"It's a very odd experience, how this is starting to feel normal"

Over the past few days, I spent some time with a friend's family in the ICU waiting room.

It was an interesting experience for me- it certainly useful every once in a while to remember how things feel from the perspective of patients and there family.

One of the things I gained from the experience is the perspective that overall, modern medicine is a wonderful thing. There are a lot of complaints with the flaws in medicine, and we have all experienced our shares of frustrations. But overall, modern medicine can do some amazing things. This is particularly true at the University of Pittsburgh- I have been thoroughly impressed since I have come here with the overall quality of care, both technically, and just the general sense of humanity. This was over a holiday week (New Years), and the number of people working at UPMC who tirelessly extended themselves to take care of the patients and their families impressed me. I was proud to be part of the organization.

I was also impressed by the love family can bring to a patient. In the waiting room of the ICU, a few families were camped out. Some had not left the side of their loved ones for weeks at a time. As a physician, I was vaguely aware that families stay at the hospital to be with their loved ones, but I had never actually seen it first hand.

One thing was striking is how disorienting the experience is in terms of sense of time. Staying bunkered in the waiting rooms completely removes you from those external cues that separate morning from night. One day just blends into the next.

Another thing that was evident to me was the toll the human body takes from the lack of movement. This is true of the patients, but you also see it in the family members who are staying with the patients. Between the lack of exercise and the ample amounts of caffeine most family members consume, plus the intense emotional toll of their loved ones being sick, nearly everyone in the ICU waiting room was shaking their legs vigorously while they sat.

One of the family members said to me "it's a very odd experience, how this is starting to feel normal." I know what he meant, and I agree it is odd.

I was fortunate enough to make it through medical school without any patients dying on me. I remember the first time a patient of mine died- I was an intern in Cooperstown, NY. I wasn't expecting it at all- of the hundreds of patients I had seen that year, the one who died was by no means the sickest. But all of a sudden, there she was- just moments earlier she had been breathing and had a pulse, and now she lay motionless.

I had worked closely with a medical student that month, and the two of us just went into a back room, and I cried. For a long time- probably an hour. I had seen dead people before, but I had never seen someone die- actually go through the process of dying to the point where they were dead. And having lived through it, the experience was definitely not normal.

I can't say that I am used to the experience now- my line of work does not lend itself to patients dying very often. But I don't know that I would cry for an hour anymore. I don't think I am particularly jaded, but the process of death is just, well, more normal for me. And as my friend said to me the other day in the ICU, when I reflect on it, is very odd when the process starts feeling normal.

The long kiss goodnight

I've never actually seen the movie "The Long Kiss Goodnight," but for some reason I love the expression. This post is about goodbyes.

I am transitioning jobs. I am finishing up my time at the University of Arkansas for Medical Sciences in Little Rock, and in a few months will be starting a position at the University of Pittsburgh. A part of this process is saying goodbye to my patients in Little Rock.

Today, I had my last clinic visit with a few of my patients, several of whom I've grown quite close to. My job in Arkansas, as is the case for all jobs, has it's ups and downs, but one thing that was a clear positive for me was the patients.

One thing that physicians don't have an opportunity to do as often as we would like is let patients know how much they mean to us. That is one benefit of changing jobs- it gives me an excuse to explicitly thank them and let them know much they enriched my life.

There are many things about practicing medicine that are less than ideal, but still, there are very few professions that allow the privilege of having such a direct impact on another person's life. I suppose teaching, coaching, the clergy- those professions have some similar elements. And I guess that is part of what it means to be a physician- a little bit of education, a little bit of motivation, and a little bit of faith.

Anyway, in case any of my patients ever read this blog, and I didn't get a chance to say thank you personally- thanks!

Biases

I realize I have no actual content. However, I think it's useful to start any discourse with the parameters of discussion, so that the audience understands my perspectives.

One of the most important of these are going to be biases. Everyone has biases that color their perspectives. I have reasons for thinking what I think, but I am aware that not everyone agrees with my particular beliefs, and therefore often will reach different conclusions. I am almost certainly not cognizant of all my biases, but here are some that I am aware of:

1. I think exercise is a good thing.
2. Most limitations to exercise are relative, and not absolute. The key, then, is to identify those barriers that limit one's ability to exercise and find ways to adapt around those barriers.
3. Not everyone is the same. This, to me, seems like an obvious statement, but I know that many people disagree with this underlying premise, and this undermines some conversations. To be more explicit:
a. Men and Women are different from one another. That doesn't mean better or worse, but they are different. I think it's important to understand those differences in order to optimize one's potential. I'll go into more detail in some other posts, but it is my personal belief system that men and women differ from one another in some fundamentally different ways that is useful for us understand (e.g., throwing biomechanics, the biomechanics of jumping and landing, the processing of spatial information, perception of pain, communication, etc).
b. People change as they age. Again, I think this is important to understand, because the treatment plans for people change over time as they age.

I'm sure readers (if I have any) will let me know about some other biases as they come up (which I welcome).

Welcome to Kinemedics!

This is my inaugural post for Kinemedics. I suppose I should start by describing who I am, and why you should care about anything I might be saying.

As to who I am, my name is Gary P. Chimes. My primary role is an academic physician who specializes in Physical Medicine & Rehabilitation. That probably doesn't mean anything to most people- to be honest, I am not sure what it means either (since my interests are not particularly concordant with many other people who have the same titles).

The main things that interest me, and the things I am likely to blog about are:
1. Helping people exercise throughout their lifetimes
2. The use of exercise as the treatment for most medical conditions
3. Recognizing how different demographic factors affect the ability to exercise- in particular, examining how gender and age affect our ability to exercise
4. Improving the quality of communication between patients and their physicians
5. Improving the quality of medical education