50 Shades of Gray's Anatomy

Guest Post by Palak Shah

At the end of my first term in medical school, as I made the journey back home, I felt like a wounded warrior granted armistice carrying home a temporary olive branch. My enemies were my tests, my weapon was my mental faculties, and the prize was far too distant to even be conceivable: receiving an MD. Medical students often talk about transformations and the alterations each student undergoes in their plight for success at the onset of medical school. For me, however, “change” doesn’t do the experience justice; it’s more of a developmental revolution or overhaul.

Needless to say, when I finally went home for winter break at the end of term one, I felt like a fish out of water. I’ve made the trip home several times. This time, however, the bags under my eyes and increase in grays in my hair served as permanent mementos from a world quite different than the one I left. Let’s get real here: medical school is this alternate universe where for 100 or so days at a time, you’re force-fed more information than you know what to do with until you’re dry-heaving endless facts and tidbits of the human body on some squalid bathroom floor. Constant cramming becomes your way of life while sleeping gets pushed aside as some non-tangible ideal. You’re a slave to your test scores. You’re married to your books. You’re obsequious to your coursework.

And then you come home with free-time galore, almost shell-shocked, that you barely know what to do with yourself, like a man on a fast for weeks suddenly unearthing a massive cornucopia of his favorite fatty foods. Eating without abandon in too short a time, and the man could end up regretting his decision. While all of us are glad to temporarily discard our backpacks and peremptorily forsake the library, it’s easy to forget how to walk on our own two feet without our books as crutches. There are some parts of us that are forever lost by the innocence-killing machine that is medical pedagogy.

I tried to fill up my time by reconnecting with all the friends and family I’d been neglecting. In between exchanging war stories and sharing updates on our lives, there are moments where I asked myself, what’s the point? I came to the realization that sometimes coming back home is like trying to adapt to quicksand. As hard as you fight to stay relevant in the lives of the people you leave behind to enter the portal of medicine, you find yourself inevitably on uneven ground, helplessly sinking.

Other people tend to group your life problems as adolescent and lump them under “school.” As if, my 5-year old niece who just started kindergarten and me, twenty years older, can relate on all levels in terms of where we are in our lives simply because we’re both “students.” I don’t blame them; it’s only natural to think this way because no description will do justice to the actual reality of living through medical school. It’s like the juxtaposition between someone describing what it’s like to be in outer space and actually blasting through the earth’s stratosphere. You can conjecture to the best of your ability to recreate the experience in your mind, but you never really know until you know.

So when I go home and hear my friends rhapsodize about the new developments in their life with wedding planning, joint bank accounts, house-hunting, 401Ks and “real-world” crisis, I understand how my life seems developmentally delayed. While they’re consumed with 50 Shades of Grey, I’m enthralled with 50 Shades of Gray’s Anatomy.  Sure, we, as medical students, sweat, worry, fight, and risk just as much our non-medical counterparts out in the “real” world, but our advancement seems much more less remarkable until we actually  ”finish” school (in actuality, the schooling never really does end in medicine). Our progress is much more behind-the scenes. It may seem as if we’re tarrying, but the truth is, we’re doing just fine.

We’ll have our day where we’re not just seen as zombies with backpacks. People will take us seriously but the question then lies, will we want them to? We’ll probably find that the hullabaloo of participating in the equalizing effect of “adulthood problems” is highly overrated, and we’ll be longing for days where our top priorities were to study, study, and study some more. Worse comes to worse, if you still find yourself at odds with both growing up and growing out-of-touch with those you left at home, Taco Bell, Hemingway, and alcohol are three friends that repeatedly deliver and never judge. I know this from experience.

About: Palak Shah is an MD/MPH student at St. George's University in the West Indies. He blogs at Shah Blah Blah. 

Be The Doctor Who Thinks Differently

I can summarize the most successful people I’ve ever known with one trait: the willingness to challenge mainstream ideas.

An Uncommon Guest Post by Leo Babauta

This has been the key to everything good in my life too:

I changed my health and drastically reduced my carbon footprint when I stopped eating like everyone else around me and became vegetarian (and eventually vegan).

I simplified my life when I stopped believing what the majority of people believe, that buying stuff makes you happier, more secure, look better in the eyes of others, etc.

I improved my health and reduced our carbon footprint when I went car-free.

I changed my career by blogging differently than others (on simplifying rather than doing more) when I started Zen Habits.

And there are many more examples, but you get the point. This isn’t a post to brag about all of that — it’s to share what I believe is a real key to life: the willingness to think differently than most people. It means you have to be willing to question what most people do and what the majority will tell you. It means you have to have the courage to try something different. It means you have to be brave enough to stand out from the crowd and not take the safe route.

The Safe Route

Most people take the safe route, because they’re afraid of being different and failing. If you do nothing amazing but you go with the crowd, then you don’t look stupid. But then you miss out on the amazing. If you never stand out from the crowd, you will always be average. True being an average physican is no small achievement but that's not the right way of looking at it. The question should be are you living your dreams are you passionate about your day to day activites? 

The people who stand out are the ones who make a mark, who innovate and discover, who learn the freedom of exploration and invention. If you stand out when you apply for residency or a job, you’ll be more likely to be noticed. If you don’t, and you play it safe, then they’ll likely ignore you. If you stand out when you start a business, people will be curious and check you out. If you’re just one of many businesses doing the same thing, why should others care about you? Why should they choose you?

And yet, most people play it safe:

Most people go to school and then college then because that’s what everyone else does. They don’t know what they really want to do, so why not take the traditional route? And that’s fine, but it’s good to look into other options. Most people get a job and stick to it because that’s the traditional way to make a living. Others might be a solo entrepreneur or start a small business and dare to create something new and live a life they’re passionate about.

Most people eat meat and dairy and eggs because that’s how they were brought up, and eating differently is weird and unthinkable. “I love my ribs too much!” But then you miss out on a whole world of healthy, delicious food, and the opportunity to change the planet and your own health. 

Most people drive a car, because that’s what everyone else does — and changing it is too difficult. And yet, cars pollute and cost a lot and make us less healthy and make the streets less safe for our communities and take up most of our public spaces.

These are just some examples in my life, however the need to play it safe turns up in every part of our lives.

Learning to Think Differently

When you hear an idea that’s different than what you’re used to, pause. Instead of rejecting it outright, consider it — is there some merit? What are the arguments, the evidence? Let go of the emotions that come up, the defensiveness. Many people, when presented with ideas conterary to their belief feel they must lash out and attack. And yet, if you set aside those emotions, and look at the arguments, you might learn to think differently — and that applies to all ideas. Looking at the world, and especially your career as a physican, through these lenses can radically change your outlook.

When you are told that this is the way to do things, take a second look. Is this really the best way? Are there other possibilities? If no one has thought of them, can you? Just because an idea is different, don’t just accept it. Look at the bulk of the evidence, and learn to spot flaws in reasoning.

Test out different ideas.

Just because most people don’t do it, doesn’t mean it’s wrong. They might all be wrong, and this might be better. No better way to find out than to test it. If it’s not a good idea, drop it and move on. Learn to be proud of your ability to test things that people traditionally believe in, and not to worry so much if you stand out. In fact, learn to see standing out as good — not just to stand out, but to forge new ground, to challenge ideas, to express your individual voice rather than blending in.

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Uncommonly Savvy, International Medicine

"Travel is fatal to prejudice, bigotry, and narrow-mindedness...Broad, wholesome, charitable views of men and things cannot be acquired by vegetating in one little corner of the earth all one's lifetime.”

-Mark Twain

An Uncommon Guest Post by Bjorn Karlman a Swede with an American accent, an Asian childhood, a British adolescence, French and American tertiary education and international work experience spread across three continents. He speaks four languages and blogs at CultureMutt.com.

The Pain

“I hate that my pay and my whole family’s standard of living is tied to my working crazy hours and then being on call. If I stop doing this day in and day out, we’re screwed.”

“How can I escape my self-made prison?”

“Why did I choose to become a physician?”

“I want out!”

We’ve all heard the above sentiments repeated ad nauseum by physicians. The news gets even worse for medical students. There has never been a bleaker time to graduate from med school. The economy is still in the tank. Reimbursement is dropping and is going to go down further with Obamacare. Physicians all over the country are shuttering in their private clinics and downsizing their homes.

“Hell no!”

I asked a physician friend from Hong Kong who practices in Northern California if he planned on encouraging his kids to become doctors. “Hell no!” he exclaimed without a moment’s hesitation. I work in health care philanthropy and am forever hearing the exasperation of the physicians around me and the gloominess they feel about the future of their profession.

Time to reframe

I really think it is time to look at this whole narrative differently. I am not going to promise hope and change because I am not running for office:) But I do think that it is time for some innovative, international, solution-focused tinkering. It was downright refreshing to poke around in the “About” section of Uncommon Student MD and see that this online medical community is “not interested in the useless hand-wringing that populates so much of medicine and that so many physicians have bought in to.”

Savvy, global do-gooding

I write the blog CultureMutt.com and am obsessed with what I call “savvy, global do-gooding”. I am absolutely convinced that a laser-sharp focus on understanding the culture of various people groups through international travel and service lies at the heart of helping to solve our collective problems. I think it could really benefit the American medical community. A broken culture drives the negativity in American medicine. The future craves a more culturally-savvy, international approach to medicine. I realize that this is a broad statement to make.

Allow me to focus it a little by outlining four ways we can put smiles back on some faces through “global” thinking:

1) International Sleuthing Trips - As much as it is true that America still is home to some of the most advanced medicine in the world, other developed countries often have a far better handle on actual health care delivery. To learn efficiencies and to learn how to do more with less, American medicine should not indulge in further navel gazing. It is time to give more thought to other models of health care internationally. We should aggressively fund more international study trips to examine global best practice in everything from direct treatment to preventative care and lifestyle medicine. The goal here is not some flimsy “experience”. It is to learn how to deliver better health care at less cost.... and travel the world!

2) International Socialization - I remember the day one frustrated health care exec told me that she believed the emotional maturation process of future physicians ended the day they began their pre med studies. That is a little harsh. But seriously, I work with a lot of physicians and many are very socially awkward. Long work hours and little play reinforce this problem. International travel and study on the other hand, are incredibly broadening. International service work should be mandatory for med students. Especially, for the really nerdy ones. We love you but it’s a quality of life thing - for them and everyone that has to endure them!

3) Red Carpet Medicine - Medical tourism is on the rise. What am I talking about? Well, Brits are going to France, Western Europeans are going to the former Eastern Bloc, Americans are going to Australia and Mexico, etc. Why? Financial reasons. There are top-notch medical clinics especially set up for this kind of medical tourism. They cost less than home and it’s a hell of a lot more fun to go to southern France for treatment than Jersey. I am talking about boutique medicine. Enterprising med students should be visiting some of these clinics for business concept harvesting purposes. Why not make the transition to high-end boutique-style medicine catering to wealthy clients in the US? My aunt works at just this kind of a practice in the Napa area. Very lucrative and based on a smart business model that doesn’t run physicians ragged. Do your market research! Success in medicine is more than just science. It is art.

4) Humanitarian Trips - Finally, a good humanitarian trip or “medical mission” abroad does wonders for your appreciation of home as well as for your overall perspective. As a young doctor, my mom worked in Nigeria for three years. The pay was horrible, the country unstable and the heat was often unbearable. But she grew so much. When you give of yourself on this level, you often become a much happier person as a result. If the doom and gloom of American medicine start to mess with your inner balance too much, a solid trip to Haiti might be just what the doctor should have ordered:)

Alright...

You see where I am going with this. We have a long way to go if we are serious about improving the American health care environment. But we can start with being purposeful about creating a more internationally-rounded vision of the medical field. And what better way to do that than to rack up some frequent flyer miles!

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The 90/30 Conundrum: How To Change The World Of Medicine

Guest post by Aaron Schenone

Is it possible to make actionable change in the healthcare industry?

I recently read an article entitled “Rebels at Work: Motivated to Make a Difference” a conversation with Lois Kelly. In her research she refers to the 90/30 conundrum where 90% of respondents agreed activating creative thinking can improve culture and drive innovation, yet only a third of those respondents were satisfied with innovative individuals’, the so called rebels, ability to provide that outcome.

Her research goes further defining these innovative individuals as creative, curious risk takers that aren’t driven by monetary gain, but by the ability to make a difference. They aren’t afraid to call out problems or be the first to do things differently. She also found people are uncomfortable with these individuals who challenge the status quo, circumvent the rules, question organizational leaders, and initiate projects without permission. Too often leaders react by throwing these habitual truants into the trapped box with the label “Rebel” on it.

It’s no surprise that innovative individuals gravitate to the world of entrepreneurship, starting their own organizations where they can create a culture that not only understands their purpose, but more importantly can provide an outlet for their ideas to make a difference in the world. We intuitively know some of these types of individuals such as Steve Jobs, and Richard Branson, but these individuals are in every industry and industry leaders are starting to recognize their value. People like Carmen Medina, former CIA Deputy Director of Intelligence, who supported the creation of a novel and dynamic approach to searchable actionable intelligence through a program affectionately called Intellipedia.

In medicine many of our innovative medical students and residents have had similar frustrations often being misunderstood and thrown into the trapped box with the label “Cowboy” on it. We feel misunderstood, locked out and all too often make an early exit from the very organizations and patients who need our ideas the most. I believe the 90/30 conundrum is a reflection on the challenges innovative people and organizational leaders have had in attempting to build trusting, productive relationships. It’s something that as innovative minded medical students and residents many of us have been battling since we sat in our first years of didactic lectures. We continue to ask whether actionable change is possible in such a large numbers driven industry.

Today, I believe it is possible to make actionable change in the healthcare industry. But to get there we must first gain the trust of our leaders. We must prove we’re not just cowboys without a cause; we’re passionate activists ready to drink H. Pylori to prove there’s a better way.

About: Aaron Schenone Third Year Medical Student in St Louis, studying clinical research in oncology

Medschool + Sharing

Two years ago I sat with my fellow students in the auditorium like newly minted pennies, fresh, enthusiastic, bright eyed and ready to mount up on our journey into the unknown world of medical school matriculation. Our enthusiasm was our armor against what we all felt, the fear of god raining from the sky smiting us out of medical school with the doomed possibility of failure.  We had all heard of at least a story of the mishaps or misfortune of a poor medical soul lost to the abyss. It was a thought we couldn’t entertain, our enthusiasm alone would will us past our insecurities.

The all mighty validation of medical knowledge affectionately called the mean, ruled whether we were on track to medical success.  Below the mean meant a darker sky, less enthusiasm, more pessimism. By the end of first year we were so good at reading each other, we could split the class in half by disposition alone.

While reflecting on first year, I took the the time to explore medicine outside the semi lit lecture hall. I read case files, sat in on tumor boards, attended grand rounds and visited patients. I saw the lives of residents and innovative leaders share their latest medical research. I saw a collaborative world where patients were put before board scores, publications, edging out peers and politics. They were candid about limitations and honest about missteps in treatment plans. I couldn’t help, but wonder if there was something intangible in medical practice that we all shared that went beyond valid assessment by neatly organized test scores.

Returning to second year the stakes were higher, the work load larger and of course our time more limited. We weren’t shiny matriculated pennies anymore, but our armor was still intact. After all we had survived first year, we could do anything. But as second year took hold, fatigue crept in and boards loomed, our armor began to crack. Enthusiasm wasn’t sustaining us anymore. We became more candid and open about missteps and limitations. We started to share study guides more openly, and compensate for each other’s missteps to save our friendly simulated patients. As our armor continued to break down we had only one thing left in our arsenal, we shared our gifts.

About: Aaron Schenone Third Year Medical Student in St Louis, studying clinical research in oncology.

Endurance Training During Medical Training

9 tips for any medical student thinking about doing a marathon, triathlon, or even Tough Mudder?

A guest post by Brad Harris, a Medical Student and Ultramarathoner currently attending Loma Linda University School of Medicine.

People always ask me how I find time to train for 50 mile races while juggling a full schedule as a medical student? It's not a difficult as it sounds but it does take some work and planning.

Here is what I've learned....

Make it fun.

The most important thing is to incorporate activities you enjoy doing into your workouts. Find something that you just can't wait to get home to do then use that for motivation.  Remember, training doesn't have to be boring. Maybe you have a frozen yogurt craving. Instead of driving, run down to the local FroYo establishment, indulge, and run back home. Just make sure to make it something you look forward to. Enjoying your workouts is a mindset.

Find your pain cave, and crawl inside.

The pain cave is an uncomfortable place to be. It's a mental state that makes you feel fatigued and want to quit. Sometimes medical school pushes you into the pain cave. Find your personal pain cave and get comfortable with feeling uncomfortable. It is through stressing our bodies that we become stronger.

EXPLORE!

Grab a map, be prepared for the conditions, and go see what's around the next corner. Never stop exploring. Where does that trail go that's behind your house? How do you get to the top of that mountain? What's it like to run through the middle of skyscrapers in the big city? During my time in SoCal I've really enjoyed finding new trails in the local mountains, its actually become a hobby of mine. Don't be afraid to wander and explore new places from time to time.

Give each workout a purpose.

I, like most people, get bored simply going out and pounding the pavement for 3 miles every morning in order to check off the exercise box on the to-do list. Build variation into your workouts. Warm up and just run hills one day. Find a running track and do repeats of 2-8 minutes of sprinting with a 2 min recovery after each. Find an elliptical trainer or treadmill at the gym and set it to a random setting while you review notes or flash cards. Seek out new workouts to push yourself and keep it exciting.

Add minutes or even hours to your day.

Wasting time on the internet is something that we all do. By limiting time on the internet with a program like StayFocused, you'll be surprised how much more free time you have for exercising. Plan out your internet usage before getting on your computer and set a time for each task. You will be surprised what you can accomplish with an extra 30 minutes in a day?

Listen to review sessions while exercising.

A few of my classmates would audio record every lecture during the first two years of med school. I know some med schools do it for each class, either way, this is a great way to maximise study time.  Goljan audio review was my running companion for most of 2nd year. This is a great way to avoid feeling guilty about exercising when the pressure is building before exams.

Rest.

Lay low every once in a while. Take mental breaks, both from studying and training periodically. I have found that taking one day off a week from studying (I know they may sound like nonsense to some, especially those with gunnorrhea) did wonders for my focus and provided opportunities to maintain sanity and balance during times of stress. The body also needs rest. Don't be afraid of taking time off from exercise to let your body recuperate.

Plan long workouts on the weekends.

If you are looking to run a 10k, half marathon, or marathon - plan your long runs for the weekends or off days when you'll have more time. If you don't plan them, they won't happen! Also, try to make them an adventure, not just a slog. Proper planning and mindset will both make a huge difference.

Exercise after tests.

Maybe you missed some of the gimme questions that everybody else in the class said were easy on your most recent exam. Getting out and exercising after a stressful test is a great way to clear the mind as well as isolate yourself from frantically looking up every question you think you missed. Exercising will allow you to burn off some frustration and rejuvenate your mind to allow for more efficient studying.

Train with friends.

Some of the best conversations come during long training runs. Invest time forging bonds with new friends and reconnecting with old ones. They will keep you motivated and push you as well. Also having someone that is counting on you to show up for a run is great for accountability.

Hope these tips help! My endurance training has truly made a big difference in my medical school experience and I believe it will make me a better doctor as well. If you have any other great tips for training leave me a comment and let me know.

The Battlefield Mentality Of Medicine

 The Physician Casualties of Medical Tragedies

A Guest Post by Dike Drummond, a family doctor who specializes in physician burnout prevention and treatment at his website, The Happy MD.

The mother of the dead baby sat in her husband's arms and simply asked "why?" over and over through the Vietnamese interpreter. I had no way to answer the question. I didn't know why. There was nothing to point to. No defect in the child or mother or the actions taken in L&D.

All I could do was say "I am so sorry" ... for your baby, for you ... for everyone involved.

It was a nightmare, losing a baby during childbirth in my family practice residency. It was THE thing each of us dreaded the most. What happened afterwards was even more devastating in the long run. What happened was ... nothing.

It had been a normal evening on call. The family practice residents ran our community hospital. I would end up delivering over 250 babies in my two years here. It was just before midnight, three women in labor, I had just changed out of my clothes into green scrubs and the typical long white jacket.

As I walked past the first labor room on the left I heard an obvious deceleration on the external monitor. HR dropped from 140 to less than 60 for almost a full minute with what looked like a late pattern. The mother was a Hmong woman who did not speak English. This was her third child. No previous problems in childbirth.

She was doing just fine. Dad was standing by the bed in the half light of the labor room. Everything was quiet - that’s how I had heard the deceleration. The night shift had just come on. A calm scene really, except for the yellow light of my nerves jangling from the deceleration.

Exam showed her to be 7 cm dilated, head well applied, normal contraction pattern. The decelerations continued. Protocol called me to rupture the membranes and apply a scalp electrode. I opened the amnion hook, had the nurse stabilize the external monitor puck and apply some fundal pressure. The father held the mother’s hand as they spoke quietly to each other in a language I couldn’t understand.

I ruptured the membranes but only a small amount of clear fluid came out. The heart rate dropped immediately to zero as if it had tipped off the edge of a table and fallen to the floor. 140 - 60 - 20 - nothing. Vaginal exam showed no prolapsed cord, no bleeding or any other abnormality. I was the only doctor in the hospital. The OB attending was 15 minutes away. This baby needed to be out right now.

With much shouting to push, my fingers completing the dilation of the cervix and good cooperation from the mom ... we had the baby out within three contractions.

No nuchal cord, no abruption, no blood anywhere ... the child was normal ... except it had been without a heartbeat for almost 5 minutes at this point. Full resuscitation. Epi down the tube. Chest compressions. Nothing. [Heart breaking. Are we getting anywhere? I do not want to call the code and give up.] Suddenly, five minutes of chest compressions and two doses of Epi in ... we have a heartbeat at 160. [Hallelujah] Stop the chest compressions. Let's tape the tube and call the NICU in the big city down south.

As the nurse and I begin to breathe again ... I feel a gentle tap on my shoulder. The father is standing next to me and points at my left hand. I notice that this whole time - as I stabilize the ET tube and the child’s head - the tip of my left pinky has been touching the baby's open eye. I thank the father, change my grip and close the upper lid. I begin to realize this heartbreak of the last 20 minutes is only the beginning.

We got the call three days later. The child showed no signs of brain activity and the ventilator had been turned off. I released the breath I had been holding since that night in this moment of final recognition. The baby was dead. That is NOT supposed to happen to anyone ... ever. Not to the baby, not to the family and not to any Resident.

The director of the residency program and the OB staff held a case review. No "fault" was found. Procedure had been followed. The baby's post mortem was normal. All actions were deemed "appropriate". I was not to blame. That was very little consolation. The baby was dead. My mind ran over and over the events like a gerbil on a wheel.

A little piece of me died that day. Deliveries were never the same joyful wonder they had been before ... they were bullets to be dodged. For years and another 300 deliveries I would occasionally be jolted awake at night by a vision of an amnion hook with a trigger on it.

In the days and weeks afterwards ... it gradually dawned on me that something I had always taken for granted ... was NOT happening. We were a small residency ... only 8 of us running our community hospital. It felt like a family. I had always assumed any tragedy would be met by a rallying around the unfortunate resident.

Here was our collective worst nightmare ... and ... nothing happened. Nothing except the case review and my meeting with the family - both agonizing experiences where I was by myself. I felt tainted, like a failure, an outcast in the wilderness.

I don't blame anyone. I am certain the first reaction among my colleagues was ... "OMG it happened". Followed by, "thank GOD it didn't happen to ME."

It’s the same thought process as a soldier in battle when his best friend goes down as they storm the beach. I don’t know if I would have thought the same things if it had happened to another resident. I don’t know if that fear would have stopped me from reaching out to them. Here’s what I do know...

Most of the physicians I have worked with have their own version of this story; something bad that happened followed by complete isolation. It has hurt us all. Let’s vow to end this compounding of the natural tragedies that occur in our profession. Losing a baby is bad enough. Coming away from the experience feeling that no one really cares and we are all on our own in the end ... is a wound on a wound. This does not have to continue. We do not have to let our own fear stop us from supporting our colleagues in their hour of greatest need.

If you are still reading this article, I want you to know something with crystal clarity. Your Physician Colleague who suffers a bad outcome wants you to come and talk with them. Sit and have coffee, put a hand on their shoulder. Make them a “hot dish” so they don’t have to cook for a couple days. (I am from the upper Midwest ... that’s just what we do) Do it again and again until they say, "enough already".

There are some stories even our significant other and parents can never understand ... only another doctor can fathom the feelings. The next time tragedy strikes in your medical community, reach out to your sisters and brothers. PLEASE don't run from them because of your own discomfort. They are not contagious, nothing is going to rub off on you.

Don't let the natural "battlefield mentality" win out. Notice it and act in spite of it. It will make a huge difference to your friend. I promise.

This is the time when you can step up and pay it forward. Just be there ... when it counts the most. You never know when you will desperately want them to do the same.

-Dike Drummon M.D. The Happy MD