It is inevitable that some people will die who get admitted to the ICU. It is always sad, and it makes us sad as critical care clinicians. It is reality, nonetheless. During the pandemic, it seemed that everyone who was admitted with COVID-19 ended up dying, and thank God, that was not the case at all.

Still, when it is clear that I will not win the battle against critical illness; when it is clear that my patient will die, then my fight changes to ensure that my patient does not die an ignoble death.

What is an ignoble death? It is one without dignity; it is a death not on the patient’s own terms; it is death of pain, distress, anguish, and suffering. No one deserves this kind of death.

None of us knows when we are going to die. None of us knows where we are going to die. None of us knows how we are going to die. Those things are, in fact, unknowable and beyond our control.

What we can control, however, are the terms of our own death. When we finally face death, how will we die? Will we die on machines? Will we die having the healthcare team pounding on our chests and shocking our hearts? Will we die having someone put a tube down my throat? Will my family be there?

We can choose the answers to those questions. We must choose the answers to those questions and make those answers known to our doctors and those taking care of us in the healthcare setting. It is absolutely essential – and dare I say it – critical that we make the answers to these questions known. Everyone deserves a death on their own terms.

And so, as a critical care specialist, I try my hardest to learn what the terms of my patients’ death are, and I fight my hardest – I battle to the fullest – to make sure that my patients die on their own terms. I battle to the fullest to make sure that my patients have a good death, one that is not ignoble: a death without pain, without suffering, without anguish, and on my patients’ terms.

During the COVID pandemic, it seemed that all we did for those afflicted with COVID was not curing the illness, but simply providing a good death. It did cause us a lot of anguish, because we are in the business of cure and healing. At the same time, there is nothing ignoble about providing a good death. If that’s all we can do for our patient, we have done our patient a tremendous amount of good.

Listen to the podcast episode about this topic here: https://healthcaremusings.substack.com/p/the-battle-against-an-ignoble-death

The post The Battle Against An Ignoble Death appeared first on Medika Life.

Individuals can successfully change anger into a driving force for personal and societal gains by adopting particular techniques and drawing from a few examples. What can you do to benefit from anger rather than have it gnaw away at you? Here are a few methods you can try:

Acknowledge and Identify Your Anger: The first stage is to acknowledge and recognize your anger. Recognize the reasons why it happens, the underlying causes, and the particular feelings that go along with it. You may better manage and direct your anger toward positive goals by developing self-awareness.

Utilize your anger as motivation: Anger can be a strong motivator. Determine the underlying causes of your rage, whether they are personal wrongdoings, societal problems, or difficulties you are experiencing. Use your anger as a motivating factor for change by establishing specific goals, making proactive efforts to reach them, and leading a corporate team. Let your emotions strengthen your resolve and dedication to change things.

Communicate Constructively: Use your anger as an opportunity to communicate constructively rather than allowing it to spark damaging arguments. Declare your wants, boundaries, and concerns in a firm yet courteous manner. You can attempt to resolve disagreements, improve relationships, and create positive change by properly articulating your feelings and perspectives.

Turn Anger Into Problem-Solving: Anger can improve problem-solving and critical thinking skills in adults and children. When you’re upset, step back and consider the circumstances logically. Use your sharpened awareness and focus to come up with original ideas, weigh alternate viewpoints, and investigate fresh avenues. Turn your anger into a resource for creative thinking and successful problem-solving.

Advocate for Change: If the source of your rage is a social injustice or problem, think about using it as a motivator for advocacy and reform. Learn more about the issues that are important to you, get involved with or donate to organizations that support them, and use your voice to bring about real change. You can have a beneficial influence on the causes that are important to you by channeling your anger into activism.

Convert Anger into Empathy and Compassion: Anger frequently arises from a perception of injustice or injury. Utilize this emotional energy to develop empathy and compassion for other people who might be going through similar things. You can transform anger into a force for empathy and compassion by changing your perspective and making an effort to comprehend other people’s perspectives. This will foster more profound connections and fruitful partnerships.

Develop Conflict Resolution Techniques: Disagreements and confrontations can occasionally lead to anger. Spend time on developing effective conflict-resolution techniques that let you handle disputes with clarity, respect, and empathy. By honing these abilities, you can turn disputes sparked by rage into chances for learning, comprehension, and cooperation.

Get Moving: As impossible as it may seem, there’s one “magic pill” for so many things, and it is physical activity to let off steam and direct anger in a positive direction. Do exercises like running, boxing, or dancing (yes, dance around the house or the office) to let off pent-up tension and energy. Frequent exercise helps regulate emotions, lowers stress levels, and gives people a healthy outlet for anger. It also boosts physical health. Contained, prolonged anger has serious consequences for your physical health, and movement and exercise can help you remain healthy.

You can harness the power of anger and use it for your benefit by implementing these techniques into your life. Never forget that you must control your anger and direct it in positive directions to prevent hurting yourself or others. Negative rage can be turned into a force for development, progress, and general well-being with discipline and self-awareness.

The post Beat Your Anger By Using It to Your Advantage appeared first on Medika Life.

The deaths of small children do not move us beyond tears and platitudes to policy action. What will? We are lost if we don’t demand a significant change in gun access policy after reading how a two-year-old wandered lost and frightened after both parents were shot and killed. After people going food shopping in Buffalo were slain. After people going to relax at a club in Colorado Springs were brutally murdered. How about the deaths at Walmart in Chesapeake, Virginia? Empathy drained. Courageous political action is tossed aside for preferred partisan politics.

Past policies passed in the bi-partisan Senate move are weak compromises.  They are face-saving actions for both major parties, not life-sparing policy moves that will reduce the death toll from gun violence. We need to make a move that will save lives, requiring a complete ban on automatic weapons. The Senate’s bipartisan gun deal includes additional mental health funding, increased school safety, more crisis intervention programs, and incentives for states to align juvenile records in the National Instant Criminal Background Check System. But automatic, high-powered velocity weapons – weapons of war – continue to be accessible.

High-Powered Weapon Purchases Are Climbing

In 1994, President Bill Clinton signed an assault-weapons ban, which resulted in the reduction of the AR-15 and similar semiautomatic rifles sales. The Ban only covered a 10-year window, in which mass shootings were down dramatically. When the assault-weapons ban expired 10 years later, gun manufacturers filled the production pipeline and sales rose. Recently – and tragically – the AR-15 has been at the scene of almost every mass shooting to hit the headlines in recent years. It’s design – the spin of the bullet – and firepower make killing as easy as pressing the trigger again and again until its 30-bullet magazine is spent.

The United States is witnessing a record year of gun violence – more than 600 mass shootings in 2022. The pressure is on lawmakers to enact meaningful reforms. But, little action is expected to curb this continued slaughter of the innocent.

Weapons of War are Designed for One Purpose – to Kill

For six years as a military paratrooper and combat medic, I carried an M-4, the preferred weapon of war for infantry entering combat.  The M-4 is a smaller, more convenient version of the M-16.  These are the weapons of war used in past mass shootings.  Some express misguided comfort that the A-15 is semi-auto only, and the M16 is fully automatic. But in combat situations, soldiers rarely fire on automatic. Few do, for every bullet counts.  Let’s stop calling these rifles “automatic.”  They are weapons created for war – weapons of war to wound and kill others.

Civilians are the Victims of this Gun-Epidemic War

We must heed the words of the onsite physician first responder in Highland Park, Dr. David Baum: 

“The people who were (killed) were blown up by that gunfire … blown up. The horrific scene of some bodies is unspeakable for the average person. I’ve never served, but those are wartime injuries. Those are what are seen in victims of war, not victims at a parade.”

Dr. Roy Guerrero, a healer of children who rushed to Uvalde Memorial Hospital after the massacre of 19 children and two teachers at Robb Elementary School in Texas, testified during a congressional hearing on gun violence:

“I chose to be a pediatrician. I chose to take care of children. “Keeping them safe from preventable diseases I can do. Keeping them safe from bacteria and brittle bones, I can do. But making sure our children are safe from guns, that’s the job of our politicians and leaders.”

The words of Drs Baum and Guerrero echo a simple truth: our politicians are too removed from the steady death toll and its horror to fulfill their responsibilities in protecting the nation. America is at war within itself. Our political leaders decline to call for a ceasefire despite rising body count.  Let’s call these weapons what they are – weapons of war. 

The AR-15-styled weapon was used in the Sandy Hook massacre, the Aurora theater massacre, the San Bernardino massacre, Marjory Stoneman Douglas High School in Parkland, FL, mass murder in Buffalo, NY, Uvalde, Texas, Highland Park, IL and the most recent shootings. What’s the difference between the AR-15 and its military counterpart, the M16?  They are assault weapons that hold a 30-bullet magazine and offer users the same firepower. Their killing capacity, like their power, is equal.

Congress must hold some responsibility for the murders around the nation. If its members cannot agree to protect the nation’s youngest citizens who sit in classrooms eager to learn to read, count, and play team sports, then they can either sharpen their empathy skills and feel people’s pain or consider their time in public office as a failure.

Congress Must See the Wounds of the Dead and Suffering

How can Congress show a higher degree of responsibility – a heightened connection to people’s enduring pain – physical and psychological?  Look and remember!  Each day, they should begin their sessions looking at the actual photos of those shot – the wounded and killed.  They should learn about their injuries, urgent care, and rehabilitation.  Also, each purchase of an AR-15 should require liability insurance.  Where there is no economic impact, death becomes cheap. For almost certain, once insurance companies are paying out claims, something is likely to change.

With less than 5 percent of the world’s population, the US has almost 50 percent of the world’s civilian-owned guns. The US ranks number one in firearms per capita. Our nation also has the highest homicide-by-firearm rate among the world’s most developed nations. Forget the reasons used to explain-away mass shootings; at the scene of each of these horrific acts are often weapons of war.

Americans need patriotic public service advocates in Washington, DC, who place the survival of its citizens at the forefront of their efforts.  Weapons of war, such as AR-15s, have no place in people’s home arsenals. Its bullet’s caliber rips its target apart – going in small and exiting the size of a fist. Members of Congress and their staff must be required – regardless of their political party affiliation– to see the destructive path of an AR-15 caliber bullet after every mass shooting – see the faces and hear the screams of the families impacted until those cries echo in their heads.  They must identify with the continued horror the first responders will likely experience for years.

Years after my military service, I remember the faces of the wounded and dead. I remember stemming blood from their gunshot wounds.  I hear their voices calling for distant mothers or asking if they will die. What was training and instinct – the ability to separate from the swirl around me and perform under fire – now is a movie reel that plays in my head. 

I cherish life, my role as a healer, and now, my responsibilities as a health communicator. But each moment in harm’s way was never about policy; it was about survival. Now, we are all in harm’s way wherever we go. Congress, you must transcend your political differences and imagine the cries of children murdered, calling hopelessly beforehand for their parents unable to reach out. Ban assault weapons. Ban weapons of war.

[This post was originally published on July 22nd and has now been updated to reflect the recent shootings the continued lack of Federal government action to guard its citizens’ safety.]

The post If Deaths of Small Children Do Not Move Us to Action What Will? appeared first on Medika Life.

Anyone with a pet knows the close bond that develops and the mutual dependency shared. Whether you come home in the evening to be greeted by a rush of fur and telling vocals and jumps or cradled on the bed or couch, it’s comforting, and there’s a sense that your feelings are understood. Anyone who says animals aren’t sentient must read up on the latest literature on the topic.

When we consider animals, of any kind, as having an emotional attachment (consider pack mentality for dogs) to us, we can better understand that if they lost us, they would grieve.

Cats may show their love and attachment to you by “washing” you as they would other littermates. Ever wake up to a cat “washing” your face as you open your eyes in the morning? Sure, it may be that you “belong” to them, but most probably, it’s a sign of attachment and caring for you. Who said cats don’t show affection?

Yes, head rubbing (bunting) is a way of spreading their scent on you because you are a member of their social group, providing a sense of security for them. It’s essential social behavior for the cat. There is research to support these cat behaviors.

Pets are members of our world and our family, and they are our companions that provide unconditional love. How couldn’t you grieve if you lost a member of your family? It’s natural, and the loss of a pet is as real as any other loss of a member of our group.

Dr. Amy Sullivan said, “Pets are a part of your life. They provide that additional support and love, and they’ve gotten you through some very difficult times. And so in some cases, grieving a pet is even more difficult than grieving a human being.”

Do you need permission to grieve a death in your family? Of course not, and it’s no different here, either. The loss is painful; they will be missed and fondly remembered for the love and joy they brought into your life.

There is no set way to grieve or mourn the loss of a pet. Despite what some may say, no formula or steps exist, and you will find your appropriate way. The one thing that will be part of your grieving process is all the beautiful memories you need as a point of concentration.

Pets bring so much into our lives, and I’ve often wondered how not ever having had a pet might affect personal growth. No, I don’t have any research on this, but I think pet ownership makes us better people, and I admit that is a bias of mine. We’ve had many pets in our family.

I recall walking on a beach on Long Island one summer when a beautiful golden dog came running in my direction. A man walking a short distance behind the dog came by, and I asked, “Is that your dog?”

Looking amused, he responded, “No, he belongs to no one. I just keep him.” The dog wasn’t a stray, and the man was telling me that the dog was its owner.

The post Is Grieving the Death of a Pet Silly and Abnormal? appeared first on Medika Life.

This is the 40th anniversary of the Battle of Sultan Yaacoub. It is also the 40th anniversary of my commitment to advocate for people in urgent need of healing.

I was part of the often-overlooked rescue force called into an overwhelming clash in Lebanon’s Beqaa Valley, where two forces were locked in battle. While Wikipedia, New York Times and Military History Fandom pick apart which army came out on top, I was among the small group of paratroopers who were like ants dwarfed by the tanks that lumbered across the ground and the attack-helicopters and supersonic jets that battled from above. For us, to survive was to win.

Decades later, I vividly remember people screaming for help and rushing to their sides to stop their bleeding or arrange for their evacuation. In the haze of the battle and commitment to the purity of arms code, I was blind to uniform, language and flag.  A broken person – no longer a combatant – became my responsibility. Their life depended on my actions; there was no time to be afraid. Perhaps their need kept my mind clear and my effort focused. Many commanders would cite extensive training as the key to overcoming battlefield terror. We should add that a clear sense of purpose can override panic.  I look back at that day and the months and years of service that would follow and recognize that my mission as a health communicator was forged in that fire. 

In battle, people discover who they are – as soldiers, friends and human beings.  We learn things about ourselves that we didn’t know, things about our ability to think and perform in terrifying situations.  As a paratrooper combat medic, I was trained to sustain and save lives. In the 24 hours from when we entered the bloody valley until a cease-fire was called, my destiny – my purpose and passion for the next 40 years – would be cemented.  I would become a healer.

Health policy strategist Dr. Glenna Crooks captured my memories as a medic caring for friend and foe in those hours in the bloody valley in her Covenants: Inspiring the Soul of Healing. Her book explores a vital theme: healing as a gateway to global peace and prosperity.  She maintains healing is the nemesis of despair and death.  Healers are the warriors pushing back the inevitable. We all must leave this world at some point, yet how we live is in our hands.  We can prevent illness in many cases, and those in the health system can rally to tackle seemingly hopeless situations through intervention and innovation.

Healing is an enduring calling. I do not forget those years in uniform and call upon those memories frequently; they sharpen my feelings of empathy and renew my energy to answer the call to action from people with serious worries undergoing their trials by fire.  I impart accurate information about cancer treatments, heart disease therapies, mental health struggles and the myriad of conditions and illnesses people face so that they can make informed decisions.  I represent the needs of patients, their parents, spouses, children and friends – all dealing with serious, often life-threatening obstacles.  I must remain sensitive to their fears and anxieties, and know that my work impacts their lives.

Years ago, physician and photojournalist Mathew Naythons, who covered the Soviet invasion of Czechoslovakia, and the Vietnam and Yom Kippur Wars, gave me a copy of his amazing photographic history of medicine at war, titled The Face of Mercy, with an inscription: “For Gil: Who has been there, and who understands…” It sits in my office as a reminder that generations of people willingly dedicate their lives, often placing themselves in harm’s way, to help others. It is an aspect of the best in human nature that continues to amaze me as I strive to “understand” needless suffering. 

Throughout history, we have faced armed conflict. This moment in time is no exception. We still witness the struggle of people trying to breathe free. We still see the brave faces of healers working in cities reduced to rubble and beneath the ground in bomb shelters to save lives.  We frequently meet people who face overwhelming diagnoses and press on with their treatments and critical decisions—all heroes and role models who ignite our desire to do more to help.

Since my time as a medic, my energy has not waned, nor has my passion or professional purpose. I am proud to be part of the generations of healers and advocate for people who urgently need care.  My wish is that, when faced with the frustration of dealing with the chaos of our fragmented health ecosystem and struggle to secure access to care for those who have pressing needs, we do not give up hope. 

The sage wrote, “It is not your responsibility to finish the work of perfecting the world, but you are not free to desist from it either.”  Remember that we are all still in the fight and sustaining life is victory.

———-

This article is dedicated to the healers and all seeking to be healed. Through the angst of diagnosis and treatment journey, may they find strength and hope. May the health system address their needs with empathy and compassion – recognizing that these difficult moments are when our humanity is tested.

The post Memories of Life-Threatening Struggle Inspire Life-Saving Action appeared first on Medika Life.

The horror of the loss will not fade. The searing pain of having to bury your child will never abate. The screams inside the hearts of these parents will never go silent. While the nation will have moved on from the tragedy, those left behind will have to deal with the unimaginable for the rest of their lives.

I lost my child to cancer in June 2009. It was the absolute worst day of my life. There is not a day that goes by in which my heart does not scream out in pain. It only takes a few moments of remembering the events of that horrible day to bring tears streaming down my face. The pain and horror of losing a child cannot be fully described by words.

A good friend of mine told me it is like having “an appendage ripped out of you.” It is much, much worse than that. It is a deep, searing, boring pain that is suffocating. And it never goes away. It will be 13 years next month, and the pain is as fresh as it was all those years ago.

At least my daughter died due to complications of cancer and the toxic chemotherapy used to treat it. I can wrap my head around that. I cannot wrap my head around losing my child to the senseless evil of a sick and depraved murderer. I cannot wrap my head around dropping my child off to school in the morning and then getting a call that he has been killed in the afternoon. Having lost a child, I still cannot even imagine this kind of terror.

But 19 families are currently going through this terror right now. 19 families are having to live with the unimaginable. 19 families are now enduring a torment and suffering that has no word in any language to describe it. Someone who loses his or her spouse is a widow or widower. A child who loses her parent is an orphan. There is no word to describe a parent who has buried his or her child. It is a monstrosity that is beyond description.

And 19 families are now dealing with this monstrosity head on. The attention on their tragedy by others will fade. Their pain, their suffering, their torment, the suffocation of their souls will never fade. Never.

And so, what can we do to help these families?

First of all, there are no words that can help. None. When they were putting dirt on my daughter’s pink casket, I became overwhelmed by the thought that my daughter is being buried, and I openly sobbed. Someone came from behind me and uttered the “right religious thing” to say. It backfired miserably. I was not comforted in the least.

What helped me the most was my friend, also coming up from behind me, holding my hand. I will never forget that or forget him for the rest of my life. We need to do the same for these families: reach out and hold their hands. Give them your shoulder to cry upon. Hug them and let them scream into your chest. Give them a space where they don’t have to “be strong,” because they are going through a pain that is indescribable in its horror.

As the days, and weeks, and months go by, the attention, the “thoughts and prayers,” and focus on Uvalde, Texas will fade. The nation – and the world – will move one. The pain and suffering of these families will not.

They will be going through their “Year of Firsts”: the first Memorial Day; the first Fourth of July; the first Halloween; the first Thanksgiving; the first Christmas; the first Birthday without their child. The same is true for the families of the two teachers also killed. It is a suffering unbearable in its scope and magnitude. Continue to be there for them as they try to pick up the pieces of their utterly shattered hearts. Continue to give them your hand, your shoulder, your hugs.

My heart bleeds and goes out to each and everyone affected by this horrific tragedy in Uvalde, Texas. My heart bleeds for each and every person – all over our country and the world – who has deal with the loss of a loved one, most especially a child. Lord our God, please comfort and heal them as only You can. Amen.

The post The Attention On Uvalde Will Fade. The Horror Will Not appeared first on Medika Life.