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First Published on March 10, 2008

He who fears he shall suffer, already suffers what he fears. ~Montaigne, Essays, 1512

Fear is a very primitive emotion, setting off a chain reaction of events that pumps our blood full of adrenaline, raises our heartbeat, tenses our muscles, expends our energy, and quickens our thoughts. This is the essence of the so called “fight or flight mode.” It is very necessary for our physical survival that we recognize danger and react to it. Its result is a complete shutting off of higher centers in the brain, in order to focus all our faculties on a threat.

While fear is good for survival, the behavior that results has lead to some of the ugliest, most savage, animalistic atrocities that our race is capable of. Read the rest of this entry »

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And we’re back, time once again for a run down of the very best, most interesting, most educational, most inspiring, and most bizarre stuff I’ve been able to pick up here and there wandering the internet between actual work.    This time I have the anatomy of hope, the anatomy of gummi bears, heady philosophy from the likes of Descartes and Barth, the link between marshmallows and intelligence, sculpting shadows and lots more.  So have a seat and enjoy the very best of that my meanderings of the ethernet led to- Read the rest of this entry »

When I was in the third grade, I learned about this very cool thing called a bike-a-thon.  I could take my bike and by just riding it help cure cystic fibrosis, a disease that I had no idea what it was, but sure sounded bad.  In my idealistic eight year old mind this just seemed like it just having fun for a good cause, so I signed right up and went for it.

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My second grader sister heard about the same thing and decided she had to do it as well.  That was a pain.  This meant every pledge I went to get had to pledge equally to the both of us by royal decree of my mother.  I was irritated, but we both pluckily canvassed the small town of under 1,000 inhabitants, all of whom knew our family, and gathered pledges.  I knew no fear in those days, heck, I didn’t even realize knocking on doors asking for money is annoying in my innocence. 

    Pledges were made per mile and so the first question we were asked was how many miles we were going to bike.  I pulled the number twenty off the top of my head as it seemed a nice even number.  I still remember some of the amused, patronizing smiles as these wordly wise adults then penciled in their donation.  Our pledges piled up and we ran out of room to contain them, requiring extra pledge sheets.  What’s the harm in donating to a couple of naive kids playing grown up biking on their Schwinn’s after all.   Read the rest of this entry »

     When I was in medical school, I was treated by my wife to a fascinating and gripping performance by Tom Hanks in the movie, castaway.  While I can’t say the movie was profound or life changing, I found its depiction of isolation and loneliness was quite powerful.  In the movie, Tom Hanks works for FedEx, where the plane he is riding crashes into the ocean.  He is the sole survivor marooned on an Island. 
     It is a very basic man vs. Nature plot, as he creates fire, steps on bad things, hurts his hand, bleeds, has a basic cavity volcano into a horrific abcess in the absence of a dentist, etc. al etc.  In the midst of all this, washing up on the shore of the Island with him are a few FedEx packages, one of which containing Wilson volleyball.  It happens to be nearby when he mauls his hand in a firemaking attempt and he smears blood on it.  A little later he fashions the stain into a face, cleverly calling it by the moniker splayed across the ball itself, Wilson. 
     The amazing part of the movie is that as Hanks feels more and more isolated, he anthropomorphizes the ball more and more.  He converses with it throughout the movie as a friend and confidant.  After some years, he escapes the Island on a makeshift raft, Wilson in tow.  As he sleeps, the ball falls off the raft and floats away.  Hanks is besides himself, grief stricken, and forlorn, and wails pitifully for the return of Wilson.  The audience themselves (well me, anyway)  experience this surprising sense of loss as well.  We grieve as He grieves.  Thus, the intrinsic human need for other human contact is put on bright display.  It is a need so powerful that in its absence we will create it out of contact with the inhuman, even the inanimate.  It turns out humans have a basic need for each other. 

Castaway, the story of a plane wreck survivor and the volleyball he loved. (now that's lonely)

Read the rest of this entry »

MS NBC has a beautiful little story about a relatively new phenomenon, perinatal hospice and the experience of having a child with a fatal prenatal diagnosis given before birth. (hat tip to PalliMed). Scientists have now unlocked the entire human genome, madly dashing to figure out what the function of each piece is. As a result our ability to test for genetic disease has exploded for an entire host of conditions. Unfortunately, diagnosing is a lot different than treating or curing. Knowing what is coming most often does not include being able to treat it or improving outcomes.

In many ways this is a throwback to the medicine of past centuries. Back then, doctors didn’t have a lot of effective treatments, so they made house calls, they learned to comfort patients, and be of whatever assistance they could. Childbirth was vastly different then as well. Infant mortality was much higher. Names weren’t picked out until you knew the child was okay. Attachment and hope were much more cautious.

My chosen specialty is often like this, though less often than you might think. There is an old joke about neurologists being admirers of disease rather than treaters. This is becoming less true everyday, but like most stereotypes, maybe had a small kernel of truth at its base, now distorted and stretched by the generalization. The sad truth is, any pediatric subspecialty is going to have more than its fair share of heartache and incurable conditions. And so, my heart went out to this family. I can relate. We doctors have to learn to deal with grief too. We love to bottle it up and this has led more than one physician on the fast track to burnout.

It makes me wonder what the impetus is for developing these gene tests. Too often in Obstetrics, it feels like the entire point of prenatal testing is to abort the pregnancy should it be deemed “defective”. I know this isn’t always the case. Being given time to adjust, grieve and mourn a very real loss can be helpful to so many families in this situation. Often, the worst part for families dealing with childhood illness is not having a diagnosis. Even if you can’t treat it, there is real relief in giving it a name and description of what to expect. It is not my wish to stand in judgement of any parent who has faced such a very difficult situation. Certainly facing the choice of “terminating” vs palliative care is heartbreaking either way. I have to say I was absolutely floored by the video interview of this family and the courage they took in loving, embracing, and caring for their child with Edward’s syndrome for the duration of its very brief life.

It would have been so easy not to get attached. It would have been simple not to mourn. It is the default protection response of many. It is a form of denial, the first stage of grief. I think it stops the grieving process dead in its tracks, and can make a family sick. You never get the chance to try to make peace with the tragedy.

I think this story is a beautiful example of what can be gained by not giving in to this impulse. In short, families are allowed to grieve, to cherish a memory and their short time with the baby. Then they can heal. Sometimes we need to allow pain to wash over and immerse us in order to move on and be healed. We need to grieve, and grieve fully.

The number of families that choose to carry a pregnancy with a terminal diagnosis to term is unknown, but definitely a small minority. They face family and friends who are often baffled by their decision not to terminate. One small British study showed that the number of families who choose this options reached 40% when perinatal hospice is offered. This tells me there are many who would like to see, spend time with, and know their infant and be able to tell them good bye. They just need a little help and support in doing so. What a wonderful cause.

Anyone who is interested in learning more, supporting, or referring a friend to perinatal hospice can find information at Http://www.perinatalhospice.org

He who fears he shall suffer, already suffers what he fears. ~Montaigne, Essays, 1512     

  Fear is a very primitive emotion, setting off a chain reaction of events that pumps our blood full of adrenaline, raises our heartbeat, tenses our muscles, expends our energy, and quickens our thoughts. This is the essence of the so called “fight or flight mode.” It is very necessary for our physical survival that we recognize danger and react to it. Its result is a complete shutting off of higher centers in the brain, in order to focus all our faculties on a threat.

     While fear is good for survival, the behavior that results has lead to some of the ugliest, most savage, animalistic atrocities that our race is capable of.

Read the rest of this entry »

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