BACK-STABBING 101— Is That the Parental Teaching Paradigm?

A recent NYTimes article http://www.nytimes.com/2013/03/31/magazine/a-modest-proposal-for-more-back-stabbing-in-preschool.html?emc=eta1 explored the question of how to raise children in an age characterized by competitveness and a “back stabbing” social and economic milieu. 

This angst of parenting is a relatively recent social phenomenon. Only one or two generations ago parents of large families were too busy ensuring their basic survival to worry about whether their kids did their homework perfectly or had the appropriate “play dates” or should be schooled in self-defense classes and SAT prep courses.  Survival in a competitve world has always existed and will continue to be a reality no matter how carefully and how cautiously parents try to soften the blow of failure, disappointment and rejection. 

Parents can offer the wisdom derived from their own life experiences.  They can emphasize the possibilities of “success” by virtue of the individual’s determination and desire to achieve what an individual goal.  I have often thought about individual personalities and how much of it is an inborn phenomenon.  There are naturally driven, ambitious children who are self-motivated to achieve certain goals.  This may be associated with a basic intelligence and talent, to be sure, but their inner drive is a quality not easily instilled from the outside.  But this is not meant as a condemnation of someone who is more laid-back, less interested in material possessions, noteriety or fame.  It is merely a different style of living.  Discord and confusion arise when individuals fail to recognize that these patterns of behavior lead to different outcomes. 

Also, it is interesting to observe that the “best schools” do not guarrantee the “best outcomes”.  For instance, I have observed excellent physicians who failed to achieve admission in American medical schools but who have demonstrated enormous intelligence and drive in their careers.  Perhaps they were not great “test takers” or found their “calling” after the traditional pre-med trial by fire passed them by. 

It is should also be noted that finding a path in life that seems to align a child’s personal talents and interest may provide the determination and drive to follow their “dream” that could not be imposed from even the intrusive helicopter-parent. 

And finally a parent can express an attitude that does not extol aggresssive  competitiveness or back-stabbing at all.  Life is ultimately NOT a zero-sum game the way it is frequently portrayed.  There is always room for another player in any field of endeavor.  Individual success and achievement does not have to imply stepping over someone, or demeaming their achievements or attempting to diminish their accomplishments. 

Good karma follows good intention.  Hard work, drive and ambition do not have to been regarded in any negative sense whatsoever.  In fact Darwinian theory extols the virtues of cooperation, collaboration, altruism and kindness as forces for success as well. 

Providing a loving, supportive foundation which fosters a child’s realistic (not delusional) self-worth is pretty much all that is necessary.  The rest is their own life’s journey, something a parent cannot micromanage anway

HOW OLD IS TOO OLD FOR A COLONOSCOPY ?

We live in an age in which health care spending has come under close scrutiny, and rightfully so.  But how will we decide such issues when dealing with the elderly.  What I would NOT want to see are decisions based on age alone.  There are protocols being generated by large groups of advisers suggesting that colonoscopies should not be performed on patients over the age of 75. 

I fear that such arbitrary declarations fail to consider the mental and physical status of any particular patient.  Patients vary enormously as they age.  Some are mentally and physically quite vibrant and functional well into their nineties.  Others suffer from such debilitating cardiovascular/pulmonary or cognitive disabilities in their forties or fifties that a colonoscopy would be inappropriate.

Allow me to offer one particular example which illustrates my point.  An 87 year old woman literally bounded into my office requesting a colonoscopy.  “My primary doctor detected an iron deficiency anemia in me and I believe I probably have colon cancer.  I need a colonoscopy”.  I was a bit taken aback by her forthright approach and obvious excellent physical and mental state of being.  “Besides, my sister had colon cancer.”  I performed the procedure and did, indeed, find a colon cancer.  A CT scan did not reveal evidence of metastases and we discussed a surgical option.  “I’m all for it”, she said “let’s go for it!”

I referred her to a local colo-rectal surgical group and spoke to the surgeon before her visit.  I alerted him to the fact that she was 87 but asked him to evaluate her on the basis of how she seemed to  him.  He agreed and soon scheduled her for surgery.  She did great and was out of the hospital in about four days.  There was no requirement for chemotherapy in her case.

So here was an individual patient who was clearly of such physical and cognitive functionality that her life expectancy might easily allow her to reach 100 with exceptional quality of life.  A colonoscopy in her made perfect sense and she has every expectation to life many more years as a result of what transpired subsequently. 

So, while motivated by a desire to reduce health care expenditures, let us be cognizant of the unique nature of each individual and avoid placing artificial limitations on testing based on age alone.

That would be age discrimination at its worst.

CONSIDERING D.N.R.– Do New “Facts” Change Anything?

The NYTimes features on ‘The New Old Age” are worthy of perusing.  In a recent piece by Judith Graham http://newoldage.blogs.nytimes.com/2013/03/14/healthy-rate-of-survival-for-elderly-saved-by-cpr/?src=recg&pagewanted there is a discussion regading new data on the outcomes of “code blue” resuscitation on patients 65 and older.  Such data seem to indicate that of the 18-20% who survive these efforts 58.5% are alive after one year.  Of this number 52% had moderate or severe neurologic damage.  The article seems to suggest that those who survive have reason for “hope”. But the author does acknowledge that there was no attempt to evaluate the quality of that life that was “saved”. 

There is no question that these end of life issues continue to be provocative and extremely controversial.  The article might lead one to be less likely to sign a D.N.R. form than previously. 

I believe the most reasonable approach (and one offered in this piece) is to realistically evaluate the quality of life we all experience on a periodic basis.  Why not make this an annual serious soul-searching event?

When cognitive decline reduces a once viable human being to a nonfunctioning one then why prolong this level of existence by means of cardiac resuscitation?  Would you want this state of existence for yourself?  But doesn’t this extend to physical suffering?  If a progressive neurological disorder renders someone all but helpless, should they not have some say in the prolongation of there life as well?  Should our goal be the number of years we or our loved-ones exist or their quality?

Again, we are dealing with the most difficult of life’s questions.  We need to continue to discuss them openly and frankly.  Will there ever be a template or algorithm that can or should be applied to everyone? Clearly not. But waiting to the moment of crisis or allowing family members to contravene our own wishes regading D.N.R. needs to be seriously addressed as well.

TRAVELING TO OUR “VACATION-MIND”

What is a vacation anyway? 

Can we find one through the pages of travel magazines, websites that portray locales with exotic beauty and escape from the chaos of our everyday lives?

Certainly our physical surroundings can contribute to a perception of change and a reduction in our day to day challenges of living. But if we truly believe a vacation from stress and adversity is a physical location, we are deluding ourselves.

Since all suffering and serenity arises from states of mind (of course influenced by life’s external events) the only true “vacation” can be found through mindful practices.  Meditation, yoga, prayer, exercise assist in clearing our mind of negative thoughts.  Being present in the moment, not attaching to thoughts or feelings of any kind, merely observing the content of our minds, allows us to reach a state of tranquility with is surprisingly restful. 

Of course we can do this when we travel.  The change in our physical location can assist us in altering our state of mind. But we can also bring our suffering with us by our thoughts and worries.  Likewise, we can achieve a sense of serenity without physically leaving our own homes. 

So learn how to find our “vacation-mind”  on a regular basis through practice and attention. It may save us some money as well.