Being Best At Who We Are

A recent editorial in the Philadelphia Inquirer by Chris Satullo (Aug 19, 2007) caught my eye. He discusses the myriad manners in which one’s pluck and one’s luck interact to result in one’s life story. I was struck how much of my own bio is luck in the context of some pluck. But thinking about it more, perhaps whatever pluck I have applied to my life is really luck….the happenstance of genes, role models, training, NIH study section assignments of my grants, and parenting.

So here I am a professor of anesthesiology at a major medical center, the culmination of a series of unlikely events, starting from the improbability of conception and survival of birth-related asphyxia. Then one summer day Mike Ruscher, in 1967 on his skateboard on the street in front of 115 Windsor Drive, suggests we volunteer as junior ambulance attendants at the local ambulance service. What a cool idea, sure lets do it! This leads by a circuitous path to medical school and then an interest in cardiac arrest associated brain ischemia and acute care medicine. This then leads to a variety of interactions with many other basically randomly encountered life influencing people and experiences and here I am!! If I had not met my health teacher Ted Kondrad in junior high, my buddy Mike Ruscher, Harold Heine in college chemistry, Peter Safar in med school, and numerous others, undoubtedly everything would have worked out differently. Probably much differently. Sometimes I look at my tattooed drug addled Viet   Nam vet biker patients and think how easily that could have been me….just one or two more C’s in college and my lottery number of 92 would have been enough.

If I had not run into Mitch Keamy I would not be writing in this blog.
One can only speculate about the many random events that resulted in him being in the MGH GRACU as an ICU fellow that July of ’82 when I first laid eyes on him.

     Moreover, I often think about the impact of numerous more or less random events on my patients. A patient being sick at just the right or wrong time, albeit in the same institution, interfaces with myriad different combinations of caregivers with varying skills and problems that affect outcomes. So, because I happen to be in an ICU room one morning at 4 AM doing ECMO in a child with chickenpox pneumonia when a nearby  newly trached patient gets trach tube dislodgement, mediastinal emphysema rapidly progressing to massive neck emphysema with extrinsic airway closure; I am able to rapidly intervene to intubate from above while the aghast resident watches his succumbing patient get her life saved by the attending in-house only because of the ECMO. What luck!

         So as we contemplate our goals it seems helpful to keep them in perspective and not get too wound up when things don’t go exactly according to script. Maybe all we can do is use whatever pluck we are lucky enough to possess and use that to optimize probability of a desired outcome. Random events and interactions have an enormous impact on our lives and on history.

Almost seems like Brownian motion.

Comments

[mkeamy]

ahhh, ECMO. We had a couple of spectacular saves; it all seemed so much more complicated then-was it because we were young?

great post.