Much more than perfect, plus quam perfect. DREAMS REALLY DO COME TRUE

If you'd gone your way 
And I'd gone mine 
We wouldn't be standing 
Where we are tonight 

The room is silent 
All eyes on me and you 
I guess it happens 
Dreams really do come true 

Be my shelter 
Be the one 
Be the witness to all that I become 
We'll have our moments 
There'll be hard times 
But I'll forgive your sins if you forgive me mine 

All the good in my life 
Everything that is right 
Now I know where life is taking us 
This love has brought us so far 
Don't ever change who you are 
Never think that you're not good enough 
You're more than perfect for the both of us 

Let's write the pages 
Build a home 
From this day forward 
You will never be alone 

When we're dancing 
Barefoot in the hall 
If you should stumble 
I will not let you fall 

All the good in my life 
Everything that is right 
Now I know where life is taking us 
This love has brought us so far 
Don't ever change who you are 
Never think that you're not good enough 
You're more than perfect for the both of us 

This world is forgiving 
And I give myself to you 

All the good in my life 
Everything that is right 
Now I know where life is taking us 
This love has brought us so far 
Don't ever change who you are 
Never think that you're not good enough 

No one of us ever will be close enough 
You're more than perfect for the both of us

The Color (Sibghah) of Allah (SWT)

The Color (Sibghah) of Allah (SWT)

"Our Sibghah is the Sibghah of Allah and which Sibghah can be better than Allah's? And we are His worshippers" (Surah Baqarah v. 138)

Have you seen shopkeepers in Pakistan dieing ladies scarves in various colors? The scarf containing original colors comes out with the color of the die. So what is the sibghah (color) of Allah? It is tawheed (Islamic monotheism)! The similitude of a non-Muslim entering Islam is like dieing his multicolored mind and heart with principles of tawheed.

Islamic theology is an integrated whole in which different parts interact with each other. One principle reinforces the other to give an holistic perspective of life. This reinforced version of Islamic philosophy provides a Mumin with the wisdom to understand different things from one perspective (Reality). When someone submits to Allah, one is bound to enter the deen completely. All fabric of his thought must be dyed with the Sibghah of Allah. No thread can be left untouched. He is not supposed to keep a multi-patched outlook to life. Islam should penetrate all aspects of his life; be it personal, family, community, national, international, economic, educational, etc. Influences from other philosophies which contradict reality has no place in his perspective.

For many of us, our commitment to Islam is motivated by social conformity, rather than conformity to its principles. A lot of us have spent a lifetime in studying some branch of knowledge for our professional development. How much time have we invested in studying & implementing the Sibghah of Allah in our lives? Is it not then surprising then to find individuals who emphasize one aspect of the religion which ignoring other aspects?

Unfortunately, these days the principles of materialism affect most of us. We compete with each other in wealth & status and use religion as a tool in this race. Let us change our situation and re-enter the die of Allah (SWT) by being His true worshipers in all aspects of His religion.

http://oak-gis.blogspot.com

AMOR FATI

Amor fati is a Latin phrase loosely translating to "love of fate" or "love of one's fate". It is used to describe an attitude in which one sees everything that happens in one's life, including suffering and loss, as good. Moreover, it is characterized by an acceptance of the events or situations that occur in one's life.
The phrase has been linked to the writings of Marcus Aurelius, who did not himself use the words (he wrote in Greek, not Latin).[1]
The phrase is used repeatedly in Friedrich Nietzsche's writings and is representative of the general outlook on life he articulates in section 276 of The Gay Science, which reads:
I want to learn more and more to see as beautiful what is necessary in things; then I shall be one of those who make things beautiful. Amor fati: let that be my love henceforth! I do not want to wage war against what is ugly. I do not want to accuse; I do not even want to accuse those who accuse. Looking away shall be my only negation. And all in all and on the whole: some day I wish to be only a Yes-sayer.
Quotation from "Why I Am So Clever" in Ecce Homo, section 10:[2]
My formula for greatness in a human being is amor fati: that one wants nothing to be different, not forward, not backward, not in all eternity. Not merely bear what is necessary, still less conceal it—all idealism is mendaciousness in the face of what is necessary—but love it.

Protocols alone cannot keep patients safe, we need a culture (of safety)

Emergency General Surgery (R2) - VUMC

EGS Service OverviewThe Emergency General Surgery (EGS) service is comprised of faculty in the Department of Surgery, residents at the PGY-5, PGY-2, and PGY-1 levels, as well as dedicated Nurse Practitioners. The EGS service evaluates nearly 1,200 patients each year, and serves as the primary consult service for acute general surgical diseases from within Vanderbilt University Medical Center as well as surrounding communities. The primary mission of the EGS service is to provide timely surgical assessment and operative management of the patient with an acute general surgical problem.

Core competencies as defined by the ACGME form the basis of resident evaluations.

1) Patient Care

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

For PGY-2 residents on the EGS service, this will largely take place in the context of perioperative care with the support and guidance of chief residents and faculty. The PGY-2 resident functions as the main consult resident for the service. The PGY-2 should also continue learning to interpret imaging studies such as plain radiographs, ultrasound, and CT scan of the abdomen. Morning report provides a forum to discuss new patients and review imaging studies with faculty and other residents. Operative skills are further developed during the PGY-2 year with increasing participation in a variety of operations as detailed below.

2) Medical Knowledge

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.

The Surgical Council on Resident Education (SCORE) has defined an excellent curriculum for the traditional 5 year General Surgery training program. This has been further grouped to aid in sequencing the material by PGY year. For the PGY-2 year grouping, diseases and conditions which may be encountered on the EGS rotation include:

• Choledocholithiasis • Biliary Pancreatitis • Acalculous Cholecystitis and Biliary Dyskinesia • Iatrogenic Bile Duct Injury • Small Bowel Obstruction and Ileus • Acute Mesenteric Ischemia: Arterial, Venous, and Nonocclusive • Lower Gastrointestinal Bleeding • Diverticular Bleeding • Diverticular Fistulae • Colonic Polyps • Colonic Cancer • Gallstone Ileus • Gallbladder Polyps • Mesenteric Cyst • Miscellaneous Hernias • Hepatic Abscess • Mallory-Weiss Syndrome • Peptic Ulcer Disease with Bleeding • Peptic Ulcer Disease with Perforation • Peptic Ulcer Disease with Obstruction

• Gastric Ulcer • Stress Gastritis • Volvulus • Appendiceal Neoplasms • Antibiotic-Induced Colitis • Meckel's Diverticulum • Intussusception • Malrotation • Pneumatosis • Addisonian Crisis • Incidental Ovarian Mass-Cyst • Cervical Lymphadenopathy • Necrotizing Fasciitis • Gastrointestinal Failure • Hepatic Failure • Renal Failure • Coagulopathy • Neurologic Dysfunction • Endocrine Dysfunction

One of the most effective ways to retain knowledge while at the same time improving the care of your surgical patients is to read about the diseases and conditions faced by patients as you encounter them.

3) Practice-based Learning and Improvement

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.

A good technique to achieve this objective is to review evidence-based guidelines (e.g. Cochrane Reviews: http://www2.cochrane.org/reviews/ ), as well as critical reading of relevant articles in the surgical literature. Self-evaluation as it relates to patient care is best performed in real-time by seeking feedback and discussion from senior residents and faculty. (i.e. What could I have done differently?)

4) Interpersonal and Communication Skills

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.

Residents are expected to conduct themselves in a courteous and professional manner when interacting with patients, families and nursing staff. Good communication is critical to patient care, particularly in the emergency setting. Examples of specific elements which are of value throughout surgical training and practice include:

• Discussion of risk/benefit/nature of the operation with patients and families in the setting of informed consent.

• Communication with the surgical team. While a “Time-out” is performed before every invasive procedure or operation, the communication ideally begins much sooner (i.e. with anesthesia re: anticipated need for antibiotics, blood products, etc, with scrub/circulating nurses regarding nature of the operation, needed equipment/suture etc).

• Transition of patient care, i.e. “sign out”

• Communication with consultants and nursing staff

• End-of-life discussions

5) Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

(a) compassion, integrity, and respect for others

(b) responsiveness to patient needs that supersedes self-interest

(c) respect for patient privacy and autonomy;

(d) accountability to patients, society and the profession; and,

(e) sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

(f) high standards of ethical behavior, and

(g) a commitment to continuity of patient care

6) Systems-based Practice

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

7) Technical Skills

PGY-2 residents will learn essential clinical skills in the evaluation and treatment of EGS patients. Time spent in the operating room in a critical part of training, regardless of whether or not one is “doing” the operation. During the PGY-2 year, you will function as the operating surgeon for many cases. In some cases, the Chief Resident may function as a teaching assistant with faculty supervision. PGY-2 residents should also strive to participate in “Chief Cases” (i.e. sick, complicated patient in which the Chief Resident functions as the operating surgeon with the faculty member assisting.)

Operations/Procedures included in the SCORE curriculum likely to be encountered by the EGS PGY-2 include:

Diagnostic Laparoscopy Exploratory Laparotomy Open drainage of abdominal abscess Incarcerated or strangulated hernias Open and laparoscopic cholecystectomy Open and laparoscopic appendectomy Laparoscopic CBD exploration Partial and subtotal colectomy Muscle and lymph node biopsies Debridement for necrotizing infections

Pancreatic debridement Pseudocyst drainage procedures Open and percutaneous tracheostomy Open, laparoscopic and percutaneous gastrostomy Repair of duodenal perforation Partial gastrectomy Enterolysis Enterectomy Ileostomy Colostomy

 

8) Education

Sign out and communication the most important parts of an EGS day, the morning report system allows for patient sign-out, case assignment, debate, and time for instruction. are critical with restricted work hours to ensure appropriate continuity of care. In order to provide additional educational benefit, it is expected that all members of the team be prepared to discuss patients, physiology, and surgical options, appropriate to his/her level of experience. 

source: vanderbit

experienced vs inexperienced

-Keep an eye out for data that conflicts with schema, or which indicate plan isn’t working

This is the sign of an experienced provider, inexperienced people are so happy they came up with a plan that they tend to fixate on it, and don’t accept new data that says their plan is wrong. That’s why new officers and residents need to be watched like hawks. They will tend to push a plan through, even though new data is indicating the plan is not working. It’s not just experience, but ego. Experienced leaders know that things go wrong, and you have to adapt. Inexperienced leaders think changing the plan is an insult to their ego (which is fragile as a new leader anyway) and try to  make reality adjust to the plan, not adjust the plan to reflect reality.

New awareness

The challenge is to keep our eyes, ears and hearts open and tuned in to the incredible interactions that we encounter daily.

Did you ever have the feeling that each day was just like the one preceding it and that tomorrow will be little different? Although our days are characterized by singular events involving patients, procedures, meetings, conferences, rounds and so on, they can blend together without our ability to appreciate the variety that can lead to excitement and creativity. Perhaps this repetition (the “Ground Hog Day” phenomenon) is the ultimate reason why we need vacations to break the “sameness” that may be the basis for the stress in our lives.

In thinking about the repetitiveness of this cycle, it occurs to me that we should be challenged to ask ourselves three vital questions at the end of each day. For years I frequently challenged the medical students and surgical residents to make sure they asked themselves the question, “What new piece of information did I learn today?” Although factual knowledge about disease processes is important, perhaps this question is of secondary importance and ultimately nonsustaining. So what are the real questions?

Question 1—for reflection at the end of the day should be “What surprised me today?” When I awakened this morning, what event or experience was I not anticipating? Obviously for surgeons, the surprise may take the form of unanticipated pathology in the operating room or the unexpected challenge of a patient’s diagnosis.

The real essence of Question 1, however, is to gauge the effect of any unexpected interaction with another person, either positive or negative. Did the comment of a patient or colleague elate or disappoint us and, if so, did we incite the surprise comment or action? If we were surprised during the day, did we react appropriately and in a manner that would make us proud should we encounter the same event tomorrow, next week or next year? There are many events that are not anticipated throughout the day. Perhaps we are too distracted to remember these isolated events, but reflection at day’s end will be rewarding.

Question 2—“What moved or touched me today?” As physicians, we have great opportunities to interact in activities that are both heartwarming and heartrending. How did we feel when we talked to our patient about the maximally invasive operation that he was going to experience? Did we understand the emotion and life-changing experience of the mother with two small children when we introduced her to her breast cancer diagnosis? Did we appreciate the struggle and pain experienced by the postoperative patients who passed us in the inpatient unit as we made rounds?

Novellas could be written about the experiences and interactions that we fail to appreciate each day. The challenge is to keep our eyes, ears and hearts open and tuned in to the incredible interactions that we encounter daily. Here, some note taking at day’s end would be advantageous since even the most poignant encounters or life-changing experiences may become lost if not chronicled. At the end of a full day, we may have difficulty discerning those fleeting moments that really enhanced our day. The very act of keeping a journal and giving answers to these first two questions will give future pleasure, insight and solace as we peruse our notes and reflect on these experiences at a later date. It might be a revelation to relive those events that moved us and perhaps changed us as a human being.

That brings us to Question 3—“What inspired me today?” What did I witness that made me really appreciate my choice of a career or push me to develop a new thought, activity or even different life direction? This is really the ultimate question. This is really why I want to get up in the morning and have the desire to repeat the exercise tomorrow, next week and in years to come. Was I inspired by my work in the OR? Was I inspired by my rounds with students and residents? Was I inspired by the Grand Rounds presentation or discussion at Morbidity and Mortality Conference, and did these discussions challenge me or create a new awareness?

Yes, each day can feel repetitive and unrewarding unless we make the effort to appreciate and chronicle those special moments, thoughts and encounters. We live in a rich and complex work environment and we should make the most of it. At the end of the day, ask yourself these three questions. You will be surprised to hear the rich and rewarding answers that are forthcoming.