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When Thanksgiving Isn’t So Happy: 6 Thoughts To Help

Thanksgiving is probably my favorite holiday. Christmas is great, but the commercialization of it has largely spoiled it. Thanksgiving seems to be the one holiday that has remained as it was when I was young: A time to be with family and friends, and a time to reflect on the good things in life.

Yet I know for a lot of my patients and readers, finding feelings of thankfulness is difficult or impossible. I see pain and loss that is hard to understand. Thanksgiving is looked at by most as a time to thank God for the good in life, but to those who suffer, God seems to have it out for them, or to be ignoring them completely. To many, Thanksgiving is a sad reminder of happier times.

A boy in my childrens’ school died suddenly last week of an anemia caused by his body attacking his red blood cells. It came suddenly and it happened swiftly. One day he was a normal 14-year-old kid, and a week later he was dead.

I have friends who are going through divorces, who have lost close family members, or who are dealing with inner demons that make celebration very difficult. Some patients have physical pain so bad that they can’t even sleep, while others have only a few months to live.

Happy Thanksgiving?

So how do we deal with this reality? How do we look at the our lives in light of those around us? Should we feel guilty for our blessings? Should we ignore those in pain?

Those are hard questions with different answers for different people. But one thing I do know is that we should not ignore reality. We can’t pretend life is a sitcom that will work out in the end. That does an injustice to the pain of those suffering — perhaps more of an injustice than the pain itself.

Here are some of my personal observations regarding these questions. They are in no way the complete answer (I am sure readers will add their wisdom to this), but it’s helpful for me to put them down. I hope it helps some of you.

1.  I am most thankful for my giving. The fact that I have been able to make a mark in people’s lives, to help them in their hard times, to be the person they needed when life was falling apart, is an incredible honor. Any thing we possess can be taken from us, but what we have done for others is ours forever. The simple fact that I can help people in their suffering lets me be thankful for what I have.

2.  It’s a mistake to “look at others less fortunate and be thankful for what you have.” This is the advice often given as a way we are blessed when helping others. It doesn’t work that way. Seeing others’ pain is a reminder that we live by grace, that life is a gift that we may not have next year, next week, or tomorrow. One piece of advice I give to people who are struggling with self-worth issues and depression is that they find people to help. It’s not to see their own blessings in contrast, it is to be a blessing.

3.  The less tightly I hold onto things, the more thankful I am for them. If I see something as a right, I am offended at not having it. If I see something as a gift, I don’t focus on the not having, but the having.

4.  I shouldn’t feel guilty for what I have. It’s not wrong to have things and to enjoy things, but it’s dangerous to think I deserve them. If I have good things because I deserve them, then the reverse is true as well: When I have bad things or lose good ones, it is because I am undeserving. Observing people’s suffering, I can say that it isn’t doled out on the basis of how good people are. That’s one of the reasons I like Thanksgiving so much – it pushes us away from entitlement, and toward gratitude.

5.  Don’t judge others on how they feel. One of the biggest mistakes people make around those who suffer is to try to “make them feel better.” This presumes either that they are mistaken in their pain and you can make it better by explaining, or that you have power that they don’t over their pain. Most of the time people “cheer up” others, they do it because the other’s pain makes them uncomfortable. They do it for themselves. Don’t tell people how to feel. Listen to how they feel.

6.  Things change. People who are in struggles at the present time may be great in a month, week, or year. People who are doing great may be struggling a year from now. I try not to think of this as being fair or unfair – it just is what it means to be a human. Living too much in the past or future will mess you up (whether things are good or bad for you now). You are you, and the you you are is the one that is here now. I know that’s easier said than done (near impossible in many cases), but it’s still worth reminding ourselves of that fact.

That’s it for today’s sermon. Sorry if this sounded like Jack Handey or a Hallmark Hall of Fame show. I have to let this side of me out of the cage every once in awhile.

Happy Thanksgiving, everyone!

*This blog post was originally published at Musings of a Distractible Mind*


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

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