Saturday, December 26, 2009

Change




What a year. We have gone from utter despair to a ray of hope. Hope is heartening considering two wars, unstable energy cost, climate change, H1N1, economic collapse and the betrayal by legal, business and political leaders. In the past we have produced leaders of gigantic proportions to help set us on the correct path. Think of Lincoln and Franklin Roosevelt. Not all their decisions were correct, many were flawed, but this is mainly hindsight. Any one who makes decisions is prone to failure.

One of my residency trainers impressed upon me that the only way not to fail is to acquiesce. I appreciate him more and more, even if he terrorized me those many years ago. In our residency clinic I would examine a patient, and use the findings to justify my diagnosis and plan. I had to think on my feet. Rarely do we have the luxury of time in medicine. There are schedules to keep, driven by the waiting room or by nature itself.

It was enlivening to report to him. Fear drove the encounter. I began to realize that he was not concerned with the specifics of my plan, nor was his vitriol personally directed at me. He could and did correct any mistakes before they impinged on the patient. He was there to train me to think, to problem solve and most important, to have the courage to make decisions.

I remember as a new intern dragging the student working with me by the ear as he tried to duck out of the encounter with our spirited mentor. I reasoned if I was going down, I was not going down alone. In medical training, as in politics, there is seldom a place to hide. At the start of the third year of medical school, even if you do not realize it, your every move is followed.

When you finally get the chance to throw a stitch in surgery it is at the very end when everyone is trying to finish and watching to see if you screw up; when you report to the attending on the hospital floor you are surrounded by classmates, interns and residents, all tapping their feet, waiting to move on to the next case. Wavering gets you nowhere. Speak with confidence and you will probably get hassled, throw the stitch and it may get redone, but your attempt will gain the respect of your colleagues.

You are finally on your own when you become an attending. The first few months are nerve racking with so many decisions to make. Suddenly what was a collaborative pursuit has turned solitary. There is very little backup for a physician. Your problems are your own to resolve.

And so this is the situation I see our new President in. He has asked for consul, absorbed the give and take, and made decisions. And as with medicine, he (and we) will live with the consequences of his actions. I applaud him for his collaborative nature. But I applaud him more for having the courage to make the tough decisions. I may agree or not with his ideas and how he has chosen to go about them, but I am pleased he has chosen not to hide, but to confront our problems head on.

The particulars will be fought over. This is hoped for in our system of government. With talk there is movement, and four or eight years down the road we will not be in the position of having to address the same issues as today.

My wish for this upcoming year is that we take stock and with introspection, not hysteria, have the courage to make decisions to change our lives for the better. Our country, our community and our relationships will benefit from this newfound commitment.

Volume 5789 (4), 1/1/2010