Kindness

                   If I fall from grace with God
                   Where no doctor can relieve me 
                   If I'm buried neath' the sod
                   But the angels won't receive me
       
                   Let me go, boys
                   Let me go, boys
                   Let me go down in the mud
                   Where the rivers all run dry  
                                                         The Pogues  1988
                                 
                                       
As the dust settles and I look ahead to some type of normalcy, I have had plenty of down time to ruminate over how and why I am here. I doubt I will gain more insight into the cause of the accident, and frankly don't much now care. That was my best shot at the Ride from coast to coast. I crashed and burned, and it will be difficult to have another opportunity. Woody Allen once said comedy is tragedy plus time. Dark comedies are my favorite genre. Maybe I'll be laughing about it soon. I will ride again with new cycling goals I'll dream up and take seriously. Currently, though, I haven't a clue.


I seem compelled to come up with some spiritual  meaning from the experience. Always having an opinion but actually knowing little about the science of  Psychology, I suspect the quest for inner meaning is a standard reaction in any tragedy, which to some extent, mitigates the broken heart. "Tragedy " is a stretch. No one was killed, but not finishing the Ride when everything was going so well, with so much fun, compounded by the significant injury, was more than just a mere setback.

As a practicing Neurologist I am, in a way, a paid/professional observer. I look at someone walk and I may decide he/she has Parkinson's disease. I look at another person's hand and may decide the person is putting too much pressure on their ulnar nerve at the base of their hand. Someone passes out while I am watching, I can usually distinguish a seizure from a cardiac rhythm problem. After years of discipline, when a friend of mine comes in for "stiff back" I am able to ignore my prejudice of not wanting him to have a significant problem, and perhaps make a diagnosis that neither he nor I want him to have. When I was a little league umpire, circa age 17, all close calls at first base seem to go the way I wanted them to go. If a particular coach was obnoxious, his player genuinely looked  "out"  on every close play. At that point I was not a real professional, of course, subsequently succumbing  to my own prejudices. A professional observer does not make you a good or bad person nor does it qualify for additional merits. It's just a fact. I am confidant Neurologists are better observers than the general public.


As a passive and fully conscious recipient of emergency and hospital treatment as well as transport, it was easy to monitor all of the care I received after The Fall. From each observation I noted a very consistent theme. Most people were genuinely kind and more importantly, relished the opportunity to deliver on their inner virtue, to a total stranger, who was obviously in need. I am no Pollyanna. I am aware when I am not liked, not felt to be humorous, and not understood when I am trying to explain a medical issue to an unsophisticated or distracted patient, family member or student. The number of people involved in my care constituted a statistically significant sampling. This included people on the highway pass, ambulance staff, clerical workers at the Wyoming Hospital, the professional staff, housekeeping, other visitors, transporters to the plane and many workers and passengers on the plane and on the ground. These were men and women, white and of color, gay and straight, old and young. I'm not even including the ER people here in Macon. They were great but they knew me. Almost everyone I encountered after my crash was kind.


Professionally, I am on the eve of new direction. Next month, for the first time, I will be teaching medical students in their 3rd year rotation. Previously I have been teaching Neuroscience and other topics for the first two years in the classroom and  4th year electives to students who can be somewhat preoccupied by graduation or their impending Residency training program. Unless the medical students have done some missionary work, the third year rotation will be their first true exposure to meaningful 'hands on' medical care. Many permanent impressions are planted at this time. I remember these initial encounters in my own medical training as if they occurred last week instead of forty plus years ago. I was frequently awestruck a by the actions of the attendings, interns and residents. I recall not only the specific medical issues but how my superiors dealt with the patients and families. Often they were delivering some very bad news. Sometimes I was impressed and other times horrified, the latter, more often from a lack of kindness than some type of medical error. 

Before The Fall I had planned to exclusively deal with clinical skills. I am on a mission to rectify the recent pervasive attitude that young doctors share:
      "I really do not need to be an expert on taking a history or doing the physical exam. It is all about ordering tests and Googling the best treatment". 


There is some truth about the value of blood tests, xrays, CAT and MRI scans of course, but these students have been receiving the wrong message about the importance of taking a careful history and doing a revealing examination, very, very, wrong. Clinical medicine is primarily taking a detailed history then: touching, pulling, pushing, and probing. I intended to teach them well.


It is as if some force has been tapping me on the shoulder to notice something I was going to miss. The first tap came sprawled out on the highway, bloodied, stopping traffic in both directions. More taps with every wrong move :
                         " Hey dude, you used up your grace. Here is your next hand of cards. Play them well and don't leave anything out." 


There are many layers with this new task. It not just history taking and examinations skills. Kindness is in there. There may be other dimensions perhaps not yet considered. The persistent discomfort might be a reminder to keep an open mind. I think I get it.