Fits Like a Glove

Today I cared for a patient in an ICU I had never practiced in before.

I was at home, comfortable and content. The nurses were superb and we were in full banter within 10 minutes — they essentially telling me to get out of the way and let them do their work but joking with me at the same time. Familiar innuendoes, knowing glances and shared experiences. Oh, it was a grand time!

I began to think about HOW MANY intensive care units I have been in during the last 40 years. Yes, 40 years. I began working in ICUs as a 17 year old orderly. I have done just about everything there is to do in a critical care unit. How many units? I cannot count them all — general ICU, medical ICU, surgical ICU, trauma ICU, neurological ICU, pediatric ICU, neonatal ICU, cardiac ICU, cardiac surgical ICU on and on and on . . .

And I loved them all.

I loved the docs, the nurses, the support staffs. I loved the patients. I loved the not knowing when everything was going to hit the fan. Crisis, thinking on your feet, making it up as you go, doing something you had never done before, saving lives, reducing discomfort, helping someone die with dignity and not alone — all of it thrilling and experiences beyond compare. My heart beats fast just writing this.

With the excitement, however, came a price. You would “burn out” every 3 or 4 years. I submit that one cannot do this type of work without becoming emotionally numb after a while. If you ignore the fact that you are becoming hardened, desensitized and unfeeling, you will personally deteriorate and begin to rot inside. You need to have a good inner warning system, good friends and protective loved ones to realize when it is time to go. Sometimes you need to leave forever — your days in critical care are done and you hope you have taught the next generation well. Often, though, you just need a break. You go do another job somewhere else, using a new skill set in a much more relaxed setting. You might join the Air Force and practice in the outpatient setting! Ah yes, but then you will again find yourself in a new ICU — maybe in Iraq — and once again filled with purpose, sharing gut wrenching experiences, taking care of the sick and maimed, and filled with expectation of the coming day.

Today, I saw just one patient in my ICU. Yet it felt like I had never left it and was about to see 20 more. How I love it. It just seems to fit me like a hand in a perfectly fitting glove.

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Free at Last!

I am sorry to inflict this upon you but I need to share it.

Today, I took my last fitness assessment test for the military. I passed. I am thoroughly relieved. I can now work on separation without the Sword of Damocles hanging over my head.

The physical fitness requirements for military service were by far the most onerous part of my service. They are also the primary reason I am leaving the service. I came into the military at 53 years of age and had to train with 20+ year olds for my entire four years. I was a SLUG as a civilian and never was taught or learned how to become fit in a way more appropriate for an aging man than a young stud. As a result, I continued to struggle with my fitness tests. I would fail at times, barely pass at other times and only once actually passed with flying colors.

However, the penalty for this training without the benefit of a personal trainer who knew how to work with older folks was physical pain. I have knees that no longer work. I cannot walk up or down stairs without pain and cannot walk moderate distances on the flat. I have similar problems with a shoulder. I really wish my training program had been designed and implemented with me by a professional invested in my personal success.

In a very real way, I feel like I failed at my military “career”. Even though I was recruited for my ability to practice medicine, it often seemed to me that the military cared more about whether I could pass a fitness test rather than my ability to deliver high quality medical care. In time this resentment may pass and my perspective may mellow. Right now, though, it is a sore point with me.

I am glad I can spend the last weeks of my time in the military not worrying about having to re-test in 12 weeks. I am free now to focus my energies on other things to complete before separation. I am free to practice medicine without the distraction of push-ups, sit-ups and running times constantly on my mind.

“Free at last, free at last. Thank God Almighty I’m free at last!”

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“A Peaceful, Easy Feeling . . .”

My apologies to the Eagles for the title of this post . . .

Today I went to one of the hospitals I often work at in the region. This is a brand new hospital, built from scratch and opened in September of 2011. I have spent 40 years of my life in hospitals. This hospital is the most beautiful and well-designed medical facility I have ever been in. I love working there.

Most importantly, it is PEACEFUL. The grand windows, which are everywhere, look out upon a rural landscape. Nature abounds on the outside and even inside due to the imagination of the architects. I sit during “down” times in a comfortable chair and look out on the green rolling hills and just relax, decompress, and indeed heal myself. This is a true healing hospital. You can feel it everywhere.

Too many of American hospitals are merely functional boxes. The environment facilitates healthcare delivery but not repair and rejuvenation of the soul, spirit and body. We lost that dimension of hospital care in the late twentieth century when science won out over humanism. Some of us fight mightily to re-introduce care of the person back into our facilities.

While sitting in the hospital today my mind wandered, as it often does, back to Iraq. Every once in a while I was there, I got a few hours off in the mid-morning. I would arise “late” and go out to the coffee shop in my little compound. Armed with coffee and my Kindle (oh, and my weapon), I would sit under the brillant blue, cloudless sky of Iraq and think of nothing except the words in front of me. I found it so quiet, so calming. In reality, we were very close to the flightline. The war jets would scream to and fro every several minutes, the helicopters would swoop in low on their way to the hospital, the generators would hum loudly and incessantly. But to me, right there, right then, it seemed like such “a peaceful, easy feeling”. The mind can find solace and solitude just about anywhere if properly prepared and accompanied by a willing soul.

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Tick, Tick, Tick . . .

I had a patient in my office today and I was not sure why. She had a very simple, straightforward, common health problem. A cardiologist certainly was not needed to evaluate her. No fancy testing was required. No treatment was indicated. I reassured her and sent her on her way, relieved and happy.

I see this every day. Multiple times a day. People with simple problems sent to a sub-specialist by their primary care practitioners. Why?

For a while, I blamed myself and my generation of medical educators. Obviously we had sent young doctors and practitioners out into the world poorly trained, lacking in basic knowledge, or limited in physical examination skills. However, the more I talked to these primary practitioners and spent time visiting them in their offices as a PATIENT, the more I realized they were very bright, skilled and well-trained individuals. No, the teachers were not at fault. The former students were not to blame.

The problem is the clock.

The typical primary care practitioner in this country lives and dies by the 15 minute appointment. Patients are booked in multiples of 15 minutes because the system demands it and requires it. It takes VOLUME to be financially successful in the practice of medicine in America especially if you are in primary care. You simply do not have the time to speak to one patient for more than a few minutes. You must speak quickly to many patients in a few minutes. Those people who control our lives as doctors in the clinic setting I unfortunately have come to refer to as “bean counters”. The bean counters have come up with the 15 minute visit. The problem is that bean counters have never taken care of the sick, the anxious, the well simply looking for advice.

So, the people I see in my office now are those that will take a primary care practitioner longer than 15 minutes to evaluate. Those patients can easily be evaluated by a generalist who is given a few minutes to get a proper history, a few more minutes to truly examine the patient and then, importantly, an adequate time to discuss the situation, give advice and reassure the patient that all is well or will be well after a little bit more information is obtained.

In my office, this is available. I am a sub-specialist. The bean counters count my beans differently than they count the primary care doc’s beans. I have no 15 minute appointment slots — and I fight daily to keep it that way. The reimbursement system “pays” me more for my 15 minutes than my generalist colleagues. Furthermore, I have TESTS that I can do. Lots of tests. I am a cardiologist! I live to do tests — EKGs, echocardiograms, TEEs, caths, EP tests, tilt tables, stress echoes, stress tests, nuclear tests etc. etc. Every test I perform brings in more beans for the bean counters to count. They tend to like cardiologists quite a bit.

So, the entire system has conspired to move patients out of the primary care office and into the sub-specialist’s office. This is exactly what the system was NOT supposed to do. Primary care MANAGERS (as they are called now) are, in my opinion, are nothing more than triage officers. The practice of medicine has forcibly been yanked away from them. They parcel out people to specialists.

The primary care folks that I hang around with detest it. They want to PRACTICE medicine. But they know that as long as they hear the tick, tick, tick of the clock louder than the voice of the patient, their practice of medicine will be frustrating, empty, and without joy.

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Summer on the Bay

We live on the Chesapeake Bay in Maryland. The summer season has begun and for this New Englander, summer on the Bay is pretty close to nirvana.

We sit out on our neighbor’s pier. The billowing white sails glimmer on the horizon in the distance. They silently slide along the surface, tack in one direction and then the next. It seems to be a big ballet on the waves — a ballet that for me defies logic. I am not a sailor. I am an airman!

The sun moves across the brilliant blue sky above. The towering feathered white cumulus clouds intercept the sun here and there.

We turn pink, then brown as the season moves on. With each day our cares, anxieties and fears seem to become smaller and smaller and smaller.

Ah, summer on the Chesapeake. I shall miss it when we leave in October but it will be in my heart forever.

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Memorial Day, 2012

Today I spent some time exchanging email with my troops presently in Afghanistan. The conversations, and the importance of this day, made me think about other soldiers, sailors, airmen and marines that I have met in the last 43 months:

The Wounded Warriors in Iraq that I could not save.

Those Warriors I DID help. I wondered, what are they doing today? Are they alive? Are they doing well? If not, what do they think of our efforts?

The 90 year old WWII pilot that I took care of in an Emergency Room stateside who responded with lights in his eyes when I asked him what aircraft he flew during the war, “EVERYTHING!”

The elderly Asian-American veteran who sat in my office telling me of his exploits in Korea and Vietnam who, when I thanked him for his service and time in the Nation’s Uniform, teared and simply nodded in affirmation with a slight smile on his lips.

The survivor of the Bataan Death March who shared with me, ever so briefly, the horror of war.

And the motto of those of us who were proud Tuskegee Medics in Iraq, “Save lives, clear the beds, take care of one another.”

 

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About

My name is Mike Therrien. I am a renaissance man. I know a little bit about a lot of things. I know a great deal about a very few fields. I have had  life-defining and self-altering experiences at odd times during my 57 years on this planet. I believe it is time to share my thoughts about my journey through life with a wider group of people — you, my audience.

I am not really new to blogging. In 2010 I found myself practicing intensive care medicine in  a combat hospital in Iraq — at 55 years old. I needed to tell my friends and family about what I was going through and to try to put this bizarre sojourn in some perspective for myself. I created a private photo blog to share those 200 days with those closest to me. Much to my amazement, I found that others found my posts fascinating, well-written, and moving. I personally found writing them to be therapeutic and calming. I write now with hopes of reproducing that magic.

I have known since age 5 that I wanted to be a doctor. It is my calling. Today, more than ever, I believe with unshakable resolve that I was put here to heal and comfort. How I have carried out this mission is the real story.

I am a cardiologist and critical care physician. I graduated from medical school 31 years ago. I was a medical school professor for a very long time. My friends will tell you that I went down seemingly strange and misguided paths while practicing — getting degrees in medical management and health law to help me fight off those I maintained were interfering with my perception of how medicine SHOULD be practiced.

After 27 years, I burned out. I had travelled so far down those distracting roads, I lost my way. I was no longer healing, no longer teaching how to heal. I needed a re-start, a defibrillation. I became a medical officer by direct commission in the United States Air Force and found myself literally running after 27 year old fellow officers in the service of the Nation. It was then they sent me to Iraq.

Now my military journey has come to a close — my obligation was completed on 19 October 2012. I have a new position helping to take care of our Nation’s veterans in New England. Come with me as I travel down this next road and read what is on my mind. And tell me what YOU think!

Mike

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