Tuesday, March 31, 2020

"Bugle Notes" - They Saw It in Color

I rounded recently in the hospital on a 100-year-old veteran of the Battle of the Bulge. It was a terrible and costly battle fought in Belgium during the winter of 1945, the coldest and snowiest in memory at that time. The German army made a desperate last stand against an increasingly overwhelming US force. Hundreds of thousands of lives were lost. He was there. He lived it. It is not a forgotten memory frozen in time in a black and white picture. He saw it in color. He caused me to think back on the other stories I heard from other patients.

He started crying. I immediately apologize, saying he did not have to answer. He regained his composure and said it was okay. He was a veteran of D-day, June 6, 1944, an infantry private with the 9th Infantry Division. He was in the sixth wave that landed on Omaha Beach that fateful and bloodiest of days, a day that changed the course of history. I cannot imagine the carnage he must have seen when he stepped off the landing craft into what could only have been described as hell. I asked him what he remembered most about that day as a 19-year-old just barely out of high school. He said:

 “I remember my best friend from high school was only a few yards from me as we landed. Within seconds he took a direct hit by an artillery shell and was blown to pieces.”

He began to cry again. I asked no further questions.

 He was a door gunner on a B-17 with the 8th Air Force which did the bombing raids over Germany. Two thirds of the planes, with their crew of 20 + men, were shot down during the war. Tens of thousands of American lives were lost. Before you could return home, you had to survive 25 missions. Most did not. His plane was shot down on his next to last mission. Most of the crew parachuted to safety, only to be immediately captured and taken to a farmhouse and lined up against a wall. He was standing next to the pilot, the “old man” of the crew at age 23. A German officer walked up to the pilot, drew his Luger and without saying a word shot the pilot in the head. He then turned and walked away. My patient spent the remaining months of the war at hard labor in southern Germany working in a mine.

He was one of the original Navy “Frogmen”, the predecessors of today’s Navy Seals. He was part of a team whose job it was to swim to the Normandy Beachhead under the cover of night, hours before the D-day invasion was to start. Their mission was to secure closely guarded bridges critical to German resupply and troop transport. It had to be done silently. They used their knives to accomplish this mission.

I write to remind you, as the patient above did me, that this “Greatest Generation” will soon no longer be with us. It will be a sad day when the last one dies. I had the privilege of caring for many. I wanted to hear their stories. I NEEDED to hear their stories before they could no longer be heard. I wonder how many I missed hearing and are now lost forever?

For me, the joy of medicine came from building relationships with my patients so they trusted me enough to share their stories and give me a glimpse into their lives when they were once young, strong, and able. One day, there will only remain the black and white pictures taken long ago. For them, though, they saw it in color. Take the time now, while you can, to hear your patient’s stories.  

Andy Lamb, MD

Monday, March 30, 2020

"Bugle Notes" - Woman by the Elevator

“How long have you been married?” The question came from a young woman kneeling down by the elevator in the hotel where my wife and I were staying while in Seattle. We were there to celebrate our 40th wedding anniversary with an Alaskan cruise. I hadn’t even noticed her as my wife and I were busy talking about the day. She appeared to be in her twenties. Her appearance was that of a person seeking attention (or masking something deeper?) - too much makeup and very provocative clothing. She held a hotel key in her left hand. She was trying almost frantically to shove a pair of jeans and a T-shirt into a small bag. Her purpose for the evening seemed apparent. It was her unsolicited question and the words that followed that surprised my wife and me and came to haunt us.

I answered, “We have been married 40 years and in fact are celebrating our anniversary.” As she continued stuffing the clothes into the bag, she looked up and said, “Just be thankful you aren’t a Millennial.” We were both stunned by this comment and did not know what to say. She then said, “My parents were married for 12 years. Stay married.” She returned to packing her bag without saying another word. The elevator door opened and my wife and I got in but she stayed kneeling intent on finishing the packing. I had the distinct impression she was purposefully delaying an inevitable event.

In the elevator, my wife and I looked at each other, trying to understand what just happened. We considered going back to find her. There had been such sadness in her voice and in her face. Was she involved in human trafficking? Was she a runaway trying to survive the best she could? What was the “story” behind those words? Even now, two weeks later, we think about her, and the words she said, words that were more like that of a sad little girl instead of a young woman. We remain haunted by that brief encounter. We should have done something yet we did not. Why? We both have compassion and concern for others yet we did nothing. What will happen to her? We will never know. We only know we missed an opportunity to help someone who cried out to us for help.

I wonder how many times in the 30 years I practiced medicine I missed the subtle cries for help from my own patients because I was too busy to “hear” them. We live in a hurting world. It is easy to not see the hurt, the pain, and the hopelessness around us because of the busyness of our own lives or maybe even our own personal struggles and pain. My hope is that each of us will hear that cry for help, however subtle it may be, and do something about it. We are in a unique position to truly make a difference in the lives of people in more ways than just medically. We only need to be willing to listen for that cry. Thank you for living a life that makes a difference every day.

Andy Lamb, MD

Sunday, March 29, 2020

"Bugle Notes" - A Silent Epidemic

She reached for my hand, her hands gnarled; the skin fragile, translucent, road mapped by bluish veins; hands that had done much in her 87 years. She looked at me from her hospital bed and with voice trembling, her eyes tearing, spoke words that penetrated my heart- “Can I stay here? Everyone is so kind. I am all alone now. I have no family, no friends left. I have no one to talk to. Please let me stay.”

Her severe COPD was taking a toll on her physically and mentally as the inevitable downward spiral continued. Despite this, she remained fiercely independent, tough, and resilient, so typical of her generation. Her toughness, though, was crumbling, and with it, her strength and will. She gripped my hand tighter, her eyes searching mine, pleading. The loneliness that now defined her life had become unbearable, painful. Its unwelcomed bed-fellows, despair and hopelessness, now resident in her heart, replaced any remaining hope and joy. Without hope she no longer lived life, she only existed, day by day. I reassured her that she would receive all the support and help she needed at home. With that, she asked me to pray for her. I did so and when I finished, she prayed for me – a precious reminder of the sacredness that is the doctor- patient relationship. She gave a nod of resignation, released my hand and, looked away. I placed the order to discharge her.

Her loneliness had become personal to me and in doing so, it became real. How many times had I missed the silent cries of others; cries from the depths of their loneliness and isolation; cries for acknowledgment, affirmation, for someone to hear “their story” and in doing so validate who they were as human beings? How many patients had needed more than physical healing? How many simply needed the warmth of love given through a human touch or words spoken with kindness and empathy?

Loneliness is a silent epidemic crying out to be heard. More patients to be seen, beds to free up, documentation to do, clicks on the EMR to make, families to talk to, the list goes on, all smothering the cry. We build walls, wear masks, and put on blinders to protect ourselves from the pain, suffering, and heartbreak inherent to medicine. In doing so, we can lose sight of the person in front of us, the humanness of that person. Relationships are an intimate human need, the absence of which creates an internal void needing to be filled. Loneliness, with its despair and hopelessness, waits to do that.

May we recognize the loneliness that envelopes so many. Even if words are not spoken, the message is still being sent – notice me, see me; I am alone, and I need that warmth of love….

Andy Lamb, MD

Saturday, March 28, 2020

"Bugle Notes" - "The Best of Their Generation"

 In the Ken Burns’ epic documentary on the Vietnam war, one statement by a veteran caused me to pause and think. The veteran said, “Those that fought in World War II have been called the ‘Greatest Generation’. I believe every war brings out “the best of their generation”. I realized he was right. The best of each generation has always responded in one way or another to the call of their country. They and their families did so at great personal costs and sacrifice.

Hearing those words made me think of all of you. Why? For similar reasons. At great personal costs and sacrifice, each of you have trained and prepared for your own “war” as you battle every day for those who have entrusted their care, often their lives, to you. Whether you trained 30 or more years ago, as I did, or just finished, you represent “the best of their generation”. Every year medicine is getting harder and the demands greater. Patients are older, sicker, and more complicated. Yet medically and technologically there is far more we can do for them. Unrealistic patient and family expectations, the rising costs of health care, the increasing administrative burdens, especially the EMR, and continuing loss of autonomy have created an environment that is arguably the most challenging ever for a physician.

I write this “Bugle Note” to acknowledge that you are the best of your generation. I am humbled and honored to serve you and, in many cases, to have worked alongside you in the care of our patients. Thank you for your sacrifice and the sacrifice of your families. Thank you for your willingness to answer the call to care for those in need. Finally, thank you always striving to provide the best care possible to our patients and our community.


Andy Lamb, MD

Post script – I wrote this “Bugle Notes” in 2017. We are now in a war against a terrible, invisible foe, COVID-19. “The best of their generation” are at the front lines fighting right now. We all owe them a tremendous depth of gratitude as they sacrifice much for us all.

Friday, March 27, 2020

"Bugle Notes" - The Question

“Will I ever get better, Andrew?” my mother asked. She laid in bed, too weak to sit up, unable to eat, her myelofibrosis in the final stages of its relentless course. Her question stunned me – did she not know she was dying? How could she not? Was she in complete denial? Was she simply grasping for a final chance at hope when all seemed hopeless? Reality quickly set in, she did not know or at least fully comprehend, that she was dying, this despite the countless doctor’s visits, multiple hospitalizations, surgeries, failed treatments, and unrelenting blood transfusions.

The answer was all too simple to me, poor communication. Throughout the nearly year - long course of her aggressive disease, her Hematologist had not taken the time to speak truth to her nor to the rest of my family. She was “too busy” to return calls or take the time in her office to address their growing concerns and fears. With each hospitalization and failed treatment, increasing frustration and anger grew.

 I became my mother’s doctor in the sense that my family sought me for unanswered questions and decisions that needed to be made. I was no longer her son which was all I wanted to be. I did not want to be her doctor. I only wanted to be her son and love her through this. But the questions came, the decisions had to be made, and my family had to be helped. It was a terrible time and it only became worse.

 I began weekly trips to Alabama, leaving Friday at noon and returning late Sunday, a 7 ½ hour drive each way, so I could see her, support my family, and address the issues that inevitably came up. This went on for 6 months, missing only those weekends I was on call. My full time private practice continued as did the hospital calls (before we had Hospitalists). In addition, I was President of Kernodle Clinic and I had a rebellious teenager. It had become worse.

Then one weekend, as I sat on the edge of her bed, she asked the question. With a quivering voice and tearing eyes, I told her the truth, “No Mama, you won’t get better.” I could not bring myself to tell her she would most likely die in a few days. She looked at me, rolled on her side, closed her eyes and said her final words to me, “I love you, Andrew.”

I was angry. Angry that I had to speak those words to her. Angry that I could not be just her son.  Angry at that poor excuse of a physician who couldn’t take the time to speak words of truth, support, and comfort to my mother and family. I went upstairs to my room, closed the door and cried. I cried in anger, in frustration, in grief, and for the lost opportunity to simply be her son. My sister came up, we held each other, and I cried more. My mother died 2 days later. She was 66.

 Have you had to assume the role of physician within your family? If so, are we surprised? Our families love us, they trust us, and we understand the language of medicine. The physician side of us wants to help, wants to make things better, and wants to prevent suffering. Being a physician is hard enough without having to take on this heavy responsibility. There comes a time, when a health crisis hits our family, we should be able to be the son, the daughter, the husband, the wife, the mother, the father, not the physician. My mother needed her son, her little boy, not her son the doctor. I should have drawn a line in the sand but I did not. If and when your turn comes, draw that line, make that boundary, and don’t cross it.

I grieve the missed opportunity to have simply loved her as a son in her final days. I tried to do that but circumstances prevented it. Don’t let that happen to you. And don’t become that physician who sees medicine only as a job instead of a calling; a profession where compassion, caring, and relationships make a difference in the lives of patients and their families. My mother deserved such a physician.

Andy Lamb

Thursday, March 26, 2020

"Bugle Notes" - When All Else Fails

 During my 30 years in medicine, and especially as I began leading medical missions in 2005 to the poorest countries in the world, I have seen much need, tragedy, and heartbreak. It is overwhelming. Despite our best efforts medically to help, we fail. What do you do when all else fails? What do you do when someone has lost all hope and you feel you have nothing else to offer?

In his book “Unspeakable: Facing Up to the Challenge of Evil” noted author and speaker Os Guinness relates a powerfully moving story of incredible faith in the face of unimaginable horror. He tells of Baroness Caroline Cox who is known as the “Mother Teresa of the war-torn poor”. She is to many of the world’s helpless, “love in action” in human form and a powerful voice on behalf of the forgotten. Regardless of the color, creed, or race of the victims of war – those who have been maimed and raped, their families robbed, killed, or taken into slavery – she reaches out with food, clothes, and medicine. Often when she arrives, the people greet her with the words: “Thank God you’ve come. We thought the world had forgotten us”.

She was once asked to relate both her worst moments and her best during all her journeys of mercy. The worst? She thought for a moment, then described with brutal simplicity what it was like to enter a Dinka village after Sudanese government-backed soldiers had left:

         “The stench of death was overpowering. More than a hundred corpses lay where they had been savagely butchered. Men, women, children, even cattle, had been cut down or herded into captivity to be carried north as slaves. Straw huts were ablaze, crops had been razed, and devastation and death confronted the eyes everywhere. Worst of all was the knowledge that the militia would return with their gunships and Kalashnikov rifles, and the area’s villages would once again lie naked before the ferocity and bloodlust of their attackers from the North. Genocide is an overworked word and one I never use without meaning it. But I mean it.
          And the best moment? It came right after the worst. With the raiders gone and the results of their cruelty all around, the few women still alive – husbands slain, children kidnapped into slavery, homes ruined and they themselves brutally raped – were pulling themselves together. Their first instinctive act was to make tiny crosses out of sticks lying on the ground and to push them into the earth. What were they doing? Fashioning instant memorials to those they had lost? No, the crudely formed crossed sticks, pressed into the ground at the moment when their bodies reeled and their hearts bled, were acts of faith. They served a God who they believed knew pain as they knew pain. Blinded by pain and grief themselves, horribly aware that the world would neither know nor care about their plight, they still staked their lives on the conviction that there was One who knew and cared. They were not alone.”

Hopefully, none of us will ever face such horror. But what each of you do face each day are patients and families who often are going through an illness or personal tragedy that, at the time, is truly overwhelming for them, just as devastating, just as heart-breaking, just as life changing. And when faced with these patients and families, sometimes even our best efforts medically fail. Sometimes even our best attempts to give hope, to be “hope-givers”, are not enough. What do you do then? Medical training does not teach what to do when there is nothing left medically to do and all hope seems gone, at least I wasn’t. This is when, I believe, there is only one thing left to do - to give what I call “the warmth of love” that comes through a loving touch, holding a hand, giving a hug and more powerfully, shedding tears as you share their pain, hurt and hopelessness. Have you ever done this with someone? It is a frightening thing to be so transparent. This is especially true for those in health care who have learned to “compartmentalize” their emotions. I believe, and I have experienced this many times, that the true “art of medicine”, the human side of medicine, comes through brightest and most powerfully at just such moments when we allow ourselves to be” tears” for them. Are you willing to be “tears” for your patients and their families? If you are, you will find a renewed joy as you experience real medicine once again and your patients will know that they are not alone.

As always, thank you for the hard, selfless and caring work you do every day.

Andy Lamb, MD

Wednesday, March 25, 2020

"Bugle Notes" - "Stained - Glass Windows"

I recently saw a powerful video about an amazing nurse who is a foster mother to children dying of cancer. She lovingly cared for them no matter the circumstance, the difficulties, or the heartbreak that came with each and every death of one of these precious children. It broke my heart to see and hear. It caused me to reflect on how fortunate we are within Cone Health to have people with hearts much like hers, physicians and nurses alike. It was a special reminder of what a unique and privileged opportunity we have to care for those in the last days or weeks of their life. This time can be heart-breaking but it can be soul healing as well.

When asked how she could continue to love and care for these children, all of whom die, she said one of the most moving things I have ever heard:

“We invest deeply and we ache terribly when these kids die, but our hearts are like stained-glass windows. These windows are made of broken glass which has been forged back together, and those windows are even stronger and more beautiful for having been broken.”

Hearts like “stained-glass windows”, made of broken glass, forged back together, only to be even stronger and more beautiful for having been broken! Does this not speak to the essence of why we do what we do but also the price we pay as nurses and physicians, as human beings, for being willing to do so? Nurses understand this because they are the ones who spend the most time caring for our patients, ministering to their every need no matter how difficult it may be. Physicians understand because they have the ultimate responsibility for every patient and bear the burden that goes with that responsibility.

To all the physicians, advanced practice providers, and nurses, I say thank you. Thank you for having hearts that with time have become more and more like “stained - glass windows”, broken all too often only to be forged back together, stronger and more beautiful than ever. You are the “heart” of medicine. You selflessly and tirelessly care for those who are sick and suffering and afraid and alone and frightened. In their time of greatest need, you are their hope-giver. But when all else fails, you do the only thing left to do, you give of yourself but at the cost of this “stained-glass window”. It is a heavy price to pay but you are stronger and more beautiful for having done so. Thank you for the many sacrifices you make every day. Thank you for the difference you make in every patient.

Andy Lamb, MD

Tuesday, March 24, 2020

"Bugle Notes" - A Decision Made

Three straws held in a hand; each a different length; a decision to be made. It was September 1990, the hospital commander held them so they appeared equal in length. The instructions were simple, the long one wins. The consequences, though, were not – separation from family; physical and emotional hardship; possible injury and even death. There were three of us, Army physicians assigned to the hospital at Ft. Campbell, Kentucky. We stared at the straws the weight of the decision palpable. One of us would stay back, the one who drew the long straw. I drew it. I would stay while my two colleagues deployed with the 101st Air Assault Division to Saudi Arabia in support of Operation Desert Shield soon to become Desert Storm, the First Gulf War.

I sat motionless, the long straw in my hand. At first, there was relief. I would not be leaving my wife and three small boys to potentially go into harm’s way. I looked at my partners. One was only 2 months out of training and newly married. His eyes were downcast, shoulders slumped forward. The other, like me, experienced, with a young family as well. Suddenly my thoughts went back to my father. It was the summer of 1965, Ft. Benning, Georgia. He was packing his gear to deploy to Vietnam with the 1st Cavalry Division. It was the first major buildup of the war. He was happy, my mother was not. He was humming and whistling to himself which only made my mother madder. I heard her say, “Why are you so happy? Don’t you know you could be killed and leave me with all these children?” I remember my father’s answer vividly. “Don’t you understand that this is what I have trained and prepared for my entire life?” Suddenly, I knew I had to go. I could not remain back. I, too, had prepared and trained for war starting at West Point. A decision was made. My new colleague stayed back.

Decades later, a decision is to be made again. The coronavirus has appeared, a pandemic declared, the unknown, still unknown. For me, this is a war, very different from my first, but a war nevertheless. This time the enemy is invisible. There is hype from the many media avenues. What is true, not true? What to do, not to do? A novel infection, unanswered questions, people dying - a recipe for fear. I remember the straws and my father’s words. I could not sit back while others – physicians, nurses, hospital staff remained in harms’ way. They are my friends, colleagues, co-workers; my “band of brothers and sisters”. I have served with them through the years doing what we do best, caring for others no matter the circumstances.  I make a decision. I will go back to patient care after 5 years in hospital administration. I cannot do other-wise, my father’s words echo in my mind.

To everyone on the front lines of medicine, you are trained; you are prepared; you are ready to do what you do best; and you will do what must be done. Thank you for making a decision to do so. 

Andy Lamb, MD

"Bugle Notes" - La Esperanza

                                                   La Esperanza
Sh-h-h ninito, no llores. Dios te ama. Sh-h- Little one, don't cry. God loves you. Over and over I whispered these words to the frail, emaciated little Honduran boy as I gently stroked his thin, black hair. I didn't know his name or even his age, though I estimated him to be around a year and a half old. So frail, so sad, so frightened - my heart ached to comfort him.

I  first met him an hour  before. I was on a medical mission trip to the tiny town of La Esperanza in the mountains west of Tegucigalpa. I was there as an internal medicine specialist with a team of others to provide basic medical care in an underserved region. This was my fourth medical mission trip to Central America. The mission trips were a catharsis for my soul, cleansing me of the built-up frustrations and pressures from years in clinical medicine. Not even 50 years old, I was beginning to "burn out" and more and more I wondered if I had made a mistake going into medicine. My heart was hardening and my passion for medicine and compassion for people were eroding. These mission trips enabled me to experience medicine in its purest form unencumbered by paperwork, managed care and a litigious society. I felt joy again in ministering to the beautiful people of  Honduras. Little did I know that God, instead, would use a tiny child to minister to meLa  Esperanza, which means hope in Spanish, would restore hope in me. 

As I was seeing patients each day, several women on the team saw the need for the children to be bathed, deloused, and dressed in clean clothes. They scoured the small town's stores and bought all the children's clothes and shoes they could find. An area was set up for bathing using large trashcans-each child was washed, had his or her hair deloused and was then given new clothes and shoes. The laughter and delight of the children reverberated throughout the site. The word spread and more children camel As I witnessed this, I ,  too, wanted to be part of this special ministry. I decided to take a half-day from seeing patients and instead spend the time helping wherever I could with the children. 

He was the first . He cried and cried ever so weakly, his black eyes brimming with tears. His thin arms and legs covered with dirt, too weak to really resist the help we offered. As carefully as I   could,  I    cleaned him. He left dressed in fresh, new clothes and shoes, no longer crying-but not smiling either. An hour later he was back, his new clothes completely soiled and a feeble cry again on his thin, trembling lips. As he stood weeping, I carefully removed his clothes and shoes. I laid him down on the sun-drenched walkway and began cleaning him again. Thoughts of my own boys, now nearly grown, came to mind, and I was overwhelmed with a need to show this little one the love and caring that was missing in his life-a life of poverty compounded by physical and emotional neglect. His crying continued, barely audible at times. He laid lifeless, hardly moving, head turned to the side where he continued to stare as if  looking for someone. Suddenly, memories of rocking  my boys as infants came flooding into my mind. I began to whisper a soft, soothing sh-h-h-h in his ear just as I had done with my sons telling him again and again "No llores, ninito, no llores. Dios te ama". His soft sobs eased and he looked at me with his ebony eyes. He calmly lay there as I finished cleaning  him, all the while continuing to whisper to him as lovingly as I could. Once he was dressed, he was taken away-to where I do not know. 

In that brief encounter with this Honduran boy, I was reminded again of why I went into medicine - to serve others. The years of demanding work, long nights on call, administrative headaches and managed care had slowly hardened my heart. God used this little one to begin a softening, one which continues today.

Andy Lamb, MD

Monday, March 23, 2020

"Bugle Notes" - They Are Not Alone

Years ago, I watched an interview on TV with nurses who cared for a man dying of Ebola.  Their words and actions continue to ring as true today during the on-going Coronavirus - 19 pandemic as they did then. 

I was deeply moved by their compassion for this man dying a horrible death. They did all they could for him not only medically but also emotionally. They spoke of the fear that gripped them knowing the personal risks they faced. Yet, each voluntarily chose to care for him. When asked why they would put their lives at risk, they gave the answer you would expect - I am a nurse, this is what I trained to do; I’m a professional; but the answer that moved me to tears was, “He was alone because his family could not be with him.” Each of these nurses did not want him to be alone, to die with no one to love him, comfort him, care for him. They described how, despite wearing all the protective gear, they would hold his hand, speak words of comfort and reassurance, and toward the end simply hold him. The nurse caring for him when he died said that there were tears coming down the patient’s face after being placed on the ventilator. She tried to reassure him that everything would be okay but 15 minutes later he died. The nurse cried and said,” It was the worst day of my life.”

Each of these remarkable nurses, risked their lives to care for a man they did not know. Sure, part the reason was that it was their job, they were trained to do this. But as you listened to their words, the emotion in their voice, saw the trembling of their chin, and the flowing of tears from their eyes, there was a much bigger reason. They truly had compassion on this man and “He was alone because his family could not be with him.” So they became his family. They lovingly cared for him; wash his face with a cold wash rag; dealt with the copious diarrhea and vomiting; changed his clothing and linen; and administered his medications and fluids despite the risk to themselves. More importantly, though, they simply loved him by their words and actions. When medical treatment fails and nothing else can be done, then the real “art of medicine” begins - the compassion, caring, and love of wiping his face, speaking words of comfort, and simply holding him.

Watching these interviews took me back to the earliest days of my internal medicine training during the 1980s. I trained at the peak of the AIDS epidemic before there was any adequate treatment. I cared for scores of young men with HIV or dying of AIDS.I and was present until they died of AIDS despite our best attempts. This was a time, much like with the Ebola scare, where there was much fear, uncertainty, and unfortunately prejudice. As a result, we, the nurses and house staff, watched repeatedly as these young men were abandoned by their families - parents, wives, siblings, and friends out of fear and ignorance. As a result they were alone as well. I will never forget how dramatically that impacted me. No one deserved to be abandoned like that, no one should be left to suffer and die alone. We gave them the best treatment possible knowing that they would still die. When nothing more could be done, we sat with them, held their hand, comforted them and let them know we cared, that they were not alone.

Is this not what medicine should be about? Is this not why we went into medicine? There’s so much more to medicine than simply the medical/surgical treatment side, as important as that is. There’s the human side - the compassion, caring, and loving warmth of a human touch; the knowing that at a patient’s time of greatest fear, helplessness, and need, that they are not alone, we are there for them.

Medicine is hard, very hard. There are times when we need to be reminded why we went into this profession, this calling, lest we forget in the busyness of our days with all the many demands placed upon us. Sometimes we need to step back and remember the last time we were there so they would not be alone. Thank you for the sacrifices you make each and every day for your patients, for your community, and for your families. You’re not alone in this.

Andy Lamb, MD

Sunday, March 22, 2020

"Bugle Notes" - Without Hope

“The only end to pain is the graveyard.” Those words are etched forever in my mind. They underscore the hopelessness of so many throughout the world. She was 90 years old, crippled by arthritis, no family, and lived alone in a dirt floor hovel with no electricity or running water. She lived in a tiny village of 2000 people in the poorest country in Europe, Moldova. She lived every day without any hope that her life would get better. Her entire life has been one of daily hardships and struggles to survive. She only knew pain-physical and emotional. She had no hope, no joy.

I was leading a short term medical team to Moldova as part of a faith-based organization that sends teams to the poorest and neediest countries in the world. Moldova is in Eastern Europe and was once part of the Soviet Union. It is, though, for historical reasons, viewed by surrounding countries as the “ugly stepchild” of what is now Russia. Multiple factors through the years have contributed to this - oppression under communism, the “Great War” (known to us as World War II), the purges under Stalin and other Soviet leaders, corruption, and finally the collapse of the Soviet Union resulting in Moldova’s complete economic and socio-political collapse. Moldova has not recovered and life there remains hard.

Each day of clinic, I would send a small team to make home visits. On this one particular day I went with the team. Home visits in developing countries can be both powerfully moving and emotionally heart breaking. As you go into the homes of the poorest of the poor, you never know what you will see, hear, or experience. More often than not you leave that home changed by what you just experienced. Such was the case with this woman.

She was thin and frail. Arthritis had crippled her body. She walked slowly, bent over, cane in hand. I sat with her on the concrete steps leading into what was her “home”. Through my interpreter, we spoke of her health issues trying to determine what could be done for her if anything. Her only complaint was the arthritis pain that she lived with constantly. As I was sitting with her, I noticed she was staring into the distance at a cemetery. Then she said these words, “The only end to pain is the graveyard”. As someone who had lived nearly her entire life under communism, she had no belief in God or “anything more” after death. All she knew was the ever present physical pain from her arthritis and emotional pain from loneliness. Her only hope to ending this pain was death, the graveyard. I remember vividly thinking how terrible it must be to live a life without hope, any hope. That was the only life she knew.

May we take the time to pause during the busyness of the day to reflect upon all we have. Compared to the majority of the world we truly are fortunate, most fortunate. We do have hope. Most of all, we are privileged to be in a profession that can bring hope to others - physically, emotionally, and even spiritually. Thank you for being “hope - givers” to those in need. In doing so, you are making a difference one life at a time.

Andy Lamb, MD

"Bugle Notes" - Soldiers and Fathers

He was in his 30’s, strikingly handsome with the short-cropped hair of a soldier. This was Ukraine and it was at war with Russia. He was now part of that war, a war the rest of the world has forgotten or no longer cares about, even as its’ young men continued to fight and die in the horror that is the front-line. His unit’s chaplain asked me to see him because he recently returned, after many months, from the front. Every year he brings “his boys”, still healing from physical and emotional wounds, to see me. Having been in war myself, I could at least listen with empathy, and be a source of support and encouragement.

 The hatred for Russia is palpable. With Ukraine’s history under the previous USSR’s hegemony, it is understandable. Yet, this hatred is deeper, more pervasive, even soul piercing. The death of each soldier feeds it, grows it, fuels it. 18 year - old males have mandatory service for 3 years and eventually go to the front lines, as with this soldier. He had served with bravery and distinction even though he was not a combat soldier. He was the Director of Music for his unit! The front lines, though, were fluid and there was no “safe” place. Repeatedly he found himself nearly surrounded by Russian soldiers. He began to carry a “big gun” because he said, “If you are captured by the Russians, you never return”. I sat shocked.  

He spoke calmly of his experiences - a severe concussion from an artillery shell explosion, repeated shrapnel wounds, and three fellow soldiers killed next to him as they attempted to extricate themselves to a safer place. I found no evidence of obvious emotional trauma. I decided to ask how he was adjusting back home with his family. His eyes welled with tears. He said the only reason he was alive was his family. His wife and two young daughters were always in his thoughts and prayers. He had determined to survive for them at all costs.

Listening to his stories, looking into his eyes, I began to see my father as I will always remember him – big and strong, the Airborne Ranger Infantry officer he was. He, too, had experienced combat, losing many men, some close friends. Yet twice he returned home from that war seemingly untouched by it all. Memories began to surface from a place deep inside me. It was then I remembered. My father had died exactly one year ago to the day. I had been with him those last two weeks, the memory still painful.

The tears came. I thought of my sons, now grown. Had I been there for them? How much of their lives had I missed during the years of medical school, residency, service in the Army and the First Gulf War, building a practice, all the busyness that is life? The refrain from Harry Chapin’s song “Cats in the Cradle” came to mind:


            “And the Cat’s in the Cradle and the Silver Spoon, Little Boy Blue and the Man in the Moon

               When you coming home, Dad?

               I don’t know when, but we’ll get together then, son, you know we’ll have a good time then….”

 These words became a compass for my life. Despite missing much of my early years due to war and other assignments, when my father was home he was present in every way. My fondest memories are throwing the baseball with him. I promised myself I would never let those haunting words come true in my life. I would do as my father did. I would be present.

I looked at him, this “ghost of my father” sitting before me, and said, “Go home, hold your wife, tell her you love her. Go home to your girls and tell them they are beautiful, they are smart, they are important”- those touching and empowering words from the movie “Help”. He nodded, tears tracing his face. He reached to his right shoulder, removed his unit’s combat patch, earned at great cost and sacrifice, gave it to me, and left. My interpreter and I were speechless. She, too, was crying.

I needed to be alone - to process, to grieve? I found comfort walking the dirt roads of the picturesque village of Ostap’je, a light snow falling, dusting the newly plowed fields soon to bring forth new life.

Guard yourselves against wishing time away in the busyness of your lives, in the search for something more or better. Time is precious, time is now, cherish it. It will pass, too fast, and with it the memories into that deep place within. What you do is hard. I understand. I care. Thank you for caring as well.

Andy Lamb, MD