Blast from the past

A few days ago, I had a near-encounter with my childhood bully.

When I was around 7-9 years old, I got picked on a lot in [language] school because I was one of the youngest kids in my class, and I was an easy target for my classmates. The ringleader was a guy about 2 years older than me and his father was the principal, so he probably got away with a lot of stuff. I won't go into detail what happened back then, but it usually ended up with me in tears (I cried easily as a kid). It was a miserable time of my life, and to this day I tend to avoid anything related to that particular church (and maybe church in general) because it was not a safe place for me at a time when I needed (and did not get) extra support.

We grew up, and while the bully and I still had mutual friends (and the same music teacher), we never really crossed paths again after junior high. One of my friends developed a crush on him at a region meet; I was quick to talk her out of it. I'd heard he'd gone out of state for college, but in my 4th year of undergrad, I ran into his mother on a plane on the way home from a med school interview. She then proceeded to tell me how her son was attending a prestigious medical school and was doing very well for himself, emphasizing his interest in research (which I personally did not care for). When I told her which medical school I got accepted to, she immediately cut me down, saying it was a horrible school and that I should withdraw my acceptance. Wow, really?

Flash forward nine years to 2014. My medical education complete, I was starting my 3rd year as a hospitalist when I learned that the bully had also begun practicing medicine in the same city as me.  My PCP belongs to a multispecialty clinic which sends regular email updates on any new hires; imagine my surprise when I opened an email which announced that the bully was joining the clinic as a medicine subspecialist! "You've got to be kidding!" I muttered out loud. Several other doctors in the vicinity asked what had happened. Not wanting to go into detail, I just said that one of my least favorite people will be practicing medicine across town. Some of the male docs immediately assumed that the bully was an ex-boyfriend; that's a laughable idea.

At that time, I wondered what would happen if I did run into the bully again. Would he even remember who I was? Was he ever sorry? Does it even matter, 20+ years later? We're all adults now, and people change. I can definitely say I'm no longer the crybaby that got picked on almost every week; in fact, people tell me that as far as first impressions go, I can be pretty cold until I warm up to you. Interestingly, not long after I saw that email, I had a dream in which the bully and I talked things over (don't recall exactly what), and at the end he said he was sorry. After that, I decided that I would no longer let him cast a shadow over me. Though we may live in the same city, the chances of us crossing paths was very low, and I put him out of my mind.

Then, while visiting my family over Thanksgiving, I recognized the bully's father when we went to one of our favorite restaurants for lunch. My dad recognized him, too, and while those two stopped to exchange greetings, I proceeded to my table without saying hello. I wondered if the bully was there, too, and suddenly I dreaded the thought of having to come face to face with him. Was that my inner child rearing her head? My dad returned to the table and told me that he saw and shook hands with the bully, and said that I should be polite and say hello, too.

I did say hello to his father, but when I saw anyone who even looked remotely like the bully in the buffet line, I turned my head and made myself invisible. Because even though it's been 20+ years, I had no desire to acknowledge his presence or speak to him. "Hate" is too strong a word as I do not waste time thinking about him and he is not worthy of whatever hatred I may possess; however, I think I can certainly say I dislike him for how his bullying affected me in the long run. Maybe I was a coward for avoiding him, but he has no place in my life, and I prefer to keep it that way.

Of course, there's still a slim chance that I'll cross paths with him again. And if it happens, I hope I'll be able to leave childhood hurts aside, and show that I've truly changed for the better.

Dangerous Skies

I used to never be afraid of flying but with all the recent airline disasters in the past year (most recently the recent deliberate crash of Germanwings 9525 into the French Alps), I can't help feel a bit anxious every time I set foot on a plane now. The latest reports suggest that the co-pilot of the Germanwings flight had a medical condition (depression?) that deemed him unfit to fly, yet his employers knew nothing about it. If his condition was really that serious, did his physician have a duty to report this if working meant putting other people's lives at risk?

I had a similar case approximately 2 years ago when I admitted an airline pilot to the hospital after he had a seizure during a marathon. His CT head was negative and he later got an MRI, but he left AMA before the results came back. He'd believed that dehydration was the cause of his seizure (he did have AKI but felt better after getting fluids) and saw no need to stay in the hospital. Usually when people leave AMA we don't follow up on their results, but the following day I looked up his MRI report and saw that he had a brain mass. I asked my partners what to do, and they said to call him and his PCP so that he could self-report to his employers that he could not work.

I called the patient at home and gave him his MRI results, telling him that he needed to schedule an appointment with his PCP so that he could arrange followup with a neurosurgeon. I further told him that he could not fly anymore and needed to tell his employers so. Then I faxed a letter to his PCP explaining what had happened, then called the PCP the next day to confirm that he'd gotten the letter.I was somewhat amused when the CMO of our hospital called me about a day after I spoke with the patient's PCP telling me I needed to notify his employers immediately of his diagnosis so that he can't fly. "Already done," I told him, and couldn't help but feel satisfied that I was one step ahead of him.

Within a month of diagnosis, the pt had his brain mass resected and was diagnosed with stage IV GBM. What happened afterwards I don't know, only that the craniotomy left him debilitated and he required extensive PT and OT before he could undergo XRT. I doubt he will ever pilot a plane again, but at least we were able to stop him before he potentially had a seizure mid-flight, and no lives had to be put at risk. Who can say what was going on in Andreas Lubitz's mind when he chose to fly the plane into the Alps. Committing suicide is selfish enough, but why take 149 other lives with you? Nothing about this case makes sense to me. I shouldn't have to wonder if my pilot is of sound mind and body before I board a flight; that should be a given.

Hospital Under Siege

Yesterday a cardiothoracic surgeon at Brigham and Women's was shot in cold blood on a routine day at work by the son of a patient whom he'd treated. We don't know the whole story yet; apparently there were complications and the patient (the shooter's mother) had died. No one likes to think that this could happen at their hospital, and yet it did happen, and at one of the nation's most prestigious hospitals no less. Needless to say it's shaken me (and several coworkers) to the core.

The concept of doctors getting attacked at hospitals is not a new one. I still remember the episode of ER where a schizophrenic patient stabbed two doctors, one of whom died and the other ended up addicted to narcotics. Then there was that episode of Grey's Anatomy where the disgruntled husband of a patient who'd died went on a shooting spree at the hospital in revenge. He, too, was targeting doctors, specifically the doctors involved in the care of his wife, and killed many people.  I remember watching that episode while on call in residency, and my classmates and I briefly discussed where the best places to hide were in our hospital. And yet when an earthquake struck the East Coast and the very room where we were relaxing began to shake, none of us knew what to do. We just sat where we were watching the closet door sway back and forth, wondering whether to evacuate or wait it out.

It did cross my mind once or twice to wonder where the safest place in the hospital would be if there were a shooter in the hospital. To reach another floor, you'd have to use the staircases; you need a hospital badge to get from floor to floor and if the shooter did try to enter a staircase, he's essentially trapped there without a badge. The physician's call room is code protected, but that's not safe either. Some of the nurses know the code and could be forced to give it up under duress. Not to mention once you're in there, there's no escape. The shooter could just shoot through the glass even if I did hide under the table or behind the couch. Then of course there's the random empty patient's room, but no matter how much I think about it, there really isn't a safe place in the hospital.

Then the next question: flee or fight? I'll be the first to say I'm a coward when it comes to confrontations, that when I see a ball flying toward me I'd duck before I'd try to catch the ball in mid air. And yet, I'd like to think that if it really came down to it, I'd fight back if I had to. It's not like I have zero training in self defense. I've been taking kickboxing classes for over a year; I know my kicks are more powerful than my punches, I know where to press my thumb into someone's throat to cut off their airway, and I know where to aim to bring someone to their knees. But what good is that against a gun, which could snuff out my life in an instant, as it did the life of Dr. Mike Davidson?

It's sobering to think that any one of us, if we pissed off a patient too much, could end up dead, injured or worse. I have no intention of letting fear take over my life, but I will be vigilant just in case.