I can still remember my first time cooking a full meal. It was summer-time and we wanted soup. Soup was what we had for dinner every Friday. For months I had observed. It was mine time to repeat what I had observed. I followed the recipe as I had seen. I made what I thought was great soup. We enjoyed to the last drop. Since then I have enjoyed cooking. I enjoy cooking and would love my girls to have the same joy from cooking. Cooking is an excellent way of learning science and may help us eat better. By better I mean great tasting food with lower caloric density.
Making breakfast for my girls this morning was a wonderful expression of my love for them and my indirect way of passing unto them great eating habits. I suggest we all cook more. We all should eat more home cooking. Eat more home cooking for better health and family unity. I made what the girls requested, one fried egg with two strips of Turkey Bacon and blueberries. What is on your breakfast menu this morning?
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.
The encouragement to take a daily multivitamin continues to be strong. However, the accumulation of data suggests strongly that daily supplementation is not necessary. The reasons for fortification of specific foods with specific nutrients starting in the early twentieth century was deliberate and with good reason. The indications for Folic acid, VItamin D, Iron and Iodine were clear and scientifically proven interventions using prevention as treatment for neural tube defects, Ricketts, iron deficiency and goiter. For these diseases the scientific connection was clear and proven. Forward to today and vitamin and micronutrient fortification is touted as a panacea and treatment for all that ails. The evidence for the addition of most supplements is weak at best. Frankly, it is without merit and almost totally baseless.
The extrapolation that since we need small quantities larger quantities will be better is short-sighted and potentially dangerous. The evidence does not support that view. The industrial production and addition of vitamins to every conceivable food item is primarily a marketing tool. It is a waste of money for consumers. If we look at nature we can see a better paradigm to extrapolate from. The concentration of vitamins and micronutrients are small and very large quantities of whole foods would need to be consumed to approach the quantities in many of the marketed items. If there is not a proven deficiency there is no need to add to our foods. The proven need is for small quantities that is more than adequately supplied by a balanced diet. The evidence for benefit beyond that is none existent.
Although, the evidence for potential harm is small we must ask the question. Will super sizing the quantities we ingest be harmful in the long run? Like with the craze for copious quantities of bottled water we have been marketed a hook and we have bitten and are drowning in a sea of misrepresentation. Improve your diet. Make fruits and vegetables the base of all meals and stop wasting your money on bottles of urine coloring.
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 cycle of war and peace continues like the flow of water. Unlike the processes of nature, it is not inevitable. The process of life is about choice. We have the ability to choose the path we take. The decisions we make are not preordained, we are our life’s directors. As we direct our life we must take care of the vulnerable among us. War is a selfish act, resulting from the disregard for the many. It is the result of disordered thinking, that justifies killing as a means of protection. The incongruity of that argument is evident if we would reflect on it. Our reflection must consider the social nature of our species where we will follow those among us that profess caring and loyalty to the group. Unfortunately, the malicious and selfish among us have and will continue to exploit the majority, until the majority decides to be as concerned about the stranger as we are about the ones closes to us.
The more important question that needs examining concerns what will our future be if we do not break the cycle. War may bring a temporary peace, but the underlying discord will resurface. The cycle must be broken, if humanity expects to survive. The cycle can be broken when we address the root causes. Where the root of war is usually the exploitation of the many for the benefit of the few. We must reconsider our use of the planet’s resources. It will be painfully to many, but will be beneficial to the most. We may not think that we are exploiting anyone, but if we examine our life it will become clearer that many of us are consuming excessive quantifies of the available resources.
If we all consider and re-order our life’s the great masses of the deprived on our planet could have the possibility to improve their lives. The cycle of war with interludes of peace could be broken by each of us say no to exploitation. We all have a responsibility to our species. Our care needs to extend further than down the street. We need to extend our care and concern to the father thousands of miles away that cannot feed his family, while we dump more food that we eat.
War is and always will be about resources. Let us all take a stand and share.
The epidemic of morbid obesity engulfing the world is a testament to mankind’s greed and lack of insight. We continue to devour the planets resources without any close examination of the consequences. Some are so greedy that we think we should have a right to plunder without regard for the other creatures that share the planet with us. This gross lack of understanding of the ecosystem that we are apart is expressed as our expanding waist lines.
As we continue to grow later in number and individual size we complain about over crowding and stress. We complain about obesity associated diseases but still have giant food parties at work and home. We want what we want and will not change. This lack of insight to connect our greed with our continuing illness is continuing to kill us. We continue to teach our kids to eat empty calories and expect that they will grow into healthy adults. This gross lack of insight is a reflection of a society devoid of competent leaders.
The good news is that the upcoming generation will in fact have better insight because of the wasteland of a planet that our generation will leave them. I see the seeds already. They will not be burdened with the excess earns that leads to purchasing for purchasing sake. They will make better use of their resources and in doing so will rescue our sick planet from the brink of our self-imposed destruction.
I hope to live long enough to see concrete evidence, but I have seem enough to be hopeful.
One day the greedy self-centered industries that feed the obesity beast will be found out and regulated into oblivion. That day cannot come soon enough, but I will be patient because the patient shall inherit the earth.
Again I find myself looking at the Affordable Care Act, aka ObamaCare and wondering how did we get here? With a rapidly aging population and escalating costs some changes were inevitable. We spend more per patient but get worse results. I have heard and read many blaming the newly arrived sicker immigrants and the lazy minorities. Those attitudes represent the bias in the healthcare system were minority patients are often not treated with the respect they deserve and often get substandard care. As a minority physician I saw this a Medical student and choice to do rotations in areas with significant minority populations. What I realized is that poor care is not a choice of commission, it is most often a result of omission. The truth is that most patients get great care, but the system often gets it wrong with minority patients. Having family members with great insurance and serious chronic medical issues puts the disparity in care front and center. Lack of insurance is not the most significant problem. The problem is bias. On countless occasions, care is significantly delayed for no apparent reason. As a physician I can make that statement with confidence, because I have experienced it on many occasions. That loud minority patient is not just loud, but loud because after giving the system the benefit of the doubt she or her family is still sitting waiting for urgently needed care. I usually do not announce that I am a physician and thus get to experience the treatment I often heard about but did not believe. I am here to affirm the assertion, if you are a minority patient you will get poor treatment.
Will any of the changes of ObamaCare make the care of minority patients any better? I am not sure, but at least outcomes are being closely tied to pay. Yes I went there. Tying objective criteria to payment is an excellent means of encouraging improved care. We might not want to accept that outlook, but if we expect our patients to take their medications as prescribed why shouldn’t payers expect us to provide evidence based care. If we would enforce some self-regulation we would not be here. For minority patients we are hoping that our care improves with the general expectation of higher standards. This is our hope for ObamaCare.
As a physician I wonder about the goals of Obamacare and lament the loss of freedom. I dread the arrival of the heavy hand of government regulation. The problem is that as physicians we have not been good stewards of our privilege. As a group we are reactive not proactive. Unfortunately we are once again reacting to the new paradigm. Many of these changes have been in the works for significantly longer than the discussion that surrounds ObamaCare. Instead of organised self-regulation we now have government mandates. These mandates are not the answer, judicious self-regulation is the answer. We need to examine the new paradigm and workout a constructive path to achieving our goals.
No matter what our goals are, the constant absurd chatter about the evils of the law is a waste of precious time. I suggest a more constructive conversation would be to evaluate how we got here, look for the future challenges and proactively respond. We are problem solvers. Let us look closely at the issues and solve the problems before the government goes further in destroying the practice of medicine.
Our lives are short and then we die. How are you going to make the best of your experience? Are you going to be conservative and play it safe?
We often worry more about others and are less concerned about how we are using our limited time. Ignore them, because in the long arc of time they do not matter. I say wake up and dream. Dream of your adventures, but make sure you wake up and experience them. Do it now because only you will live the regret. Do it now because there is no better time. Do it now because we hold the keys to our happiness.
Take hold, escape and live it.
Because life is what happens when we are making plans, plan less. Life is in the moment. Make your list and check it off, because time will not wait for you. We have come too far to give up now. We have survived for a reason. We have survived so we can enjoy. We are here because evolution has chosen us. She is a strict master and only those who take hold and grow will succeed.
We have gotten lucky, we have come too far to give up.
We need to raise the bar. We need to go out and take our rightful place. Do not get pushed, go do the pushing. Brush off the dust. Go dancing in the rain because you are a champion and the world is your play ground. We are like butterflies. We have survived a long birth, it is time to explore. The world will hear us. The world will respect us. The world does not matter. It is our world. Hold on, but not too tightly. Enjoy it, do not stifle it. Take hold and make it count. Be a little breathless, but mostly keep your smile on and remember that it is your world.
Having children has changed my life for the better. Having girls has allowed me to see the world through changed eyes. I often do not like what I see, but there is always hope. I am hopeful because I can see strength in my princesses and I can see the world evolving. The change is not as fast as I would like, but change is happening. My princesses have been born into a world where they have access to opportunity and much improved safety. As women of African heritage they have unique challenges and strengths, but mostly they are from a long line imbued with confidence and self-sufficiency.
I continue to be sure of their success because they have great role models. My instinct is to protect them from all that is bad in the world by building a wall around them. My struggle now is to determine the height of that wall. I want them to grow by learning from my successes and failures, but understand they will learn best from their own experiences. All parents have that nervousness, but for a father of a women of African heritage the world is a little different.
My princesses are still innocent to the crazy world and I will protect them from it for as long as possible. They are three and five years-old and their life is changing fast. My five year-old is ready. She is the love of my life and I worry, and I am excited for her. I am ready for her to discover more of what the world as to offer. The world has already expressed their low expectations of her, but like her ancestors before she will perform above and beyond because her corner expects her to be the best. High expectations lead to commensurate performances. I will continue to protect and love her, and be her shield and sword. I am a parent, I am her father and her friend for life. I will always expect more.
I am not big on holiday celebrations. Most holidays have degenerated into a shopping experience. However, like many others I have a special place in my heart for mother’s day. This year more than others I feel the pull of the celebrations. Being a mother is a tough job and the challenges are many. After 9 months physically attach to another human I am not sure how one can ever let go. The challenge of letting go is a skill that nature has had many opportunities to refine. I am glad that the tires that bind are stretched not broken.
I am very thankful for all the mothers in my life. All the mothers that took me in and made me the person I am. Looking back over my very short life I realize that the mother that carried me for 9 months was just the principal of a my “moms” committee. I had an exceptional committee and will continue to shout their praise from the mountain top.
Mothers are special people. Mothers are special woman. Mothers are those special woman who have and continue to lookout for your best interest in spite of yourself. They are the women in your life that have kept you going. They have kept you on the difficult path because they know that the fire of life creates strength for the ages. Mothers do not see genetics, they give love because we deserve it.
Mother’s day is an anti-climax. It is a let down. It is not sufficient to celebrate the depth of love I have for my mothers. In spite of the inadequacy of the day, I want to express a sentiment not said often enough. Mother I love you. Mother I love you because you have been and continue to be my safe resting place. Thanks for the love and the pain. Thanks for the joy and let down. Thanks for the commitment to a better me. Thanks, because you have been my champion and I will continue to be yours.