Friday, September 28, 2012

Wednesday, August 1, 2012

The Survivors

This week a ninety-year-old World War II veteran found his way into my exam chair. The first thing I noticed as he shuffled through the door was a small contusion on his left upper eyelid. It was so small that I almost considered it not worth mentioning. Little did I know that this slight bruise was the only visible manifestation of a much deeper wound—a wound that had been festering for nearly seventy years—a wound that no medicine can ever fully heal.

I initiated the visit with my usual questions: How have you been since your last visit to the clinic? Any changes in your vision? Any questions or concerns today? As I listened to his responses I did more than hear his words. I judged his speech, observed his eye movements, evaluated his vocabulary, and rapidly reached conclusions about his mental ability, education level, and yes, even socio-economic status. Though this sounds distant and clinical, it is a necessity. Without making such an assessment I would not know how to best communicate with my patients. But this clinical process drives a wedge between me and them. It takes away from the humanness of a conversation. It somehow prevents me from being able to look them directly in the eye and perhaps catch a glimpse of their soul.
And so as he answered away, I completed my secret evaluation: mental faculties fully intact, college educated, well groomed, still married, could probably survive without social security.
When he finished answering my opening questions he said, “So did you notice my black eye?”
“Yes. I was just about to ask you about that.”
 And only then did I finally really look into his eyes. They struck me as unnaturally dark.
“It’s the dreams. They won’t stop. I keep trying to bail out of my B-24. This time I made it out and hit my head on my nightstand. The worst one is where I am lying on the ground—I can see the wreckage of my plane and there is this line of gasoline stretching from it to me. I can see the fire coming, but I can’t move. After all these years it still has never managed to reach me, but it’s getting closer. Do you think there is any treatment that can make the dreams stop?”
It turns out he flew 36 combat missions in Europe and got shot down twice. The second time he was behind enemy lines and was the only one who managed to walk away from the wreckage. Somehow he survived. And it haunts him to this day.
I told him I was honored to meet him, that I consider him a hero. He doesn’t see it that way. He didn’t know what he was signing up for. He just did what he was told. And for better or for worse, he survived. But I don’t care what his intentions were. The fact is that he served. He sacrificed. And without the sacrifices he made, and continues to make, our world would be a different place.
I want to tread carefully here with what I am about to write, because the last thing I want to do is detract from those who have paid the ultimate price with their lives. But we must not forget the survivors and the hefty price they also pay. We often call death the “ultimate sacrifice,” and this may be so, but for some the cost of survival is a close second.
These wounded heroes from World War II are fast disappearing, but they are being rapidly replaced by another wave of walking sacrifices. A few months back one of these walked through my door. He was twenty-two years old. At first I thought he was seventeen. But not after I looked into his eyes. No, his eyes were much older.
When I pull up a patient’s electronic chart, every so often a banner will pop up on my screen. Sometimes they warn of a history of behavioral problems, or suicide risk, or other important need-to-know information. This particular fellow had a banner I had never seen before: “Warning, patient suffers from severe post-traumatic stress disorder triggered by images of dirt roads, or mention of dirt roads.” You see, on three separate occasions his armored vehicle had managed to find a roadside bomb. All three times his vehicle flipped, maiming or killing those inside. He walked away from two, but had to be carried away from the third, and somebody finally decided he had had enough.
We can read “Unbroken” or watch “Band of Brothers” or rent “Respeto” but most of us will never be able to fully comprehend the sacrifices our combat veterans make for us. I have only caught a glimpse, and it has left with me a deep appreciation. I hope I never forget.

Wednesday, April 25, 2012

The Value of Amazon Book Reviews

I have a confession to make. I purchased books on amazon for more than 10 years and not once did I bother to leave a book review. I read the reviews and often used them as a tool to evaluate prospective purchases, but never contributed myself. Why not? Several reasons. Who cares what I think? This book already has several reviews, another won’t make a difference. Too much of a hassle.

I never really understood the value of amazon reviews until I found myself on the other side of them. Your reviews are much more powerful than you think. Fifty strong reviews can help catapult an unknown author up the charts. A few negative reviews can kill an indie author’s dreams, or at least help them face the harsh reality that they’re a hack.

Reviews can influence a book in several different ways. Customers can organize book lists while they are browsing to weed out low-rated books and place highly rated books at the top of their genre lists. In this way, higher rated books become more visible and attract more customers and books with low ratings drop off the radar.

A book’s average review rating along with the number of reviews submitted is displayed prominently next to the title and has a strong influence on a book-browser’s first impression. “Wow, a hundred people reviewed it! It must be fantastic.” Or, “Oh, only 6 reviews and an average of 3 stars? This isn’t worth my time.”

Customers can vote on individual reviews and indicate the review’s value. A single well-written rave review can convince hundreds of “on-the-fence” book browsers to at least download a free sample, and if these customers indicate the rave review was helpful, that review gets displayed more prominently so more people will see it. A single harsh review can have the exact opposite effect.

So next time you enjoy a read, consider contributing your own review. Keep the following things in mind:

-          Always be honest but try not to be brutal.

-          Amazon allows you to create a “pen-name” for your reviews so you can remain anonymous (you have to navigate through your account settings to create your alias, but it is fairly simple to accomplish.)

-          Don’t give a book five stars unless it truly deserves it.

-          If you give a book less than 4 stars, try to be specific about why you didn’t like it.

-          If there are already several reviews and everyone has already said what you want to say, leave your own review anyway. Your review still holds a lot of value because it adds to the number and affects the average. Think of it as a way of thanking the author for their hard work, or punishing them if you felt ripped off. Trust me, authors pay attention to their reviews.

Happy reading!

Friday, April 20, 2012

Who is Performing Your Surgery?

This is a legitimate question. Is it an expert attending physician who has performed over a thousand cases? Or is it a resident physician who has performed five? If you could choose, who would you rather have? Should you have a choice? Do certain people deserve to have a choice while others don’t?

Here is the problem: surgeons must be trained, but training them is risky. Who should bear that risk? Who should be a resident’s first case? Should it be a volunteer? Or should it be an unwitting patient who has no idea they are about to be a young surgeon’s first case? When you sign permission for your surgery, do you deserve full disclosure about whether or not a trainee will be operating on you? Do you deserve the right to opt out of having a trainee operate on you?
Well, let me tell you how things really are.
Every expert surgeon began with their first case. Every expert surgeon had more complications when they were beginners, and then they got better over time. We call this the learning curve. Patients who find themselves at the beginning of a surgeon’s learning curve are at a greater risk of having a poor outcome or complication. That’s just how it is. There are ways to reduce this risk, but the risk will always be there. Take any teaching hospital and see if you can find their morbidity and mortality statistics. I’ll bet you anything the worst months are July and August. Why? Because that’s when the new first-year residents start taking care of patients.
So how risky is it to be at the beginning of a surgeon’s learning curve? The risk of the learning curve is the pink elephant in the room. Institutions that train residents are often reluctant to study it or measure it because if word gets out that the risk is large, they will lose customers. And they don’t like to explicitly inform their patients about the degree of resident involvement because most patients in their right mind would want to opt out of a trainee performing procedures on them. But if patients all refuse to allow trainees to be involved in their care, how can we possibly train our young surgeons?
So how does our current system handle this problem? Here are the strategies currently employed:
1)      Be as vague as possible about the level of resident involvement in surgeries so as not to scare away patients. Some attending surgeons don’t mention it at all. Others bury the facts in the fine print of the consent forms. Very few take the time to explicitly explain the degree of trainee involvement and whether or not this imposes any increased risk.
2)      Try to shift most of resident training over to county hospitals or similar types of systems where the patients don’t really have much of a choice about their care. These captive patients are less likely to ask tough questions about who their surgeon is because they are just happy someone is doing their surgery. And they can’t go elsewhere to get their care even if they want to.
3)      If someone tries to buck the system by saying the above strategies are unethical and a form of social injustice, ignore them, or minimize their concerns by justifying the means with the obvious need to train our surgeons.
Tell me, do you think it is ethical to force the uninsured, under-insured, or underprivileged patient populations to bear the brunt of the risk of the surgical learning curve? Or should this risk be spread evenly across the population?
Do you think every patient deserves to be explicitly told whether or not a trainee is operating on them? Or is it okay to hide this fact from patients?
Society has a dilemma here, and in my humble opinion, we aren’t handling it fairly.

Saturday, March 3, 2012

My Journey to Indie Author


I’ve been asked how Prime of Life came about, so here’s the story.
Way back in college I wrote a novel and thought it was brilliant. Turns out it was terrible. Really, really terrible.
In medical school I wrote another, this time a YA novel called The Incredible Adventure of Thomas Fate. It was passable. I sent samples off to Literary Agents and actually landed one, but all the acquisition editors passed it by. I’m working on a re-write of this one and think it might still see the light of day. (see the Thomas Fate link to the right for more on this)

In residency I wrote my third novel, The Blinding. My agent passed it along to several editors and it got some serious attention, but no contract.

Near the end of my residency I completed Prime of Life (it was titled Too Late at that time). The publishing houses were more excited about this one. It even made it to the final committee at a few houses, but the marketing people passed on it.

Five years went by.

In the meantime the Kindle was born. Suddenly it became possible for independent authors to put their work out there for people to discover, download, and hopefully enjoy. This phenomenon is a wonderful thing. Anybody can publish an e-book and it doesn’t cost a dime. If it is any good, it will sell. If it stinks, it will fade away and settle among the other 1.2 million titles available in the Kindle store, perhaps to be forgotten forever—or maybe to be re-discovered at some later date.

So I took a deep breath and put Prime of Life out there.

So far thousands you have chosen to download it. For me this is huge. And if you found your way to this blog, that means you probably read it. Thanks for doing that. I really appreciate it. Maybe you loved it, maybe you thought it wasn’t very good, but the point is, somebody is reading it. All my hard work is no longer sitting on a shelf collecting dust.

And that’s the beauty of Indie Publishing.

So if you actually enjoyed my book, please visit amazon and leave a friendly review. You can also link it through your facebook page or twitter account to spread the word.

Thanks for the support!

Thursday, March 1, 2012

Book Reveiw: Lost Christianities by Bart Ehrman

Most people who self-identify as “bible believing Christians” operate under a certain understanding of the history of Christianity. Whether their view of this history is learned or assumed, it usually goes something like this in a nutshell: The canonized scripture is the inerrant word of God. The New Testament was formed sometime shortly after Jesus Christ’s resurrection and ascension—most of it from first-hand witnesses to Jesus’s ministry. Because Jesus’s teachings were so clear, and his great commission so compelling, the early church quickly formed and mobilized to spread the gospel around the world. While there may have been false teachers around this time trying to pollute the teachings of Jesus, they were few and relatively insignificant. Orthodox Christianity was the earliest and truest form of Christianity, and the creation of this religion is precisely what Jesus set out to do, which is why orthodox beliefs survived while the rest faded from memory.
While this view of church history is certainly neat, tidy, and faith affirming, it couldn’t be further from the truth. The truth is far more interesting. If you want to start learning the truth, Ehrman’s Lost Christianities can serve as a very nice jumping off point. But before you take that leap, you might want to check your reserve chute—especially if your view of history mirrors the summary in the preceding paragraph.
So what is this particular work by Ehrman about? The dust jacket sums it up rather nicely: “…a compelling look at the early forms of Christianity and how they came to be suppressed, reformed, or forgotten…Ehrman examines in depth the battles that raged between ‘proto-orthodox Christians’—those who eventually compiled the canonical books of the New Testament and standardized Christian belief—and the groups they denounced as heretics and ultimately overcame.”
Before I continue with my review, it might be helpful if I introduce the author a little more. From his website:

Biography of Bart D. Ehrman
Bart D. Ehrman is the James A. Gray Distinguished Professor at the University of North Carolina at Chapel Hill. He came to UNC in 1988, after four years of teaching at Rutgers University. At UNC he has served as both the Director of Graduate Studies and the Chair of the Department of Religious Studies.
A graduate of Wheaton College (Illinois), Professor Ehrman received both his Masters of Divinity and Ph.D. from Princeton Theological Seminary, where his 1985 doctoral dissertation was awarded magna cum laude. Since then he has published extensively in the fields of New Testament and Early Christianity, having written or edited twenty-four books, numerous scholarly articles, and dozens of book reviews.
And a little more of his biography from his book, God’s Problem, includes the following:  As a young boy he was baptized in a Congregational church and reared as an Episcopalian, serving as an altar boy from the age of twelve through high school. He became very serious about his faith after attending a Youth for Christ club and eventually decided to train for ministry at Moody Bible Institute, where he earned a diploma in Bible and Theology. He completed his college training at Billy Graham’s alma mater, Wheaton, where he learned Greek so he could study the New Testament in its original language. He couldn’t get enough of this, so he went off to Princeton to complete a master of divinity and then a Ph.D. in New Testament studies. While he pursued these credentials he was actively serving in different churches, from being a youth pastor at an Evangelical Covenant church to serving a year as interim senior pastor of the Princeton Baptist Church. And after all this, he eventually lost his faith. Not, says he, because of problems he has with the Bible, but because he realized he could no longer reconcile the claims of faith with the facts of life—in particular the problem of suffering.

Now that you know a little more about Ehrman’s life journey, impressive academic credentials, and probably more importantly, a little about his faith journey, I shall proceed with this review.
If you take a look at the customer reviews for this volume on Amazon, you’ll find that many people awarded this work less than 3 stars, mostly because they viewed it as an attack on their faith. So why does this book make Christians so upset? The answer is simple. Erhman brings up some seriously tough issues. He forces the reader to consider the possibility that their understanding of Bible (along with their particular brand of faith) might be rooted in something other than the Truth. And for many people, this is a very threatening notion.

In my own faith journey, I see myself as a truth seeker. Most Christians don’t view themselves this way. Most of them are quite certain they already know the truth, even to the point that they can justify legislating their moral beliefs so that the rest of society must conform (hence the righteous battle for a ban on gay marriage.) Where do these Christians point when asked about Truth? To canonized scripture, of course.
But what if some of the Truth was forged? What if the Gospels we cherish left out some of the essential details about who Jesus really was? What if there really was a secret version of Mark, a longer version with tantalizing homoerotic undertones that some first-century scribe edited out because those parts didn’t fit with the particular brand of Christology currently popular in his region? What if, and here I’m directly quoting Ehrman from another one of his works, “rather than being an inerrant revelation from God, inspired in its very words, the Bible is a very human book with all the marks of having come from human hands: discrepancies, contradictions, errors, and different perspectives of different authors living at different times in different countries and writing for different reasons to different audiences with different needs?”

These are all really big what ifs. Christians can respond with the bumper sticker slogan “The Bible says it, I believe it, that settles it,” or they can actually start investigating the origins of their beliefs. In Lost Christianities, Ehrman offers an accessible overview of these origins, and in my view, reading this work is only the beginning of an essential journey that every person who claims to know the Truth should take. But if you want to take that journey you’d better buckle up first.
I give Lost Christianities 4.5 out of 5 stars. High marks for clarity, accessibility, degree of thought-provocation, and tantalization. Only wish it had delved deeper in some areas, as it was a little narrow, but as I said before, it makes for a great starting point.

Monday, February 13, 2012

Hello world. I finally did it. Wrote a novel five years ago and finally put it out there. I decided to create this space on the off-chance that there is a handful of readers out there who have any interest in some mindful chatter about my writing or about anything at all for that matter.

Click the link to the right to enter the Amazon Kindle store to download a free sample of Prime of Life.

Read it, try to enjoy it, then return here to post a comment, ask a question, or just engage in some mindful chatter.

Also check out my reading list to the right. I plan on creating pages to host discussions about some of these works. I've already started a discussion about Richard Carrier's book, Why I am not a Christian.

Thanks for visiting and I look forward to the conversations!