WHY THIS LIFE ? — It’s a Novel with Many Chapters

I hope what I’m about to write resonates with some of you.

 Most of us look at our own lives as some unexplained mystery.  Why do we experience what we do? Why do we encounter people who seem either loving or toxic to us? Why do some individuals seemed bound to us by proximity or kinship and seem to different from us?  Why is life just so impossible to figure out?

Perhaps we need to enlarge our perspective on life itself.  Let me offer a few thoughts and see if they even remotely make sense.

 Let us suppose, for the point of this exercise, that reincarnation is a real force in the universe.  If that is so then certain aspects of our life here begin to make some sense.  If our true nature is that of a spiritual being having a human experience, then we return to each lifetime with a mission, or at least a goal.  Overcoming adversity, embracing relationships, working on our faults, connecting to the planet, encouraging other beings to become their best selves, etc. etc.

 In the context of rebirth, each lifetime could be regarded as one chapter in our soul’s journey, the ultimate novel.  If our soul, the immortal self, requires multiple lifetimes to evolve, and that we forget the details of our last one, we find ourselves living this life confused and bewildered.  The analogy would hold because if we came upon a novel we have never read, picked one chapter in the middle and begin reading, we would most likely remain confused.  Who are these characters? Where did they come from? Why they interacting with each other? Where are they all going anyway?

 I suspect that our soul’s journey is like that.  If we had the benefit of a greater perspective, many of life’s mysteries and conundrums might make sense.  Since we don’t, this is all mere speculation.  But if reincarnation is real…..it might just make sense.

Stay tuned.

ALTERNATIVE MEDICINE BREAKTHROUGH–acknowledgement of its Influence

The highly regarded American Journal of Gastroenterology (aka Red Journal) published an article in November’s issue Volume 109 Number 11 pp1705-1711 regarding the use of CAM (complementary and alternative) treatments by US adults with gastrointestinal conditions from 2012 interview of over 13000 individuals. Nearly 42% utilizes CAM modalities.  

This is an impressive number. Even more impressive is the attention from one of the most widely read and respected traditional GI journals. Recognition of the appeal and effectiveness of some of these treatments.  

This is a welcome trend. We need the scientific establishment to be open to these approaches and to apply their analytic skills to their study.

JOAN RIVERS– Revisited

The latest revelations from the Joan Rivers tragedy seems to indict her treatment at the Yorkville Endoscopy clinic.  The importance of these latest findings which appeared in the NYTimes and are based upon a “federal report” seems to point to a variety of avoidable errors and omissions.

The importance to me on a personal level  ( in addition to the Ms Rivers tragic death) is that I participate in an ambulatory surgicenter where upper endoscopies are performed on a daily basis.

I do hear from some of my patients who have expressed concern regarding their own fate. 

To summarize:  there seems to have been a failure to notice her deteriorating vital signs.  To me this points to a dereliction of duties by the anesthesiologist involved in the case.  Their job is to administer the drugs and closely monitor the patient’s vital signs.  That is their responsibility.  The anesthesiologists I work for are compulsively monitoring our patients on a continuous basis.

Again there was notation of the unauthorized ENT doctor Korovin who performed two laryngoscopies.  Even without performing a biopsy, this procedure is known to potentially result in spasm of the larynx and trachea, the result leading to bronchospasm and inability to oxygenate the patient.  This was clearly an inappropriate procedure for an ambulatory surgicenter and may have directly led to the anoxia (lack of oxygen) that resulted in “brain death”.

 The taking of “selfies” was an act of poor judgment and unprofessionalism but not directly contributory to Ms.River’s death.

So in summary, her death was most likely avoidable.  Poor medical judgment and perhaps an anesthesiologists lack of attention contributed to it. 

Obviously I am not responding to sworn testimony for this assessment, merely the NY Times article. But at least I can offer my own patients some assurance that their experience will be much different at our center.

BRITTANY MAYNARD DIDN’T DIE TODAY — But She Is Planning for It When She Chooses

It is highly unlikely that 29 year old Brittany Maynard would choose to become famous because of her choice to end her life prematurely.

The cover article in PEOPLE Magazine October 27 th edition outlines her struggle with a fatal brain cancer and her decision to choose physician assisted death on November 1. She has chosen to postpone that decision because she still has a reasonable quality of life. Apparently she has not decided to change her mind about her ultimate choice.

She is the poster person for a powerful movement to bring personal choice to the issue of death. It is about dying with whatever grace and dignity one can possess in the face of life’s inevitable end. It is about choosing to avoid the loss of control, degradation of the body and suffering for oneself and one’s loved-ones.

Of course controversy surrounds these issues. The role of physicians in the process is equally charged.  I for one believe we need to air this debate openly and bring it to the public forum.  I regard it as an area of bioethics, the law and spirituality intersect.

Oregon remains one of five states with Death-with-dignity laws on the books. Other states including New Jersey have begun the legislative process. Organizations such as Compassion & Choices are strong advocates for legislative action as well as personal support for patients and families battling these issues.

All of us need to think seriously about how we want to end our lives. Death being what it is, many will not have the opportunity to choose how and  under what circumstances it will occur.

The aftermath of Oregon’s experience in the 14 + years since the law was enacted should alleviate some of the fears of its opponents. Massive numbers of people did not move to the state in order to facilitate their own death.  The law is restrictive in many ways.  It insists that depression and psychological issues not be the diagnosis. A prognosis of six months or less must be documented by more than one physician. The patient must be physically and mentally capable of ingesting the lethal dose of barbiturates.  In practice nearly one third of patients who qualify for the law and have the drugs DO NOT use them.  But they feel empowered that they have the choice to do so. And fears that Hospice or palliative care options would be abandoned have proven false.  In fact their utilization has increased. Patients are more apt to make use of all available support because of the increased public awareness of end of life choices.

So let us appreciate the courage of Ms Maynard to share her public tragedy which will ultimately be for the benefit of us all.

PHYSICIAN ASSISTED DEATH ? — How’s “Termination of Suffering”

The debate over physician assisted suicide (PAS) is hampered by its terminology.  For some, suicide is always an evil.  

I personally don’t have a problem with the term but other’s prefer physician assisted death (PAD)_.  There is legal precedence now accepted in four states.  It began in Oregon and is making its way through the NJ legislature. (not sure where at present).  Criteria are extremely strict and the process is highly regulated.  Physicians who sign on to the program can prescribe a lethal dose of  medication.  The patient must be physically and mentally capable of ingesting the drugs.  There must be no clinical evidence of depression.  

The Oregon experience seems to contradict the fears of many who oppose such legislation.  Massive numbers of individuals did NOT sign up for the program.  Only about 10% of those who qualified and received the drugs actually took their own lives with them.  Palliative care and Hospice use actually increased in Oregon (as opposed to opponent’s beliefs) and there was no deterioration in the patient-doctor relationship.

Kevorkian exhibited the right intentions but his efforts were not well thought out.  He was actively challenging the law and forced the country to take notice.  His active euthanasia was too provocative for the population to accept.  He was not particularly careful about screening out those who were severely depressed and not truly terminal.

 Perhaps there would be even more acceptance if our labelling of the program would change.  Termination of Suffering says it all.   Perhaps we should change the term to PATS (physician assisted termination of suffering).  I hope no one truly believes that hopeless suffering servers some higher spiritual purpose?

Who in their right mind would object to that?  How naive of me.   There are those who will.

THE BLACK JEWELRY BOX — Unexplainable Experiences

A devout skeptic, my metaphysical journey was first triggered by hearing first hand the personal experiences of ordinary individuals who had unexplained experiences.

 What was so compelling was the context of these experiences.  They were told to me in deepest confidence.  The experiencers were rather reluctant to share what had occurred for fear of appearing strange or foolish.  Yet I knew many of these individuals for years.  I knew they had nothing to gain by fabricating these stories.  They were compelling yet unexplainable. There was a level of credibility to them that drew me in.

 I still find them compelling and worthy of investigation.  Although they remain unexplainable, they point ever so subtly to a level of reality which transcends every day awareness.  Do they “prove” survial of consciousness after physical death.  Hardly. Yet taken as a whole they cannot be easily dismissed.

 The following was told to me by a patient and acquaintance of many years.  His credibility is without question.  I have altered the names and details of the story but the core of it remains intact.

 I was cleaning out my Mother’s house prior to the official closing.  After she died we tried to empty it of all its objects.      First we held a garage sale.  They we donated what was left to a local church.  Some of it became garbage.  We went through her possessions is great detail, many times, as did the numerous visitors.  We were particularly seeking to find her black jewelry box which she claimed had become lost.  She had suffered from some dementia before she passed.  She cherished the modest jewelry she kept inside and my family had bought it for her.  It was essentially gone and we began to believe it would never be found.  Now I was the last one to visit the home.  I walked through the rooms one last time.  I removed the mezzuzahs from the door posts.  I spoke out loud to my Mother thanking her for all she did for us and that now she was moving on as were we.  There was a deep silence that followed.  For some reason I glanced one last time into the empty living room.  The jewelry box was there!  It was literally impossible for that to be so.  Dozens of people had marched through the home.  Our family checked every square inch of it for that box.  But there is was.  Here’s the photo of it.  We have it securely with us  now.  I thought you would find this interesting.

   To say the least.

 

THE TRIBAL GENE — Our Dark Nature

It goes like this. We are tribal creatures. Deep down in the recesses of our DNA we evolved with the propensity to associate in small groups and to regard them as our kin/family. We immediately perceive outsiders as a threat and are capable of annihilating them without remorse.  We do not see them as ourselves. Although they are like us, exactly like us, we are capable of de-humanizing them. We feel no guilt or remorse regardless of what and how we destroy them.  After all they are a threat to our existence and the existence of our tribe.  How do I know this to be true?  Look at the world today.  Look at the world yesterday, or a thousand years ago or probably since the inception of Homo sapiens sapiens.  And perhaps further back to our primate ancestors who we share with contemporary chimpanzees.  They, too, are capable of ripping apart fellow chimps found within their territory.  They, too, create military-like bands which fight to the death for their tribe.  The tribal gene was necessary for our survival.  Today it threatens the world.  Our tools are powerful, and the subsequent destruction they can inflict can destroy the planet.  But the instinct to use them runs deep within us.  When we teach our children to hate we merely reinforce their inherent tribal instincts to do so.  This is not about religion.  We point to radical Islam today, to Hamas inculcating hatred into their children.  We are shocked when Palestinian mothers dress their children in homicide bomb outfits.  But we should understand why and how this is so.  The tribal gene leads us to sacrifice our own lives for the sake of the tribe.  We see this in the heroism of the battlefield as well. We know that religion alone is not the culprit.  Hitler was successful in his creating of the German myth of tribal supremacy.  The Jews and others were clearly of another tribe and by definition a threat to be dealt with by any and all means. Racism is tribalism  but even within the same race African tribes annihilate each other by virtue of the same tribal impetus.  There is rarely a sense of guilt when members of the other tribe are destroyed.   And so it goes.  Is there any hope to at all?  The answer is yes.  The approach is shockingly simple.  We must recognize our true nature.  We need to be aware of this tribal imperative.  We need to re-define what a tribe is and our relation to it.  We need to recognize our common humanity and teach this to our next generation.  We are ONE tribe.  It is the Golden Rule expanded to recognize the biologic truth.  Our DNA speaks to it.  But we must fight the impulse to break down into small units.  Our tribal gene pushes us to find differences amongst each other.  Our neocortex provides us with the ability to think.  We need it to direct us away from instinctive reactivity.   Is any of this realistic?  Perhaps not.  But we have nothing to lose at this point by trying.

WANT TO HAVE YOUR CHARTS?– Then What?

Access to medical records seems like a perfectly fine idea.  After all they are your records.  I have always been a supporter of that contention.  Problems occur, however, under conditions when medical records are released to patients without explanation.

Patients have had access to their lab work for years. Abnormalities that are noted by these print outs may have no real clinical meaning and yet will induce immediate and unnecessary distress.

 Now patients have access to radiology reports with detailed discussions of findings.  Many of these are “incidental” meaning they have no clinical significance.  But does the patient know that?  No and they should not be expected to know.

What then occurs in the real world is a frantic attempt to read, comprehend and analyze medical terminology by the lay public who do not possess medical knowledge and experience. The inevitable results–internet searches, panic, despair and immediate calls to doctor’s office to make sense of it all. Patients want immediate phone discussions or internet responses.  That sounds just great.  The problem is that communication which is not in person is much more difficult and often leads to more confusion.

 I would prefer to discuss medical records/ radiology documents, pathology reports, endoscopy papers, lab data etc. etc. face to face in front of my patients.  Then I could immediately put their concerns to rest, or offer explanations, or suggest subsequent testing or referrals.

So hurrah for full disclosure. Let’s bring some practical sanity back to the situation.   Now I understand the impracticality of ALL discussions in person.  When a quick call can dispel immediate fear, I all in favor of it.  But when then there is further confusion or significant complexity, the examination room, not the phone or internet is the best place to do so.

WANT YOUR MEDICAL RECORDS ? Now What?

I get it.

It is a consumer’s right to have access to their medical records.  God forbid some physician denies you that right. We are obligated under some vague government penalty to allow you to do so.

 So now what?  What do you do with them?  What happens when you find some abnormality in your lab work?  What is that abnormality on your CT scan?  What is that dark hole on your endoscopy report?  You will panic.  You will search the internet, frantic to understand specific medical terminology, you will make yourself crazy with fear.  You will call me in my office in panic.  What is this? What does that mean?  What is that shadow? Is that a mass on my colonoscopy photo?  And now it is up to me and my office staff to undo what has been done.

 WE need to do this together—in the first place!  This is why I don’t routinely offer photos of my patients colonoscopy/endoscopy reports until I see them in my office……so I can explain what they are looking at!

 And yet I am not following the new guidelines.  I should be handing everything to you without comment.  But then we have the problem of trying to explain it all to you.  

So please.  Let us do this together.  I’ve been doing this a lot longer than you have.

 Thank you for your consideration. Its better for both of us.

MAGIC IN THE MOONLIGHT — Woody Allen, Metaphysician

I have always been an enormous fan of Woody Allen’s films.  Even his less than stellar creations are worth viewing and as a body of work there are few in his league.  I was particularly fascinated by this summer’s Magic in the Moonlight.

 I will not attempted to critique the film as such.  I am strictly an amateur on the subject.  But I am a devotee of metaphysics– the field that seeks to comprehend the nature of reality.  Woody (I feel I can freely refer to him as such) has touched upon such themes as the nature of life, death, the soul, the existence of God, the “unseen world” in many prior films.  But here he addresses it directly through the character played brilliantly by Colin Firth.

 As a magician (Woody as well) he is a master of illusion.  He understands the gullibility of mankind, their need, even desire to believe in more than this physical world.  Yet as the ultimate skeptic he is capable of debunking the fraudulent perpetrators of such scams.  To summarize all too briefly, he becomes the victim of a scam himself and begins to believe in the afterlife and the power of the Emma Stone character to truly communicate with a spirit realm.

 In the end all is exposed and our skepticism renewed and validated.  Woody, the ultimate romantic, seems to feel that love is capable of transcending rank cynicism.  But to me he still wrestles with the metaphysical questions.

 I, too, was the ultimate nonbeliever.  Yet my experiences with mediums and ordinary individuals has led me to understand that there is evidence for a spiritual domain (see my book and various prior postings).

 I do not claim to understand the depth of this world.  I am a total novice, but I do believe an open-minded skeptic can explore this area on their own and eventually come to their own conclusions.

 I’m sure Woody is still in hot pursuit of the ultimate truth.  I’d love to share what I have learned with him and make suggestions for his own exploration.  In either case I wish him well.