There is a GREAT marriage and relationship book titled: Love and
Respect. The premise of this book is simply: “…each individual
among you also is to love his own wife even as himself, and the wife
must see to it that she respects her husband.”-Ephesians 5:33

It is very interesting that the author of this letter, Paul, doesn’t
ask the wife to ‘love’ the husband. Men, in general, feel loved by
being respected. We all want to be loved. We all want to hear the
words: ‘I love you.’ But men in particular need to hear that they are
valued. Most men would prefer to hear the words: ‘You are my hero.’
Strange as this may seem, I have seen this truth played out in my own
life and in the lives of the vast majority of men.

It is important for ALL of us to feel valued, to be respected. It is
important to treat each other and our patients with R.E.S.P.E.C.T.

“Step 1. I analyzed the situation fearlessly and honestly and figured out what was the worst that could possibly happen as a result of this failure.”

“Step 2. After figuring out what was the worst that could possibly happen, I reconciled myself to accepting it, if necessary…After discovering the worst that could possibly happen and reconciling myself to accepting it, if necessary, an extremely important thing happened: I immediately relaxed and felt a sense of peace that I hadn’t experienced in days. ”

“Step 3. From that time on, I calmly devoted my time and energy to trying to improve upon the worst which I had already accepted mentally.”
“I probably would never have been able to do this if I had kept on worrying, because one of the worst features about worrying is that it destroys our ability to concentrate. When we worry, our minds jump here and there and everywhere, and we lose all power of decision. However, when we force ourselves to face the worst and accept it mentally, we then eliminate all those vague imaginings and put ourselves in a position in which we are able to concentrate on our problem.”

“The same idea was expressed by Lin Yutang in his widely read book, The Importance of Living. “True peace of mind,” said this Chinese philosopher, “comes from accepting the worst. Psychologically, I think, it means a release of energy.” That’s it, exactly! Psychologically, it means a new release of energy! When we have accepted the worst, we have nothing more to lose. And that automatically means we have everything to gain!”

“If you have a worry problem, apply the magic formula of Willis H. Carrier by doing these three things: 1. Ask yourself,’ ‘What is the worst that can possibly happen?” 2. Prepare to accept it if you have to. 3. Then calmly proceed to improve on the worst.”

[Ann Emerg Med. 2010;55:125-126.]

“I have a confession to make.”

This is my favorite part of the history. It’s also the part I understand the least. It typically occurs after I’ve asked questions I wouldn’t ask my mother. After I’ve inquired about the medical history, perused her potential illicit drug use, plumbed the depths of the sexual history, examined all the parts the patient wouldn’t show strangers on the beach or even a spouse in the bedroom. This is the part where I find out the secret nugget of information in whose context everything that has happened up to this point needs to be placed. This is where it will all fall into place and make sense. It’s the moment when I believe the patient knows I want to help and is showing some trust. I don’t understand it because the confession so often seems less intimate, less personal, less critical than everything else I’ve said, heard, and done in the room. But it’s my favorite part, because it has a sense of sanctity to it, a mark of the physician-patient covenant. It doesn’t happen every time, but I like it when it does.

I sit back down on the lid of a trashcan, so she knows I’m not in a rush. I’m superficially familiar with the studies about sitting when you’re talking to patients and I’m a fan of both sitting and evidence-based medicine, although I’m not sure if any studies address where you sit. I avoid the biohazard bin as a sign of respect for what might be in there (I am also a fan of signs of respect), but the trashcan is the perfect height. It also has a big lid, so I feel less unstable on it than on a stool, which is really only good for pelvics and procedures.

“Tell me what’s on your mind.”

By way of background, this woman does not see doctors. Period. She hasn’t seen a doctor since the birth of her last child 30 years ago. I am aware that I feel a little honored that she has chosen to see me, because I know this isn’t easy for her, and she wouldn’t be here if she didn’t think she needed to be. As a corollary to this, she is not insured and has no money. She is about the age of my mother, and I wonder if maybe she’s thinking all the things my mother thinks of my appearance. I try to sit up straighter and arrange myself more ladylike on my trashcan. I cover my dozen earrings with my hair.

She is here for a rash. It’s on her left buttock and has been spreading for a couple of days. She’s starting to feel unwell, with chills and fatigue. It looks to me like cellulitis, and she doesn’t seem ill enough to warrant admission. This makes her happy. I was about to write her some prescriptions, but she has stopped me from leaving, and now I am perched waiting for her confession.

“I take fish antibiotics.”

Fish antibiotics. I turn this over in my mind, trying to look at it from all angles. Is this actually a psychiatry patient? Does she think she’s a fish? Is she saying she can only take fish antibiotics? Maybe asking me to prescribe fish antibiotics? Do you need a prescription from a fish doctor to get fish antibiotics? Is she familiar with the common metaphor that the ED is a fishbowl? Is she making fun of me and my job? Is this the kind of day I’m going to have? Is my next patient going to take reptile antibiotics? Will he think he’s a dinosaur? Suddenly, my rapport with my patient teeters vertiginously on the edge of the chasm of my judging her.

“I’m sorry. What do you mean?” I can hear my tone has changed, and hope she doesn’t hear it.

“I’ve been taking fish antibiotics. You know, from a pet store. I thought you should know, because I’ve been taking fish amoxicillin for 2 days. I’ve done it for years, but this time, I’m not getting better.”

Suddenly, I understand. Aquarium drugs. The loophole of the United States prescription antibiotic system. I remember treating my own home aquarium with an antifungal tablet, and how many choices there were for antimicrobials, no prescription necessary. So she’s been on amoxicillin of some formulation or other, intended for a goldfish. I am no longer irritated or judgmental. This woman is resourceful. She has no insurance. She has no doctor. She has needed drugs over the course of 30 years and has researched what she thought she needed and treated herself to good effect up until now. She has never been to the ED before. She likely would have made a better choice for herself if she had had more information on community-acquired MRSA, and then she wouldn’t have presented for care this time, either. I wish patients didn’t do this, and I wish it wasn’t an option for them, but in the same situation, it’s something I can see myself doing. In some ways, it is what I do for myself. I decide what I think I need and prescribe it.

“Um, ok. Thanks for telling me. That’s really helpful information to have. Do you mind if I ask you how you dose it?”

“I take one tablet. I figure I’m about the size of a 10-gallon tank.”

I quickly do the math. 80 pounds. Not even close.

I write up a prescription for doxycycline and some generic discharge instructions. I add in, “It would be a good idea for you to see a primary care doctor, as this is safer than you trying to figure out what infection you have and buying antibiotics intended for an aquarium. If you do buy antibiotics for an aquarium, remember you are the size of a 20-gallon tank.” I hope this will help her make a more informed decision next time.

• They spend a lot of time focusing on positive moments
• They spend a lot of time focusing on keeping passion alive
• They spend a lot of time focusing on keeping a positive attitude

These are ancient principles.  The research points out that it is not about the negative or bad times, and it is not even about how we deal with those negative or bad times.  It is ALL about looking at the good, being grateful, counting blessings, quality time, communication, and celebrating life’s positives every chance we get.

“Numerous studies show that intimate relationships, such as marriages, are the single most important source of life satisfaction. Although most couples enter these relationships with the best of intentions, many break up or stay together but languish. Yet some do stay happily married and thrive. What is their secret?

“A few clues emerge from the latest research in the nascent field of positive psychology. Founded in 1998 by psychologist Martin E. P. Seligman of the University of Pennsylvania, this discipline includes research into positive emotions, human strengths and what is meaningful in life. In the past few years positive psychology researchers have discovered that thriving couples accentuate the positive in life more than those who stay together unhappily or split do. They not only cope well during hardship but also celebrate the happy moments and work to build more bright points into their lives.

“It turns out that how couples handle good news may matter even more to their relationship than their ability to support each other under difficult circumstances. Happy pairs also individually experience a higher ratio of upbeat emotions to negative ones than people in unsuccessful liasions do. Certain tactics can boost this ratio and thus help to strengthen connections with others. Another ingredient for relationship success: cultivating passion. Learning to become devoted to your significant other in a healthy way can lead to a more satisfying union.

“Until recently, studies largely centered on how romantic partners respond to each other’s misfortunes and on how couples manage negative emotions such as jealousy and anger – an approach in line with psychology’s traditional focus on alleviating deficits. One key to successful bonds, the studies indicated, is believing that your partner will be there for you when things go wrong. Then, in 2004, psychologist Shelly L. Gable, currently at the University of California, Santa Barbara, and her colleagues found that romantic couples share positive events with each other surprisingly often, leading the scientists to surmise that a partner’s behavior also matters when things are going well.

“In a study published in 2006 Gable and her coworkers videotaped dating men and women in the laboratory while the subjects took turns discussing a positive and negative event. After each conversation, members of each pair rated how ‘responded to’ – how understood, validated and cared for – they felt by their partner. Meanwhile observers rated the responses on how active-constructive (engaged and supportive ) they were – as indicated by intense listening, positive comments and questions, and the like. Low ratings reflected a more passive, generic response such as ‘That’s nice, honey.’ Separately, the couples evaluated their commitment to and satisfaction with the relationship.

“The researchers found that when a partner proffered a supportive response to cheerful statements, the ‘responded to’ ratings were higher than they were after a sympathetic response to negative news, suggesting that how partners reply to good news may be a stronger determinant of relationship health than their reaction to unfortunate incidents. The reason for this finding, Gable surmises, may be that fixing a problem or dealing with a disappointment – though important for a relationship – may not make a couple feel joy, the currency of a happy pairing.”

Suzann Pileggi, “The Happy Couple,” Scientific American Mind, Jan/Feb 2010, pp. 34-36.

“In the 1990s scientists rocked the field of neurobiology with the startling news that the mature mammalian brain is capable of sprouting new neurons. Biologists had long believed that this talent for neurogenesis was reserved for young, developing minds and was lost with age. But in the early part of the decade Elizabeth Gould, then at the Rockefeller University, demonstrated that new cells arise in the adult brain – particularly in a region called the hippocampus, which is involved in learning and memory. …

“Studies indicate that in rats, between 5,000 and 10,000 new neurons arise in the hippocampus every day. (Although the human hippocampus also welcomes new neurons, we do not know how many.) The cells are not generated like clockwork, however. Instead their production can be influenced by a number of different environmental factors. For example, alcohol consumption has been shown to retard the generation of new brain cells. And their birth rate can be enhanced by exercise. Rats and mice that log time on a running wheel can kick out twice as many new cells as mice that lead a more sedentary life. …

“Exercise and other actions may help produce extra brain cells. But those new recruits do not necessarily stick around. Many if not most of them disappear within just a few weeks of arising. Of course, most cells in the body do not survive indefinitely. So the fact that these cells die is, in itself, not shocking. But their quick demise is a bit of a puzzler. Why would the brain go through the trouble of producing new cells only to have them disappear rapidly?

“From our work in rats, the answer seems to be: they are made ‘just in case.’ If the animals are cognitively challenged, the cells will linger. If not, they will fade away.”

Tracey J. Shors, “Saving New Brain Cells,” Scientific American, March 2009, pp. 47-48.