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The Imperative of Hope

Many friendships are contextual, deriving from circumstance and position or profession. Some professional relationships stay strictly so, while others morph into varying degrees of friendship. Depending on the person and their openness to brushing aside a professional veneer, social media has the ability to give us glimpses into others’ lives and make us feel closer to them – through pictures, stories, and brief exchanges, and can carry connections over longer times and farther distances, even when the initial connecting impetus is long in the past.

The man who was principal at our sons’ high school is such a friend. For the consecutive eight years our boys were there, he was the face of the school. As reasonably involved parents with kids active in sports and music, we had plenty of interactions through the years. We had his cell phone number. Lest you be impressed with what one might assume is a sign of a special closeness, I need to tell you that he put this number on a big slide during back-to-school-parents’-night (or whatever they called it – curriculum night, maybe?) every fall, kept it up for a good several minutes while he gave his spiel, and simply requested that folks refrain from using it in the middle of the night except for a true emergency. He openly friends parents and students on Facebook, and shares pictures and stories and intense glimpses of his family and his life in general. He also sees those pictures and stories and glimpses of others, and that of course contributes to how well he knows his students and their families.

Halfway into our family’s tenure at the high school, after our eldest had graduated and as our youngest was starting, I made an appointment to speak with him. I could count the number of times I had an actual complaint about something in our school system on one hand, even if I were missing a couple fingers, and this was one of them. It was something quite trivial in the grand scheme of things, I assure you. As I walked into his office, I prefaced my explanation of my concern with something to the effect of “I’m not necessarily completely rational at the moment and I’m overreacting to things because I’m really missing Zac” (although our children took flight from the nest with ease, it was not so easy from my side). I started to launch into my reason for being there, and he said “Stop. Wait a minute.” And he hugged me. Not a perfunctory social hug, but a real, honest-to-goodness hug you give someone when you really mean it. And he’s a really big guy, so it made an impression.

Fast forward eight years from that hug. He’s moved to another state. All of our boys have graduated from college. We’ve kept up with him through Facebook and comments and messages – he is a friend. It’s not an even friendship – by nature of the circumstances and positions of our connection, he is much more of a friend than I am from a give-and-take perspective – but I still see it as a friendship.

But this isn’t about friendship.

Two weeks ago, I was on the phone with a friend who’s recently moved overseas when Zac called me. I texted him to let him know I was on the phone with her and that I’d call him back later. I saw a notification that he’d texted back, which I assumed was the normal expected “ok, talk to you later” response. But ten or fifteen minutes later, I realized something about the text fragment at the top of my phone wasn’t hitting me right, and I clicked to read it: “Can you call her back? I saw something very sad on FB that you should know about now.”

Fuuuuuck. My stomach sank, I told my friend what Zac had texted and she said, “Go. Call him. Call me back.”

I called him, my heart already racing. Sad shit happens all the time. Generally, one of us will put it in our family group chat. If this required a phone call, this wasn’t going to be easy to hear.

Our high school principal, that man who leads communities from within, who shares his family with all of us, who listens and hears and sympathizes and empathizes and shares the sublime and the ridiculous, had just lost his 21-year-old son.

Fuck. Just fuck.

I called Doug and told him. Then Ryan and Andrew. Was not able to keep my voice from breaking during any of those calls.

Our family was hit with a ton of bricks. As were thousands of other families who are in the communities in which our principal and his family have been such larger-than-life, yet down-to-earth and humble, parts.

The next part of this story is somewhat surreal. At a time of utter devastation for this family, when the world should carry them, they continued to carry others.

The family held a celebration of life ceremony the morning after announcing their child’s death. It was outside, on the shore of a beautiful pond on the grounds of the university where he had just begun his senior year. His mom spoke, then his older sister, and then his dad.

His name was Sam. And it was suicide.

I say this out loud, because Sam’s mom was adamant that we do – without shame, without stigma. She spoke of her son and his strengths and his silliness and his empathy, and with an unwavering assertion that her son was wrong, that there is always hope, and that suicide cannot be an option. Sam’s mom knew her son and her audience – there were hundreds of people both at the pond and tuned into the video from afar, many of whom were Sam’s friends, who had turned to him for support. Her message was one of a person making damn sure that people who looked to Sam as a leader did not, ever, look to his final act as one to follow.

Sam’s sister spoke of her brother’s goodness and kindness, his ease of making friends, his never hesitating, even for the smallest fraction of a second, to help someone, and how we could all learn from that.

My friend, Sam’s father, spoke of the light of fireflies in a field and of the stars in the sky and of a perfect evening fishing trip just taken with his son, whose invitation he had almost turned down, and the importance of maximizing the time, the moments, with those you love.

Sam’s aunts made Facebook posts in tribute to their nephew, speaking clearly about suicide.

But this is not about suicide.

Sam died in the week before Rosh Hashana, the Jewish New Year. Rosh Hashana is a time of celebration, of eating apples dipped in honey to symbolize wishes for a sweet new year ahead. I could not stop thinking about how, as I and my family were entering a new twelve moon cycle much like any other, with our family whole, my friend and his family, who also are Jewish, were now embarking on a devastating and new rest-of-their-lives.

Rosh Hashana marks the beginning of the Days of Awe, a period of ten days of self-reflection, of focusing on how we might have hurt others, and how we can make amends. The Days of Awe culminate with Yom Kippur (the “Day of Atonement”), a day of fasting – of “afflicting our souls” – and prayer. During the ten days, God is making judgments and decisions as to who will live and who will die, who will suffer and who will experience good things. Although we all “sin,” and sins are confessed communally, repentance and prayer can lessen the severity of judgement. At the end of Yom Kippur, so the liturgy goes, the gates of judgment are closed.

I have always hated Yom Kippur, Judaism’s holiest day. It scared me as a young child, as I had a very concrete take on it. I was convinced that my little brother, a toddler at the time, was going to die because he had a temper tantrum and fought with my parents on Yom Kippur. That leaves a bad taste in one’s mouth.

As I got older, I moved to a much more symbolic understanding of religion and learned to appreciate what I see as the good parts of it – tradition, community, ethics, helping others, providing structure for people who need it, providing solace for those who are suffering. I pick and choose the traditions I follow. I have my own interpretations of the words I sing and actions I do – very big on the symbolism aspect of “God” and “prayer” and “soul” and such, with much poetic license taken.

I don’t believe in closing gates or predestination. I believe that “life,” which Judaism (and most other religions as well) holds as sacrosanct, includes more than a clinical definition.

The body, the mind, the soul, are intertwined, inseparable. And that soul, that nebulous concept, to me is the unique, permanent, indescribable (though I’ll try), indefinable, undeniable, combination of a person’s thoughts, words, emotions, and actions and their interlacing impact with people and with the world. My understanding and view as a doctor is that Sam’s body is no longer alive, but his impact on the world lives – people are different because they knew him. The impact of his soul continues, and will ultimately affect people who haven’t even been born yet. Similar to the light of the stars my friend spoke of, which show us light from billions of years ago yet help us navigate today.

And may Sam’s family, his beautiful, devastated family, whose souls have been so deeply wounded, have an interpretation of Yom Kippur that does not tell them to “afflict their souls” and “fast” and “refrain from pleasure,” but allows them, if they should experience a joyful memory, to revel in it, and to have the hope and sweetness of apples and honey or a taste of one of Sam’s favorite foods. May the concept of holding life above all include healing souls over “rules” of a day.

The gates are not closed. There is hope. There is always hope.

Wishing all of you sweetness.

What Football and Infectious Disease Control Have in Common

Communication. Such a simple concept. And yet so many ways in which it can fail.

Two examples of communication failures hit the news this past week, both of which have potentially severe medical repercussions, albeit on very different scales.

The first occurred this past Saturday at a Big Ten football game. The quarterback took a hard hit, and his head slammed backwards onto the ground. When he got up, he was so shaken and off-balance that he stumbled and collapsed into his teammate. So obviously, he would be pulled from the game and given medical attention, right? Nope. The coach put him back in for another play, as the crowd booed its displeasure and indignation. No one could believe the coach would show such blatant disregard for his player’s well-being, and there are strict regulations in place regarding head injuries in sports and protecting the athletes when there is any suspicion they have suffered a concussion.

But the coach didn’t pull the player out for a neurological check because he (the coach) hadn’t seen the player’s hit, his head-slam, or his resultant signs of head injury. The coach knew the quarterback was playing on an injured ankle (which had been medically cleared for play), and when he saw him limp back to the sideline, he assumed it was an ankle issue, stuck him in for another play, then had medical personnel check his ankle, and put him in again. Thousands of people in the stadium saw what happened. Millions of people saw on TV. Everyone assumed the coaches saw. But they didn’t – they were monitoring so many different things, planning, talking to people, and assuming important information would get to them. But the information didn’t get to the right people.

The university where this occurred is taking steps to ensure such an event doesn’t happen again. For example, they’re placing medical personnel in the press box for future games and giving them direct communication lines to the coaches. Systems approaches are good. They help. I’m glad they’re putting in extra safety layers to protect their student athletes, and I hope other schools and teams follow this lead. But systems measures can only go so far. We also need individual safety layers, and I cannot overstate the importance of personal advocacy (both self-advocacy and advocacy of others).

If the quarterback had said, “Hey, Coach, I hit my head and don’t feel right,” or, if he was too dazed to speak for himself, if his teammates had told the coach about the injury and their concern, or if anyone who had seen the incident had spoken up and relayed the information to the coach, then the athlete would have been given prompt medical attention and not sent back out on the field to be head slammed again. People need to speak up. And they need to speak up to the people in authority – the decision makers – and not just grumble quietly or complain amongst themselves.

Earlier this week, the news hit that the first person in the U.S. had been diagnosed with the Ebola virus. Ebola requires close contact with someone who is symptomatic with the disease in order to spread. We have good infection control measures in U.S. hospitals. We have quick dissemination of news. We have the CDC (Centers for Disease Control and Prevention). We have state and local health departments. We have a lot of good systems in place. The patient had recently come from Liberia, where there is a current outbreak of Ebola. He developed symptoms, he went to the hospital, and he told some of the medical personnel that he had just recently returned from Liberia. And he was sent home with a prescription for antibiotics. And he continued to be symptomatic, exposing other people for days, until he returned to the hospital and received the correct diagnosis, appropriate medical care, and concomitant infection control measures.

In this case, the patient actually had communicated the important information, but it didn’t get to the correct people. A systems issue, to be sure. But more individual advocacy and strong communication would go a long way here, too.

I was not on the sidelines with the football team, and I was not in the emergency room where the patient first presented, but I have some pretty good ideas as to some of what may have been going on.

Both the sidelines of a football game and an emergency department can be bustling with action. Things are going on in different areas. Different teams (offense, defense, trauma, radiology….) and their respective coordinators (offensive and defensive coaches, head coaches, triage nurses, nurse practitioners, attending doctors, etc.) are functioning within a larger whole, trying to attain their overarching goal (winning a game, getting all the patients taken care of) while trying to maintain the well-being of each individual (the athletes, the patients). With so much going on, communication frequently suffers. And when people are nervous about speaking up, communication suffers.

Players may have been afraid to “argue” with a coach. They may have assumed the coach knew all the facts. The patient or his family or the nurse he originally spoke to may have assumed the ER doctor or Physician’s Assistant or Nurse Practitioner who discharged the patient had read the travel history and considered the possibility of an Ebola infection. Both situations just needed someone, anyone, to say to the decision maker, “Hey, wait a minute. Do you know that (I hit my head and can’t walk straight/the quarterback looks like he has a concussion/this patient was just in a country with an Ebola outbreak/I just flew in on a plane from Liberia)?”

Systems approaches. Individual back-ups. Individual care. Systems back-ups. All necessary to minimize the holes in the information sieve. Don’t skimp on the systems. But also never be afraid to plug the holes in the systems yourself.


On the Air Today at Noon!

For those of you who may be interested, I am being interviewed by Health Reporter Sean Lee from WWJ, the CBS affiliate radio station in Detroit. today, sometime between noon and 1 p.m.. So listen in on 950 AM radio, or through their website (click the watch/listen tab and then click on the WWJ 950 button) at

I’ll be talking about how to protect yourself and make sure you’re receiving appropriate medical treatments. I’ll update with more detail after today’s show.


Web Radio Conversation

Practical Medical Insights will be featured on the Conversations in Care web radio broadcast this Wednesday, March 20, 2013, at 2:00 p.m. EST (1:00 p.m. CST).  I will be interviewed by the host, Tami Neumann, and we’ll be talking about the background of Practical Medical Insights, personal medical advocacy, what I do to help my clients, and tips for staying in control of your own medical situations.  Click to hear the broadcast.  You can either listen during the live program or after the show (the same link will be available for on-demand listening after the broadcast).

As always, if you have any questions you can visit or contact me directly.



I can’t believe no one caught me yet on my mistake!  I misspoke – I said there wasn’t saturated fat in the cornbread, but it is made with two eggs, so there IS saturated fat from those, and there is a tiny amount in the canola oil and low-fat buttermilk (the Trader Joe’s brand I mentioned only has 1% fat).  But it’s way less than if it were made with the butter or shortening that standard recipes call for, and if you use egg substitute it knocks the saturated fat level close to nothing.

Sorry about that!  I have fixed the post.  And once again, enjoy the Superbowl!