America’s Weight Loss Surgery

Posted on July 31, 2011 by Robert Sewell, MD

Everyday I see obese patients who want me to help them lose weight. Many of them have struggled with their weight most of their lives and tell me they have tried everything without much success, so now they are considering surgery. When I ask them “Why now?” the answer is often “Because my weight is effecting my health and I want to be around for my kids and grand kids.” A diagnosis of diabetes or high blood pressure may have frightened them into making the decision to do something they would otherwise consider as too drastic or too dangerous.

Last week I was a guest commentator on “Fox and Friends” discussing the subject of whether or not the state should pay for weight loss surgery. http://tinyurl.com/427btks My position was that while many people get great results from surgery, in large part their weight loss depends on their personal commitment to changing their behavior. You simply can’t keep doing what you’ve been doing or you’ll keep getting what you’ve been getting. Obesity is indeed the result of an addiction to unhealthy behaviors with respect to food. Addictions always are the result of a complex set of situations, including stress, fear, desire, guilt, trauma and other psychological factors. But one thing is consistent; the last one to recognize the true nature of the problem is typically the addict himself who remains in denial.

As I reflect on the diagnosis and treatment of obesity, I’m reminded of the debate going on in Washington over the debt limit and our nation’s spending habits. The fact is our government, on both sides of the aisle, is addicted to spending money they don’t have. For decades the Congress has appropriated funds for everything from building war ships to supporting research studying invertebrate behavior, based on a belief that as the most prosperous nation in history, we can afford it. We’ll just borrow the money and pay it back later. This sounds like the overweight guy who promises himself that he’ll workout tomorrow to make-up for that great tasting ice cream sundae he just devoured. Tomorrow brings still another excuse for not exercising, but there is no reason not to enjoy yet another bowl of ice cream.

Our nation’s economic health is very much like that of a 400 pound man with diabetes and high blood pressure. How best to treat it is at the core of the debate that rages on as we try to avert the looming disaster of default, the equivalent of a national heart attack. Unfortunately the solutions being offered have failed to address our underlying addiction. Despite the political rhetoric, our government continues to spend money we don’t have (deficit spending). But in large part the debt and deficit issues aren’t just about the guys in Washington. For decades we’ve elected lawmakers, and in far too many cases repeatedly reelected them, based on their willingness to appropriate money for programs that directly or indirectly benefit us, their constituents. Every two years they cobble together campaign platforms based on promises that “We the People” want to hear, and we keep sending them back to Washington to represent us. They are indeed our national addiction enablers.

Over the last century our elected representatives have passed numerous laws and initiated programs that we now feel we can’t do without. Our government has attempted to provide welfare for the poor, food stamps, unemployment benefits, free education, free healthcare, secure retirement, clean air, a strong defense, etc., etc. Only recently, has the general population become aware of the side effects of this “spendaholic” behavior. Some have started demanding that something be done, thus the rise of the TEA Party movement. But a large segment of the population has already become totally dependent on government spending and vigorously resists any change since they will feel the pain the most. For them the solution is higher taxes on those who are not government dependents. But once there are more people taking from the government than there are paying in, the system will very predictably collapse.

Obviously, the idea of a Balanced Budget Amendment as a mechanism of forcing us to live within our means sounds great, but like bariatric surgery it simply won’t work unless we make a commitment to making a fundamental change in our collective behavior. Perhaps since amending the Constitution requires a two-thirds vote of both houses of Congress and passage by three fourths of the State legislatures, successfully completing that process will demonstrate our national willingness to address our current spending addiction.

I often tell my patients that losing weight and keeping it off is perhaps the most difficult thing they will ever do, even with bariatric surgery, because it requires a fundamental change in behaviors that are deeply ingrained within them. But if they’ll stick with the program the results can be dramatic and very rewarding. I emphasize that there’s no such thing as a quick fix. The exact same thing can be said about reducing our national debt. My fear is our current “crisis management” approach is another quick fix effort and we’ll keep getting what we’re getting unless we stop doing what we’re doing. Spending money we don’t have, regardless of how worthy and honorable our intentions, will lead us to an early demise and therefore must be averted. Its time to schedule your weight loss surgery America, are you ready to make the changes necessary to succeed?

visit www.robertsewellmd.com

Twitter – @DrBob_Southlake

Medicare 101

Posted on July 28, 2011 by Robert Sewell, MD

This is a repost from November 2010. It is presented to make everyone aware of the facts surrounding government run healthcare. Obamacare will be no different, and it should be repealed before any of us have to go through this gauntlet.

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Yesterday, November 15^th, was the first day of “Open Enrollment” for Medicare options for seniors, so I went over to my 88 year old mother’s apartment to help her get signed up. Last year she was with a Medicare Advantage Plan that was partially paid for by her former employer, Avon Products and partially by Federal subsidies to the insurance company that offered the coverage. Her policy covered all approved Medicare expenses, including Part A and Part B, as well as a prescription drug benefit, and for this she paid $20 a month; a pretty sweet deal. A couple of months ago Avon notified her they would no longer offer this comprehensive coverage, but would instead provide her with a counselor to help her decide on a replacement policy and would pay the first $1,000 of premium costs each year. My mom is still pretty sharp but asked me if I would help her decide on the best option for her. I agreed and went to the Medicare web site to research the available options. As a physician I thought I understood Medicare pretty well, but the truth is I had no idea! What a convoluted mess! There is NO WAY for the average senior to make any sense of the Medicare program.

Armed with my printouts from the Medicare web site I called the counseling service number that my mom had been given and within just a couple of minutes a pleasant young woman answered the phone. After giving her my mom’s basic information and the reason for my call she asked to speak with my mother to make sure that I was indeed representing her. My mom gave her the okay to speak to me but only after she was asked to reiterate all the same information I had just provided. I explained to the advisor (Teresa) that my mom wanted to sign-up for a Medicare supplement, commonly called a Medigap policy and she also wanted a Medicare Part D policy. It turns out there are 14 different types of Medigap coverage (A-N) each with different levels of coverage, and each is offered by one or more different companies, all with varying premiums. Teresa naturally recommended the broadest range of coverage with the highest premium. So I asked about some of the other options and after some back and forth, we finally settled on the “N” policy through AARP, which would cost about $165 a month.

We then focused on the Part D coverage and this is where things really got complicated. The policy is relatively inexpensive at $44 a month, but trying to determine what it covers and how much it pays is like solving a Rubik’s Cube. Different medicines fall into different categories, and two of my mom’s five prescription medications are in a group call “preferred generics.” Under this policy for this class of drugs she would pay $7 per prescription per month for each one. That sounded like a good deal until I asked what the actual cost of the medication would be if she purchased them herself. The answer – $4 per month each – What? Now her other three prescriptions are what are called “non-preferred generics” and for these she would pay $39 per drug per month. The actual cost of these medications is between $125 and $175 each for a month’s supply, so the coverage would be worth it assuming she stays on these medications. But now for the tricky part – the “Donut Hole.” Under Medicare Part D the coverage is effective only for the first $2,830 after which the “insured” person must pay full retail price for the next $1,720. Once the total reaches $4,550 the policy kicks back in under what is termed catastrophic coverage. Given my mom’s drug costs she would hit the Donut Hole right around the first of July, after which she would pay 100% of her drug costs until about the first of November. For the last couple of months of the year 95% of her medications would again be covered by the policy. Where people come up with such schemes is beyond me.

Doing the math in my head was more than I could accomplish so I quickly jotted down the figures. The total monthly premiums for the two supplemental policies would be $207 with the first $1,000 picked up (reimbursed) by Avon, so her out of pocket cost would be $1,484 for the year. Add in the actual amount she would pay for her drugs, approximately $2,000, plus her $20 to $50 co-pays for office and ER visits along with a $155 deductible and her Medicare Part B premium of $115 per month, her total out of pocket expenses will be right at $5,000 for 2011. This is for a government-sponsored program designed to keep seniors from depleting their life savings in their golden years. Incredible!

By this time I had been on the phone with Teresa for about 45 minutes and I told her that my mom wanted to sign-up for the two policies; one through Humana (the drug coverage) and the other through AARP. She said, “okay, great!” then asked to talk with mom again. At this point she proceeded to re-explain to my mother everything we had just gone over, right down to the specifics of every co-pay, every payment option and which of her drugs were in which category. She even asked for her to repeat all her identification and medical history information, again. Just at the point where I thought we were about finished she informed us that she could not complete the application process for the AARP Medigap policy; she would have to transfer us to an AARP representative to accomplish that last step. After another 10 minutes on hold, followed by another round of identification and past medical and insurance history questions the AARP rep actually attempted to convince my mom she needed to buy another AARP insurance product totally unrelated to her health coverage.

The final straw came when the AARP rep revealed that she could not complete the Medigap policy application over the phone, She would need to mail the application to my mom who would then need to fill it out and mail it back to their office. One hour and forty-five minutes on the phone with the ultimate result being an application that would be submitted through the mail? You have got to be kidding me!

I have presented this lengthy account of my encounter with the bureaucracy surrounding Medicare to emphasize the extraordinary complexity of the current government sponsored healthcare system. Wouldn’t it make more sense if the government just gave those people who qualify a defined benefit and allowed them to use it as they see fit. This is the spirit of a bill that will be introduced in Congress after the first of the year. It is call the “Medicare Patient Empowerment Act” and calls for the government to get out of the business of arbitrary price controls and allow patients to freely contract with the physician of their choice without losing the benefits they have paid into their entire lives. Personal freedom should trump government fiat. Isn’t that what the American Revolution was fought for?

“Be most on guard for your personal freedom when the government’s purposes are beneficient.” Thomas Jefferson

What has Happened to Healthcare in this Country?

Posted on July 14, 2011 by Robert Sewell, MD

I’m asked this question that is the title of this post both by patients and colleagues on a nearly daily basis. The answer is simple, Money. Before anyone jumps in with the old line “doctors make too much,” I want to point out that most physicians are making far less money today than they did a decade ago. This is true across the board for primary care and specialist physicians alike. Don’t believe me? Just ask your doctor. And while you’re at it, ask him or her about their relative satisfaction with their life’s work.

But we’re spending more money on healthcare than ever, right? So where does all the money go? Certainly there are many more hands in the cookie jar than ever before. Pharmaceutical companies and device manufacturers are profiting from the sale of products that didn’t even exist a few years ago. Hospitals are buying the latest multi-million dollar scanners and surgical robots just to stay competitive. Healthcare has become a massive marketplace with everyone trying to get a bigger share.

No single segment of the healthcare system has become more about the money than America’s hospitals. The era of the small community hospital, run by the town’s doctors and supported by a religious group, is over. Mega-hospital systems have swallowed them up largely in an attempt to increase their contracting leverage with third party payers and squash their competition. Many of these healthcare giants hide behind their highly cherished, tax exempt “not-for-profit” status, but make no mistake, all these systems are businesses where the bottom-line is the bottom-line. An example of the healthcare shark-tank appeared as a news story in the Texas Tribune, April 11, 2011. Community Health Systems of Tennessee was attempting a hostile takeover of Tenet Healthcare Corporation, a smaller Dallas based hospital conglomerate. If you read this article (http://tinyurl.com/6gudnec) you won’t be able to distinguish between this business battle and those that occur in the telecommunications, manufacturing or banking industries, because there isn’t any difference

But the business of healthcare isn’t like selling cell phones or offering home mortgages. It is, by its very nature, a personal service offered by individual physicians, nurses and support staff to those in need. The hospital’s role should be to provide the necessary equipment and ensure the proper environment in support of the healing arts. Unfortunately, once the profit motive has been introduced, hospital systems aren’t satisfied with that limited role. The corporate moguls pulling the strings in countless boardrooms across the country are continuously looking for ways to expand their “business.” Over time they have established a set of clear priorities that further their objectives, despite the deleterious effect they have had on the actual delivery of care.

The Three P’s – Priorities for running a successful American hospital

#1 – Payment

Obviously, it is not possible for a hospital to remain open without receiving payment for the services provided. Most payments are received from third party payers and typically are at a negotiated rate based either on the admitting diagnosis (Medicare DRG) or a discounted fee based on a set percentage of billed charges, which generally have little or no relationship to actual costs. Typically if a hospital collects 50% of their “charges” they’re doing well. The key then is to place a high priority on capturing every possible charge, thus the need for computerized management of everything from how many Tylenol tablets are dispensed, to the number of minutes spent in the operating room. So what’s the problem with that you ask? Nothing, until the pursuit of payment becomes a higher priority than the delivery of care.

#2 – Process

Once upon a time, not so long ago, hospitalized patients complained that no one answered their call light when they needed help. Today there are typically several nurses at each station all the time, but the call lights still go unanswered because the nurses are too busy filling out forms. Things that used to take a few seconds now take several minutes because there is a system-mandated “process” for everything. The argument that these processes help ensure patient safety is, in a word, laughable. In an article published in the Richmond Times-Dispatch, CMS Director Donald Berwick sited the increasing problem of hospital errors and of course proposed even more regulations and processes. What is lost in these proclamations is the fact that every patient is a unique individual and every nurse and physician as well. Trying to micromanage every component of every point of care through process implementation has become a recipe for increased errors and decline in personal service.

#3 – Protocol

In recent years we have been bombarded with catch phrases like “Best Practice Guidelines” and “Quality Healthcare Management.” These are euphemisms for “you must do things according to a standardized protocol.” Frequently, such protocols are created by some academic committee and use statistics as a lever to move reluctant, albeit experienced participants. Hospitals are encouraged to implement such protocols because third party payers increasingly demand strict adherence as one more hurdle that hospitals must negotiate to receive payment. But, not all physicians are willing to go along with this cookbook style of medicine. One very effective way to force conformity is for the hospital to simply hire the physicians. Once on the payroll, physician protocol compliance ceases to be a problem. The net effect is every hospitalized patient gets pigeonholed into what one can only hope is an appropriate protocol. The most alarming aspect of protocol implementation is the absence of critical thinking on the part of healthcare professionals. Everyone is encouraged to “just do everything by the book.” Administrators quickly add that following the protocol is of course completely defensible in a court of law. Not that that ever enters the discussion.

What is interesting is the spin that is constantly being put on all this. Like any business, hospital systems recognize the need to maintain an image in the communities they serve. So, in the last decade we’ve witnessed a barrage of public advertising, promoting healthcare expertise and compassionate care by hospitals. But wait, does the “hospital” actually provide care? No, not really. It is the physicians and nurses that provide the actual care. This is why when patients have a positive experience they invariably attribute it to a specific nurse or physician, or in some cases a team of people who exhibited personal care and compassion. But when they have a bad experience it is common to hear patients talk about the poor care they received at a particular hospital. The lesson then is: Person-to-Person Care – Good; Impersonal, Institutional Care – Bad. This is clearly an over generalization, but the trend is definitely there and growing.

A major hospital system here in Texas recently launched an ad campaign with the tag line being “Making Healthcare Human Again.” The logical implication is that somewhere along the line healthcare became non-human, or perhaps more grammatically correct, inhumane. This is not a very pleasant thought for anyone entering through the doors of an institution where they have little control and are compelled to trust completely. But, until the public demands that the insurance industry, hospital conglomerates and the Federal government cease their efforts to practice medicine through hyper-regulated Payments, Processses and Protocols, the American healthcare system is likely to continue to deteriorate.

Exceptionalism Revisited

Posted on July 8, 2011 by Robert Sewell, MD

Today marks the 6 month anniversary of the Tucson massacre when the actions of a madman on January 8, 2011 scarred our nation in many ways. It is amazing how one individual could directly impact the lives of so many and at the same time effect our political discourse in such a vile and malignant way. The days following the tragedy should have been filled with somber mourning and peaceful reflection, but instead were marked by vicious attacks and counterattacks by those who seem to have hatred as a guiding political principle. Even the President’s call for civility was not heeded by those hell-bent on making outrageous accusations. This was a sad time for America.

On the other hand, as a surgeon I watched the events unfold on television and I was struck by how efficiently the emergency medical system responded to this major disaster. This was not some pre-rehearsed disaster drill, this was the real thing! On just another lazy Saturday morning I’m certain the emergency department at the University of Arizona Medical Center was in the process of seeing a few minor injuries, a couple of children with fever, and perhaps an elderly gentleman with chest pain. Suddenly, they were in the middle of what must have felt like a war zone. Helicopters and ambulances were arriving one after the other with critically injured patients, including Congresswoman Gabriel Giffords. To describe such a scene as chaotic would be an understatement.

It’s truly remarkable how a civilian hospital and the personnel who work there were capable of shifting gears, becoming a major disaster management center in just a matter of minutes as 10 separate gunshot victims arrived at the University Medical Center, and all but one of them survived. The lone exception was nine-year-old Christina Green who had been shot in the chest. Regrettably, nothing could be done to reverse the mortal wound she suffered. The others were quickly and expertly transported into operating rooms where life-saving care was administered. Now, six months later, Gabrielle Giffords continues to undergo rehabilitation therapy, with her survival and recovery nothing short of miraculous.

Over the last three and a half decades I’ve spent countless hours in hospital emergency departments caring for a variety of sick and injured patients, including victims of trauma, and I can assure you that the split-second actions of the trauma team in Tucson did not occur by accident. Similar teams across the nation regularly train for such events and stand ready to deal with them whenever and wherever they occur. So, if there is one thing positive to come out of the tragedy in Tucson, it is the realization that physicians, nurses and various support personnel stand ready and are capable of dealing with even the most horrific acts of human violence or natural disaster. The results may not always be perfect, in fact sometimes an injury or illness is simply irreversible, but with God’s help the tireless efforts of dedicated individuals can, and often do, produce phenomenal results.

One final point: Over the last several years during national discussions regarding healthcare in the United States, advocates for change have consistently used various statistics to suggest that we have poorer quality care at a higher price than elsewhere in the world. Personally I reject that notion and would point directly to the events of January 8, 2011, in Tucson, Arizona as proof of the exceptional standards of American medicine.

www.robertsewellmd.com

Its Time for a Second Declaration of Independence

Posted on July 4, 2011 by Robert Sewell, MD

On this date, 235 years ago a small group of brave souls stood up to what was at the time the most powerful nation on earth and declared their independence from the tyranny of the British crown. The Sugar Act of 1764, the Stamp Act of 1765, and the Declaratory Act of 1766 (Collectively known as the Townsend Acts) along with the Quartering Act of 1765 and ultimately the Tea Act of 1773 lead to the uprising of the colonies and ultimately the American Revolution. Today we are faced with a tyranny of a different sort, which is likewise unacceptable. The Patient Protection and Affordable Care Act of 2010 (Obamacare) represents a significant overreach by our own government and all freedom loving Americans should vigorously oppose it.

I am privileged to represent the American Society of General Surgeons both in the American Medical Association and in the Coalition of State Medical and National Specialty Societies; a rather loose consortium of conservative organizations within the AMA. Following the recent annual meeting of the AMA House of Delegates in Chicago we were frustrated by the fact that the House reaffirmed existing AMA policy supporting a government requirement that every American purchase health insurance, the so-called individual mandate. Our Coalition actively opposed that policy, and we came away from that meeting without a clear understanding of what our next move should be. Various e-mail threads since then have failed to define a coherent strategy. One such series of communications was titled “What is the Battle Plan?” While some would prefer the term Game Plan, either way it is clear that we’re talking about a critical contest.

As I ponder the question it seems clear to me that before any competition one must determine what is the object of the battle, or game. The problems that exist within the healthcare system are myriad, but central to every argument, or battle if you will, is one question; is healthcare a basic human right and therefore the responsibility of government to provide for its citizens, or is it a benefit that has been developed by a civilized society and should be available to those who exercise individual responsibility to obtain it. Not surprisingly this question is quite polarizing, both for healthcare professionals (notice I didn’t use the phrase “providers”) and for the public as a whole. This is obviously a complicated issue for which there is no simple answer. The real answer likely falls somewhere between the two extremes but depends largely on whom you ask.

Both sides often spout extreme statements, but I think we can all agree that the American healthcare system is not the worst in the world. It is however the most expensive, at least if one considers the overall gross cost, and this fact is the reason behind the impassioned pleas for reform. Part of the reason our system is so expensive is because there are so many hands in the cookie jar. Insurance companies make significant profits off their health insurance products. If they didn’t they would not offer them. They are in business to make a profit, but often those profits are more or less guaranteed by government regulatory agencies, appointed by our system of elected officials. These same companies are often major campaign contributors and they maintain powerful lobbies in every state house and in Washington, DC. The same can be said of the major pharmaceutical companies and even the American Hospital Association. For years these and other special interest groups have invested heavily in obtaining power within the ranks of government and they have been very successful. In fact, it was these very groups that essentially authored the more than 2,000 page healthcare reform act that passed the Congress last year. Not surprisingly the members of Congress had not even read the bill as the Speaker readily admitted. Addressing the House, Mrs. Pelosi said, “We have to pass the bill so that you can find out what is in it, away from the fog of the controversy.”

It should be noted that the AMA was only peripherally involved in the process of producing this Federal healthcare reform. Its leaders were relegated to the role of commentators, not authors of what is now the law. During the debate they seemed content to be at the table, but failed to recognize that they were indeed the main course. While the AMA leaders openly supported some elements of the bill they objected to others and told their members that they would “fix” those items when the bill came to conference committee. But aggressive politicians who recognized their opportunity (“If not now, when?”), worked in concert with the media, using AMA sound bites supporting the bill along with a last minute parliamentary maneuver, to push the Senate version of bill through to the President’s desk without any further opportunities for modification.

Whether you agree with the concept of universal health insurance or not, (again note I didn’t say universal healthcare because they are clearly not one and the same) the question remains whether it is the role of the government to command it. This argument has been going on for at least a century, but it wasn’t until those who favor such a centralized system were successful in capturing both houses of Congress and the White House in 2008 that they were able to push it over the line despite the objections of not only the majority of American physicians but the public as a whole.

Our patronizing lawmakers have since told America’s physicians and the American people that this Congress and this President know what is best for us and that we’ll like this new system once we get used to the idea. That reminds me of a statement made during a campaign by a gubernatorial candidate in Texas a few years back. He offered this advice to any woman being raped. “As long as it’s inevitable, you might as well lay back and enjoy it.” Well, obviously he lost the election and based on the results of the most recent midterm elections, a clear majority of Americans have not yet learned to “enjoy it” and would prefer to fight back. Many of my fellow physicians would gladly join in that fight. So to my colleagues I would offer the following outline as a guide for our efforts.

What is the objective of this fight? Repeal the entire law that we unaffectionately call Obamacare, and start over to create a patient centered system that encourages personal responsibility and rewards individuals for good health practices rather than punishing those who refuse to submit to government mandates. To accomplish this we must first reorganize practicing physicians who have been disenfranchised by the AMA. It seems highly unlikely that we will be able to use the AMA to accomplish this task, at least in the near term because the vast majority of our colleagues are no longer members and are not inclined to return. (Once burned, twice shy).

What is the Battle Plan? Our Coalition must accept the mantle of responsibility to represent practicing physicians and work with other similarly minded groups to save our beloved profession. The battle starts with winning the hearts and minds of our fellow physicians. Our message should be that the future of healthcare relies on the individual physician’s moral compass and professional ethics and responsibility, not arbitrary controls mandated by any third party, including the Federal government. If we provide clear leadership for those who have lost faith in their representative organizations we will be able to effectively call up the vast militia of practicing physicians to join the fight. They will then be able to marshal the support of their patients who intuitively trust their doctors and want them to lead the way.

What is our first engagement? Our primary obstacle to achieving our objective of repealing Obamacare is the current uncompromising administration in Washington. Therefore, our first mission must be to help the American public change the current regime. Unlike the Patriots in Philadelphia in the summer of 1776, we can accomplish this change at the polls, but it will not be easy. Between now and November 6, 2012 we must work tirelessly to turn the political tables on those who believe they know what is best for us and all our fellow citizens. There is a true urgency to get to work immediately as the elections are just over a year away, so our battle cry in this effort should include that now famous phrase “if not now, when?”

As Eleanor Roosevelt once said, “With freedom comes responsibility.” The corollary to that statement is equally true – only by exercising responsibility do we truly deserve freedom. It is clear our freedoms are like a handful of sand. You don’t lose them all at once; rather they slip through your fingers one grain at a time until one day you wake-up and realize they are gone. Only through our collective actions can we alter the future of this nation’s healthcare and individual freedom for our posterity.

http://www.robertsewellmd.com

We are all Chicken Little Sometimes

Posted on July 2, 2011 by Robert Sewell, MD

Last night I flew from DFW to Chicago to visit my surrogate son. He had just undergone a highly specialized surgery to revise the above the elbow amputation of his left arm. Four years ago, at age 20, Chase was working as a firefighter and suffered a major burn ultimately leading to the loss of his left arm and right leg. Yesterday’s procedure was a complex nerve to muscle transfer performed by Dr. Greg Dumanian at Northwestern University hospital and it promises to greatly enhance Chase’s functional capabilities in the coming years. (See video here http://tinyurl.com/3mu9gzf)

After landing at Ohare I took a taxi to the hospital downtown. The driver was a pleasant young man, about 35 years old, of Bahamian origin. As we got on the freeway headed southeast we were met by one of the most vivid displays of cloud to ground lightning I’ve ever seen, and living in Texas I have seen more than my share of supercell thunderstorms. As we grew nearer to the city, a few large, random raindrops began to fall on the windshield, but in the distance I could see what appeared to be a dark gray curtain across the road. Soon the raindrops began to increase in frequency and were now accompanied by a few pea-size objects, which made a distinctly different sound as they struck the roof of the minivan.

If you have ever been in a hailstorm you know they can be pretty scary. I recall a few years back a major line of thunderstorms rolled through Fort Worth, Texas during a Mayfest outdoor gathering. It pummeled the crowd, their vehicles and the vendor’s tents with softball-size meteors, which had everyone literally running for their lives. The pictures on television the next day showed destroyed trees and smashed car windows, and looked like a scene from the movie “Armageddon.”

Last night, as the hail fell with increasing frequency on my taxi, I could see the stones had grown to about golf ball size as they collected on the street. Having been through similar events several times I wasn’t really concerned for my personal safety, but the same couldn’t be said of my cab driver. As the sound of the icy bombardment grew to a deafening roar the only thing I could hear over it was the wailing of the cabbie. “Oh God save me! Oh Jesus have mercy!” he shouted over and over. He was obviously convinced this was the end of the world, because to him the sky really was falling. When later I discovered he’d never before seen hail, I understood why he was so frightened.

When confronted with something frightening that we’ve never encountered before, each of us can potentially be overtaken by “the sky is falling” syndrome. As a surgeon I see this frequently when patients are preparing to undergo surgery for the first time; sometimes even when it’s their second, third or even tenth procedure. Typically what I hear is “It isn’t the surgery I’m worried about doc, it’s the anesthesia.” But obviously the real issue is their loss of control. That loss of control is the principle force behind our reactions, whether as “backseat drivers,” a “fear of flying” or the paralyzing anxiety before undergoing surgery. It can occur any time we are compelled to put our trust in someone else to bring us through what we perceive to be a life and death situation.

While it may sound trite or old fashion to some, I’m convinced the only way to cope with life’s uncertainties is to put your trust in God. Over the years I have had countless patients tell me just before their surgery, “My life is in your hands,” and then they quickly add, “yours and God’s.” My response is always to emphasize to them that God is the one in charge and he works through all of us. I know this is true based on a lifetime of experiences, both as a surgeon and as a father.

Last weekend I had occasion to share with a new friend the story of how Chase and our youngest son Ryan were both literally on death’s door at the same time four years ago. The same day that Chase sustained his 56% total body burn, 16 year old Ryan was on a ventilator fighting for his life against the rare Hanta Virus Pulmonary Syndrome, which carries a 50% mortality risk. As I was describing the helplessness of both situations my friend chimed in with, “I don’t know how anyone can possibly deal with the major stresses of life without faith in God.” I agreed, and was reminded of that statement again yesterday when I heard the cab driver crying out for divine intervention when confronted with a situation that was out of his control. Then again today, watching Chase recover from still another in a seemingly never-ending series of operations, I realized he would not be here were it not for the power of prayer and the grace of God.

As you may know, this blog is typically filled with many of my personal frustrations, anxieties and yes even fears about the declining state of healthcare in America. But, on this occasion I wanted to inject a ray of hope into the discussion rather than more dismay. As we celebrate our nation’s birthday this weekend let’s remember the motto that made her “that shining city on a hill,” In God We Trust. The next time you feel like Chicken Little because you realize that you are not in control, which is pretty much everyday for me, don’t run around in a panic crying “the sky is falling.” Simply understand that God is there to protect all those who call on him. My wife and I were particularly comforted during those hours of extreme fear four years ago by God’s message, which is stated very clearly in the book of Isaiah, Chapter 43, Verses 2-3: “When you go through deep waters and great trouble, I will be with you. When you go through rivers of difficulty, you will not drown! When you walk through the fire of oppression, you will not be burned up; the flames will not consume you. For I am the Lord your God, the Holy One of Israel, your Savior.”