The measure of your day

The Pool at Central Park, Burnaby

The Pool at Central Park, Burnaby

Is today just another day?

And tonight after it has passed, will it be forgotten?

Is it a day in the way? That’s a countdown day that you just want to get through because it stands between you and what you anticipate – a special day in the future, a holiday or the weekend.

In the trance of everyday life, we can get caught up with nonstop activity, endless goals and distractions. We lose sight of what matters most, and we can forget a simple truth.

Every moment is precious and every day a gift.

When they were young, I taught my children to frame each day.

Before they rolled out of bed, I asked them to say a prayer of thanks, considering all the good in their lives, especially the people they loved. By beginning the day with their cups half full, they would be more inclined to see the positive throughout each day, and when their cups were full, they would be more likely to share and give.

Again at the end of each day, at suppertime and at bedtime, they would recall the gifts of the day: what they enjoyed, what they received and what they gave.

This summer, my kids are asleep when I leave the house and they’re awake when I go to bed. I no longer keep track of their prayers, and I wonder if they like most grownups and teens have become too busy to frame their days and measure their moments day by day.

Most physicians experience a nearly constant pressure of time. While looking after our patients, there are always competing demands on our time. And outside of clinical time, we may be on call, attending endless committee meetings or managing a perpetual pile of forms and reports.

I must confess that every one of my days – like an overstuffed suitcase – is packed with activity. I sometimes judge the day by how much I have accomplished: A good day is a productive day.

But none of us should wait until the next holiday, retirement, or the end of life, to wake up and live each day.

We should begin – and continue – with the end in mind.

To not waste a day does not mean to pack it full of activity.

We waste this day by not being fully awake.

What gives your life meaning? Are you awake to the experience of being alive – tasting, touching, breathing, feeling?

What are your greatest goals? What are you doing with your time?

What are you doing this day to take one small step in the direction of your dreams?

Today are you talking to the people who matter most? Are you fully present in the presence of others?

The measure of each day is like the measure of our lives, and the unit of measure is love.

How have you shared love this day? Be gracious when receiving it. Be generous in expressing it.

How were you helped in big and small ways, and how are you helping others?

Don’t let this day slip by as another blur of time, another square on the calendar or another countdown day.

Make it count.

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Posted in Grace, Happiness, Parenting, Positive Change, Positive Potential, Purpose, Relationships, Wisdom, Your Calling, Your Goals | Tagged , | Leave a comment

Three keys to a better hospital stay

Prague Castle

What happens if you try to run in a hospital gown (Prague Castle)

If you’re admitted to a hospital, you may lose your sense of control over your own healthcare.

You’re expected to wear a gown instead of your own clothes. Many people pop into your room unannounced, and they write notes in a chart that you can’t see. You may be given medications but not know what they are for, and sometimes, you may not know who is making decisions for you.

Yet autonomy is a cornerstone of medical ethics. Capable patients must be sufficiently informed in order to make the best decisions for their own care.

When you visit a physician, nothing is done without your consent. After listening to your concerns, asking more questions and performing an examination, the physician will offer a working diagnosis and suggest some options for investigation or treatment.

In order to make informed decisions, you need four key pieces of information: (1) the purpose or reason for the treatment or investigation, (2) the common side effects or risks, (3) the serious, including life-threatening, side effects or risks, and (4) alternatives to the proposed treatment or investigation.

Here are three keys to improving your hospital experience.

  1. Stay in control. If you are capable of understanding your situation and treatment options, you should continue to make important decisions about your care in the hospital. Ask the four key questions for any proposed treatment or investigation.

Ideally, you should express your wishes before you find yourself in the hospital. Consider writing an advanced medical directive. If you become ill or incapacitated, what types of treatment would you want? If you were no longer capable of making your own decisions, whom would you entrust to make decisions on your behalf? Discussing these issues ahead of time will make things easier for your family and will make it more likely that your wishes will be respected.

  1. Know the team. There are so many people working in the hospital that many patients don’t know who is who. It doesn’t help that many health care workers wear surgical scrubs (or “greens”) and white lab coats.

What could be easier than getting up and changing from comfy pink sleeping pajamas to comfy green pajamas? If we all did this, no one would buy pajama jeans.

You could try to read the nametags, but if you’re not sure, don’t be shy. Ask for each person’s name and their role (i.e. nurse, respiratory technician, pharmacist, dietician or doctor). If it’s a doctor, what is their specialty (i.e. internal medicine, hospitalist or surgeon)?

Most importantly, you need to know who is the “attending physician” or “most responsible physician.” This is the physician who is directing your care throughout your hospital stay. It is possible that this might change from day to day which of course is less than ideal.

  1. Set up a channel of communication with your attending physician. Some hospitals have white boards in every patient’s room indicating the plan or schedule of tests or procedures, the results of tests and the expected length of the hospital stay.

If this isn’t the case, you should have a large pad of paper at your bedside so that this information could be written down for you. You should prepare your own list of questions for your doctor. Try to find out when that doctor is expected.

Like the traveller forcing himself to stay awake on the plane so he won’t miss his meal, patients dread falling asleep and missing the doctor during daily rounds.

I’m hoping you won’t find yourself or your loved ones in the hospital any time soon, but if you do, follow these three steps to maintain control of your care.

 

 

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Posted in Empowering Healthcare, Medical Ethics, patient-doctor relationship, Uncategorized | Tagged , , , , | Leave a comment

The Lonely Patient’s Guide to Your Hospital Adventure

 

Prague

Prague

I’m writing this in my hotel room in the Old Town of Prague.

In this ancient city of a hundred spires I’m surrounded by wonder and beauty, but in a place so different from home, I’m reminded that I’m a traveller in a land that is strange to me. Along with the adventure of new sights, sounds and experiences, comes a subtle discomfort with the unfamiliar and the potential for danger.

It is not unlike the experiences of my own patients, friends and family who have found them selves in another strange place – the hospital.

A big difference between travelling to another country and finding yourself in a hospital is the surprise and misadventure that brings you to the latter. It’s like being a refugee fleeing from disaster rather than a vacationer to the happiest place on earth.

As a patient, you might feel like Dorothy being swept to the Land of Oz, and I don’t mean Australia.

You might end up in the hospital for a procedure such as an operation, which many times can be planned and expected. In this case, it’s almost like a pre-booked holiday (perhaps with a very long wait) and the length of your stay is usually predictable.

Most patients, however, are unexpectedly admitted to the hospital in response to an accident (e.g. a fall with a fractured hip) or an illness (e.g. infection, stroke, heart attack or symptoms of an as yet undiagnosed condition).

The goal for most patients admitted to the hospital of course is health – having undergone a successful operation, illuminating investigations or therapies that allow you to leave the hospital not only stable but healthy – or at least healthier than when you came in.

The not-so-secret secret is that hospitals can be dangerous places, and we’ve all heard stories of patients getting sicker due to medical misadventure, mistakes that weren’t picked up, unnecessary delays and hospital-acquired infections.

This is the reality when you gather many sick people in a large institution where every patient comes in contact with numerous health care workers. Fortunately, the vast majority of patients do well in the hospital and not only survive but thrive.

Since Hippocrates, the first rule of medicine has been to do no harm. Hospitals and health authorities are actively doing their best to reduce patient risks. Safety has been part of the new culture of health care.

Though patients are not to blame when things go wrong in the hospital, I’ll offer in my next column some key tips in being a more assertive patient or advocate for a friend or family member. In fact, I could write a whole book – or like travel writer, Rick Steves, a whole series of books on hospitals around the world; maybe the Lonely Patient’s Guides to Surviving Your Medical Adventures.

I’m writing this in my hotel room in the Old Town of Prague.In this ancient city of a hundred spires I’m surrounded by wonder and beauty, but in a place so different from home, I’m reminded that I’m a traveller in a land that is strange to me. Along with the adventure of new sights, sounds and experiences, comes a subtle discomfort with the unfamiliar and the potential for danger.

It is not unlike the experiences of my own patients, friends and family who have found them selves in another strange place – the hospital.

A big difference between travelling to another country and finding yourself in a hospital is the surprise and misadventure that brings you to the latter. It’s like being a refugee fleeing from disaster rather than a vacationer to the happiest place on earth.

As a patient, you might feel like Dorothy being swept to the Land of Oz, and I don’t mean Australia.

You might end up in the hospital for a procedure such as an operation, which many times can be planned and expected. In this case, it’s almost like a pre-booked holiday (perhaps with a very long wait) and the length of your stay is usually predictable.

Most patients, however, are unexpectedly admitted to the hospital in response to an accident (e.g. a fall with a fractured hip) or an illness (e.g. infection, stroke, heart attack or symptoms of an as yet undiagnosed condition).

The goal for most patients admitted to the hospital of course is health – having undergone a successful operation, illuminating investigations or therapies that allow you to leave the hospital not only stable but healthy – or at least healthier than when you came in.

The not-so-secret secret is that hospitals can be dangerous places, and we’ve all heard stories of patients getting sicker due to medical misadventure, mistakes that weren’t picked up, unnecessary delays and hospital-acquired infections.

This is the reality when you gather many sick people in a large institution where every patient comes in contact with numerous health care workers. Fortunately, the vast majority of patients do well in the hospital and not only survive but thrive.

Since Hippocrates, the first rule of medicine has been to do no harm. Hospitals and health authorities are actively doing their best to reduce patient risks. Safety has been part of the new culture of health care.

Though patients are not to blame when things go wrong in the hospital, I’ll offer in my next column some key tips in being a more assertive patient or advocate for a friend or family member. In fact, I could write a whole book – or like travel writer, Rick Steves, a whole series of books on hospitals around the world; maybe the Lonely Patient’s Guides to Surviving Your Medical Adventures.

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Healthier way to see yourself

Parliament Building, Budapest, Hungary

Parliament Building, Budapest, Hungary

In high school, my friend, Stan and I were amateur psychologists. He would introduce his latest categorization of people by saying, “There are two kinds of people in the world.” For example, there are those who see the cup as half full (optimists) and others who see it as half empty (pessimists).

The exceptionally joyful see the cup as overflowing, and the extremely negative see that cup as chipped, stained and half emptied of dirty, bitter scum.

After far too many categorizations, I had the final word. There are two kinds of people in the world: those who think there are two kinds of people, and those who don’t.

In her book, Mindset: the new psychology of success, Carol Dweck, an expert in motivation and personality psychology, describes two types of mindsets.

With the fixed mindset, we see our abilities as limited and stable. With the growth mindset, we recognize that we can improve our abilities and develop our talents over time.

This has implications in every aspect of our lives, including parenting, teaching, coaching and relationships.

As parents we might label one child the creative one and another the shy one as if their talents and personalities were permanent. These labels are often internalized and the child may come to believe in their limitations.

You might think of yourself as not creative, fearful of public speaking or never good at math and with a fixed mindset, never see yourself becoming more artistic or musical with training and practice, challenging and overcoming your fears, and learning to be both skilled and comfortable with numbers.

A growth mindset recognizes possibilities and potentials. It fosters hope and can motivate us to learn, practice and improve. Just because this is how we have been doesn’t mean we will always remain the same. We can grow – at any age.

Not only can a mindset shade how you see yourself and others, it can limit your relationships. Family members can fall into habits of behaviour, replaying the same interactions and seeing one another as caricatures of their whole selves. Over time, they don’t expect to see any improvement, so they don’t even work to improve their relationships.

A growth mindset with respect to relationships recognizes the potential to improve communication and foster the evolution of each relationship.

Consider how you have come to see yourself, others and your world. Have you been limiting yourself and your relationships through a fixed mindset? In what areas of your life do you see the possibility of further growth?

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Posted in Growth, Positive Change, Positive Potential | 1 Comment

Making your doctor more attentive

St Stephen's Basilica, Budapest, Hungary

St Stephen’s Basilica, Budapest, Hungary

My golden rule of medicine is this: Treat every patient with the same care I would want for my best friends and family. I order the same tests, refer to the same consultants and offer the same treatment options.

When I teach medical students about hand washing to prevent the spread of infection between patients, I encourage them to consider it as an important ritual between closing an encounter with one patient and being fully present for another.

When health care providers are rushing from patient to patient, not only are they less likely to clean their hands sufficiently with soap and water or alcohol-based hand sanitizers but they are more likely to be inattentive and make mistakes.

When we are not observant, thoughtful and listening, we miss out on valuable clues, jump to the wrong diagnosis and fail to really help that patient. An experienced clinician develops intuition, and a wise one attends to it.

If our diagnosis doesn’t quite match all the symptoms and physical findings or if we feel that we are missing out on some crucial information, we leave the examination room feeling uneasy. If we ignore that feeling and move on to the next patient, we may be preoccupied and not fully present again. This can have a snowball effect to the detriment of every patient seen that day.

So I teach mindfulness meditation to patients, medical students, residents and colleagues. With each patient’s visit, that patient must be the centre of our attention. We must listen carefully, ask the right questions and perform an appropriate and focussed physical examination. We must consider a broad differential diagnosis. What conditions may explain these symptoms and physical findings? We don’t settle for the most common diagnosis especially if it doesn’t quite fit. We consider less common and more serious possibilities.

We all know that feeling when we have a conversation with someone who isn’t fully present. They may ask, “How are you doing?” but don’t really listen to your answer. They don’t have to be texting to show that they’re not all there.

Healthcare providers can easily fall into a mindless routine, rushing from patient to patient, asking a rapid-fire list of oft rehearsed clichéd medical questions, jumping to the most common diagnosis, not really seeing the person in front of them, and moving on to the next in line.

If you ever get the feeling that the doctor is rushing and may have jumped to the wrong diagnosis, there are ways of triggering a pause and reflection.

I recommend to friends, family members and any of my patients who might be treated at another clinic or hospital – perhaps in another town – three key questions.

1. What else could it be? This forces the doctor to step back and to reconsider the diagnosis. Could it be something other than the obvious that doesn’t quite fit? Do I need more information? Should I ask more questions?

2. What is the worst thing it could be? This triggers the doctor to consider worst case scenarios. One of my patients is alive today because I considered one of the rare but serious possibilities for her worsening sore throat and fever. A day earlier, the nurse attending her during the colonoscopy told her she probably had a cold. That night, the emergency physician prescribed antibiotics for strep throat. I recognized the subcutaneous emphysema – air released from her perforated bowel that had tracked under her skin up to her throat. I sent her to another surgeon who saved her life by removing the injured portion of her bowel and treated the resulting infection with IV antibiotics.

3. What would you recommend if I was your mother (or father)? This of course asks the doctor to consider the golden rule – a gentle reminder that you are someone else’s loved one and deserve that same special attention and consideration.

Dr. Davidicus Wong is a family physician and a Clinical Assistant Professor in the Faculty of Medicine at UBC.

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Posted in Empowering Healthcare, patient-doctor relationship | Tagged | Leave a comment

Real love and real beauty. Truth in a fairy tale.

What We Learn From Fairy Tales Davidicus Wong, M.D., July 7th, 2014

DSC04776

My beautiful daughter turns 16 this week.

Once upon a time, when we were all much younger, a favourite family ritual was to make up a fresh bedtime story each night. By capturing the experiences, thoughts and feelings of my children’s day, I engaged their imaginations while providing parental lessons both subtle and obvious.

What follows was a favourite inspired by the funny faces my then 8-year-old daughter made. Parents have always warned their children that their faces may freeze that way.

Of course, there is some medical truth in this. In our thirties, we discover that our parents were right after all. Our wrinkles reveal our habitual emotions with lines betraying smiles or frowns.

I trust that my daughter will remember this story for its deeper lessons about real beauty that inspires us more than a striking physical appearance and real love, the recognition of that truer beauty within.

To be truly loved is to be accepted and cherished just as we are. As we age, we wrinkle and weaken, shorten and sag yet authentic love sees a beauty that persists. As Yeats wrote in his poem, When You Are Old, “How many loved your moments of glad grace, and loved your beauty with love false or true, but one man loved the pilgrim soul in you, and loved the sorrows of your changing face.”

The Scary-faced Princess

On the day she was born, Princess Michelle had the most beautiful face ever seen. She was certainly the most beautiful baby the doctor had ever delivered. At the moment of her birth, he couldn’t resist pinching her dimpled cheeks. The newborn princess frowned, wrinkled her brows and scrunched up her nose. So shocked with this scary transformation, the doctor nearly dropped her.

One day, the queen while feeding the princess could not resist pinching her precious dimpled cheeks.   The pretty princess frowned, wrinkled her brows and scrunched up her nose. The queen was startled and Princess Michelle spat up her milk into the queen’s eyes.

At the princess’ baptism, everyone in the court, all of the villagers, and each of the forest fairies came to adore her and bring gifts. Each visitor was enchanted by her incredibly sweet face. No one could resist pinching her soft dimpled cheeks.

The royal baby soon grew weary of this. Just at the moment the Pink Fairy approached her crib, raising her wand to grant a spell of eternal beauty, Princess Michelle frowned, wrinkled her brow and scrunched up her nose.

So shocked was the Pink Fairy that she dropped her magic wand into the crib. After an explosion of starry flashes, the Pink Fairy was nowhere to be found.

The king and queen rushed to their daughter’s side but with one look at her once sweet face, the king fainted. The queen, who could not see quite as clearly because of the milk in her eyes, quickly bundled up the princess in a soft blanket and hid her from the eyes of the court.

The face of the once beautiful princess was frozen with her frown, wrinkled brow and scrunched nose. The effect on others was immediate and frightening. One look upon the princess’ face caused a reflex of fear.

Only one person in the kingdom was able to look upon her features and not freeze. The queen whose eyes had been clouded by warm milk could not see the frown, the wrinkles and the scrunch.

Though still loved by her parents the princess grew up in the dark so that even she could not gaze upon her own features in a mirror. No one else would be frozen by her frightening features.

Servants brought Princess Michelle her meals to this darkened room lit only by a single candle in its farthest corner. They would only see the outline of her body, which appeared like a shadow.

Her voice and her heart remained sweet and kind. Each visitor would be entranced by her gentle spirit.   She had many friends but none ever saw her face.

In her dark room, the princess had learned to listen. When her friends came to visit, she would listen and reflect back what they were truly feeling. She had the gift of compassion. The heart of anyone who came to see her would leave a little lighter and happier for no one else could listen and understand so well.

One true friend, Peter learned from the princess how to listen well. He helped Princess Michelle grow up in the dark. He told her of the outside world – what it was like to play with other children and to see the beauty of nature.

The king and queen too enjoyed their daughter’s kind company and counsel. It is difficult to rule a kingdom. There is so much to think about and so many decisions to make.

Princess Michelle was able to make their work easier and their hearts lighter. She had acquired wisdom beyond her years. They knew that one day she would be a fitting queen.

Yet the king and queen worried that she would never marry. Her frightening face would certainly freeze the heart of even the warmest suitor.

According to tradition, the princes from the surrounding kingdoms were allowed to ask for her hand in marriage when the princess was old enough to make her choice. The king and queen could not deny the parade of young men who came to meet the princess when that day arrived.

Although they knew that most of these princes only wanted to acquire the riches of the kingdom, the king and queen felt they must warn them of the princess’ secret. None believed them.

One by one, each prince would enter the princess’ meeting room, where he would try to convince her to accept his hand in marriage.           The princess told each prince that she sought only true love – love that would last regardless of age, illness or appearances.

After each prince, promised such love, she would open the curtains of the window revealing her frown, wrinkled brow and scrunched up nose.One by one, each prince froze in fear and had to be carried out by her servants. The princess was heartbroken. It seemed she would never find true love. No prince would see past her scary face.

At that moment of need, her best friend, Peter came to comfort her. He knew her better than anyone in the whole world and he knew that she had beauty within. Peter then revealed his secret.   He was also a prince and he had always loved her.

Before she could stop him, he opened the curtains of the window, gazed into her eyes but instead of fainting or freezing, he smiled and kissed her. Princess Michelle felt her face transform – her frown melted into a smile, her brow relaxed and her nose unscrunched. The room was filled with a wondrous light, and the kingdom was again enchanted by the princess’ beauty.

 

Posted in Love, Parenting, real beauty, real love, Relationships, The Qualities of a Child | Leave a comment

Live Life Deliberately

Our lives are bittersweet – messy and beautiful.
Like a baby with diapers, tears and giggles.
Like a toddler with tantrums, laughter and sweetness.
Like a six-year-old, stubborn but wanting to please.
Like a teen, with budding maturity and brimming with emotions, messy and beautiful.
Like parenthood with sleepless nights, endless work and great expectations.
Like our relationships with quirks that endear and infuriate and our bonds of intimacy.
Like maturity with bittersweet memories, physical decline and wisdom.
So easy is it to be caught up in the messiness of life – the demands of the day, the detours from our dreams, illnesses and accidents. Sometimes it seems that our lives are not our own. We are flotsam randomly floating on the waves, gerbils running endlessly in our cages, or gamers reacting to obstacles thrown before us.
The alternative is to live life deliberately.
Some of us are fighting life. We start off with goals, but life intervenes. We fail, relationships end and we don’t get the job of our dreams. It can seem that fate conspires against us and things never go our way. Life is a battle.
Some of us just go through the motions. We do what we’re expected to do as students, employees, parents or friends but we are not fully engaged. Our days slip on by as we forget about the fleeting nature of life and its circumstances. Everything and everyone about us is in constant motion and change. What is here today may be gone tomorrow.
Our relationships are never perfect except in rosy retrospect. We are all guilty of not being at our best and not fully appreciating one another. Life together is messy, bittersweet but potentially beautiful. We can only realize the best in our relationships through our actions today.
Some of us live passively. Surrendering as if none of it is within our control, we take the job that comes and do it without question. We settle into passionless relationships and do nothing to make them better. We float along to the end of our lives then wonder where it all went.
Some of us live reactively. Life hits us so we hit right back. We take a lousy job to pay the bills. We explode in anger to each successive frustration. We can’t win but we keep on fighting.
At no time are our lives totally under our control – not as a dependent child, a starving student, a young adult, or a busy parent. Yet we can resolve to live our lives more deliberately.
It begins with making choices. Choose happiness. In the hours of your day not consumed by work or duty, choose what you really want to do and with whom you wish to do it. With your limited funds and resources, recognize your personal needs and honour your passions. Do what you love to do. Do what you need to do.
Live life on purpose. When life seems to have no meaning, you must find it or make it. Where do you find meaning? Put your time and energies where your heart is.
Resolve to live life more deliberately. If you have a choice, have you chosen the work that best engages your passions and talents? How can you make this day more meaningful? What can you do today to bring more happiness to you and others?

Dr. Davidicus Wong is a family physician.

Posted in Growth, Happiness, Positive Change, Positive Potential, Purpose, Relationships, Wisdom, Your Goals | 3 Comments