The Man Who Lost His Heart

Rest assured, dear friends, that where your pleasure is, there your heart is. Charles Spurgeon

From the lips of Spurgeon, the man who found his heart.

“I knew a man who lost his heart. His wife had not got it, and his children had not got it, and he did not seem as if he had got it himself. “That is odd,” say you. Well, he used to starve himself. He scarcely had enough to eat. His clothes were threadbare. He starved all who were round him. He did not seem to have a heart.

A poor woman owed him a little rent. Out she went into the street. He had no heart. A person had fallen back a little in the payment of money that he had lent him. The debtor’s little children were crying for bread. The man did not care who cried for hunger, or what became of the children. He would have his money.

He had lost his heart.

I never could make out where it was till I went to his house one day, and I saw a huge chest. I think they called it an iron safe: it stood behind the door of an inner room; and when he unlocked it with a heavy key, and the bolts were shot, and the inside was opened, there was a musty, fusty thing within it, as dry and dead as the kernel of a walnut seven years old.

It was his heart.

If you have locked up your heart in an iron safe, get it out. Get it out as quickly as ever you can. It is a horrible thing to pack up a heart in five-pound notes, or bury it under heaps of silver and gold. Hearts are never healthy when covered up with hard metal. Your gold and silver are cankered if your heart is bound up with them.”

JAMA Fish Drama

Let your hook always be cast.  In the pool where you least expect it, will be fish. Ovid

Photo: Diliff

Not everyone has heard the latest hoopla regarding fish oil supplements. Like the folks at Carlson Labs, manufacturers of my personal favorite fish oil supplement. I called them today to see what they thought about JAMA’s recent announcement that fish oil supplements were no more effective than a placebo at preventing premature death or serious cardiovascular problems. The Carlson rep thought I had said, “Have you read the latest Drama study”.  Evidently the drama from JAMA has not effected Carlson’s sales because she thought I was nuts. She wasn’t impressed with my summary of the report. She confirmed sales are brisk. People are still taking their omegas, and unless they have had it with fish burps, a new study won’t persuade them to stop.  I’ve been taking the supplements for over 2 years, and I too see no reason to stop.  Besides, what would I do with the super-sized bottle I just bought?

After re-examining data from 20 previous clinical trials over the past 2 decades involving nearly 70,000 patients, Dr. Moses Elisaf concluded that the Omega 3 supplements won’t prevent a heart attack or stroke. Really? Whatever. It’s still good for me, right? After all, It is an anti-inflammatory. And I know that tons of health problems are related to an inflammatory process.

The Carlson rep toted the benefits of fish oil: great for joints/arthritis, dry skin, brain and eye health. Some people take it to help with their ADD, or to keep depression at bay (not enough omega 3 = less dopamine and serotonin in the brain). And, medical practitioners do prescribe it for high triglycerides levels.

Best healthy bet: Eat food that is good for you, and include at least 2 servings a week of cold water fish. No, it can’t be fried or in the form of a fast food patty – the frying cancels out the benefits and could increase your heart disease risk.  Your body needs omega 3 fatty acids (EPA and DHA). It doesn’t make it so you’re going to have to eat it.  Anchovies, sardines, mackerel, herring, lake trout, albacore tuna, salmon, scallops, flax seeds, walnuts, and olive oil are all good sources.

The jury is still out on what the future holds for omega 3 fatty acid supplements. More specific long-term trials and studies are warranted. For now, with my doctor’s blessing, I shall continue my Carlson norwegian salmon oil 1gm daily, and do my best to eat sardine (gag), anchovies (yuck), and herring (puke).


A Wizard’s Formula for Success

Genius is one per cent inspiration and ninety-nine per cent perspiration. Thomas Edison

Thomas EdisonWhat can we learn about success from Thomas Edison? In his lifetime, how was he able to achieve 1093 invention patents, work 100 hour weeks, and despite a sensory impairment, stimulate teams of people to generate innovative ideas? The Wizard of Menlo Park did possess character flaws that distanced family members and hurt others, yet no one can deny Edison was a genius who changed the world for the better.

He was completely deaf in one ear, and had 80% loss in the other. His head was oversized. He was kicked out of school because of his ADD-like behavior and constant torrent of questions.  His mother home-schooled him and his father paid him to read the classics. He fell in love with Shakespeare and poetry. His independent learning style, his unquenchable thirst to know more, to understand why, and his persistence to never give up, proved the right formula to earn him the title of America’s Greatest Inventor. He was a rags to riches legend. He suffered illness, rejection, abuse, poverty, and great losses. Yet, he rose above and gave everything he had with a passion only few could understand, and even less would ever want.  What can we learn from this wizard?  What character qualities and lifestyle habits led him to success? He had many, but I believe these were key…

Adaptability: “Even though I am nearly deaf, I seem to be gifted with a kind of inner hearing which enables me to detect sounds and noises that the listeners do not perceive.”

Ambition: “Pretty much everything will come to him who hustles while he waits. “

Vision: “Be brave as your fathers before you. Have faith and go forward!”

Discipline: “I never did anything worth doing entirely by accident….Almost none of my inventions were derived in that manner. They were achieved by having trained myself to be analytical and to endure and tolerate hard work.”

Satisfaction: “Personally, I enjoy working about 18 hours a day.”

Focus: “The first requisite for success is to develop the ability to focus and apply your mental and physical energies to the problem at hand – without growing weary.”

Insight: “Its not the hard work that kills, its the worrying that kills.”

Altruism: “I want to save and advance human life, not destroy it.”

Curiosity: “We have merely scratched the surface of the store of knowledge which will come to us.”

Perseverance: “Many of life’s failures are experienced by people who did not realize how close they were to success when they gave up.”

Perspective: “Why, I have not failed.  I’ve just found 10,000 ways that won’t work.”

Intellect: “Our schools are not teaching students to think. It is astonishing how many young people have difficulty in putting their brains definitely and systematically to work.” 


“The boast of heraldry, the pomp of power, And all that beauty, all that wealth e’er gave, Awaits alike the inevitable hour: The paths of glory lead but to the grave.” from Thomas Gray’s Elegy To A Country-Edison’s favorite poem

Save the Gold Nuggets

Rob Lavinsky,

A leader is one who knows the way, goes the way, and shows the way. —John Maxwell


An excerpt From The 21 Irrefutable Laws of Leadership by John C. Maxwell.

Maxwell gives leadership advice to a stand out 19-year-old in the audience at one of his seminars.

I’ve been watching you here, and I’m very impressed with how hungry you are to learn and glean and grow.  I want to tell you a secret that will change your life. I believe that in about twenty years, you can be a great leader.  I want to encourage you to make yourself a lifelong learner of leadership.  Read books, listen to tapes regularly, and keep attending seminars.  And whenever you come across a golden nugget of truth or a significant quote, file it away for the future.  It’s not going to be easy, but in five years, you’ll see progress as your influence becomes greater.  In ten years you’ll develop a competence that makes your leadership highly effective.  And in twenty years, if you’ve continued to learn and grow, others will likely start asking you to teach them about leadership.  And some will be amazed.  They’ll look at each other and say, “How did he suddenly become so wise?”  You can be a great leader, but it won’t happen in a day.  Start paying the price now.

A Cup is a Baseball

All you need is love. But a little chocolate now and then doesn’t hurt. Charles Schulz

A cup and a baseballIf you haven’t already, chance are you will be completing  a health survey next time you enroll for your health insurance.  Fail to meet the “healthy” criteria and you’ll forfeit a substantial discount.  Plan on reporting your cholesterol levels, last eye exam, dental and medical check-up, weekly exercise total, daily food intake, smoking status, alcohol consumption, and recreational drug use. The one area I scored poorly on was diet – Since the 2011 demise of the food pyramid, I admit I haven’t nailed down the proper number of food group servings I should be eating.  Now that I’m nutritionally savvy from my sleuthing,  thought I’d share my findings with you.

The foundation of your diet should be a healthy plate, each meal (plate) should be 1/2 full of fruits and vegetables, 1/4 grains, 1/4 protein, and include a serving of low-fat dairy. Half of your grains should be whole-grains.

Servings for an average adult:

  • Fruit: 3 (serving=1 cup or 1 whole piece) may be fresh, canned, frozen, or dried
  • Vegetables: 3 (serving=1 cup of raw or cooked vegetables or vegetable juice, or 2 cups of raw leafy greens)
  • Dairy: 3 (serving=1 cup milk/yogurt, 1.5 oz. hard cheese, ½ cup cottage cheese)
  • Grains: 6 (serving=1 oz which is any of these: 1 slice of bread, 1 cup cereal, ½ cup cooked rice/pasta/cereal/oats)
  • Protein: 5 oz total (serving: any of these is a 1 oz serving: ¼ cup cooked beans, 1 egg, 1 tablespoon of peanut butter, ½ ounce of nuts or seeds)
  • Oils: You are most likely to get your daily need (5 tsp) in food preparation.  Only eat  MUFAs – Mono-unsaturated fatty acid and PUFAs-polyunsaturated acids.                    Trans fat=death trap.

Sorry, there is no RDA for chips, candy, sweets, soda, sugar, or any other lusciously decedent dessert. Indulge at your own risk.

Nothing beats properly measuring your food, but considering most of us don’t carry tablespoons and measuring cups in our laptop bags, here are some visuals to help you eyeball portion sizes:

  • 3 ounces of meat=deck of playing cards
  • 3 oz of fish=checkbook
  • 1/2 cup=tennis ball
  • 1 ounce of cheese= six dice
  • 1 ounce of nuts=handful
  • 1 tablespoon=tip of your thumb.
  • 1 bread slice=DVD
  • 2 tablespoons=ping pong ball
  • 1 cup=baseball
  • 1 teaspoon=1 die
  • 1/4 cup=golf ball

More information on MyPlate:


Explosive Potty Humor and Buddha was a Thin Man

Uncle John’s Fully Loaded 25th Anniversary Bathroom Reader

I’ve had my fill of toothpaste and cold medicine instructions. Never one to bring a book or newspaper (unless we’re out of toilet paper) to the bathroom, when things are taking a while, I resort to reading whatever I pull out of the cabinet.  Get in and get out is my usual philosophy.  But, isn’t it nice to have reading material handy for those occasions when our digestive systems are sluggish? Why not take maximum advantage of the predicament –  read an anecdote, eye witness account, learn some frivolous trivia, or a dumb joke to make you feel like you haven’t wasted time sitting around waiting for something to move. With over 600 pages of witty sayings, conversation pieces, and collections of wacky and sometimes useful information, this loaded reader will provide entertainment when you need it most.

Here’s a sampling of my favorite nuggets: Lost in translation (signs):

I like your smile but unlike you put your shoes on my face.

Sorry we’re open.

Please do not feel or scare the animals.

Because I do not have a tissue always ready in this restroom, please buy used one.

Foreign language insults/threats.

Fantong! Mandarin for useless (literal: rice bucket)

Nameh Ten-No! Japanese for you want to fight? (literal: what are you licking?)

Sutki Pala! Polish for chill-out (literal: your nipples are burning)


Want to brush up on your bowling lingo? Say this next time you’re at the alley:

“Look at him reading the lane with his benchmark ball, I bet he’s a squeezer cranker bound to get a clothesline or a 7-up.”

And one of my favorite sections: dispelling myths. I was shocked to learn that Buddha, traditionally depicted as a fat god, was actually tall and lean. With 600 pages, so much time suck awaits you. The Bathroom Reader might even make it out of your bathroom and into the main living areas of your home. If it sounds like one of your family members is having a good time in the john, let’s assume The Bathroom Readers’ Institute is to blame. And just so I can feel like I’ve offered you a little preventative medicine, here’s some tips to  avoid irregularity from the makers of the OTC product I recommend to my patients with constipation.



Ignorant People are Dangerous

Ignorance: lacking knowledge or information as to a particular subject or fact, showing lack of training


If you aren’t consistently seeking to improve yourself, pursue new information, or explore the latest trends in your field, more likely than being lazy, you might be dangerous.  And, you may slowly waste or fade away like an old photograph.   I think of my 82 year old aunt –  I have never known her to take a class, attend a seminar, or research something she knew nothing about.  She gains her education through reading tabloids and watching junk TV.  And she wonders why her life savings is gone and she makes decisions that she consistently regrets.

That’s just the way I am.  I can’t help it.  I’m too old to learn.  What’s done is done.   He’s the expert. They say.  I read somewhere.  I’m not going to change now.

Information is everywhere.  You are limited only by your own lack of interest.  No money?  No computer? No excuse.  Try the library.  It’s been around since 1731 and is still the best thing since Starbucks Americano with room.  For my nursing colleagues, I have added below links to several of my favorite sites for free CEU’s. My medical institution requires 60 a year. I do well over that and have never paid a cent. In my field, it is dangerous not to stay informed.  You may not cause harm to anyone if you don’t continue your education, but won’t you feel like you’re missing out? Whatever you do, wherever you are, be all there, and do it better every day.

It is impossible for a man to learn if he thinks he already knows.  Epictetus


Sources for free CEU:


Discovery Channel 


Cleveland Clinic

Medpage Today 



My Preceptor is Dead

Humpback whale tail by Captain Budd Christman

The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires. -William Arthur Ward

He was my preceptor, my collaborator, my children’s pediatrician, and my friend. He died August 26th, 2012 – sudden death on a beautiful August morning. 55, active, non-smoker, world traveler, patient advocate, and deliverer of the kind of care you would want for yourself and the world. I heard the news from an email:

“I got a call this morning. Jay passed away yesterday while working at Urgent Care.  I’m still in shock.  He was so healthy and only ate what was good for you…I saw him in July. He looked great.  Such a shock. Take care and this proves that life is too short.”

Passed away. I kept reading them over in unbelief. Then I stared at them, thinking maybe I could will the words away. I heard he was cremated. It wasn’t until a week later when I stepped inside the funeral home and saw the memorials – his favorite puffin tie, high-school yearbook, awards, and larger than life photograph of his robust, smiling face. It was true, he was gone, and I sobbed. Jay had a huge impact on the Nurse Practitioner that I grew to be. As I formed, he gently led me like a father, and slowly let me take my own shape – finding my own way through diagnosing and delivering care to our patients. He game me his pearls. Amoxicillin for smokers. Erythromycin for my-cough-plasma. Brand Tylenol only. Worst Strept throat think Mono. Verify allergies. Save ears for last. Suspension not solution. Maltsupex. 3-day food diary. OM? Remove the wax to see the drum. Toilet paper roll=cheap spacer. Always order HCG despite claim “impossible”. Paps: touch thigh before nether regions. Pharmacist is your friend. Wait one year before RX new drugs. Use mom’s lap for clingers. Be nice, stay humble, eat well, and enjoy life.

Twenty years ago, I was privileged to have trained with him, honored to have worked alongside him, and blessed to have known him. Today’s Nurse Practitioner students are rarely precepted by MD’s. What a shame. Removing them from our education only widens the division of our professions. Perhaps if we took another look at how things used to be we would see ourselves as players on the same team, not separate entities who are different in their approach to patient care. I see no difference. APN’s in training: if you have a chance to precept with a Family Practice Doc, consider yourself one of the lucky ones. My preceptor has died, a life gone too soon, and the loss is devastating.

Nurses Who Eat Their Young: The Dirty Secret of Bullying

Those who can, do. Those who can’t, bully.

Last night I went to my local nursing association’s business meeting.  I enjoyed a glass of wine over a lovely dinner while engaging in long overdue conversations with colleagues and friends.  Then the presenter began the evening’s topic on horizontal violence (AKA workplace bullying). It wasn’t long before smiles faded, heads dropped, and yes, tears flowed.  The air chilled as we sadly shared with one another our early experiences with bullies.  First as children, then later as new nurses, we told tales of being victims of lateral violence. Here we sat, a room full of education, degrees, awards, diversity, and experience – several had more than thirty years in the field.  But we all had one thing in common – we had either been eaten, or we were the ones who ate their young.

One of the presenters, a May 2012 nursing graduate, did her capstone honor’s project on horizontal violence.  She spent a year collecting data from a local hospital’s acute care unit. 82% participation disclosed over 50% of the nurses reported being bullied by a manager or colleague.  And then her research became reality – just two weeks into her dream job at a high acuity ICU she became a victim.  She had come full circle and wondered how her life dream could turn into a present day nightmare.  Even with her years worth of knowledge in identifying and confronting this malignant nursing behavior, she felt powerless, alone, and desperate for a solution.

By definition, workplace bullying is ““Persistent, offensive, abusive, intimidating or insulting behavior, abuse of power or unfair penal sanctions which makes the recipient feel upset, threatened, humiliated or vulnerable, which undermines their self-confidence and which may cause them to suffer stress.” (MSF Union, 1994) Examples of such behavior include eye rolling, frowning, shouting, sarcasm, passive aggressiveness, gossip, exclusion, derogatory comments, failure to communicate patient information, intimidation, silent treatment, excessively critical. Key word: Persistent. Everyone has a one time temper tantrum or bad day. But if it is ongoing, there’s a problem.

Why would a nurse engage in such contemptible behavior?  Many factors can contribute; high stress, short staffed units, job dissatisfaction, personal troubles, isolation, and the all too common nurse manager who’s a top notch nurse but knows nothing about management. Whatever the reason, it is shameful, dangerous, damaging to both the patient and victims, and has got to stop.

So what do we do? Is there any hope for us? Can we work together and put aside our differences and personal baggage and make our workplaces a healthy, inclusive environment? Though our nursing careers varied, we all agreed that what kept us in the profession was our commitment to our patients – they were the reason we do what we do.  For their sake, we must change.

Here are some ideas on how to keep the mothers from eating their babies:

  1. Acknowledge the problem.  If you see a repetitive bullying behavior, it needs to be addressed. Whether it is you or one of your co-workers, it’s time to take action.
  2. Confront the bully. In a respectful manner say something like , “I sense you disapprove of my performance with….you might not have realized when you said I was inexperienced it made me feel bad and has since continued to bother me. Let’s talk.”
  3. Document. Keep track of the incidents adding as much specifics as possible, along with dates/time/shift/witnesses/etc.  Log your actions and attempted discussions.
  4. Know your institution’s policy and follow it. Go up the ranks until you find someone who will intervene.
  5. Band together.  It’s easy to bully one, it’s harder to take on a team.
  6. Request training in horizontal violence. Give your continuing education department a head’s up that  you have a dysfunctional work environment and need serious help.
  7. If you’re the bully, admit it and stop. Seek help.You are a care giver who needs care.  It takes more courage to repent than to keep on sinning. Your fellow nurses will forgive you.
  8. If you are a manager, learn how to manage. It takes more than seniority and a MSN to be a good manager. Get some training and make a promise to improve your weak areas.
  9. Network. Join your local nursing organization and get involved.  You’d be surprised how many nurses are going through exactly the same thing you are. Talk to each-other, form friendships, and believe that things can change.
  10. Don’t give up. Unless you are out of options and your health is suffering, believe in yourself, your dream, and continue to give outstanding nursing care to your patients.  They need you.

Based on our dialogue last night, the consensus was there is a ton of work ahead, but with a united front, and empowering ourselves through education and support, we can overcome. Rather than eat them, nurses will teach their young. And when the fledglings are ready to soar, we will contentedly smile and remember why we chose to be nurses:

“To know even one life has breathed easier because you have lived – that is to have succeeded”. Ralph Waldo Emerson