"pain is a noun, acts like a verb"

As the pain was getting unbearable for him, he became numb. This paradoxical effect of pain was new to us but not to him. His journey of pain care has taken him from doctor to doctor to get some relief so he could even eat, walk, and sleep. 

He was suffering from spinal stenosis with arthritis.  He had undergone physical therapies and diagnostics. He followed his primary care doctor's plan and the pain management specialist's recommendations. The trials of topicals, oral medications, and injections were not cutting through the intensity of his pain.

Then the other day on his follow-up clinic visit, he announced that he accepted a life living with pain. That was the day when a verb became a noun for him as he phrased it.

As he was talking about his companionship with pain, he expressed his regrets about pain management in the healthcare system. He described his experiences with pain management specialists as non-comprehensive procedure-based. They just want you to have an injection.

To some, pain is a non-verbal communication, a warning to watch out, a construct of the brain, a noun that acts like a verb and pushes one to initiate an action.

Others take pain as it is. They claim to have a high pain tolerance, making one wonder about the why of their threshold of pain, whether they are gifted or they became numb.

"as in life so in love"

 As I was taking the history of illness from her husband, I was made aware of their vows of love by the nursing staff. Everyone was sad about their situation knowing it must be hard for them.  She had suffered from a stroke and ended up with a dependency on the ventilator. She was alive on the token of a breath, a heartbeat, and a very involved husband.

Every passing day she was having difficulty in achieving transcendence. There were genuine feelings but the facts contradicted the hope, The team saw the struggles. There was a heart ready to beat a rhythm of life but the brain was numb. We knew that he knew about her poor prognosis but he was not ready to let go of her.

One day the husband requested the team to have her started on Reiki treatment; "the life force may heal her" was his reason. There was skepticism about his want for a nonconventional treatment. 

We are in the practice of medicine following the order of black-and-white protocols, said one who spoke his mind. There was a certainty in her dismal prognosis that everyone concluded, but a curious empathic mind allowed an unconventional path to ease their final goodbyes.

To some, when standing in the no man's land of medicine, supporting a family even if it is against all odds is a "step-up compassion". Others know that the process of living while losing a loved one makes people do things.  As in life so in love, some acts are heroic and others are wishful. 

"the dose makes the poison"

It was controlled chaos where security staff was assisting in caring for a person who was out of control, under the influence of disrupting thoughts and perceptions. It appeared as if he had some loss of contact with the reality of the present. We were in different spatial zones.

The medical staff struggled to list the triggers. They were focusing on medication reconciliation and a broad differential with a battery of diagnostics. There must be an iatrogenicity as the sane voice echoed in an insane situation and someone shouted: "Sola dosis facit venenum".

The evaluation found that the green Wednesday brownies in the bag were also stuffed in the stomach to get the desired effect. The rest of the story was proven by a virtual tour of the stomach and an endoscopic lavage. 

To some, the fallacy of  "more is better" ends up with consequences like overdose and intoxication

To others, while pondering upon the Tea Alchemy where a set of steps makes a fantastic cup of tea, know that whether  weed or water, "the dose makes the poison" 

"Artificial Intelligence (AI) is a misnomer"

 This is the age of Artificial Intelligence. Everything can be done with a command.to a computer. Doctors will no longer needed. A person can ask his DocGPT and get recommendations.

As he was talking, everyone was attentive. Yes, we also got worried about job security and what the future will hold. His perspectives were fascinating on one hand and somewhat intuitive as well. His statements were the subject of discussion during his stay at the hospital.

He was suffering from an autoimmune disease, a disease in which the body's immune system attacks one's healthy cells. He was consumed by his own self as his body was fighting against itself. He was brilliant but reasonable knowing that diseases don't reason. He knew that very well. He once said Artificial Intelligence (AI) is a misnomer as it is really a Substitute Intelligence (SI) created by Human Intelligence (HI).

To some, there are domains of knowledge, critical thinking, creativity, compassion, connectivity, and self-reflection. These are some of the intelligence attributes of the superior being, the ashraf-ul-maKHluqaat.

To others, Artificial intelligence will take over Human Intelligence at a finite point in our lives. That day it will be called Substitute intelligence, and it will make us doubt ourselves by taking away the power of creativity; the day after that will be the birth of auto intelligence; the autoimmune disease of human intelligence  He hoped that humans may survive that challenge through their collective wisdom of perseverance through finding humility in each other.

"a homeless with a home"

He was brought to the hospital emergency department as a man found unconscious.  He was screaming about his eviction from his home but I was told by the ambulance transport team member that he was homeless and was found unconscious at a bus stop booth. He was intoxicated with spirit, losing mind and body, and incontinent with an odor mix of booze and urine.

He appeared unkempt,  he told me that he drank too much and passed out. I  asked him questions about his health and ordered tests. While I was doing his history and physical examination, he kept asking me about his belongings and the property where he was residing. There were many reasons for him to be homeless those were sadly preventable but none to blame.

To some, the observation of whether he was truly homeless is rightful as he claimed the bus stop booth was his address. They may argue the rights of convenience for one that infringes others rights and is inconvenient to many as in his case he was literally living at a public bus stop booth. Others ponder about the burden of caring for an individual from the ill effects of elements, which is a task that requires creative kindness at many levels.

Some find it as an opportune leap of faith as we were foretold about the situation as noted:

"And Jesus said to him, “Foxes have holes, and birds of the air have nests, but the Son of Man has nowhere to lay his head.” (Mathew 8:20)

"the cadillac spirituality"

 What rich people do with so much money. They were talking about the world's wealthiest three. Why they do not donate to lots of charity. Why they need so much money, what they will do witt it. Then one of the nurses said if I have that much money I would be doing a lot of charity, not like these people. 

I was there to look at the bedsores and stage III wounds during my wound care visit. I stayed quiet during those commentaries as my patient was getting wound care with the wound nurse. 

Then the patient spoke whom we all admired for his wit and humor. He said, it is not your money why do you care what they do with it. Then he smiled and said, in reality, these wealthy people do a lot for charity, just google it. Wealth brings different kinds of spirituality, the power of abundance: the Cadillac spirituality. 

As we smiled so was he while looking at us as he got our attention. Our expectations from money are to pay bills and buy unfulfilled dreams: house, car, vacation, helping family, children education and giving for charity, etc.  But the power of abundance brings another level: feeling beyond materials, freeing oneself from the ordinary. This is the life most wealthy people strive for but since it not on display we lose ourselves by judging them with our own lives and what is in our valet.

Then he reminded us that was already said:

"Every day is a bank account, and time is our currency. No one is rich, no one is poor, we've got 24 hours each" (Christopher Rice)

“For the LOVE of money is a root of all kinds of evil. Some people, eager for money, have wandered from the faith and pierced themselves with many griefs” (1 Timothy 6:10)

"PRN (PRO RE NATA) MEDICATIONS"

During the morning round she appeared very sleepy and difficult to stay awake to answer questions about her condition.  She was suffering from anxiety, acid reflux, and chronic pain issues besides other comorbidities.

As I asked about her last night with regards to her anxiety and pain; she broke into tears as she mentioned that she suffered all night from anxiety and pain and she has to ask for help.  She said help arrived but after she keeps asking for medications.

As I reviewed her chart she was on multiple scheduled as well as as-needed (PRN) medications for anxiety and pain.  She received scheduled medication on time but as-needed (PRN) medications were discretionary and not received.

As we know, and some may not that p.r.n.: abbreviation meaning "when necessary" (from the Latin "pro re nata", for an occasion that has arisen, as circumstances require, as needed)

She wanted me to make a  difference in nursing practice by implementing a COWS rule for every nursing shift. Nurse must review PRN medications with their patients as not to miss an opportunity to intervene when help is already on stand by. The red flag then turns into a smiley face on COWS (Computers on Wheels) as a goal to achieve structured compassion.

To some with their old school of care, nursing involves care of giving beyond one's asking for help. They feel with their heart and eyes. They know what is there for their patient's needs. Others forget available necessary medications even as circumstances require to be administered. Certainly, the abbreviation PRN does not mean "please remember not".

"secret of being humble: two words"

If you want to be humble, just remember two words, two states of being. The professor was talking while getting prep for his colonoscopy.  We were wondering as what will he say to enlighten us. Then he said two words with a  smile: Diarrhea and Constipation, 

Only those who suffer know it quite well; the discomfort, embarrassment, and the moment of weakness. The private sufferings of one's privates; losing control, or failure to let go of waste.  Everyone has it, only a few remember that moment.  Then the return of ego, anger, conquest, win or lose. The claims of one better race over others, the superiority of being in what. Everyone has same number one and two to wipe and wash.  The blockage or a free-fall makes us all equal human beings: whether royals or commoners, all feel the same. The simple pep talk started in the Endoscopy suite end up as food for thought. 

To some, these bodily dysfunctions become a chronic issue. They get restricted, isolated. They feel embarrassed as they feel that they are the only ones with issues. Others enlighten themselves as all are born equal, search for humility in a moment of weakness, a remembrance of a common thread of being human and so weak as to get incapacitant with one's own bodily dysfunction. 

"ambulance in the rearview mirror"

As I entered his hospital room, I saw loud crying than laughing, and then praise to the Lord. The priest was there and they were praying. I was asked to join.

He was admitted with a heart attack while he was shopping in a mall. Luckily he was saved and now recovering. 

He told me that he was saved by the power of prayer. Someone prayed as they saw his ambulance in their rearview mirror while pulling over the car to have healing receive him at the hospital by the grace of God.

He told me that day his own son's prayers saved his life as he was the driver of that car who saw his ambulance in the rearview mirror.

To some, pulling over for an ambulance is just an act, as this is a law. 

Others, pull over and send a prayer in motion; those are the ones who make a difference not known to many.

"anyone can be a nuerosurgeon"

He was recovering from his surgery, anal fissure with significant pelvic pain, He described that as a constant burning sensation in his privates, and a feeling of a hot iron rod inside. His descriptions made me shiver in my spine. Then he said, anyone can be a neurosurgeon as his pain was not well treated but the operation was done well as he was told by his surgeon.

I saw pain everywhere. The pain which was oozing from his wound, and the pain which was not measurable on the pain scale of zero-ten.

The current atmosphere of judgments upon people who use narcotics for dependency and those who need it for post-operative care has become a gray area. In the grand scheme of control, everyone suffers. There is room for compassion but it is a slippery slope.

To some becoming a neurosurgeon is the achievement of one's lifetime. No doubt they have hard-earned skills but some gain those at a cost; while perfecting a skill ignoring that a beautiful well-healed wound is still a wound, not a medal and the bearer should be made comfortable at its best. 

Others strive to speak up and look outside the box; tools to heal and control pain. They are the ones who remind us that not anyone can be a neurosurgeon.