"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

"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

"Bugle Notes"- What Are You Passionate About?

"What are you passionate about?" This is a question I often ask people when I meet them for the first time. Anytime I am around young people, as I am through medical missions, I always ask this question. I believe the answer to it is key to understanding the heart of that person.

We can be passionate about one thing or many things. I bet if asked, every one of you could quickly come up with an answer to this question. If you cannot, you should ask why not because one's passions, to a significant extent, reflect who they are as a person – emotionally and spiritually. Who wants to live a life devoid of passion? I cannot imagine doing so. To me, that would be a life without adventure, without purpose, without real significance – a boring life!

I have my passions. These passions define who I am as a person. Those who know me, know I am a fly fishing "nut"! I will fly fish any time, any place, under just about any condition. I also tie my own flies and build fly rods. I love it! When I am standing in a cold, crystal-clear stream with the mountains surrounding me, I am at complete peace. The only things I think about is catching the next trout and thanking God for allowing me to be in such a beautiful place. I can literally fly fish for hours and not once think of anything - not work, not all the demands on my life, not the latest trouble I may be experiencing - only the beauty, serenity, and peace of the moment and the trout!

As passionate as I am about fly- fishing, it does not compare to what really gets me excited - leading short- term medical missions around the world and investing, mentoring, and encouraging young people. I have had the privilege of leading over 40 medical missions to eight different countries on four different continents since 2004. I have served with hundreds of amazing people who have a passion to serve and love others. They want to live a life that counts, a life that makes a difference in the world. They are also our future and they want someone to mentor them, to invest in them, and help them through the ups- and- downs of life. That is what I do, that is about what I am passionate. My question again is, "What are you passionate about?" How do your passions affect your life priorities, who you are as a person, and even as a physician, or do they?

Every hospital must have a “Culture of Excellence”, a culture that is passionate about exceptional patient care. Anything less should not be acceptable. This is a passion worth having! The humbling thing is that each of you, whether in the hospital or outside the hospital, is doing this! What you do every day for your patients, your hospital, and your community makes a difference and is foundational for providing this exceptional care.

 As always, thank you for all you do every day on the front line of patient care. I know the hard work you do and will never forget that. You are making a difference - one life at a time!

Andy Lamb, MD

"Bugle Notes" - The Helicopter

You are a 19 year old kid. You are critically wounded and dying in the jungle in the Central Highlands of Vietnam.  It’s November 14, 1965. Your unit is outnumbered 2:1 and the enemy fire is so intense from 100 yards away, that your commanding officer has ordered the Med Evac helicopters to stop coming in. You’re lying there, listening to the enemy machine guns and you know you are not going to get out. Your family is around the world, 12,000 miles away, and you will never see them again.

As the world starts to fade in and out, you know this is the day. Then over the machine gun noise you faintly hear the sound of a helicopter. You look up to see a Huey coming in. But…it doesn’t seem real because no Med Evac markings are on it. Captain Ed Freeman is coming in for you. He’s not a Med Evac, so it’s not his job, but he heard the radio call and decided he’s flying his Huey down into the machine gun fire anyway.

Even after the Med Evacs were ordered not to come, he’s still coming. He drops in and sits there in the machine gun fire, as they load 3 of you at a time on board. Then he flies you up and through the gunfire to the doctors and nurses and safety. And he keeps coming back, 13 more times. Until all the wounded were out. No one knew until the mission was over that he had been hit 4 times in the legs and the left arm. He took 29 of you and your buddies out that day. Some would not have made it without him and his Huey. For gallantry above and beyond the call of duty, Captain Ed “Too Tall” Freeman was awarded the nation’s highest honor, the Medal of Honor.

My father was an Airborne, Ranger Infantry Officer. He knew Ed Freeman. He too, like “Too Tall” Freeman, and all those involved in what was the first major battle of the Vietnam war, the battle of Ia Drang, were members of the 1^st Cavalry Division. They deployed to Vietnam in the summer of 1965. This battle is immortalized in the book “We Were Soldiers Once and Young” and the movie years later. I remember the time well. I was 10 years old living in Ft. Benning, GA. During this time a new concept of battle was developed called air assault – bringing soldiers directly into combat by helicopter.

It was a hard time for my mother, alone with 4 children under the age of 12, the youngest less than 3 months. She cried often especially when she received word that the husband of another friend had been killed. In our neighborhood during 1965-66, there was not a man around. They were all in Vietnam. At the age of 10, all I knew was that my father was fighting a war in Vietnam. I never seriously thought he would be killed. Why should I? He was invincible in my eyes. Every night, as a family, we ate dinner on TV trays. We watched the iconic Walter Cronkite as he talked about the latest action in Vietnam, the black and white, days old film footage flashing before us. We watched, hoping beyond hope, for a glimpse of my father, our eyes glued to the screen. We thought we saw him once.

As I reflected on this story, I wonder if I could have done what “Too Tall” did? What caused him, or for that matter, anyone, to do such selfless acts of bravery at incredible risks to themselves? I began to see a connection between what he did and what each of you do as physicians. The connection is a special bond that exists between those who have experienced shared hardships in pursuit of a common purpose – in our case, years of arduous preparation in medical school, followed by more years of demanding residency training. There are few things that bond people more closely than shared hardships for a common cause. I experienced this at West Point, during my residency, and during the first Gulf War while deployed on the Iraqi border in support of the 101^st Air Assault Division. This bond also results from being part of something bigger than yourself. For “Too Tall” and my father, it was the identity they had with the 1^st Cav Division and the resulting sense of duty to their fellow soldiers and their country. There is an unwritten code among soldiers – NO ONE left behind! From these bonds, relationships are made, strengthened, and invariably trust grows.

 I believe the most important part of being a physician (or any health care provider) is not the clinical acumen possessed (as important as that is) rather the relationships developed and the surrounding influences and qualities produced by those relationships. A culture built on such relationships is one of trust, respect, and caring. This is a culture which allows the best in every person to be realized. In medicine, it translates to every patient getting the best care possible, every time. Thank you for being willing to be part of something bigger than yourself through which you can do even greater things and make a bigger difference.

Andy Lamb, MD

"Bugle Notes" - "This Is Water"

“There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says, “Morning boys. How’s the water?”

And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, “What the hell is water?”

These are the opening lines of acclaimed author David Foster Wallace’s last book “This Is Water”. It was published shortly after his death in 2008. He posits the question to university graduates, “How do you measure the value of the education they received?” What followed was a thought - provoking examination of what he called “the capital-T Truth”. The challenge we all face he wrote, in understanding this “capital-T Truth”, is overcoming what he called “your default setting”. This is the place you go in response to life’s many challenges. It is the way you automatically and even subconsciously believe something is true even though you may be wrong. Why? Because we all believe, to one degree or another, that we are “the absolute center of the universe, the realest, most vivid, and important person in existence.” Anything else we reject or don’t recognize, just as the two young fish did not know what water was because their natural default setting did not recognize it as separate from themselves. Their world was all about themselves.

Wallace writes that our default setting of seeing things only as we see them and rejecting other possibilities has in our present culture yielded extraordinary wealth, comfort, and personal freedom - “The freedom to be lords of out tiny skull-sized kingdom, alone at the center of all activities.” He goes on to write, though, that the kind of freedom that is “most precious” we do not hear much about “…in the world of winning and achieving and displaying”. This freedom involves attention, awareness, discipline, effort, and being able to truly care about other people and to sacrifice for them, over and over. Isn’t this what we have all done, sacrificed for others over and over during the arduous years of schooling and training and even beyond?

Do you live in “your default setting” blinded to what is real and truly important (“What is water?” as the young fish asked)? Or do you choose to live a life with an awareness of what is so real and essential, yet so hidden in plain sight all around you, that you have to keep reminding yourself over and over, “This is water. This is water.”? In doing so, you can have that “precious freedom”- you can truly care about those entrusted to you. You can then do what you do best, better – making a difference in the lives of others and doing so with compassion and caring every day.

Life is precious, the work you do important, and the impact you have on others life-changing. May the busyness of medicine and its’ inherent frustrations, not cause you to lose sight of what is important, why you went into medicine, and the difference you make every day. What is my “capital-T Truth”? It is to live a life that counts, to make a difference in the lives of others every chance I get. What is yours?

Thank you for the privilege of serving you any way I can.

Andy Lamb, MD

"Bugle Notes" - You Are Not An Island

The years 2000 - 2002 were a very difficult time for me. I was in a busy Internal Medicine private practice as well as its President. My outpatient clinic was full to the point that I could no longer see new patients. Hospital call was the “old way” before the time of Hospitalists - 24-hour call for both assigned and unassigned patients and then working the following day. I stayed in the hospital call nights. There was no use going home because invariably you would be called back for an admission. Then there were the countless phone calls from the answering service or from the floor nurses. Call was hard and becoming harder. I was also very actively involved in church, doing medical missions, coaching my sons in baseball and basketball, and trying to be the best husband and father I could be. I was not doing a very good job as a father.

Any of these would be enough to raise one’s stress level. However, the final straw came when my mother was diagnosed with a rapidly progressive form of myelofibrosis of the bone marrow in early 2001. She was only 66 years of age and completely healthy up to that time. 2002 was the most difficult time of all. My father, three brothers, and sister were not handling her illness or the reality that she was dying well at all. My mother’s Hematologist/Oncologists did a terrible job communicating with them. By default, I became “her doctor” in the eyes of my family while all I wanted to be was her son.

Starting in January 2002 until she died that May, nearly every weekend I would leave from my office as soon as I could in the early afternoon on Fridays and drive 7 ½ hours to my parent’s home in Alabama. I did this to see my mother, calm my family, and insure things were being done for her care. I would return each Sunday only to repeat the same thing week after week, month after month. The only time I did not go was if I was on call. Needless to say, this was emotionally and physically exhausting.

 I began to notice a change in me that at first I could not understand. I became very irritable, impatient, and withdrawn to the point that as soon as I went into an exam room to see a patient I immediately had a nearly overwhelming need to leave. It was all I could to make myself stay in a room and listen to the patient’s complaints especially since all that was happening in my life made their complaints seem inconsequential. I began to question whether I had made a mistake going into medicine and this was why I was feeling as I was. I was definitely “burned out” among other things but had yet to fully recognize this.

One night, while driving to Alabama, I was trying to find a radio station outside of Atlanta. I happened to come across a talk station and the topic was depression and in particular depression in men. For some reason, I continued to listen and as I heard the manifestations of depression in men and how they can differ from women, I realize that nearly everything they were saying I was experiencing! I suddenly realized I was depressed. I wasn’t simply “burned out”, or had made a wrong career decision, I was truly clinically depressed. The thought of depression had never crossed my mind. After all, I could handle stress as well as anyone. My years at West Point, my time in the Army to include in a war zone, the arduous years of medical school and residency training more than proved I could handle anything, or so I thought.

When I returned from Alabama, I immediately sought help. More importantly, I also began opening up to close friends. Until that time, I had not talked to anyone. I simply tried to bear this alone. I thought I could handle it on my own, after all, I had always done so in the past. I quickly began to improve and the irritability, impatience, frustration, etc. all resolved and I was back to my usual self. 

From this, I learned that no one is immune to significant life stressors and all that can happen as a consequence - burnout, disruptive behavior toward others, maladaptive responses, and even depression. I had failed to recognize this could happen to me. I only thought of it as happening to others or my patients but not me. But it did and the same can happen to each of you.

 There is a saying “No man is an island” and it is very true. People need others to encourage, support, and help them during difficult times. It is not a sign of weakness to acknowledge that, it is a sign of being wise. Not doing so can have significant consequences on you emotionally and physically as well as those you love. There is help whether by opening up to a trusted friend or seeking professional help. I know the work you do. It is hard and getting harder.  Take care of yourselves so you  can do the same for those entrusting themselves to you. Thank you for all you do every day in the care of others.

Andy Lamb, MD

"Bugle Notes" - A Legacy - What Will Be Yours?

As I am approaching the twilight of my medical career, it has caused me to pause and reflect. Memories come flooding back - the thousands of night calls; tens of thousands of patients seen and cared for; those that died; the joys, the heartbreak, the doubts, the burnout, the tears, the hugs; the good and the bad, the joyful and the sad. I find myself wondering how will I be remembered, what will be my legacy?

There are a number of things for which I hope to be remembered:

 - I lived a life that counted, that made a difference for God, for my country, for my family, for my community, and for the under-served of the world.

- I experienced the needs of the world in a personal way and they became real to me.

- I was a physician who cared for the whole person and did so with excellence, humility, and a servant-heart.

-I invested in, taught, encouraged, and mentored the next generation, our future, every chance I could.

- I was a servant-leader who cared for people and inspired others to do what they do best, better.

- I worked to bring joy back into medicine because without joy medicine is just hard work.

- I lived a life that reflected West Point’s motto – Duty, Honor, Country.

We will all leave a legacy. The past is history from which to learn and grow. The present is here and now. This is the time to lay the foundation for yours. When you come to the twilight of your life, how do you want to be remembered? There will be no second chances or go backs.  

Andy Lamb, MD

"Bugle Notes" - "Ten Commandments of a Servant Leader"

      

   

I have seen great leadership and bad leadership. As a leader, I have also made my share of mistakes and I am sure I will make more. When I do, I will immediately take ownership of it, learn from it, and do all I can to not make the same mistake. However, there will be times I may not recognize my failure as can happen with any leader. This points to something critically important - leaders need to be held accountable.

My leadership style is that of a servant leader inculcated in me from my earliest days at West Point. A number of years ago, I created what I call my “Ten Commandments of a Servant Leader”. These Ten Commandments are based upon life experiences with lessons learned and wisdom found, as well as my personal faith journey. At the end of each week, I will go down a checklist of these Ten Commandments to see if I met them, thus holding myself accountable. My “Ten Commandments of a Servant Leader” are:

      -  People are your most precious resource; take care of them

2.     -  “Clothe yourself with humility”

3.      - Eat and sleep last (Your people’s needs come before your needs)

4.      - “Open wide your heart” (Being transparent)

5.      - Trust is the foundation of all relationships

6.     -  Make a difference each day, one life at a time

7.      - Encourage, teach, and mentor every chance you can

8.     -  Every day is a good day, and some days are better than others! (Having a positive attitude)

9.     -  Listen more and talk less

10  - Learn to follow

Andy Lamb, MD

                             “If serving is below you, then leadership is beyond you.”

                                                                                           Anonymous

"Bugle Notes" - "Just Another Day in Paradise"

 I have led 12 missions to El Salvador and, as a result, I have grown to love it and its’ people, culture, and natural beauty. I consider it “mi segunda casa”, my second home. Yet the hard truth is that it is routinely listed as one of the most dangerous countries in the world due to the extremely serious gang situation there.

 Two dominant gangs control parts of the capital city San Salvador and many towns in various regions of El Salvador. They are an ever present and brutal part of life for the typical El Salvadoran. These gangs are the result of a terrible civil war that occurred in El Salvador during the 1980s which resulted in the death of over 300,000 civilians. Subsequently, thousands of orphans were left. Their only chance of survival was to come together as a “new family” and thus the gangs came into existence. El Salvador is now seeing the next generation of gang members some of who have been born and raised within their ranks. This generation has no conscience. The members are brutal beyond compare and will do any despicable act in order to exert control, power, and fear over the people. They routinely make demands upon the El Salvador government and if these demands are not met, quick and usually deadly retaliation occurs against the people of El Salvador.

During the many times I have been to El Salvador, I have always felt safe. The government, and my host partners, do all they can to ensure our safety. We always have at least three armed national policeman, especially trained in gang activity, with us 24/7. Whenever the team travels we are escorted by police vehicles that leapfrog back and forth to ensure we do not stop at intersections or in traffic, thus becoming a more likely target. Of course, the safest routes are always chosen and no precaution is left undone. The policeman become an intimate part of the team and are much appreciated!

 My last mission to El Salvador, though, was an exception. Gang violence had significantly increased due to the governments’ refusal to meet their latest demands. As a result, the gangs chose to attack public bus transportation, especially in those areas under their control. The day my team of 69 people arrived in San Salvador, six bus drivers were killed. Fortunately no passengers were. The next day, another driver was killed just blocks away from the hotel where we were staying. Another bus driver was later to be killed. We were traveling on the buses normally used for public transportation. Our guards were on high alert and as a team leader I took extra measures to ensure the safety of the team and our young high school El Salvadoran interpreters. Many of our interpreters had to drive home with their parents through gang controlled territory every day. Despite all this, we remained safe and the mission was one of the best!

During the week, I had the opportunity to talk a great deal with my host partner, Rene, a man I have known over 10 years and is like a son to me. I received an education in the mindset and activities of these gangs that shocked me to my core. For brevity’s sake, I will not go into all the details of the terror tactics and brutality used by the gangs on the people of El Salvador. It is heartbreaking, incomprehensible, and worldview changing. As a result, the members on this mission came back changed. The needs of the rest of the world had become more than real to them, they had become personal.

Imagine, then, how I felt when on my first day back to work I had the following brief encounter with a physician on the medical staff. I came in very early that morning and as I was walking toward the hospital’s main entrance, I saw a physician whom I have known for many years, leaving the hospital. He likely had been called in for an emergency and thus tired and probably not too happy. I said hello and asked how he was. As he got to his car, he responded, “Just another day in paradise”. My first inclination was to let it pass but with all that I had just experienced in El Salvador, and my years leading medical missions, I couldn’t help but respond. I said, “If you had been where I have just come from, this is paradise”. I probably should have kept quiet. Thinking back on it though, I have no regrets. Is any hospital, or for that matter our healthcare system today, really “paradise”? Of course not. However, each of us is truly fortunate to work in a healthcare organization that provides us with a beautiful place to work, amazing technology, wonderful support staff, and a safe environment. Things can always be better, things can always improve. I understand this very well. For me, though, this is “paradise” when I consider all I have seen and experienced.

 I know how hard you work and the challenges you face every day. I have been there, too. Sometimes I needed to be reminded how fortunate I was to do what I did when I became discouraged or frustrated for whatever reason. My intent with this story is not to lay a guilt trip on anyone but to provide a gentle reminder that, yes, things could be worse and, in fact, for the majority of the world, things are far worse, unimaginably worse. In light of this, we do experience to some degree, “paradise” every day whether we recognize it or not.

As always, you are much appreciated!

Andy Lamb, MD

"Bugle Notes" - Making "the Unbearable, Bearable"

I once heard someone say they wanted to “make the unbearable, bearable”. These words deeply resonated with me not only because of what I have seen and experienced through my years in medicine and on the mission field, but also with the death of my father. Watching the compassion and caring of the hospice team allowed me to experience how they made “the unbearable, bearable” for my father and my family. These words are now real to me because they have become personal.

Do you realize that in caring for your patients you are doing the same? They come to you sick, frightened, and vulnerable, often not knowing how much longer they can endure. They seek relief from what has become “unbearable” to them and their families. Whenever you care for someone with unhurried time, give the warmth of a loving touch, speak words of comfort and concern, give a reassuring hug, or simply being present right there with them, you help make the unbearable, bearable.

I write these “Bugle Notes” to remind you that you make a difference every day in the lives of others; that what you do is important; and that it is still a privilege to do what you do. You can never be reminded enough of this. If you have been through a period of emotional/physical pain or unrelenting hopelessness and despair, then you understand the realness of the word unbearable. It has become personal to you. You understand what it means to make the unbearable, bearable. When you do so, you are making a difference in the life of that patient, that family. May it be a reminder of why you chose to go into medicine.

Thank you for living a life that counts, a life that makes a difference in this world.

Andy Lamb, MD

"Bugle Notes" - Veterans

  

 I am a veteran, my father and all three of my brothers are veterans. I have been to war, separated from my family, with the danger real, living in the desert, in a tent with the sand blowing through the walls, sleeping on a cot with cardboard boxes for furniture. I know how it feels to lay on that cot, in the darkness, missing your family so badly it physically hurts. You silently lay there while the tears flow. I know the sacrifices made by every veteran and by those serving our country now.

I know the pain of leaving your family, your wife, and three young children, to go and do your duty in a foreign land where the possibility of not returning is a reality. I know what it’s like to cry when you make that final goodbye and not be able to stop crying for hours no matter how hard you try. You find a place alone and simply cry until there are no more tears left and then you pick yourself up and do your duty. I know the sacrifice.  

I know what it is like to have your father twice leave for war in a faraway jungle where he would personally be in combat. I know what it’s like to watch your mother cry every time a soldier in my father’s unit died in combat and see the fear in her eyes as she knew my father could be next. I know what it is like to live in fear that someone would show up at your door with a message of condolence from the President.  I know the sacrifice the families make.

I know the commitment, sense of duty, honor, and country that veterans and those serving now have. They would willingly give up everything, to put their lives in harm’s way for freedom, no matter what the cost. I know that feeling. I know the heart of a veteran.

I know the sense of pride of having served your country, doing your job to the best of your abilities because you recognize how privileged we are to live where we live. I know how quickly this could be lost if it were not for the veterans. I know because I have been there.

Duty, honor, country - these three words define the heart of every military person, veteran and active duty alike. These three words have dictated who they should be, who they can be, and who they will be. It is the soldier who hates war most of all because they are the ones who will be called upon to make the ultimate sacrifice. All veterans understand this. Please take the time to thank a veteran and to reflect upon the sacrifices they made for you.

Andy Lamb, MD

"Bugle Notes" - The Missing Link

Medicine is hard and getting harder. You know this all too well. Many factors contribute to this. There is one thing, though, that when missing, will suck the joy out of medicine. That missing link is passion, a passion for what you do every day. Without this passion, there is no joy, without joy it becomes work, hard work that is less fulfilling, less meaningful, and less soul enriching. The demands and expectations, though, continue to increase, slowly crushing what joy remains. 

        

From where does this passion come? I believe from a commitment to something bigger than oneself. It is a commitment that shapes who you are and your actions so that they are subservient to something beyond your personal concerns, beyond any direct personal gain or benefit. It takes you from being self-centered to other- centered, from a selfish heart to a selfless heart.

Without this passion, it is very difficult, if not impossible, to persevere during the valleys of life that we inevitably experience. These are times when you may feel like a “dead man walking”, simply going through the motions trying to make it through another day and all the while no one seems to care. You reach deep inside yourself to find the strength to persevere. This may work for a while, but eventually there is nothing left inside. You have used all you have and your “bucket is empty”.

I know what it is like to live without hope, without joy. I have had my own personal “valley of tears”, standing on the edge of a pit called despair and its brother hopelessness. Each day is a day of survival. Where is the joy, the contentment, the purpose in that? However, when you are committed to something bigger than yourself that passion will give you the strength and purpose to continue.

Without this commitment, the inevitable question arises, “Is this all there is?” No matter how good you look, no matter how much wealth, fame, power, and position you have, you will experience a profound lack of fulfillment, incompleteness, emptiness, and even pain. Joy is lost and passion for what you do a distant memory.

Overcoming this crisis requires having a commitment to the future, a cause, that leaves you with a passion for living and the joy that follows. Every person has the power to choose this commitment. In doing so you will find passion, energy, and joy once again. You will live a life that counts, a life that makes a difference in ways you cannot imagine. I have chosen this commitment, and it has made all the difference! What would such a commitment look like for you? Even more, how would it impact you, your family, your friends, those around you, and the world?

Andy Lamb, MD

"Bugle Notes" - Making a Difference?

I was somewhere over the Atlantic Ocean, heading to Ukraine “to make a difference”, or so I hoped. I was leading a medical mission to this beautiful yet poor and war-torn country. I was watching the movie “First Man” about the landing of Apollo 11 on the moon that epic day in July 1969. I was not quite 14 years of age at that time but I vividly remember the live, grainy TV footage of that first step by Neil Armstrong. Millions across the world watched, breath held, as he did so.  This was the culmination of over a decade of meticulous preparation and selfless dedication to a goal, a dream, far bigger than anything ever done before. It began with the first Mercury space launch, then the Gemini series, and finally the Apollo missions to realize what President Kennedy had promised in 1962 – before the decade was over, to put a man on the moon and bring him safely back. Throughout my elementary school years in the 60’s, teachers would stop classwork and turn on the generic black and white TV so we could watch the live launches of every “next step” toward that seemingly impossible goal.

I was inspired - inspired by the sacrifice, courage, and perseverance of Neil Armstrong, by every individual who had risked their life, by those who had lost theirs, and by the families who endured, so that “one small step by man” would become a “giant leap for mankind”. I tried to hide the tears in the darkness of the plane. Memories from that time suddenly surfaced – a time when my future was before me – unknown and waiting to be discovered, explored, and experience.

It caused me to posit, “Have I made a difference with my life? Have I lived a life that counted? Must I do something truly “great” to make a difference?” Up until I saw the movie, I would have answered unequivocally, yes, that I had made a difference and was still making a difference. However, after watching it, I was not so sure anymore. What does it look like to make a difference, to live a life that counts? Do you have to be a Neil Armstrong, a Mother Teresa, a Martin Luther King, an Abraham Lincoln, or a Mahatma Gandhi?

 Leading medical missions, I have learned that every one of us make a difference and it can be significant! We do it “one life at a time”. Every surgery, medical intervention, restored health, loving touch, kind words, listening ear, and “stained glass heart” makes a difference in someone’s life. This is what you do every day yet it is so easy to lose sight of that in the world that is medicine today. You may never know the full impact on the lives of those you touched but there will be an impact and a ripple effect. Thank you for being a difference maker! Thank you for the years of sacrifice you made so you can make a difference in the lives you touch. You are living a life that counts and I for one am grateful for you.

 

 Andy Lamb, MD

"Bugle Notes" - The Potter's Hands

 In her book, “In Shock”, Dr. Rana Awdish, an Intensivist, describes how, after a near- death experience and prolonged, difficult recovery, she came to appreciate the importance that people have had in her life. She spoke of those who trained her and of her colleagues, each playing a role in molding her, like clay in a potter’s hands, into who she was. She said, “I learned from them that relationships can shape us….That we can allow ourselves to be supported by an enveloping mold in the hands of others.”

 All of us have had people be our “potter’s hands”. After my father, the biggest influence was my Little League baseball coach, “Skip”. He had been a professional baseball player but a severe wound from the Korean War ended his career. He turned his passion for baseball on us. His love for the game was contagious. He taught us how to look and to play like a Major Leaguer! I loved it. I loved him. I remember at the age of 12 thinking that one day I would coach Little League. I wanted to bring the same fun and joy to kids and I tried. I coached youth baseball nearly 20 years, even before I had children.

There were others as well:

My 11^th grade Chemistry teacher, the best teacher in the school. If you could make a “B” in his class, he would write a letter of recommendation to college for you. He taught me how to study!

My high school ROTC Instructor. He told me in the 10^th grade that, if I got into West Point, which he made clear he doubted, he did not think I would survive the rigorous 4 years there. He was the only person ever to tell me I could not succeed at something. His words were like a blacksmith stoking a fire, fueling it, making it grow hotter, more powerful. I determined to prove him wrong.

My Tactical Officer at West Point. A highly decorated combat veteran in Vietnam who became a Four- star General. He was the toughest of all the officers assigned to develop, teach, and discipline cadets. There was an intense love-hate relationship between my company mates and him. He made our lives miserable but secretly we took pride in being in the hardest of the 36 companies there. He taught me physical and mental toughness, perseverance, accountability, responsibility, and attention to detail.

My Hospital Commanding Officer in Saudi Arabia during the First Gulf War. His reputation as the toughest Chief of Surgery in the Army Medical Corps preceded him. I know because I trained where he was the Chief and heard all the “stories” from my surgical contemporaries. However, when war came, and I was his Chief of Medicine, he was one of the best leaders for whom I ever served. He knew how to take care of his people.

Who helped mold you? Who invested in, taught, encouraged, and mentored you? Are you doing the same for those coming behind you? You have a special gift to give - your wisdom and knowledge from years of training, and experience. In doing so, you become “the hands of a potter”, shaping and molding them into the best they can be. In doing so, you will make a difference in their lives just as others made a difference in yours. In doing so, you can find joy.

Andy Lamb, MD

"Bugle Notes" - Christmas Eve

Christmas Eve 1990, Saudi Arabia, a few miles south of the Iraqi border - it is cold and dark as I lay on my cot, my sleeping bag around me, the constant hum of the generators in the background. I am listening to Pachabel’s Canon in D minor on my cassette player. Rain pelts the tent I share with nine other Army doctors. The sides move rhythmically with the wind, my heart beating in unison, a concert of emotions being played in my mind.

Two months earlier, I, along with two hundred plus soldiers, left Ft. Campbell, Kentucky for the desert of Saudi Arabia as Operation Desert Storm began gearing up. I was the Chief of Medicine for the 86^th Army Evacuation Hospital based at Ft. Campbell.  Two months prior to this Saddam Hussein had invaded Kuwait and the normalcy that was my life disappeared. After weeks of preparation and too many “go/no goes”, we finally left not knowing what to expect or how long we would be there. We only knew that war was imminent and we faced a crazy man who had already showed he would use chemical weapons.

We landed in Dharan, Saudi Arabia. The next two months were spent preparing for the war to come. We stocked up supplies, equipment, and medicine. Physicians cross -trained the nurses and corpsmen so that together we could best care for the 600 new casualties we expected every 24 hours, mainly from the 101^st Air Assault Division. Many of our nurses were married to those soldiers. Would their husbands be among the dead and wounded? That weighed on everyone’s mind.

On 23 December we moved the 400 - bed hospital 8 hours north to the Iraqi border by 112 flatbed trucks.  We got the hospital set up by the evening of Christmas Eve. It was a dismal time. Our only contact with our families was through mail. There were no phone lines established.  Internet, cell phones, emails, and Skype did not exist, only letters. How special every letter was! We lived for mail call. I wrote home every day. Letters were my only connection to my family, to home, and to the hope that one day I would see them again.

That evening word came down from the 101^st Command Center, that a large armor (tank) contingent of Iraqi Republican Guard was less than 10 miles north of us poised to attack.  At that time, we had no defensive perimeter and no armed security. That night, and into the early morning hours of Christmas Day, in the cold and pouring rain, the Engineer Battalion from the 101^st worked tirelessly setting up anti-tank barriers and digging deep trenches between us and the Guard. I quit feeling sorry for myself as I thought about what those soldiers were doing. How could I ever repay them except to insure, if and when they needed our medical help, we would be there for them? It gave me a new appreciation of sacrifice and what it looked like to be part of something much bigger than myself. My perspective on life, my family, and my priorities had changed.

  I know how hard you work, the frustrations you face, and the sacrifices you make. It is easy to lose “perspective” on what is truly important in life. Keeping a good perspective can be critical as you do the work you do. It won’t necessarily solve the problems nor remove the frustrations you face. Remembering past challenges or hardships, though, can help you view things through a different lens. Like those soldiers on the front lines working through the cold and rain that dreary Christmas Eve, I thank you for the sacrifices you make and all you do to care for our patients. You are greatly appreciated!

Andy Lamb, MD

"Bugle Notes" - A Serious Business

                                                                                                                                                                                                                                                                   

He stood silently, his eyes fixed on us, immaculately dressed in a dark 3 piece suit adorned with a gold watch and chain, hair meticulously groomed, a brightly colored bow tie centered perfectly on a freshly starched white shirt, wire collar stays in place, black wing-tip shoes glistening. Gold cuff links and military-like, sharply crease pants, with just a subtle break of the cuff on the shoe tops, completed the picture. He could have passed any inspection I went through at West Point! Then he spoke:

“Medicine is a serious business”, he said firmly. “You should never smile, joke or laugh with a patient, nor sit on a patient’s bed. At all times, you must be professional and maintain a proper distance physically and emotionally. You must not allow yourself to become emotionally affected by a patient’s condition, no matter how bad it may be, otherwise you risk losing your authority and your objectivity which could end up harming the patient.”                                                                                                          

He was my instructor in history and physical examination during my second year at University of Alabama School of Medicine in Birmingham. I was excited, as were my classmates with me, to take those first baby steps toward becoming a “real” doctor. His words burst that bubble of innocence. Speechless, we stood there, heads nodding dutifully, obediently, in unison. How could we respond otherwise and what right did we have to say anything? He was, after all, a world-renown cardiologist. We quickly understood our proper place in this intimidating new world of medicine in 1980.

I looked at him, in all his “glorious perfection” and thought, “This guy is full of crap! That’s one of the most ridiculous things I had ever heard.”  Only a few years out of West Point and having served 3 years in Germany as an Army officer, I had heard my share of “wisdom” from those above me. Most of the time I learned from it but sometimes….well, this was a sometimes. Of course, we all did exactly what he said those weeks under his omnipotent, omniscient presence. He was hard on us, too. We learned how to do a complete history and physical exam to his demanding satisfaction. We memorized every review of systems question, reciting them back to him time again. I was grateful for the high expectations he placed on us. We learned well. However, I knew that as soon as I was on my own caring for patients, I would be smiling, laughing, joking, and, heaven forbid, sitting on the side of their bed, as long as I knew it was okay with them. Being professional was not the issue.

For 30 years as an Internist, I did just that. I believe patients do not care how much you know until they know how much you care. All people have an innate need to feel loved, cared for, and treated as persons of worth and value. This is especially true than when they are most frightened, vulnerable, and dependent as during illness or injury. This forms the foundation of the “sacred trust” that is the doctor/patient relationship. This will only happen when compassion, caring, empathy, and “the warmth of love” are given and received. This is the “Art of Medicine” in its truest form. From trust springs hope. To live without hope is a terrible thing. The emotional pain of despair will soon follow. I know. I have experienced it both in the world and at the deepest level personally.

 The world needs more hope-givers. Be that person. In doing so, the joy you once had, you can have again. Medicine is “a serious business” but more importantly, it is a deeply personal, fully human endeavor. Humility, empathy, compassion, caring, and love are its fickle guardians. The busyness and business of medicine can easily blind you to this truth. We build walls and wear masks as protection from the heartbreak, the loss, the hurt, the pain that surely will come. May you take down your wall, remove your mask, and let people see who you really are, a person, a physician who cares, understands, and is completely present with them no matter the circumstances.

Yes, medicine is “a serious business” but far more than that, it is a privilege, albeit a hard one. Every day what you do is important and makes a difference in the lives of those you touch. Thank you for being that person!

Andy Lamb, MD

"Bugle Notes" - The Girl

She sat across from me, a Soviet-era wooden table between us. I was leading a medical mission to a tiny village in Moldova, the poorest country in Europe. Once part of the Soviet Union, Moldova struggled to survive as an independent country. For many, to live in Moldova, is to live with little hope of anything ever getting better. The young people are most affected by the collapse of the Soviet Union. They have little job opportunities. They cannot travel freely except to a few “approved” countries. They are prisoners in their own country. . As a Moldovan pastor once told me, “The world either has never heard of Moldova or does not care about us”.

She was unsmiling, eyes downcast, shoulders drooping. At 15 years of age, she had the striking features so typical of eastern European women. Through my interpreter, I asked the usual questions as I took her history. In a barely audible voice, never looking up at me, she spoke of having abdominal pain off and on for the past several months. Further questioning revealed no other worrisome symptoms. I reassured her, gave her some vitamins, and spoke to her about why we were there as a medical team. After praying with her, she quietly thanked me and left without another word.

Not long afterward she was back. This time complaining of chronic, recurrent headaches. I was surprised she returned but I did not give it too much thought. I addressed her concerns, reassured her, and sent her on her way. As I was seeing the next patient, I could see her standing to the side looking at me with what? – sadness, hopelessness, desperation? At first I was irritated. Had I not already seen her twice? Could she not see that I was busy and there were many other patients? She continued to stand, waiting, looking. It was then I realized there was something more going on than I had realized. This was a cry for help.

I called her over and asked if there was anything further I could do for her? She became anxious and began looking around the room as if looking for something, or someone? She brought up a new physical complaint and I reassured her. “How are things at home”, I asked? Where did she live? Did she live with her parents? Was anything going on at home she needed to talk about? My gut told me that there was something very wrong. After all, Moldova is the central hub of human trafficking in Europe. Was she trapped in that most horrible of situations?

With compassion and caring, my interpreter translated these questions. Her chin began to quiver and the tears to flow. She nodded her head yes, softly saying that her older brother was sexually abusing her and had been for over two years. They lived with their grandparents as their parents were both working out of country as is very common in Moldova. Financially, it was the only way many families could survive. The grandparents knew nothing as she was too afraid and ashamed to speak up. Her brother would beat her if she did.

My heart broke for her as I fully comprehended her situation and the fear she lived with every day. Whether human trafficking or domestic violence, the trauma, the pain, the guilt, the shame, the hopelessness are ever present. She could not return to that environment. I spoke to the local pastor and explained the situation. He would have his wife take her into their home and get her help. It would be a long road to recovery for her.

I do not know what happened to her after we left. Always there is the realization that this is too common a situation. How often do we miss the subtle cries for help because we are too busy to “hear”? We live in a hurting world. People are not always “fine” as they say when you ask them the proverbial question, “How are you”? Too often they are not fine or good or wonderful. It is easier to say so than to admit the painful reality in which they live.

 We are often allowed into the most intimate aspects of a patient’s life – the good and the bad. The sacredness of this relationship is a special privilege. How often do we miss a “cry for help”? Medicine is much more than the medical care we provide. There is also an emotional, physical, and spiritual component – caring for the whole person. To do so we must be ready to see the need in front of us, otherwise we will miss it. There is too much at stake. People are crying for our help. Are you hearing them?

Andy Lamb, MD

"Bugle Notes" - "and They Loved Me"

During the battle for Okinawa in 1945, thousands of American soldiers and hundreds of thousands of Japanese soldiers and civilians died. The fighting was desperate, horrific. In the midst of this carnage, courage and sacrifice prevailed but no more than by PFC Desmond Doss. He was a medic. Remarkably, he was a Conscientious Objector yet wanted to serve his country. He refused to carry a weapon. His faith was such that he could not take a life under any circumstance. He was beloved, though, by the men in his unit as his courage was undeniable. On one nightmarish night, following hours of ferocious combat leaving one hundred American soldiers wounded on top of a 400- foot cliff, PFC Doss’ courage  went “above and beyond the call of duty” earning him the Medal Of Honor.

While under continuous enemy fire, protected only by darkness and the returned gunfire of the wounded he was attempting to save, he lowered by rope, one soldier after another to safety. Despite being wounded as well, he kept going back saying to himself, “Just get one more, just one more”. He singlehandedly saved 75 men that night. Years later, Doss would say during an interview, “I wasn’t trying to be a hero. I was thinking about it from this standpoint – in a house fire, and a mother has a child in that house, what prompts her to go in and get that child?” “Love”, he said. “I loved my men and they loved me… I just couldn’t give them up, just like a mother couldn’t give up the child.”

Doss’ words powerfully speak to a special bond forged by shared hardships and sacrifices. Despite the horrors of war, those who survive speak of how much they miss the bond they had with their fellow soldiers. I know this bond and I believe each of you do, too. For me, it occurred with my classmates at West Point, my fellow residents in training, my physician tent mates during Operation Desert Storm, and those with whom I have served on medical missions. This unique and intimate connection makes the unbearable, bearable, the impossible, possible.

I suspect you experienced this during your medical training as well. Those years of grueling work and sacrifice were possibly the toughest of your life but the friendships formed may very well be some of the closest you have ever had. You were there for each other. You depended on each other. There was an unmistakable, unspoken bond between you. I believe the bond continues today. Every day, you serve alongside colleagues and a myriad of others – nurses, APP’s, ancillary staff – who share a common passion, providing exceptional healthcare. The passion therein is the fuel that stokes the fire from which this bond is forged and then strengthened by the demands and expectations you face.

Why write about this? Am I naive to think it important? There is no metric for it. It is not on the “scorecard”. I write because what you are doing together, whether in the inpatient or outpatient realm, is important. You are making a difference in the lives of others every day and it is still a privilege to do so. My hope is that you will “see and feel” the bond that connects each of you. It is this bond, and the one you have with your patients, that will sustain you in the years ahead. When nurtured, this bond will not break. Cherish these times, these friendships, this bond for they are reminders that you are part of something much bigger than you are. As a result, you can do even greater things!

Andy Lamb, MD

"Bugle Notes" - What Makes You Cry?

I rarely cried growing up. The time I remember most, I was twelve. I was pitching in the semifinals of the Tennessee State Dixie Youth Baseball tournament to qualify for its equivalent of the Little League World Series. In the first inning I gave up a walk and 2 hits which unfortunately included a 3 run homerun. However, the next 5 innings I pitched hitless, scoreless ball striking out 15 batters total. We lost 3-2 and I cried. I cried because we had lost and my dream of going to the World Series was gone. Mainly, though, I cried because minutes after the game ended, I got into the car with my family and we left for my father’s next Army assignment at Ft. Leavenworth, Kansas. We literally went straight from the ballfield to Kansas. I never saw my closest friends, the best baseball coach I ever had (to include in college), again. Such was my childhood.

 When I was 9 and then again at age 15, my father served in Vietnam. He saw significant combat both times. When he left I did not cry even though I knew what could happen. I was raised that “Men don’t cry” which said to me that “Boys don’t cry, either” so I didn’t or at least I did my best to not. The movies “Old Yeller”, “Shenandoah”, and the book “Where the Red Ferns Grow” didn’t help, though! I was good at hiding my tears.

It was thirty years before I learned it was okay for men to cry, for me to cry. I learned this from another man named Lloyd. We served on mission teams together for many years. I came to know him better than my own brothers. I love him as my own brother. Lloyd is a “man’s man” if there is such a thing. He was a great athlete through college, even drafted by the Montreal Expos. He was unlike any man I had known. He cried easily and unashamedly. He cried when he saw the needs and hurting of those we served during missions. He cried when he saw God at work in and through others. It wasn’t long before I cried as well.

I thought about writing this story as I was listening to classical music. The sweeping crescendo and decrescendo of the movements; the intimate softness of piano keys or string instruments exquisitely fingered speak to my heart and bring tears.  I can cry at the beauty of a sunrise or sunset over the ocean or at mountains rising above a clear, shimmering stream; of my son playing with my grandson or of long -ago memories of the same with my sons. These are the things that move me deeply.

What makes you cry, or do you? You have had reasons to do so – joy-filled moments and memories or heartbreaking events and tragedies. It has nothing to do with gender and everything to do with the condition of your heart, everything to do with your humanness. I know your hearts. They have become like “stained-glass windows”, windows that have been broken and then put back together again, stronger and more beautiful than ever for having been broken. You know this intimately. It’s the “cost” of medicine but a cost worth paying. So… what makes you cry? Better yet, why not cry?

Andy Lamb, MD

"Bugle Notes" - Grieving

                                                                  Grieving

“Grief never ends….but it changes. It’s a passage, not a place to stay. Grief is not a sign of weakness, nor a lack of faith…. It is the price of love.” – “Anonymous”

                                                                     

The “price of love” – we are now paying that price with the passing of Debbie this weekend. I grieve as I write this. The entire hospital and everyone who knew Debbie grieve. We have a right to grieve. We need to grieve. It is the price we pay for having loved her.

Despite the heartache, the pain, the loss we feel, we would not, could not have it otherwise. To not grieve, would be to deny knowing Debbie. That would have been the greatest loss of all. To not have known her heart, seen her smile, or experienced her love for others, would have been to miss “The Dance”. I would rather experience the “Dance of Life” with Debbie, and the grief that inevitably comes, than to never have known her and missed all she had to offer – and she offered so much!

To be in medicine is to know grief, pain, and heartbreak in a personal way. They have become all too real to us. With time, we eventually develop hearts like “stained glass windows”, windows that have been broken only to be put back together again, stronger and more beautiful than ever for having been broken. Debbie lived a life that made a difference, a life that counted for others. In doing so, she touched thousands of lives, each life changed in its’ own unique way. May we live such a life.

 The beloved “Mr. Rogers”, of so many childhoods, said the following:

 “I believe that appreciation is a holy thing - that when we look for what’s best in a person we happen to be with at the moment, we’re doing what God does all the time. So in loving and appreciating our neighbor, we’re participating in something sacred.”

Thank you, Debbie, for having a heart like a “stained glass window”. Thank you for showing us how to appreciate the best in others. Thank you for teaching us how to love others. It came at a heavy price, that of loving you. Our grief will never completely end but it will change and we will be changed for having gone through that passage.

Well done, Debbie, be Thou at peace. We love you.

Andy Lamb, MD

"Bugle Notes" - Nurse Appreciation Week

This week is “Nurse Appreciation Week” so I write this “Bugle Notes” to all nurses with heart-felt appreciation. As weird as it may seem, the first thing that came to my mind when I realized this was Nurses Week was my first day in my very first assignment at my very first military post only months after having graduated from the United States Military Academy at West Point in June 1977. I was a fresh new “Butter Bar” as a new Second Lieutenant is unapologetically referred to in the typical military vernacular. How all this relates to nurses will come out so bear with me!

I remember that first day as if it was yesterday. It was December 6, 1977, my wife Cathy and I had  arrived in Zweibruecken, Germany 3 days earlier. We had been married since June and I had only a few months of basic Signal Corps Officer training in Georgia under my belt. I was as naïve and nervous as you could be! My job was to be the Operations Officer for a Signal Communications Company in support of all US Army units operating in that region of Germany. I knew absolutely nothing about what that job entailed and needless to say how to do it! To really increase the anxiety level, I had 3 Non-commissioned Officers (NCO’S) working for me. I was now their “superior” officer. Each of these NCO’s had a minimum of 15 years and up to 20+ years in the Army and they knew their jobs! Even more anxiety producing was that they were all Vietnam veterans.

When one graduates from West Point it is very similar in a way to finishing medical school. In both instances you come away with a great amount of new knowledge and skills but the truth of the matter is that when it came to putting that knowledge into action in the “real world” we knew nothing, at least that is how I felt in both cases. I would bet the majority of you reading this felt the exact same way that very first day as an Intern. So, here I am, my first day as the “new Lieutenant” responsible for all the telecommunication, microwave, satellite and telephone communication operations of a 100+ person company supporting thousands of soldiers all over southwestern Germany and I know absolutely nothing, zero, zilch. However, and this is a big however, I at least knew that I knew nothing as compared to other new Lieutenants going through the same process who truly thought they knew everything and by God they were going to make sure you knew it, too! The equivalent of course in medicine is that one can start their first day as an Intern with the same approach – either recognizing you know nothing about how to really care for patients or pretending you know all there is to know. Only a fool would believe the latter but, like the Army, medicine is not immune to foolish thinking!

Being wise enough to know that I knew nothing and that these 3 NCO’s now working for me knew everything, I chose the correct approach, the humble approach, the “I know nothing will you please help me?” approach. I walked into the office where all 3 were sitting, each of them in their late 30’s to early 40’s and I just barely 22 and I said these words, “Hello, I am Lieutenant Andy Lamb, your new Operations Officer and I know absolutely nothing about what to do and how to do it. I need you to teach me all you know and I promise I will listen and learn from you. I cannot do this without your help.” From that moment, they immediately took me under their wings and taught me all I needed to know to do the job and much more. We became very close over the ensuing 18 months that I served in that position and I will always be grateful for their willingness to teach and support me. I was officially their “superior” officer, but in the eyes of most NCO’s, new Lieutenants are pretty much a pain in the rear unless they come in with the right attitude as I did. When a Lieutenant does that, those NCO’s will do everything in their power to teach, support and encourage him or her. That’s how a good NCO is and that’s why they are the “back bone” of the Army. Without them, nothing gets done and the mission fails.

Now to the whole point of this story! I grew to love those 3 senior NCO’s who cared for me and protected me. In the exact same way, I quickly grew to love the nurses during my Internal Medicine residency years, but especially those nurses whom I had the privilege to work with and learn from those first very precarious months when, again, I found myself in the position of knowing next to nothing about patient care. I will say again, only a fool would believe otherwise coming straight out of medical school. I took the exact same approach with the nurses on the floors, ICU and ED as I did those NCO’s. I needed them to tell me if I was doing something wrong or could maybe do something better. I WANTED them to tell me and I asked them to do so. How many times, especially during that first arduous year with no limitation on work hours or patient load, did a nurse save me from making a mistake and potentially harming a patient! Lovingly, patiently, compassionately, and professionally they cared for me and watched over me. They were as integral to my learning experience as any resident or attending when it came to learning what true compassionate and personal patient care looked like. I will always be grateful to those nurses. I will always remember how they cared for me on call nights when I was sick with fever and could barely stand but still had to cover the ICU. I will never forget the head ICU nurse look at me and say, “Dr. Lamb, you just go lay down in the call room here in the ICU and sleep. We will call you if we need you, promise.” And that is exactly what they did. I slept in the call room, they did not disturb me one time even though the unit had many sick patients. They took care of every patient and me as well. For this and many reasons more, I will unabashedly say, “I love nurses!” and I truly mean it. They were there for me and cared for me every time.

To all nurses who are on the “front lines” of medicine lovingly, compassionately, and competently caring for patients - you are the “back bone” of medicine and I thank you for who you are and all you do!  You are greatly appreciated, needed, and loved.

Andy Lamb, MD