attain new heights. Those heights attained are the source of stories for our grandchildren. The joys of the effort and the intensity of our victories are what we will remember. I think I have lost that drive for big accomplishments.

Now all I think about is how am I going to make life better for my daughters. At Sarah is 4 years old and Samantha is 3 years old and they only ask for my time and attention. That is easy to give, but what happens once its time for more substantive investment. My love will not pay for college nor will it be enough for that first car. So, like all parents I have to save. Will it be enough? I am sure I am worrying for no reason, but without planning for those events I will not be ready. I promise them I will be ready.

When my oldest was born, I was reborn. They are my world and no one comes ahead of them. Making them strong, confident and productive is my goal. The question of how to accomplish my goal is both harder and easier than it seems. Easier because I have my parents play book to look at and harder because of the same. Picking from what I think worked and not repeating their mistakes is a tough challenge.

Sarah, my oldest taught me a lesson this weekend. She is already strong and confident. I watched her perform under the big lights with her cheer team and she was perfect. She performed with intelligence, poise and confidence. I am a proud dad. At 4 years old she is already setting a great example for her 3-year-old sister. I had to smile when my 3-year-old said to me, “Daddy, next year I am going to win like my sister”. I am going to keep loving them and allowing them to dream big, while I dream of their success.