January 12, 2019
Today was much better. Even though I was a little groggy and still not feeling perfect physically, I had a great night of sleep and I was mentally back in the game.
The first half of the day featured a landing on Danco Island, another amazingly beautiful spot along the Antarctic peninsula. After getting off the zodiacs, most of the group hiked a zig-zagging route up to the top of the island, creating a human highway separate from the already established penguin highways.
While in Antarctica, I learned a new term – FOMO – Fear of Missing Out. It is the desire to be everywhere and to do everything so you don’t miss anything. The irony is you may miss out on what is actually right in front of you.
I had my FOMO epiphany on Danco Island. Climbing to the top of the island was a pretty good hike, so despite the mildly cold summer day, I got pretty hot and started peeling off my layers. Part way up, I sat in the snow off to the side our our human highway and took a break. I then went a short distance more, but realized I was physically spent – not so much in an “out of shape” sense, but in the sense I still wasn’t feeling perfect and I was worn out.
So this was my FOMO moment. It wasn’t that much further to the top and I’m not one to leave a challenge on the table. I wanted to see the amazing views from the top and nearly everyone one else from the group was up there. Surely I could push myself.
Or, I could acknowledge the views I had were already amazing, I might feel worse if I pushed myself, and while nearly everyone else was at the top, there were a couple of teammates who had parked themselves near the penguin rookery further down the trail. It occurred to me, albeit not this clearly at the time, if I turned around and went back down the trail, I would miss out what was going on at the top. But if I went to the top, I would miss out on what was going on back down the trail. It was a big mental challenge for me, but I decided to turn around. It was a conscious decision to live in my moment and not worry about what other moments I might be missing. This also ties nicely to the earlier coaching I received from Pollyanna about Yes/ No, No/ Yes. By saying, “No” to going to the top of the island, I said, “Yes” to spending time at the rookery.
Here are a couple of videos. They certainly aren’t going to win me any Oscars for film production, but there’s no such thing as too many penguin videos. At around 1:15 in the first clip, there’s a good view of a penguin squawking. For the second video, skip ahead to 0:30 and turn your screen sideways.
In the afternoon, we had a session with Fabian Dattner, the founder of Homeward Bound and a science theme presentation. Again, I find myself frustrated with the quality of my notes. I’m honestly not 100% sure that these notes go with this session by Fabian, but if they weren’t from this session, I’m pretty sure they were from another session by her. The topic was about emotional response. At the top of the page is this big circle with an underlined statement and a big asterisk. Clearly this struck a cord with me (even if not grammatically correct).
But, further down the page is this gem (also not totally grammatically correct).
My mother has a saying, “Feelings are neither good nor bad, it’s what you do with them that counts.” As kids growing up, it drove us crazy every time she said it, to the point that as I hear the quote in my head now, it’s said in the voice of a teenager being nagged by her mother (though my mother is anything but a nag). I think it was so irritating because she would typically only say it when we were stuck in the unproductive state of a negative emotion like anger or frustration, when we just wanted to fester or stew. It was a challenge for us to acknowledge our emotions, but not be defined by them. I had to laugh as I found myself, some30+ years later, writing down the same sentiment like it was absolute gold.
We also had our last session of the Symposium at Sea (S@S) today and today was my turn to present. For those who may not have read my prior post, each member of the team was required to give a strictly timed 3 minute S@S. Each talk was also limited to 3 slides. These presentations were an opportunity for each of us to share our science with the group and spark conversations to generate future collaboration.
At this point, I think it’s worth taking a step back to my application and acceptance into Homeward Bound.
I knew I wanted to be a part of the program, but as I was filling out the application, I was filled with the self-doubt typical of Imposter Syndrome. I was a doctor, not a scientist. I’d never worked in a lab or done field work counting birds or whales, or chased some exotic species to a remote corner of the world. I was pretty sure I wouldn’t be of interest to the program.
And, then I got in.
Had they made a mistake? Maybe only 80 people applied. How would I hold my own with a group of scientists? Would they be disappointed in choosing me?
I will always remember our very first video conference call. Fabian asked us, by a show of hands, whether or not we thought we belonged in the program. I think only one person raised her hand. It was eye-opening to realize we all had similar feelings of self-doubt. For myself, as the year progressed, the self-doubt began to vanish.
But, when the topic of the S@S was introduced and we were instructed it was an opportunity to present our science, it was enough to rekindle those feelings of self-doubt. I didn’t have a “science” – what would I talk about? Based on responses from some others in the group, I could tell I was not alone in this feeling. Fortunately, Fabian reminded us we were all chosen for a reason, each of us had something unique to offer to the group.
So I would talk about Pediatric Surgery, but how would I distill it into 3 minutes? And to a group of women on a mission to save the world?
I went around and around in my head on the best way to do this. I could talk about the diversity of my practice – the variation in patient size from 500 grams to 70,500 grams, or the variation in surgical techniques – open versus laparoscopic, chest versus abdominal, or the variety of conditions – congenital anomalies, trauma, solid tumors, inflammatory bowel disease, chest wall anomalies, appendicitis, pediatric hernias and so on.
Ultimately, however, I realized this was not my opportunity to explain Pediatric Surgery, but rather this was my opportunity to explain why this Pediatric Surgeon was on a ship in Antarctica as a part of Homeward Bound.
For me, it’s about my patients and the precious gift of our planet. The next generation holds the promise of an untold future, they are the heirs to our legacy, and we are borrowing the planet from them. #ourkidstheirplanet
So, I started with the story of a patient I cared for this past year. He was born with a congenital anomaly called gastroschisis which is a defect in the anterior abdominal wall. In utero, the bowel is herniated through this defect and floats freely in the amniotic fluid. Following birth, the bowel is completely exposed, essentially laying in bed next to the baby. The bowel is typically quite inflamed and does not function normally for several weeks necessitating the use of intravenous nutrition.
A newborn with gastroschisis requires prompt attention for a variety of reasons. The bowel is at risk for injury, the blood supply to the bowel can become kinked compromising the viability of the intestine, and there can be significant thermal and evaporative losses from the exposed viscera.
Somewhat surprisingly, we are usually able to get all of the bowel back into the abdominal cavity with some variety of abdominal wall closure (there are a couple of different techniques). Less commonly, the bowel won’t fit back into the abdomen and we place the bowel into a plastic silo which is suspended above the patient’s abdomen. This protects the bowel, maintains the blood supply, and prevents heat and fluid loss. It also allows time for the swelling of the bowel to improve and for the abdominal wall to stretch out. Typically, the bowel is back in the abdomen by 5 – 7 days and the defect can be closed.
My patient required a silo, but unfortunately due to profound inflammation, his abdomen could not be closed in the typical fashion. His case became increasingly complicated. He required several trips to the operating room and had a very resource intensive stay in the Neonatal Intensive Care Unit which lasted for several months. Ultimately, he was discharged to home with his bowel where it needed to be, working normally.
Needless to say, I lost many hours of sleep and have more grey hair as a result of this patient. But, he also has a piece of my heart. He has an infectious laugh and his smile and personality light up the room.
Most people don’t realize “If the US health care sector were itself a country, it would rank 13th in the work for green house gas emissions, ahead of the entire UK.” (As cited by Eckelman and Sherman, PLOS One, June 2016).
So we need to do better. I need to do better. As a provider of health care for the next generation, I feel a moral imperative to address this issue. How can we talk about success and long-term patient outcomes if we are simultaneously destroying the planet we are leaving for our patients?
As I stated in one of my earlier blog posts, when building my personal strategy map, I initially chose the values of “Future generations”, “Integrity”, and “Decisiveness” for my work. However, as my journey progressed, I realized that “Future generations”, “Ambitious”, and “Courage” were more appropriate. My reason for keeping “Future generations” should be relatively clear. I chose “Ambitious” because any meaningful work to address the environmental impact of healthcare will need to be ambitious. I chose “Courage” because I will need to have the courage to show up both to myself and others. And, I will need to have the courage to ask for help. #StrongerTogether
There was a sense of relief after I was done with my S@S. Not in the way of “Thank goodness that’s over”, but more in the way of knowing there was love, respect and acceptance for the piece of my heart I shared with the group. Knowing I have the support from my Homeward Bound teammates is an incredible feeling. It is love, community, empowerment, and so much more.
When our group started the S@S sessions, a Polaroid picture was taken of each speaker and posted on a sheet with the speaker’s name and 3 key words from her talk. Somewhere about 2/3 of the way through the S@S sessions, the Polaroids stopped and were substituted by pictures drawn by Daisy Hessenberger. (I’m not sure if this happened because the camera broke or someone decided Daisy’s pictures were better.) Daisy is a geneticist currently working in conservation. She is also the member of an Improve troupe and an artist. Here is her drawing of me. I love the quote she captured. It was a fleeting comment in my talk, but is at the heart of what I do everyday.
I don’t remember the name of where we sailed that night, but it was beautiful.
Summer in the South 