Giving thanks

Though November means that true winter is still a month away, the harvest has been gathered, and the sweaters have come out of their reverse hibernation. The pinnacle of the month is Thanksgiving. Despite the dangers of this holiday, including E. coli gastroenteritis and tryptophan torpor (see “Food for Thought” in the November 2012 ACP Hospitalist), there is much to be said for the act of giving thanks. Thanksgiving is a truly American holiday, whether you believe the tale of 52 Pilgrims and 90 Native Americans sitting down to dinner in the fall of 1621 in Plymouth or simply enjoy turkey, canned cranberry sauce, and football. Giving thanks and accepting gratitude may have physical and psychologic benefits. So for this column I'd like to share with you, my readers, some things for which I'm thankful.

Colleagues: Hospitalists are team players. It's part of the hospitalist vibe. We cover each other's shifts and share the management of both fantastic and difficult patients. Unlike outpatient physicians, who manage their cohorts of patients primarily on their own, we hand off multiple times a day. It's collaborative and mostly congenial. I am grateful for the hospitalists who bend their minds around medical statistics, design quality improvement projects, have bottomless depths of knowledge, and are kind in the most difficult of situations. And especially for the ones who don't panic. I'm thankful for the expert specialists without whose knowledge and procedural and surgical skills I could never manage my most complex cases. I appreciate the nurses' skill and caring, and especially their situational awareness. I am thankful for the therapists and technicians and the environmental service and transport crews. And I'm especially thankful for my administrative colleagues who work incredibly hard behind the scenes to keep the hospital functioning. They don't just drink coffee and sit in meetings. (I'll admit, though, I am undyingly grateful for coffee.)

Mentors: When I was in practice in Galveston, Texas, I had a partner, Charlie Stone Jr., MD. I learned a lot from him, and I still quote him on a regular basis. He would call me into his office and say in a baritone drawl, “Plant it on the Naugahyde. I'm impaled on the horns of a diagnostic dilemma.” This almost always meant he was transferring the care of a complex or difficult patient into my hands. His best advice was simple: “Boy, you need to learn to say no.” He also joked that each day that he woke up and did not see his own name in the obituary column was a good day. I only hope that I can stay in practice as long as he did. We hear a lot about the importance of mentorship. Some people are naturals; others must learn the secrets. I am grateful to have had a few great mentors across the years and try as hard as I can to not be a “De-Mentor.”

Electronic medical records: That's right, I'm actually thankful for my EMR. My hospital is in the midst of a major conversion to a new system. It's been painful, frustrating, and generally discombobulating. I've lost all the “tricks” that I developed over a decade. I don't love dot phrases and templates, but I'm sure I eventually will. Nonetheless I remain quite grateful to have an EMR at all. I can still remember well the pre-EMR days (see “Just for the Record” in the January 2009 ACP Hospitalist). I went into medicine because of my poor handwriting. My sixth-grade teacher, Mrs. Miller, noting my good grades in everything but penmanship, told me I should become a doctor, and who was I to argue with Mrs. Miller? But that same factor became a liability when it came to writing notes on those old yellow sheets. If the chart was ever dropped on the floor, there'd be a maelstrom of indecipherable recommendations. It was impossible to find lab results, and after spending hours looking for X-ray images, I'd hoard the films to bring on rounds, making it impossible for anyone else to see them. I'm not saying the current EMR is error-free, far from it, but I'm appreciative every time I don't have to scrawl a note. Bless you, cut and paste.

Health: Being healthy enough in mind and body to walk into the hospital for a day of work is a true gift. Though I am unlikely to be a centenarian marathoner, I am extremely grateful for the miracles of medicine that we sometimes take for granted. We try to heal or palliate the diseases of our patients on a daily basis, but it's not until we ourselves or our families are patients that we realize once again what it all means. That we have antibiotics and vaccines, artificial heart valves and pacemakers, insulin and cortisol, is due to centuries of effort by our medical forebears. I'm especially grateful for my metal hip. By the time I was 49 I could no longer walk without severe pain. It was aging me rapidly. Every time I go hiking in the mountains, I feel great gratitude. I'm also glad I didn't die from a perforated appendix. Just saying. And as a corollary, I am thankful for great health insurance.

Family: Thanksgiving can certainly be a family drama extravaganza, or it can be a time for those you love to gather together from places far and near. Most commonly, it's a combination of the two. I am thankful to my children for making me be a better person and letting me share their lives. I haven't always been an all-star uncle or brother or son (CMS star rating to come), but I appreciate my family more than they'll ever know. Well, maybe they do now.

Newman's Notions: Finally, I am thankful to be going on my eleventh year writing this column. It's made me stay creative and I've gotten to work with some awesome editors over the years. And of course I am grateful (and somewhat surprised) that you, dear reader, to have taken the time to read this in its entirety.