Holly Cuts to the Chase

Do you remember when you were a little girl, or boy? Do you remember that fire inside you? The dreams? The plans you had? Did you dream of being a CEO, owning a farm, becoming a doctor or starting your own business? 

And then? Did life come in and swallow you whole? Your vision suddenly and seemingly permanently clouded by the demands or desires of others? Every once in a while the dreams peak through, like the sun in the midst of a terrible storm. Little rays pop through and remind you that you weren’t meant for this. You’re here for something else. 

But the dreams pop away, scolded by the college debt, the poopy diapers, the Sunday morning baby food assembly line, the fatigue, the fear to take a chance and leave the stability and comfort of your current brain stagnating job to follow that lousy dream of yours.

Last weekend, while enjoying my monthly on-call weekend beating (a weekend that gives me a tremendous appreciation of car seats, gun control, pool fences and a healthy coin free diet), I was really moved by an interview on NPR of Paolo Coehlo. He spoke of suppressed frustration and life dissatisfaction, despite financial “success” due to failure to achieve one’s personal legend. He spoke of pursuing  life goals that were prescribed to you by someone else and remembering only later that you really wanted something different for yourself. He spoke of the self destruction that occurs when one denies themself pursuit of their personal legend . 

I see it….everyday. People miserable in their jobs because their heart isn’t in the work. The risk to do what they love feels like they are walking across the Rio Grande on a tightrope with their family and their kid’s  college funds on their backs. A personal legend doesn’t need to be grandiose. Maybe you dreamed of writing a book, of going back to school to become a nurse, running a marathon, inventing some cool contraption that is scribbled on a paper somewhere in the back of your underwear drawer. I have no idea what you dreamed of.. Big or small…but you do. 

The fear of change keeps us in bad relationships, contributes to poor self esteem and creates a cycle of self hate, pity and depression. Comfort creates complacency. 

Close your eyes and remember that fearless girl, full of fire, inspired, empowered. Grab her tight and shake off the “I can’t”s. Dust off her dreams, her skills, her “yes, I can”‘s and find a path to your personal legend. Leave your comfort zone. You don’t need to be reckless or irresponsible, you need to be inspired.  Do your kids even know what you’re good at? Have you ever dared to show them? 

It’s time. I see the sun peeking through the clouds, and it’s for you.. For me.. For us. Write down your dream.  Stick it on the wall. Don’t listen to the “you can’ts” or the “buts”. You were meant to do this.

Be inspired. Be Inspirational. 

❤️

998 mass shootings in the US since Sandy Hook… Where America’s Children were massacred while at school. Since that time, nothing has changed. You can still get an assault weapon, a semi automatic, bullets that penetrate armor… Weapons that are purely designed to efficiently kill humans.  This isn’t for your favorite sport of hunting down and feasting on Bambi… This isn’t for self protection. These guns are to kill people. People like me, like you, like your adorable children. Churches, schools, movie theatres, malls, clubs, sporting events, military posts.. Everywhere… Anywhere…

So what has changed… Each time, Congress has a moment of silence, President Obama honors the dead, our nation’s flag flies at half mast… And that’s it….

Well.. That’s all that changed unless you are the mom, dad, brother, sister, lover, teacher, neighbor, husband, wife, cousin, son, or grandparent of someone killed or forever wounded due to our inaction.  Because a lot has changed for them.

 Nothing has changed unless you are the police officer, emergency worker or trauma surgeon on that day who will never wash the blood soaked images from their indelibly marked minds…

 Nothing has changed unless you knew the person or people who carried out the crime… Wondering every second of every minute of every day if somehow you could have recognized  the plan and stopped it. 

Nothing has changed unless you’re Muslim or from middle eastern descent and are now the undeserving victim of nationwide republican candidate sponsored discrimination.

Nothing has changed if your phone hasn’t rung or the police haven’t shone up at your home to gather you and inform you of your loss. But as the numbers increase.. So do the chances that they will. 

GUNS KILL PEOPLE. Period.

It’s not just the mass shootings. There is domestic violence, an increase in suicide (particularly in teens), and look at our inner city high schools here in Miami… There is an all out war in effect and we are losing our precious inner city youth on a daily basis to gun violence. 

BUT YOU WANT TO KEEP YOUR GUN.

To hell with you. Today I told my 7 year old what to do if she sees someone with a gun while at the movies. A conversation no mother in the United States of America should have to have. But yet, we do… We are no longer free. We are imprisoned by our racism, our bigotry, and our appropriately placed fear. So you want your gun?  Then it will happen again. We will see 999… 1000… And so on. More Americans dying on American soil from gun violence than died in war in Afganistan. This isn’t about them…however you define them… This is about US, our families, our children, our beautiful diverse nation, and it must stop. 

SUPPORT GUN CONTROL

SUPPORT MENTAL HEALTH SERVICES.

MAKE A STAND

“Hate can never win. Together we must be sure of that. Your tragedy is our tragedy” James corden

Tonight #PrayForOrlando

Tomorrow, stand up, put down your gun and #prayForAmerica

I went to yoga recently and the teacher had us do about 50 goddess poses… And hold them for 5-20 breaths each.  She stated in the middle of the last and longest goddess (during which my thighs convulsed in such a way that I’m not sure how I stayed standing) that doing something like this required your inner goddess. 

Inner Goddess? Hell Yes! I’ve  got one and she rocks ..but she’s a bit of a bitch, so I also have a little whiny super chatty princess too. Ying-yang, dark- light, good-evil (I’m not sure which is which sometimes).  I wasn’t sure how to word it before .. The compulsive mean me… The one that’s goal driven, super competitive and kind of bitchy = Goddess. The whiny princess is annoying but I think sometimes keeps me from getting injured or fired…. 

So, I’m swimming in the pool at the University of Miami, Apple Watch on (against manufacturers recommendation) so that it doesn’t wrongly accuse me of laziness (so far, so good). I’m training for a 2 mile open water swim. Sometimes it’s hard for me to self motivate unless I have a goal.. With a date… Signed up for and paid for. Otherwise… It’s just another day and I don’t really feel like exercising…. The whiny princess takes control. And I’m the queen of excuses.

The amazing thing is that once I start exercising, I’m compulsive. Truly. So today I’m swimming. This pool is beautiful and as I push off the wall I love the way the water feels around my body, like it’s propelling me forward, supporting me. I wonder if that’s what it feels like to birds when they fly. De-lightful! The goddess takes the reins.  I just love the way it feels once you get going.. Whether running or swimming or… Well actually I never ever get that feeling while cycling. Sorry cyclists… There is something for everyone.. And I just feel like cycling to the nearest ice cream shop and getting a little snack. 

I always mentally design a workout before I start.. Because without that I WILL stop early and I choose intervals so that I don’t just hang out…. And then it starts… The mind games, the competition, the compulsion. Last night I decided to swim 6 500’s to total 3000 yards plus a little cool down (like 50 yards.. I tell myself 200… But I know myself and I know that’s a pipe dream..  the princess- knowing that I’ve finished the “real work” is going to lift my butt out of the pool convincing the goddess that all is good with this 45 year-old-stiffer-than-an-embalmed- mummy body and no stretching or cool down required.. What could possibly go wrong?

Each 100 has to be faster or the same as the last and each 500 has to be faster than the 500 before… It’s started… Game on. Can’t stop… Who does this to themselves? I actively question that but the compulsive goddess retorts that it helps keep track of the laps…

The princess gets tired, maybe a little bored … Starts looking at the incredible six pack swimming next to me… I’m quickly commanded to swim faster.  “What you do once you can do twice and again and so forth”. Flip, glide, 2 dolphin kicks…. Dear god I need air! What doesn’t kill you makes you stronger! What if it does kill us? Whiny little princess B**ch… Quads cry, lungs squeeze.. Six pack glides by in the next lane. There is really something to be said for swimmers bodies. Was that 6 or 7 laps? Stop looking at 6 pack!! You’re getting distracted! Well yes I am! Faster and faster. I often wonder why the hell I do this! And why does it feel so good! And what this must look like to a far away planet above… What are they doing swimming back and forth in that pool? Generating electricity? And the same for running… My husband runs marathons? What on earth?! Running for 4 hours and maintaining the same pace? Well not for me.. I have some “GI issues” (that’s code for I will poo in my pants) if I run too far. Honestly.. Thank god or the goddess might want to try that too, but goddesses don’t like poopy skorts.

Sometimes I have guilt that while some people are fighting for their  lives, their homes, their families… Walking for necessity.. Here I am jogging around a beautiful neighborhood or taking an hour to swim back and forth playing crazy mind games with myself.

Why do we do this? One word. Sanity. The mental struggle between the compulsive me and the distracted me is never ending. All the stressors of the day, week and year come up, get mulled over and then get purged out by the compulsive me in that pool or during that run (not biking.. No purging with biking..just snacking.. I always need a destination). Thoughts come and dissipate with each flip, each glide and each hypoxic event. 

The goddess gets tired. Gives up the battle after achieving the goal. When I get home or to work, I’m chill.. Less confrontational.. Less nitpicky.

I feel healthy. I feel a sense of achievement and if I don’t hit my goal, I have something to work towards the next time.  Get out there and get your Goddess on! (And tell that whiny bitch to shut it down for a bit)

❤️

I refuse to accept that I’m old, but some things sure have changed in the last few years. I thought maybe it was a “Miami thing” the way doctors are treated… Somewhere between a waitress when you don’t like the food at a restaurant and a hairdresser at supercuts (sorry Supercuts).

The attitude toward physicians and nurses from hospitals and administrators seems to have changed. We are no longer the über educated, independently thinking, hard working physicians, surgeons, nurse practitioners and physician assistants we once were. Now, we are “providers”. Here to provide specified care to the hospital’s “clients”, here to experience a “cultural transformation” to “efficiently utilize” the available patient encounters and maximize the patient experience and survey scores while minimizing expense incurred to the hospital. Each provider/FTE must be used to maximum efficiency and profit.

I link the change in attitude to a change in language. Instead of a letter addressed “Dear Dr Neville”, often with a gentle blue line through the formal title and “Holly” handwritten in, now my letters are printed on cheap paper  folded unevenly addressed to “Dear Provider”… Usually followed by instructions to take a “mandatory CBL”.. on hand washing.. or not committing fraud. I’m not sure they realize this, but I have a mother.. And she did a good job raising me…

I AM A HUMAN! A PHYSICIAN! A SURGEON!! I TAKE CARE OF HUMANS AND I WASH MY HANDS!! (AND I DONT COMMIT FRAUD EITHER)

My patients are handed to me (and my freshly washed hands) by their tearful parents. The parents entrust me with the life of their beautiful child… Who doesn’t look much like an RVU to me.

When I finish,  the hospital proceeds to calculate my efficiency, the time it takes and cost of the instruments and equipment I use and compare it to the other “system providers”. They then generate a report and provide me, the provider, with recommendations and tips to reduce cost and assist the hospital to maximize reimbursement for the CPT and ICD10 that the provider has provided.

I had a partner who used to tell me “you’re only as good as your last hernia”… maybe… But listen up hospital administrators… That hernia? On your client, for my RVU’s based on your CPT’s… It’s gonna be good, it’s going to be efficient… Not because of your policies, CBL’s or weekly reviews. It’s gonna be good because I chose this field to be a teacher, a caregiver, to make sick infants and children well, to hold hands, to wipe tears, to be a physician and the best surgeon that I can be. And so did my “provider” colleagues.

So please, call me Dr Neville, Doc, Hey You, or call me Holly… I’ve been called plenty of things most of which I’ll accept or have even deserved…  but please don’t call me “provider”.  My patients deserve better. 

Yesterday, another valued, esteemed physician died. I suspect every physician knows of at least one physician who died prematurely. Lots of times its for “natural” causes… I say “natural” because crashing your car while driving mostly asleep is kinda natural (but not really); because cancer in a person who hasn’t properly slept, eaten, or exercised in 10+ years is kinda natural; because so many causes of premature death that are natural are also preventable, but require the time, energy and investment in yourself to prevent them… And then sometimes their premature death is not natural…. But we don’t want to talk about that. We don’t want to dishonor their memory. Maybe we don’t want to accept that it’s preventable… That it could happen to you, or me, or a friend or colleague or spouse…

I want us, as physicians and as a society, to acknowledge that there is a problem. I want us to acknowledge that we are losing more than one physician a day to suicide… in their homes, in their workplaces, in their call rooms.  I want us to recognize that physicians are more likely than others to suffer from depression, drug abuse, alcohol abuse and ultimately commit suicide- intentionally or unintentionally. We need to be aware that as physicians we have excess stress leading to medical conditions that result in our early demise. In women physicians,  suicide is 250-400% more common than in non- physician women. 

What the hell?? We are bright, energetic, intelligent and successful women! Why are we killing ourselves?

It isn’t just the career, and it isn’t just this career. It’s with any high powered profession and it starts young. We are not prepared for the  cold, cruel reality of medicine or business or law,  or even life. We are told from when we are small that we are the best. We are so smart, so talented. We can do anything.  We are the valedictorians, the varsity athletes, the small town success stories and inner city kids who make it big. Our parents told us how wonderful we are, our teachers told us how smart we are, our coaches told us how talented we are… And then one day… We are just not good enough. 

That’s right. We are not good enough. That person you’ve been charged with taking care of dies. What happened to “I can do anything?” What happened to “I’m the best.”  

Well, sometimes our best isn’t good enough, and even worse, sometimes we make mistakes. We fail. 

So, there you are…. Feet planted to the goddamn OR floor in pure protest of surrender and you can’t fix it….fingers grasping your ICU patient’s bedside table and you can’t prevent it.… Arms pumping the chest of the toddler in the ER and you can’t get him back.…”no one dies on my watch”, but they do….and you can’t handle it. 

But in any full time, intense high power career where years are spent in preparation and excessive hours are spent at work, it happens. Failure happens. 

 Your boss or attending screams at you about what an idiot you are. You repeatedly come home late to a failing marriage, perhaps you succumb to the temptations within the workplace with no real accountability due to “long hours”, call, and overtime. You miss another of your kid’s events… They start acting out… 

You begin to unravel. Failure… You have no coping skills for failure. You never expected failure…. Not me…

More stress, more unraveling…. Access, money… It’s a recipe for disaster.

Physicians turn to drugs, alcohol, dysfunctional behavior, destructive relationships, depression. They claim “no time” for more healthy releases like exercise, me time, mindful awareness or meditation. 

Well guess what?

I want a pledge. I want you to pledge to not let this happen to you. I want a pledge that you will keep this in mind when dealing with your colleague and friends and even students. 

We are smart. We are good. We need to take care of ourselves! Learn to accept failure.  You don’t have to like it. But learn from it. Don’t fail yourself. Take a yoga class. Try out mindful awareness. Speak up if you are concerned about yourself or someone else.

There may not be second chance.