Mortality and other trivial things...

In this, the 3rd month of my medical residency, I find that I am learning lessons beyond science. The technicalities of medicine are thick, that is for sure, but the art of connecting with someone in a profound moment has been a pleasant surprise to me. I am not the kind of person to enjoy "touchy-feely" moments and often I will be the first to back slowly out of a room once someone starts crying. But there is something curiously satisfying about dealing in human mortality. The kind of lessons only learned at the border of life and eternity are found in the most unusual places and times... perhaps the least unusual is in a hospital. We expect deep insights on life to come from a place of healing, and often times death, but nobody expects them elsewhere in our daily lives. Please don't allow me to write melodramatically here, I do not want to write about the fast-paced ER or the operating table where lives almost always hang in the balance. Instead I want you to practice the art of bringing out the good and the eternal in everyone around you.

Simply put, we do not experience life as a brotherhood. Something inside us (I am addressing this to Americans mostly) tells us that we value things too differently to express the ancient good in public with strangers. What do I mean by ancient good? The next time you wake up feeling happy and you go to work or out in society, dance a little jig or sing a little tune and see what happens... $100 says that the people that see you do it will smile, laugh, or even join you! That is the ancient good. We all understand what you are expressing and we want to be a part of it. The ability to recognize good is lodged deep in our souls (perhaps because we are so inclined to do evil). But with that one moment of joyful expression you have instantly shared a common purpose with us and that brings people together. (And for Christian believers, letting out this ancient virtue is not only satisfying, but is commanded from you).

Unfortunately there is a less enjoyable side to the ancient good... that is our basic drive to preserve life. With an extreme minority of exceptions, almost everyone would do something to save the life of a stranger sitting next to them if the need so arose. We know it to be right, and it's irrefutable. Some of us would be petrified with fear, but the drive to save that life would still be there. We want life. Mortality prevents us from having it, right? (I would argue here that death is not the opposite of life, only the absence of it, but that would take an entirely new post. Perhaps later.) I digress. The point is that this kind of experience isn't so different from the first, we instantly share a common goal. We connect in our desire for life. Whatever the outcome, we go through it together. Sometimes it turns out badly, other times we can celebrate, but we always remember and learn in the end. As a resident physician, I gratefully experience this daily.

The lessons of connecting with people on a base level do not come easily, but the opportunities to do so are more abundant than we have convinced ourselves to believe. We all strive for the same things; happiness, peace, rest. We all honor the same qualities; true courage, bravery, generosity. The only difference are the ways we contrive on our own to get there. And we have made up some stupid and almost always harmful schemes of trying to attain a clear conscience on our own. So the challenge I offer today is... Do not let your fear keep you from expressing the ancient virtues that we were meant to own. We have been given the grace of God and that alone is reason enough to act on those ancient truths. If you do... you will share life in it's fullest with strangers around you.

Sacrifice...

A whole year? Really!? Wow, who would've thought I could go that long without Blogger.com deleting this stagnating thread? I'm glad they didn't toss my posts... my attitude towards life and everything else has changed and grown over the last 5 years. If I lost the record of it, I wouldn't see the change as sharply. Anyway, I'm glad to update you today blog, since I have great news.

For the last year we've seen nearly everything change. The economy, wars, leaders, even our culture have experienced drastic shifts. For many of us, what lies in the near future, makes us apprehensive at best. A growing sense of mistrust sits in our gut, waiting for the hammer to fall. Most of us are hard-working, independent types who know the value of looking out for family, self, and one another. I say most because until this year, I would not have considered myself hard-working. Sure, I've accomplished much in school and abroad... but my attitude was that of folk my age... "What's in it for me?" Entitlement is the word the pundits on the TV assigned to the phenomenon. And I will confess... I am guilty of entitlement.

Why have many people developed this tumor of selfishness? Is this anything new or is it a theme of the fall of humanity? I'd say it's both. I won't attempt to defend the disposition at all, but maybe an analysis of why we are suddenly overwhelmed with a "me" sentiment is in order. What does it mean for the future? How can we change? And with a few speculations of my own, perhaps the few who really see the problem can do something about our "Entitlement".

It seems to be a new issue, but I know better. Selfishness is the original sin after all. We've carried it since the dawn of mankind and it has wrecked everything we have ever done on our own. So why does it feel like a new problem now? Are we really being selfish, or are we genuinely entitled to something better? For ages man has tried to improve his condition, make work easier and remove obstacles. To our credit we've made great strides, the overwhelming number of them have occurred in the last century... most in the last 30 years. How does working hard to improve our circumstances make us selfish? In itself, it doesn't... but we've reached a tipping point of comfort. Waiting in uncomfortable circumstances has become a non-option. The routine of instant results has trained us to expect them in every facet. In a time when literally everything is a few clicks of the index finger away, why wouldn't we expect more? I see it all the time in the hospital. A patient will refuse to see that the best solution to his problems is long-term lifestyle change. Instead he seeks the instant, easy to swallow pill because... well, it's easier.

I've brought all of this up today because I see it as the root problem in our culture... and I've had a change of heart. In this last year of no job, and what seemed no clear purpose, I've craved work. Any work... I cleared brush and trees in Ireland just for food in return and it was the most satisfying experience I have had in a long while. The effort made me grateful. And for the first time in a long time, I was willing to do anything just to give back. God rewarded me with a task I would have scoffed at a year ago. This last March I got a residency in Family Medicine. I am grateful. It isn't what I would have chosen, but that's exactly my point... if it's not what I want, but I still work hard to give back to my people, then it is worth so much more. Sacrifice for others is the definition of love. And that, my friends, is not easy.

My generation has forgotten these lessons, or was never taught in the first place, but God will teach us again with the difficult times ahead. They are coming. My hope is that our record, the history of my age, will not say we were a selfish generation, but that we repented and humbled ourselves to the difficult work God gives us.

Keep the fight.

Adrift...

A week has past and I have tried multiple times to write about something worth reading. Call it writer's block, call it laziness, or perhaps lack of direction... I imagine all three play a large part. When I see the blank page in front of me, all of the infinite combinations of words log-jam in my brain. Endless options, some more exciting than others, linger on the tips of my fingers. Still nothing flows out of my mind. My expression fails. "Why is this so difficult all of a sudden?!" I shout behind my eyes. "Just write about anything that fits! I can make that blank page into anything I want..." So in this issue of The Aviator's Review... How do we choose to fill a blank page?

It's no secret that the end of medical school came and went not too long ago. For the last 4 years my life's path has been set in the Hippocratic stone. The 4 long years of lessons on how to act in every situation, and often how to act in general, are ending now. Choices during my training rarely required exploration and often defaulted to one answer because I knew to stay the course. In those times I knew the where's and when's of upcoming years... until now. Finally, the question of what to do next is unclear again. Life set down a blank page.

All of us have experienced turning points in life, the moments when we realize that our lives will not be the same. The course becomes unclear and choosing a direction can be like setting out to sea without a map. Some of us live for this come-what-may kind of adventure, others fear the unkown, and some never even look to the sea... but I still believe that all of us crave the freedom that an unknown future holds. For the exact same reason, nobody reads the end of a chapter before reading the beginning.

We love stories.

"I can make my blank page anything I want." ...or at least that is what I'd like to believe. The truth is I can't create just anything. Some stories will never be put to paper by my hand, and more importantly, I am not the author of my life. Some ideas, however great, will be left unwritten because I have an expiration date. My life will end someday and my chance to fill the pages will be over. Many ideas and opportunities exist, but the time is short... We only get one story to write. Choose your course well, use the small starlight in the sky that the Almighty places on your way to guide you, and never be afraid of an open horizon.

Filling in the gaps...

Due to my tendency to drop off the grid entirely at times, I have left a large 8 month gap of unwritten blog in the Aviator´s Review. Last May I left you in a cliff-hanger of sorts with my departure from Israel and the end of an era. For 8 months no words crossed the pages of The Review. No stories and no thoughts to share could be found. I like to think of myself as a story-teller and one to seek out stories worth telling. What happened next? Where did I go? Could this be the end for our intrepid hero!?... Well, here are the lost accounts of the past year....

-- They call NYC the city that never sleeps... probably because the never-ending brouhaha that ensues on the streets every night is nearly impossible to sleep through. With a cast of characters as theatrical as any on Broadway, I am entertained and educated everyday on my new neighborhood streets. Harlem... 145th and St. Nicholas.... third stoop from the deli... second floor. Light years away from any place that I have lived before, I find my ability to adapt stretched to it´s limit. Nonetheless, I am accepted here as many foreigners before me were welcomed to the new world. Maybe it´s their way, maybe it´s me, or maybe... I find that we are not all that different.

Everyday I sit on the subway on the way to the hospital and, in typical New York fashion, try to ignore the tapestry of humanity in front of me, but I am too captured by it´s beauty and sorrow to think of anything else. All of these different colors and cultures stitched together, sometimes unwillingly, in such a close way takes the work of centuries. Each new wave of strangers adding a new shade to the works.

The emergency rooms at Harlem and St. Luke´s hospitals also fill with a parade of histories both old and recent. If you pause for just a moment, you can see where their stories wind together in those few hours. I say a few hours, but really I mean a continuous shift that never really seems to end. This fall I have worked more than any year previous, but everyday brings that crisp edge of a new beginning that only comes with days truly seized. The orchestrated chaos of the ER gives me a chance to laugh, argue, and sometimes grieve with this band of characters. Days, nights, and all hours between. It´s an experience that I haven´t found anywhere else save maybe a good book or story. I hope my story is as well written when the end comes.

Ciudad de Oro

After many months of putting off documenting my recent adventures (of which I have had plenty), I find it ironic that the easiest place to write to you all is situated at 11,000 feet in the Peruvian Andes. Here I am again, miles from home in a small tienda that leaves one puzzled at how the internet could even reach such a place. This little obscure room connected to a much bigger world of obscure rooms sends my imagination running. So from my eccentric room to yours, I am glad to be writing again.

In order to polish up on my Spanish before working in the hospitals here, I enrolled into a language school here in Cuzco, Peru. The city itself has taken on a role of tourism, but you need not wander far before reaching a place that time has long forgotten. Just yesterday I rode a bike 7 hours through some of the roughest and most overwhelming terrain available at 11 thousand feet. The mountains swallowed the clouds as the afternoon rain pushed to no avail against them. Boulders and crevasses marked the narrow trail that clung to the side of cliffs hanging in those same clouds as we rode down. I tell you this, that I have never seen such a creation in all my life. The scenes in front of me seemed so distant and holy that they, for me, became the foreshadowing image of what will someday come.

I enjoy telling you all my adventures, it gives me a sense of pride and accomplishment. But when I see things in this world like those mountains, I realize that I have accomplished nothing. It is only Him who creates that can achieve the end.

Know that you too are one of His greatest achievements and you are loved more than mountains. Hope for the day that is not yet here and in Him who will make it so... because if it is anything like the Andes we will not want to miss it.

The Road Behind...

Here we are. After months and months, the long road of life has brought us all to the place in which we now stand... or crawl... or perhaps lie unconscious.
No matter which direction we have chosen or have had thrust upon us, this is where we are. Regardless of which path you currently travel, or the scenes it takes you through, a quick look around to gather your bearings or even to appreciate the scenery could do you some good. For the past 5 months my road has zigged, zagged, and sometimes fell out from under me, but nevertheless I am now here. It's time for a good look around....

For those of you now concerned for me, I am fine... despite a few metaphorical bruises here and there. In fact, two weeks from now I am moving back to the States. So this day marks the beginning of the end for my Israeli medical chapter and it is a very welcome change. However, I can't help but look around with a bit of... I hesitate to call it this... nostalgia. Here I am at the point that I have wanted to be for last few years and even though it was difficult, I suddenly find myself stopping at this waypoint, looking back at my desert with tired eyes, catching my breath saying, "Well...(gasp).. that wasn't...(wheeze).. so hard."
In fact, in a masochistic way I feel ready to take on almost anything now as long as it is something around the next curve. Even though I am tired, this place has taught me and pushed me so that I would become stronger and I can't help but be grateful for dusty ol' Beersheva.

A professor once told me in a survival lesson that a man can live weeks without food, days without water, hours without shelter, minutes without air, but only seconds without hope. Wherever you stand on the path, there is always hope even though the road ahead is unknown. Love and help one another as so many of you have done for me. Someday I will get the chance to help you in return.


May the road rise up to meet you.
May the wind be always at your back.
May the sun shine warm upon your face;
the rains fall soft upon your fields and until we meet again,
may God hold you in the palm of His hand.

Over the knife...

Alright, it seems I am once again long overdue for an update. It's the story of my life... my time moves just a bit slower than the world around me. Good old smalltown living taught me that. Medical living, however, has a different rhythm and will not slow down for anything. Surgery in particular is a blur. Everyone has their specific job and they all work like a Nascar pit crew. Since the last time you heard from me I have moved back to Jerusalem and started work in the operating room. Here's my review...

Many of you know what it is like to go under the knife for an important surgery or procedure, but it's that period of time when you were blacked out on the table that few people know much about. In fact, most of you probably recall only a cold room with bright lights just before the anesthesiologist counted to three. Believe it or not, several hours passed in that room full of sharp objects and I'll bet you have the scars to prove it. For the past three weeks I have been watching over those patients unfortunate enough to need an extra hole in them. Today I want to tell you about my experiences over the knife.

It's fascinating to me in this day of lasers and beams of all kinds, that we still rely on a sharp piece of metal to cure disease. It gives me great satisfaction that the world's most educated men and women use a tool we all know how to use. Obviously the catch is knowing where to cut and when, but there is little more to know since the goal is only to find what you are looking for and cut it out. In the operating room last week the surgeon spent a good 30 minutes just rooting around in some guy's abdomen with his hands looking for a tumor. Along the way he would point out the various vital structures and tell me to hold them off to the side. You don't need to know much to hold a man's liver up... just a strong set of arms since you are likely to be that way for several hours.

Surgery takes much patience and, in my opinion, the mind of a mechanic more than an academic. One of the docs in the OR actually reminds me of my dad in his hangar fixing planes... He takes his time, says very little unless speaking to himself, and is meticulous about the end product. Even the room itself brings back pieces of my childhood memories in the air shop. For starters, there is a central table that can hoist the patient up, down, left, right, or even upside down and hold him there. All kinds of colored fluids eventually cover the floor in the same mosaic pattern that an uncovered engine leaves behind. Tools, and even a few power tools, lie everywhere in the room. Sharp ones, blunt ones, and some that I still can't imagine what they could be used for. Finally, the music...

One of the most profound things in life is the way music can enhance even the most forgettable of memories. In surgery, music... any kind of music really... steadies the tempo of a hectic operating room. It places everyone in time with each other, even the patient's heart monitor seems to match the beat. Everything outside of the room disappears. What kind of music can do this you say? Well depending on the type operation, we've gone with everything from Bach to Abba, and Norah Jones to Britney Spears. (I've got to tell you, there's nothing more entertaining than seeing two very serious ex-Soviet surgeons rocking out to Britney's "Oops, I did it again." Oh the irony.)

My time in surgery has passed by all too quickly, but I won't be sad to move on to something else. The chance to see something entirely different was a much needed break. However, getting caught up in the ultra-competitive, long-hours lifestyle can be tempting... But I want something that will take me to the ends of the Earth, not the grand medical centers of the western world. Life as a surgeon would only pin me down, and I've got to follow my dream. It is hard to pass up the opportunity for all the power, prestige, and money, but if there is anything I have learned from cutting people open...

it's what is on the inside that matters.