Friday, March 26, 2021

A Knock at the Door



 “There will be a knock at the door,” says Rene, an El Salvadoran Pastor and my close friend, “and they will say, ‘Give us your daughter or we will kill you and your family’.” He continues, “Gangs control many of the villages. They are in the schools; they are in this school! If the leader sees a girl that he likes, no matter her age, he sends members of his gang to her home and demand the girl be given to them to be used as the leader decides. If the parents refuse, the gang members keep their word and take the girl anyway. When a boy reaches the age of 10, if he does not join a gang, he may be killed. This is one reason why many of the children arriving at the US borders are alone, without parents, or a significant other. Their parents had to make a decision; a decision of life or death; a last resort, gut- wrenching decision; yet the decision becomes all too clear. It is safer for their children to make this most perilous journey than to remain in their own home.”

 I listen in disbelief as I sit on the crumbling concrete steps of the village school where our medical clinic is temporarily located for the week. The village is located on the side of an inactive, waterless volcano where large cisterns dot the mountain side collecting precious rain water for the people’s every day needs. This is my 12th year leading medical teams to a country and people I have come to love deeply. It has become my “segunda casa”, my second home, yet, somehow, I have not heard this story that is the reality for many in El Salvador. It is a beautiful country of volcanic mountains and rock - strewn beaches. Its beauty in stark contrast to the ever-present violence and intimidation of the gangs. Even the capital, San Salvador, cannot escape this dark reality. Mara Salvatrucha, MS 13, are names that illicit fear in every El Salvadoran; most of all the fear of a knock at the door.

 Often, “Coyotes” will take these children, and others willing to sacrifice everything for a chance at a life offering a glimmer of hope, on this most hazardous trek where illness, injury, and death are ever present. They are soul-less mercenaries who feed on and live off this agonal reality at a precious cost to these desperate families – of money, fractured families, and even death. To live without hope is not to live, it is simply to exist. So, the decision is made and the children are sent. Hope of a better life for them and their loved ones left behind a powerful driving force.

 In the villages, lacking many of the modern luxuries of the larger towns and cities, little is known about the news of the world. For them, life is a daily struggle of survival. They know not of the “immigration problem” that is often front- page news in the US. They are oblivious to the polarizing issue, with all its ugly faces, that it has become in our country. They only know what they have always heard, that America stands for freedom, opportunity, and most of all hope. They want that for themselves but especially for their children. So, this heart-wrenching story is repeated over and over again and the tears fall, hearts break, and families separated.

 Many in the U.S. ask the question, “Why?” Why would parents send their children on a potential death march? How could they ever do that? How could they be so heartless, unloving, irresponsible? Did they not care for their children, love their children? “I would never do that”, we all easily say without hesitation. But, in those same circumstances, would we? Fortunately, we do not live such a cruel reality.

 My heart aches and eyes glisten. There are children at the school now that we will see in the clinic who live in this “Twilight Zone” of reality. I feel helpless. As a physician, I seek to comfort, treat, and heal. As a father, I do everything I can to love and protect my children. The people of El Salvador seek to do the same for those they love, no matter the cost, no matter the sacrifice. May we not forget this. I never will.

 Andy Lamb, MD





Sunday, February 14, 2021

"Fire Pit Time"



The flames flicker, tantalizingly reaching upward, and I sit mesmerized. How many times have I sat by my back yard fire pit and watched this ageless dance? I think, I meditate, I pray; a cigar and bourbon often accompany me. I especially love to stand by it while the snow falls enveloping me in all its beauty. The memories are many; and they are good.

My sons are with me around the pit. I cherish these times. I try to remember every moment for I know they are numbered, the passage of time unrelenting. Our conversations varied, often deep, always important. I learned their hearts and better yet, they mine. I am happy and so very proud.

I am with friends, my "Band of Brothers", fellow physicians with whom I have served through the years. With cigar and bourbon in hand, we, too, talk about "anything and everything", sometimes medical, most often not. I sit in awe of them as I ponder the lives they have touched, and more, the difference they have made. We are growing old together. It is good to have such friends. I love them as my own brothers. 

I sit surrounded by young faces; the heart of the medical staff; those who are coming behind me; their "yet to come" of the future still greater than their "already been" of the past. They are my passion, the real reason I have remained in medicine for as long as I have. I want to invest in, teach, encourage, and mentor them any way I can. They are the future leaders of medicine - the visionaries, the decision-makers, the catalyst behind the inevitable changes that must come if we are to provide the best for those entrusting their care, often their lives, to us. They want someone to mentor them. It is an often unspoken request conveyed through a language unique to each of them. I have learned to "hear" the subtleties of this language through my years of leading medical missions and teaching  medical students, PA's, and NP's. I want to be there for them so I make my self available. I do so around the fire pit as often as possible. We share food, drink, and life-giving conversation. Relationships are made and strengthened between different specialties and trust created. Only trust can bond them together so they can be the unified, cohesive, and effective team required to lead us forward. "Fire pit time" brings them  together and that brings me joy.

Medicine demands much from us and we need much in return. We all need our own "fire pit time", however that may look. I hope you will find yours.

Andy Lamb, MD

Friday, January 22, 2021

Getting Personal

I recently spoke at a local Leadership Forum on Opioid Abuse. I was asked to speak to the role of hospital systems in addressing this important issue. As I thought on what I would say, I realized there was very little I could add. The crisis is epidemic and hospitals are ill-prepared to do anything proactive. It is that overwhelming. Leading medical missions, I learned an important lesson that has given me a different perspective on this. The needs of the world are overwhelming as well. These needs, though, do not become real to us until they become personal – you live it, breathe it, taste it, smell it, touch it. In 2009, the opioid crisis became personal to me, it became real.


As a physician leader, I have sought to be transparent. Transparency is critical to establishing a culture that is safe and caring. Others can then feel safe to be the same themselves. In a culture characterized by openness and transparency, great things can happen! My “Bugle Notes” through the years hopefully have reflected this transparency to you.


I decided, after much thought and prayer, to be very transparent with you. Doing so leaves me feeling exposed and vulnerable but I choose to do it anyway. My hope is that through my story this crisis will become more personal to you and thus more real. This is my story of how close I came to going down that perilous path that is opioid addiction (or any addiction for that matter). I was fortunate that I stopped before I went too far down that path. Unfortunately, too many are unable to stop and continue the downward spiral toward that deep, dark pit called despair and its brother hopelessness. If this could happen to me, it could happen to anyone. If my story prevents even one of you from experiencing this, then the trepidation I feel sharing this will be worth it.


It began after my first back surgery in 2009 for an acutely herniated disc while leading a medical mission to Moldova in Eastern Europe. It was the worse pain I had ever experienced. My right leg was weak and numb. I had to be carried into my host home and put to bed – no running water, primitive outhouse, hit or miss electricity. It was not a good situation. I placed myself on prednisone hoping it would help but the following morning I was no better, in fact, worse.  As the team leader, I realized I would have to be urgently evacuated to the U.S. However a “miracle” occurred that allowed me to regain neurologic function temporarily and I was able to finish the mission. That “miracle” may need to be the topic of another “Bugle Notes”!


Two days after returning home, I went to surgery. The surgery was a complete success. I was discharged on Oxycontin with a refill, which was common practice at that time. It did help the post-op pain and I was surprised how good it made me feel overall. It had a calming effect as well. Prior to the mission trip, there had been a lot of stress at home, my practice, and the hospital. I began looking forward to taking it. Since I was still on medical leave, there was no concern with it affecting my patient care. I would be at home enjoying the feeling. I rationalized that there was nothing wrong with that and, besides, I could stop anytime I wanted.  Little did I realize the dangerous path I was choosing.


I found myself counting the remaining tablets each day. I started to dread when they would run out. I was embarrassed to call the neurosurgeon for another refill and have him think I was an addict or drug seeker! After all, that could never happen to me! Then reality set in. I used the last pill and within 24 hours I began having withdrawal symptoms- restlessness, abdominal cramping, diarrhea. Though relatively mild, it frightened me. I never imagined I could become physically and mentally dependent. I thought this only happened to people who were “weak” or lacked “self-discipline”. I was wrong.


It was a surreal experience in addition to being scary and humbling. Surreal because I never thought this could happen to me, humbling because it exposed my vulnerability. It gave me a new perspective on those who struggle with addiction of any type. If it could happen to me, it could happen to anyone! No one is immune.


The reality is that many of our colleagues are at risk if they are not already on a downward spiral. The pressures of medicine can cause anyone to seek an escape mechanism and substance abuse of any type is an easy way to go. I care for you and do not want any of you to fall into this seductive trap. The consequences are devastating. So, I share my story, not knowing how you will respond to it, whether it will change your view of me, or even question my fitness to be a leader. My fervent desire is that it will make this crisis more personal and thus more real to you. Only then can you better know the enemy you face and how best to defeat it.


Andy Lamb, MD

Wednesday, January 6, 2021

A Matter of Honor


A few years ago, I went to my 40th West Point class reunion. I had a wonderful time especially renewing friendships with those with whom I lived, studied, and trained during those four arduous years. We truly were “a band of brothers”. 44 years later my time at West Point continues to significantly define who I am today.


While at the reunion, I was interviewed by West Point’s Center for Oral History as a result of my experiences while a cadet, in particular during the Honor Scandal of 1976. At the time, it was a huge event receiving national attention and threatening to destroy the very foundation that makes West Point great - it’s Honor Code. Though innocent, I was caught in the middle of it. I found myself in a battle to prove my innocence and defend my honor. Instead of being innocent until proven guilty, I was guilty until proven innocent. It was a terrible, transformative time.


The honor scandal involved an electrical engineering exam that my entire class took just before Spring Break my Junior year. This was a take-home test, yet, as was true with any work at West Point, you were honor bound to not ask for or received any help from anyone, no matter how minor. If you did, you were required to footnote the help you received and your grade was reduced accordingly. Many of my classmates, for reasons known only to them, chose to help each other and not footnote that help. Thus, they had violated the code. An investigation of epic proportions ensued.


In the months that followed, I and others under investigation, were moved to barracks separate from the rest of the Corps of Cadets; relieved of leadership responsibilities within the Corps for the summer; assigned a lawyer; and given a trial date. The first time I met my lawyer he told me I had a 20% chance of being found innocent! I was shocked to my core. I responded, “Sir, you’re telling me, someone who is completely innocent, that I have only a 20% chance of being found innocent?” He reminded me that up to that time, scores of my classmates had gone before the Honor Committee and all had been found guilty and dismissed. It was the lowest, darkest time of my life. To be accused of something you did not do is one the worst things that can happen to a person.


My lawyer came to believe in my innocence and so began a many - months fight to prove it. I won this battle, but at great emotional cost. I was extremely embittered toward West Point and all it represented. It was an institution that prided itself on over 200 years of unparalleled education, military, leadership, and character training. Yet I, and many other innocent classmates, were caught up in an investigation that became a witch hunt. Eventually, hundreds of us were investigated and over 150 found guilty and dismissed. It left a chasm within my class that to this day has not completely healed.


The day I graduated was bittersweet for me. I was happy beyond words to have survived the blood, sweat, and tears of my four years there. But I was also extremely bitter toward West Point. When I drove my car through Thayer gate into “freedom”, I intentionally flipped my rearview mirror up so I would not see a trace of it. I was so angry I refused to wear my class ring for years. I was not convinced that what I had been through had been worth it. Eventually, with time, bad memories begin to fade and my anger softened. With my acceptance to medical school, I realized the critical role West Point played in opening that door for me. I came to understand that all the pain and sacrifice had been worth it.


 I am a better person for having gone through that most difficult time. As a result, I have a strong sense of justice and a resolve to be a man of honor and integrity, living up to the West Point motto “Duty, Honor, Country”. As a leader, I continually seek to create a culture of respect that allows people to do what they  do best, better, and to reach their fullest potential!


Andy Lamb, MD

Tuesday, June 9, 2020

"Bugle Notes" - A Cry From My Heart - A Letter to a Journalist

Dear Sir,

I am not sure why I feel so compelled to write you. You probably will not even see this email but I still must do so. I am a 56 year - old Christian white male physician living in NC. I am a graduate of the United States Military academy at West Point and the University of Alabama School of Medicine. I was raised an "Army Brat" as my father was a career Infantry officer who served two combat tours in Vietnam. I am a veteran of the First Gulf War as well.

 I come from a conservative and deeply southern background. My mother's family was originally from the mountains of North Georgia and my father's family was from rural Mississippi. My ancestors fought for the Confederacy. I was raised by a loving and caring family but one very much part of the prejudices of the times, thus, I spent my earliest years exposed to an environment of racism. I am a product of the Jim Crow era.

I have read your column in the local newspaper for many years and, to be honest, I either cursed you for what you wrote or cried as I recognized the truth of your words. Many times, I did not want to read your articles because I knew they would only make me mad but I did. Why? Because your words pierce my heart as if they were a scapel surgically cutting out the residual hatred, racism, and prejudice that still laid deep within. So, I continue to read you and I read you, again, yesterday, and I knew I needed to write because.... I don't know how to put it, I just NEEDED to write you.

 Thank you for your honesty, as brutal and as hard as it is at times. Often, I want to throw the paper away after I read your articles but I do not because you make me think, you make me feel, you even make me cry as I better comprehend the hate, evil and, injustice of racism still present in this country, a country I  love and, once upon a time, swore to defend and would do so gladly even now. I wish I could say that the racism of the past was gone but I cannot. Are things better than during those terrible times of the Jim Crow era? I believe they are but are they where they should be, ought to be, must be? The answer is obvious and Dr. Martin Luther King’s dream remains distant.                

 Two experiences in my life changed me as a person. After spending many years in the Deep South, where most Infantry posts are located, my father was assigned to the Presidio of San Francisco in the summer of 1969. I was not yet 14 and for the first time in my life I came face to face with the realness of my own prejudices. Joey Robinson came into my life. He was one of the most popular kids in high school, a star athlete, and he was black. Despite the fact that I was a tall, skinny, shy, dorky-looking kid with glasses, big ears, and a thick Southern accent, Joey accepted me for who I was. We became close friends and, through him and other black classmates, I came to understand how wrong were the beliefs about ‘’colored people” that I had already learned in my then short life time.

 I will never forget the last time I saw Joey. It was the summer of 1972. I was moving the next day to Alabama as my father was given a new assignment. Joey and I went to a San Francisco Giants/Atlanta Braves baseball game. After the game we returned to my home and said goodbye. I never saw Joey again, though to this day I miss him. What I remember most about that day, though, was not the game but my mother saying goodbye to Joey. Joey had become part of our family. My mother hugged and kissed Joey as she tearfully said goodbye. After Joey left, my father looked at my mother and said, "I never thought I would see the day that you would kiss a black man." To her, to all of us, Joey was neither black nor white, he was "us" - he was me, I was him. (Where are you Joey Robinson?)

Months later, I am in my Senior year in high school - quite a culture shock going from California to Alabama! I am on the high school football team. The school is well integrated and relations between blacks and whites are good considering it is ALABAMA in 1972! The presence of a nearby Army post helped as black students from military families are very much the norm. Our team captain is an amazing young guy with the appropriate name of Speedy. He was our star half back, the Junior class President, and he was African- American. Everyone loved Speedy! Not only was he an amazing person, he was an excellent student, a true leader, and a friend to everyone.

 Early in the season, we were scheduled to play a team from a part of northern Alabama known for its racism and continued presence of the KKK at that time. The week of the game, my high school and the football team began receiving hate mail from the town where we were to play. The mail, as you would expect, spewed death threats and racial epitaphs - we were not to bring our “n…..” with us. Speedy, in particular, was targeted. We went anyway.

 It was early in the third quarter, we were winning, and Speedy was having a great game when it happened. Speedy runs a sweep to the right gaining 20 hard earned yards. He is knocked out of bounds within 10 yards of me (I played defense so I was on the sideline) and as he rolled on his back, well out of bounds, the played called dead by the referee, an opposing player comes running full speed, dives and spears Speedy with his helmet, head to head, helmet to helmet. It was a clearly late, intentional hit. Speedy laid motionless. He was taken by ambulance to the nearest hospital where we learned late that night he died from a massive brain injury and bleed! The next day at practice, we all gathered as the coaches played and replayed the film of the hit that killed Speedy! We all mourned his death. We were all forever changed by it.

 I share this because I am tired of the racism, covert and overt, that remains embedded in our culture and, yes, in our hearts. It will not disappear quickly. It will take the passing of those raised in such a way and the raising and education of the "next generation". I now recognize that my anger is not toward you. You make me think, you make me question, you make me look deep into my heart and, when I do, I see the racism that still exist. I am angry, but not at you, rather at myself, and it hurts, and I cry. I will continue to read you and, as I do, I pray God will continue to transform me into a person who simply desires to love God and others.


Andy Lamb

Author's Note: I wrote this in 2012 to Mr. Leonard Pitts, the Pulitzer Prize winning journalist with the Miami Herald, in response to one of his commentaries in the local paper.

Tuesday, May 26, 2020

"Bugle Notes" - The Bugler's Last Note


It will happen to all of us, some sooner than others. Sometimes it comes as a well-wrapped package, years in the making with celebration, affirmation, and anticipation. Other times, though, it’s not so well wrapped. Sometimes, it is unexpected, disheveled, leaving you confused, unsure, sad, hurt, angry a cauldron of emotions. It may be 30 years or more in coming but it will come, like the light at the end of that proverbial tunnel; the “not yet” of the future increasingly replaced by the “already been” of the past; the bugler’s last note waiting to be played. It’s the time when you leave the work that has, in many ways, defined who you are, for that “next stage” in life, however it may look. For some, one’s identity as a person is threatened and fear and uncertainty follow. For others, it is an unexplored path that veers off the main road disappearing into a forest, its ultimate destination unknown, a new adventure beckoning.

 As I look back on my life’s journey “to make a difference” in this world, there is an exact time and place at which I can say, “That was the start, the beginning, my reveille, my early morning bugle call.” It was July 2, 1973, the day I entered West Point. I was 17 years old and I knew, at least I thought I knew, what I wanted to do with my life. I was going to be “an Airborne, Ranger infantry officer and lead men in combat”. But God had other plans for me. Medicine was my calling and making a difference in the lives of people my passion. For over 42 years I have dedicated my life to serving both my country and others. All things, though, eventually come to an end. General Douglas MacArthur, in his farewell speech to Congress upon his “retirement” from the Army, eloquently said, “Old soldiers never die, they just slowly fade away”, and so it is with me. I do so, not so much with sadness, though it is there, rather with extreme gratitude that I have been able to do what I love to do most – care for and serve others and teach, encourage, and mentor those who follow me. I do so, standing at the beginning of that unexplored, untraveled path, poised to take that first step, my “next stage” waiting. It’s how it should be; how I want it to be.

It is with sadness, though, that this will be my last “Bugle Notes” to you. Thank you for allowing me to share them with you. I wrote them to encourage you, to support you, and to remind you that what you do is important; what you do makes a difference every day; and what you do it is still a privilege. I hope I succeeded in even a small way.  You are appreciated; you are valued; you are loved.

Andy Lamb, MD

Author's comment: This is the last "Bugle Notes" I wrote to the medical staff of the hospital system where I was the Vice President of Medical Affairs. Over a little more than 5 year period I wrote close to 100. I chose for this blog page the one's I felt best sent the message I wanted to convey and would be applicable to any health  care provider no matter where they were. I will continue to write my "Bugle Notes" and add them to this page. I hope you will continue to check back periodically for my latest! In the meantime, should you so choose, there are plenty "Bugle Notes" here to be read!

If any of these stories have had a special meaning to you in any way, I would love to hear about that! I write from my heart and I hope at least a few of these stories will touch yours.
                                                                                                                             AL May 2020

Monday, May 25, 2020

"Bugle Notes" - Sharing Their Stories

In the book "The Insanity of God", the writer had been an American missionary to Somalia during the late 1980's through early 90's. This was a time when there was no place on earth with greater needs, hardships, suffering, and dying. It truly was "Hell on earth". The missionary and his small team risked their lives with every trip into this most desolate of places where there was no order, no laws except those established by the two warring classes. It was a world of total chaos in which people - men, women, and children -were starving to death by the thousands or killed in the terrible war surrounding them.

This missionary had been increasingly frustrated with their inability to truly help these people in a meaningful way. He wrote, "The people I wanted to help were living in such horrible conditions that my natural response was to focus only on what they lacked." His typical encounter with people would sound something like this: "Do you need food? We have food. Is your baby sick? We have medicine. Do your children need clothes? We have clothes for them".

He goes on to write that eventually he realized those were not the most important questions. When he took the time to really listen to them, the people themselves told them what they needed most. He wrote, "One day, I said to a bent-over, shriveled-up woman, 'Tell me what you need most? What can I do for you first?' She looked ancient, but she may have only been in her forties. She began to share the following with me:

"I grew up in a village many days from here. My father was a nomad who sold camels and sheep. I married a camel herder who did the same things. He was a good man; together we had a good life and four children. The war came and the militia marched through our village, stealing or slaughtering most of our animals. When my husband tried to stop them from taking our last camel, they beat him, and they put a gun to his head (and tears began to trickle down her cheeks). I worked hard to care for my children but the drought came and despite everything I tried to do it wasn't enough. My oldest boy got sick and died. When the last of our food was almost gone, my children and I began walking. I hoped that life would be better here in the city. But it is not, it is harder. Men with guns everywhere. They raped and beat me. They took my older daughter. I only have the little one left."

This woman, as did countless others, desperately needed more than the help that this missionary team was prepared to give. The writer came to understand that what these people wanted even more was for someone, anyone, even a stranger, to sit for a while and let them share their stories. This is the power of human presence! It is never enough to merely feed, shelter, and medically treat people. Individuals who have witnessed profound evil, endured terrible hardships, and suffered heartbreak and loss, have also lost all sense of their own humanity.

He continued, "By listening to their stories, we are saying to them that they mattered. We are saying that they were important enough to be heard. Just by listening, we could restore a measure of humanity. Often that felt more important and more transforming than one more dose of life-saving medicine or another days' worth of physical nourishment."

 We are fortunate that we do not live in such a hellish nightmare. I believe that what this missionary came to understand is equally applicable to each of us. Our patients come to us sick, frightened, at times dying. They feel vulnerable and helpless.They are often totally dependent on others. Their life has become chaos. They, too, can feel as if their humanity has been loss in the maze of increasing technology and decreasing personal touch that is medicine today.

 Our patients have their own stories, too. They may not be as tragic as the one above but they are nevertheless just as meaningful. Our lives are made up of stories and stories are a powerful way to convey a message, to tell others who you are, what you need, what you fear, and what brings you joy. In the busyness of the day, when it seems that there is not enough time to do one more thing, or when you have done all you know to do, yet nothing has helped, may we take the time to sit down with them and "share their stories". In doing so, we can bring the human side back to medicine. Isn't that why we went into medicine?

Andy Lamb, MD