A Police Shooting, A Facebook Debate

Last week a Huntington Beach police offer shot and killed a man outside of a convenience store. The deadly exchange was captured on cell phone video by two different bystanders, one of whom posted the video to Twitter within minutes of the encounter. It took only a few minutes more for arguments to begin on social media.

The video was only 17 seconds long and captured only a portion of the interaction but that was enough for hundreds of people on Facebook to make confident judgments about the rightness or wrongness of the officer's actions. The opinions were diverse, with the officer being described as everything from a hero to a murderer.

The assessments were diverse but shared a common confidence. Multiple "analysts" expressed their opinions without wavering, seemingly oblivious or uncaring of the thoughts of others. People chose their sides and held their ground eager to judge not only the officer and the man who was shot but also the assessments of fellow commenters. Scorn, praise, disdain and encouragement were freely given to complete strangers based on brief comments on Facebook. The relative of anonymity of social media led to name calling and personal attacks, peppered with dismissive insults of others such as “Embarassment”, “Fool”,  “Wackadoo” and “Asshat.”

Those against the officer's actions demanded he be punished, confidently stating he could have and should have acted differently. Some declared that the officer could have shot his attacker in the kneecaps instead of the torso, (which leads me to wonder if they have ever fired a handgun, as such marksmanship under pressure would be truly incredible). Others asserted that the officer, after an intense wrestling and fighting match with the man, should have somehow been able to subdue the man with his hands alone. Some were confident that had the officer only had better training in mental health issues he would have been able to “deescalate” the situation and avoided violence. They described the 27 Year-old man who attacked the officer in sympathetic terms, as a victim of society, the mental health system and overly aggressive policing.

Others decided not only to support the officer but to devalue the humanity of the man who attacked him. His name, once revealed, was seldom used as people chose to instead call him pejoratives such as "scum", "garbage" and "loser". Many said that not only that the officer justified in his actions but that the man "deserved to die."

Almost all of the comments revealed major flaws in American society, the seemingly universal inability to listen to and entertain alternative points of view, as well as the inability to questions one’s own positions and arguments. Battle lines take priority over lines of communication. Personal feelings of moral superiority trump the personal feelings of others. We are quick to judge, quick to speak and completely unwilling to listen to one another.

Many of the responses I read displayed a type of selfishness, an apparent desire to elevate one's self over others and to gain a sense of moral superiority. Opinions mattered more than people. Lacking in most of the dialogue was a sensitivity to those involved in the actual event, as if they were characters in a drama instead of real people. I do not know the officer but I suspect he has no need for others to question his actions.  He will undoubtedly undergone countless hours of self doubt and questioning in addition to the inevitable formal investigation. For the rest of his days he will have to deal with the reality of taking the life of another human being. The family of the man killed have had his mental illness and irrational behavior put on display for all of the world to see, with their family dynamics called into question. Those who disparage his upbringing and support network do so with no knowledge of the pain and agony experienced by the loved ones of those with serious psychiatric disorders. Families of the mentally ill often question themselves, wondering where they went wrong and what they could have done differently. This family has the added emotional stress of processing the graphic video images of someone they loved die from gunshots. With so many opportunities to question themselves and their past actions, they do not need the questioning of strangers.

It is time for all to take a step back. We need to be less confident in our opinions, more questioning of ourselves, and less questioning and judging of others. We are all flawed and broken people, we all fail, and we all struggle. None of us wants our imperfections publicly displayed and debated or to have our actions examined under a public microscope. We need grace more than we need judgment.

For me, I am going to make it a personal goal to change my initial responses to the actions of others shared in the media. Instead of jumping to conclusions and passing judgment I aim to fall to my knees and pray, for this may actually accomplish something.

- Bart

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"It's Cancer"

“It’s cancer.” I have said those words to patients hundreds of times. Sometimes the news was particularly bad, news that a cancer was not only present but had spread. Other times the news was more encouraging, of a minor cancer that was easily treated. Patient responses have been as varied as the diagnoses. On hearing the news some patients were shocked and some were tearful while others were stoic or silent. All were changed by the diagnosis as all saw themselves and their futures differently for having heard those two words.

I spent most of my morning today waiting to hear those words myself. I was certain they would come. 10 days ago I had my Physician’s Assistant biopsy a new mole on my forehead. I first noticed the mole a few weeks ago. Although no one else was worried about it,  its newness combined with my family history of melanoma made me concerned. My PA dutifully and skillfully performed the biopsy and sent the tissue to the lab for analysis.

Skin biopsy results almost always arrive within 5-7 days of submission. When day 7 arrived without results I started to wonder. This morning was the morning of day 10 and when results were still not in my inbox my wonder evolved into worry. I could not see any way that a benign diagnosis would take this long, especially when I had already gotten results back on patient biopsies submitted after mine. In my concern I had my nurse call the lab and ask for the results. The lab secretary told her that results were not yet available because the tissue had been “sent out for additional tests.”

That settled it for me. I was certain the diagnosis was melanoma. No one does “additional tests” on benign moles. The only question left was the seriousness of the diagnosis. Did I catch it early enough, or had it already progressed to a dangerous stage? I had the staff leave a message for the pathologist to call me back as soon as he arrived, wanting the final diagnosis as soon as possible. Waiting has never been easy for me, waiting for this call was agonizing. As melanomas can be deadly I found myself wondering what the impact on my family would be if the prognosis was poor. I began to mentally prepare and brace myself for the potential bad news.

My office staff was stressed as well. We are a close knit group and their concern was obvious. I made lame jokes that were not well appreciated and served to amplify rather than calm their fears. Sensing this I leaned over to my receptionist and quietly spoke words that were meant to encourage both of us saying, “Nothing about the diagnosis will have any impact on God’s eternal plan for me.” The truth of these words brought me comfort.

As there was nothing else I could do in that moment I went back to seeing patients, less distracted than I expected but distracted nonetheless. My eyes frequently drifted down to the clock in the corner of my computer screen. How long was the pathologist going to wait before returning my call?

When 11:30 came I decided I was done waiting. I called the lab myself. After a few minutes on hold the pathologist came on the line. “It is a lentigo maligna, a melanoma in situ,” he said. I felt a weight lift off of my shoulders. It was melanoma (the worst kind of skin cancer with the potential to lethally spread throughout the body) but it was “in situ”,  meaning that it was still confined to the surface of the skin and had showed no signs of penetrating deeper. I had cancer, but it was completely curable with minor skin surgery. I would not need chemotherapy, I would not need body scans or additional testing. I had caught it in time.

I spent the rest of the day emotionally drained. I felt like someone who had been involved in a near miss plane crash or car accident, relieved but shaken by the reality of the disaster that could have been. I found myself on the verge of tears as I drove home from work tonight. I realized that something about me had permanently changed. I am now, in a way, a cancer patient.

I have cancer, cancer that could kill me if I don’t get the rest of it removed. I will get it treated and I will be cured but for the rest of my life “melanoma” will be a part of my personal medical history. It will always be in the back of my mind. Every time I look at my moles and every time I look in the mirror I will wonder if there is something there. I will need to remain ever vigilant. The fear that I may not be as fortunate the next time will likely never fade away.

The events of today have also caused me to reflect on my patients who have experienced similar near misses, as well as those who were not so lucky. I currently have patients in my practice who have been treated for lung cancers, breast cancers, and melanomas. Some are battling widespread disease and face long odds. Others have no current signs of disease but continue to vigilantly follow up with their doctors, doing everything they can to detect any possible recurrence as soon as possible. I am just beginning to understand the truth of how cancer may have changed them.

I am grateful that my cancer is treatable, grateful of the time I have been given and the future that remains. More importantly, I am grateful for the opportunity to learn and grow. I pray that this episode will help me better understand the fears, pains and concerns of the cancer patients God brings across my path.

This seems to be a part of his eternal plan for me. 

Bart

Great Doctors, Terrible Outcome

I stood silently by his bedside in the Intensive Care Unit listening to the rhythmic hissing sounds of the ventilator as it repeatedly pushed oxygen into what was left of his lungs. “Poosh, poosh, poosh,” the sound a constant reminder of how sick he was. On the monitor above the bed the tracing of his heart rate kept its own rhythm, an almost mocking evidence of life. Although he felt nothing, I felt a pain deep in my stomach and an ache in my heart. I asked myself, “How did we end up here?”

He seemed perfectly healthy a few weeks earlier when he came to see me in the office for his check up. His blood pressure was good, his heart was strong, his lab work was normal. He exercised regularly and was in near perfect shape for a man in his early seventies. The only blemish on his health record was a distant one. He had once been a heavy smoker but had stopped 10 years earlier.

If his visit had been scheduled a few months earlier I would not have ordered any additional tests, but he came in shortly after a study on lung cancer had been announced. Less than a month before his physical I had been a part of a team of doctors involved in drafting a new lung cancer screening protocol for the hospital. The recent study had shown for the first time that early detection of lung cancer could have a positive impact on survival. The evidence revealed a 20% decrease in lung cancer mortality when patients over the age of 50 with a heavy smoking history had annual CT scans to screen for small tumors. He was the first patient of mine who met the criteria for testing and I enthusiastically recommended the test.

I was stunned when the test revealed a cancer but was hopeful that we had found it in time. That was, after all, the purpose of the test. I referred him to the thoracic surgery team for removal of the tumor. The surgeon, one of the very best at his craft, met with the patient, did the appropriate evaluation and scheduled him for surgery. Everyone was upbeat and hopeful. The day before the operation he played basketball in the driveway with his grandchildren.

The first hint that things might not go as hoped happened in the operating room. The initial plan had been to resect the tumor and leave most of the lung intact. The plan fell to the wayside when the surgeon discovered that the tumor was larger and more invasive than the scan had suggested. The cancerous mass had wrapped itself around the bronchus, the air tube supplying a major portion of the lung. The surgeon had no choice but to remove the entire lobe, significantly more tissue than he had planned. The doctor was disappointed, but was still confident that he had removed all of the tumor and the patient had a good chance at recovery. He sewed the patient up and moved him to the ICU, where all chest surgery patients go after leaving the recovery room. The plan was to keep him on the ventilator for a day or too while the lungs healed and then allow him to breath on his own.

That never happened. The years of smoking had caused another previously unknown problem. Although he was physically active, he had undiagnosed COPD, chronic obstructive pulmonary disease. The combination of the stress of surgery and the chronic disease were too much to overcome. The remainder of his lungs were too diseased to support him breathing on his own. Lung specialists, heart specialists, and other specialists were all asked to help but there was nothing anyone could do. He was never going to get off of the ventilator. It was up to me to inform the family of the bad news.

The conversation with the wife was intense. The question was asked, “What went wrong.” The answer was both nothing and everything. Each and every doctor had done everything exactly right. I had ordered the right tests, as had the surgeon. The surgeon had made no mistakes during the operation and the correct medications and treatments had been prescribed. In spite of our combined efforts  he remained unconscious and dependent on a ventilator. It was a hard message to accept. The wife and I agreed to wait a few more days to give him a final chance to respond, praying for a miracle. It was understood that if no improvement came that we would have to let him go. A few days later we said our tearful goodbyes.

His death was a devastating loss for all who were involved in his care. I found myself wishing I had never ordered the CT scan and grieving the decision to proceed with surgery. I wrestled with the reality that while his death from lung cancer was a certainty, it need not have happened so soon. I will never forget the anguish of his wife as we stood at his bedside, nor the heartfelt tears in the eyes of the surgeon when he told me there was nothing more that he could do. He was a good and kind man and the loss was real.

I have also never forgotten the truth that excellent care does not guarantee good outcomes. Life happens, and death happens, even when doctors do everything right. I am reminded not to assume the worst when bad things happen and to avoid placing blame and pointing fingers. Sometimes our best just isn't good enough, in all areas of life.

- Bart

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A Sunday School Lesson for Grown Ups

Important lessons can come in unexpected places. I learned a crucial life lesson while in training to be a Sunday School teacher. I expected to learn where my class was, how to get supplies, and what the curriculum was. I learned all of these things, but it was during a discussion of how to interact with children one-on-one that the most profound lesson came.

The Children’s pastor told us, “Never praise a child for their appearance. Praise them for their character.”

She based her instruction on the words God had spoken to the prophet Samuel when he was seeking the man who was to be the next king of Israel. Samuel looked to anoint the tallest and strongest man as king but God corrected his thinking saying, “the LORD sees not as man sees: man looks on the outward appearance, but the LORD looks on the heart." (1 Samuel 16)

She told us that we lived in a society that valued superficial achievements and attributes but that we should be different, for a person can be externally beautiful and yet ugly inside, intellectually brilliant but selfish and unkind. There is nothing wrong with pretty dresses, cute bows or cool shoes but these were not things to praise in Sunday School.  Our job was to teach children what God values, goodness of the heart. We were to do this by praising such things as kindness, obedience, generosity and love, those things that all children can do regardless of physical attributes or giftedness. 

I have never forgotten her words, for they have applications for grown ups too. I do not have to look far or wait long to see proof that our world praises the wrong things. In my profession I know many physicians who financially successful and clinically talented yet uncaring and rude. I have patients who were beautiful on the outside and respected in their professions who hide secret additions and abusive behaviors. I live in a culture in which it is possible to be famous and popular, to have millions of followers on social media and millions of dollars in the bank and yet be a selfless failure in important relationships. Many “successful” people are moral failures.

I want to be different. I want to be a success in the eyes of God. To do this will require me to work on my insides, the heart that only he can see. I may make less money and be less successful but is fine with me, for I may make a difference in the lives of others, which is of far greater value.

- Bart

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Cancer Doesn't Care

Cancer does not care what you think or what you feel. It does whatever it wants.

Several months ago a young man came into our office with a strange looking lesion on his scalp. I was not sure what it was but I knew it wasn’t normal. It was big enough and weird enough that I referred him on to a specialist for the biopsy. My worst fears were confirmed when the pathology report came back as a very rare type of melanoma, the most deadly type of skin cancer. I referred the patient to a cancer specialist for ongoing treatment.

The cancer doctor immediately recommended that he see a plastic surgeon for a wider excision to make sure that none of the cancer was missed and to also biopsy a lymph node in the area to make sure the cancer had not started to spread. The patient didn’t want to go. He didn’t want the scar, didn’t want to deal with the recovery, didn't want to believe it was serious. He refused to listen to the oncologist’s warnings not to trust that all of the cancer had been removed in the initial incision. The patient refused the doctor's advise and decided to instead try herbs and holistic medicines.

The cancer wasn’t impressed with the patient’s interest in natural remedies, nor did it care that the patient believed he was cured. It spread anyway, and it spread everywhere. Lungs, liver, and bones all had tumors within a matter of months. The patient is in his early twenties and is too young to die. The cancer does not care. The odds for long term survival are not good. 

Cancer never cares what we want or think. It is a heartless killer. Colon cancer does not care that you are afraid of having a colonoscopy, is not moved by your embarrassment about having someone insert something into your rectum, or worry that you can't take the time off of work. It ignores all of our concerns and attacks who it wants when it wants. It will attack 1 in 20 Americans and do what cancer does. If not caught in time it will spread and it will kill.

Breast cancer does not care that mammograms can be uncomfortable or that you have sensitive breasts. It does not care that no one else in your family has had cancer, or how big or small your breasts are. It will attack 1 in 11 American women and do what cancer does.

Cancer can not be wished away or ignored into oblivion. It does not care how positive your thoughts are. It does not care how many children you have or about your retirement plans. It moves at its own pace on its own timetable. It does not discriminate. It does not care about the color of your skin, your religious faith or what you do for a living. For many cancers it does not care whether you or male or female. It does not care whether you or rich or poor. It can attack anyone and when it does it will try to do what cancer does. It will spread and it will kill.

So what can we do? Like any enemy it is best to attack when the opponent is weak and small. While early detection does not always guarantee victory there are cancers for which it truly matters, such as breast and colon cancer. Smart people get colonoscopies and mammograms done when they turn 50. Smokers can stop smoking, and those who have smoked too long and too much can get CT scans to look for cancer after age 50 as well. When diagnosed with cancer we can listen to our doctors and pursue aggressive treatments, and trust their opinions more than our feelings. We deny denial a chance to harm us. We can do these things because we care about ourselves and our families, even when cancer doesn’t.

- Bart

Thanks for reading and sharing. More importantly, thanks for getting your colonoscopies and mammograms!