Keep resting in peace, Robert Nesta Marley! It’s been 35 years since you up and left and your music still has so much spirit, the lyrics so prescient. Prince is up there now. Have you two hooked up yet?
Like I said:
It’s been 35 years since you walked out of that door,
And the pain sure does knock more:
Ooh Bob, ooh Bob, is it feasible?
We wanna know now, for the pain to knock some more.
Ya see, in life we know there’s lots of grief,
But your music was our relief:
Tears in our eyes burn – tears in our eyes burn
While we’re waiting – while we’re waiting for the Jah Man,
See!
We don’t wanna wait in vain for Jah Man;
We don’t wanna wait in vain for Jah Man;
We don’t wanna wait in vain for Jah Man;
We don’t wanna wait in vain for Jah Man;
We don’t wanna wait in vain for Jah Man, oh!
We don’t wanna – We don’t wanna – We don’t wanna – We don’t wanna -We don’t wanna wait in vain.
I am intrigued by what I call the Frisome Women (Friggin’ Awesome Women). I was raised by one who was raised by one, married to one, have a sibling who is one and may be raising one. Smart, focused, pragmatic, creative and tough, they have a certain sixth sense for what works! They don’t mince words, don’t suffer fools, and want to get things done. I am intrigued by what makes them tick. You all know one or may even be one.
Bertha Ringer was a Frisome. She was born into a wealthy family in Pforzheim, Germany, on May 3, 1849 (167 years ago today). Her dad wanted a son and wrote in the family Bible: “Unfortunately only a girl again”! Bertha, however, was an intelligent girl who at an early age was very interested in technical things like the locomotive. When she was allowed to attend school at the age of 9, her interest was in the Natural Sciences. However, in that era, women were not allowed into institutions of higher education. It was the scientific belief that the lighter brain of women was logically unable to absorb and process as much information. Moreover, too much thinking was thought to be harmful to their reproductive abilities!
The beliefs of the day irked her greatly. It didn’t help when she read what her dad wrote in the family Bible. These factors might have lit up her subsequent determination to show her dad and the world that women could be great too.
On June 27, 1869, while on a trip with her mother, a poor young engineer joined them in their coach. They soon started talking and he told her about his dream of building a driverless carriage. She was hooked. By the next year, they were engaged. The man’s name was Karl Benz.
In 1870, Karl owned an iron construction company. His business partner was irresponsible and the company was failing. Karl was also a terrible businessman. As a single woman at that time, Bertha was allowed by law to invest in a company and so she rescued Karl’s business using funds from her substantial dowry.
They got married in 1872 and Bertha Ringer became Bertha Benz. They moved to Mannheim where she helped her husband start the Benz Gasmotoren-Fabrik – a company that manufactured internal combustion engines. Problems with the banks led to the closure of that business after a year.
In 1883, Bertha helped Karl Benz start another company – Benz & Cie. They made industrial parts. That business venture thrived. This allowed Karl to turn his attention to his lifelong dream – the invention of a driverless carriage powered by an internal combustion engine, in other words, an automobile. History then was full of several engineers before who had built versions of a driverless carriage but hadn’t been able to market them with any success.
After several failed attempts, Karl finally finished work on his first horseless carriage in December 1885 and received a patent for it in 1886. It was powered by a four-stroke, single-cylinder, 0.67 horsepower engine and had three wheels – one in front and two in the back. It was the Patent-Motorwagen No.1. For fuel it used the solvent ligroin that you bought from a pharmacy. It had no gear system and had brakes and wheels made out of wood!
By 1888, he had built 2 more – the No.2 and No.3. The No.3 was much improved with a 2 hp engine and max speed of 10 mph (16 km/h).
He showed the Model 3 at the Paris expo in 1887. In late summer of 1888, it went on sale as the Benz Patent Motorwagen.
Well, Karl like most great inventors was also terrible at marketing and couldn’t find any buyers or get anyone interested in his invention. Bertha had seen him build his Motorwagen and believed in the product. She thought it was ready for prime time and needed publicity. She had invested a lot of money in the venture and she needed to see some returns. Moreover, not too far away was a gentleman called Gottlieb Daimler, who together with his partner Wilhelm Maybach, were trying to build a driverless carriage too.
So one early morning in August of 1888 (may have been the 5th or the 12th), she left her husband a note, packed her two sons, Richard who was 13 and Eugen who was 15 into the Patent Motorwagen No.3 and drove off to visit her mum in her hometown of Pforzheim which was 66 miles (106 km) away!
Now let that go through your heads for a minute! 66 miles in a contraption that had never been tested before over more than a few miles in town! In 1888! On roads meant for horses and carriages! By a 39-year-old woman with 2 teenage boys! Now isn’t that just friggin’ awesome?
Now the big idea wasn’t really to visit her mum. It was to prove to her husband that his invention was great and ready for prime time and to give the car publicity.
The journey took her just over 11 hours. She stopped at several pharmacies to buy ligroin as fuel. The motorwagen used a surface carburetor which doubled as a reservoir for 1.5 liters of fuel. (Subsequent models had a fuel tank and also, her experience probably birthed the concept of the gas station). At one point, she had to repair the car’s ignition and she improvised with her garter. When the fuel line became clogged, Bertha cleared it using her hairpin! When the wooden brakes began to fail, she got a shoemaker to make leather pads for them, thus coming up with the idea of brake pads. At one point, she had to get two young boys to help her sons push the car up a hill (that bore the idea for a gear system).
The arrived in Pforzheim tired and dirty but in safely. Once in Pforzeim, she sent her husband a telegram to let him know they had arrived safely. Can you imagine him freaking out?
She stayed for 3 days with her mum and then made the return trip to Mannheim using a different route. This way, she was able to introduce the car to even more people. The reception ranged from wonder to frank fear of the “Smoking Monster”.
Benz Patent Motorwagen Typ III
Beside getting a lot of publicity for the Motorwagen, she had also undertaken the first test drive of a car!
Her 120 mile trip was the catalyst Benz & Cie needed. Karl Benz became credited with inventing the predecessor of the modern car. By 1899, Benz & Cie was the world’s largest automobile company with a staff that had grown from 50 to 430. That year, they sold 572 vehicles!
Karl and Bertha, along with sons Eugen and Richard, also formed a new family-owned car company, Benz & Sons in 1906. The cars they made became popular in London as taxis because of their quality and reliability. It closed its doors in 1924.
Benz & Cie on the other hand stayed in business until 1926 when it merged with it’s main competitor, Daimler Motoren Gesellschaft (DMG) to form the Daimler-Benz AG. The rest, as they say, is history!
Karl Benz among other inventions went on to build the first truck and also to invent the flat or boxer engine that is still used in Porsches and other racing cars. Among some of his honors was a doctorate from his alma mater, the Technical University of Karlsruhe. He died in 1929.
On her 95th birthday on May 3, 1944, Bertha was honored by the Technical University of Karlsruhe, her husband’s alma mater, with the title of Honorary Senator. Two days later, she died.
Among her many honors is also the Bertha Benz Memorial route. The route traces her path during the world’s first long-distance journey by automobile in 1888 from Mannheim to Pforzheim and back.
What a woman! A mother, investor, test driver, mechanic and inventor! Now tell me Bertha Benz was not a Frisome!
Can you imagine what she might have achieved if she had been allowed to study at a university? Can you imagine what Karl Benz would have done without her?
So as you speed off in your AMGs, G-wagons and SLs, spare a minute to wish her “Herzlichen Geburtstag” on the other side.
What is the saying again? Behind every successful man, is a friggin’ awesome woman!
Frau Bertha Benz, you were friggin awesome!
I know, I know……boring!…so what?.. he inspires me!……400 years ago today, April 23, 1616, poet and playwright, William Shakespeare died in his home in Stratford-upon-Avon. He was just 52……wrote 37 plays and 154 sonnets! 154 sonnets! Dang!..So I wanted to share two of my favorite quotes from all his works. The first is from Julius Caesar:
Brutus:
There is a tide in the affairs of men.
Which, taken at the flood, leads on to fortune;
Omitted, all the voyage of their life
Is bound in shallows and in miseries.
On such a full sea are we now afloat,
And we must take the current when it serves,
Or lose our ventures.
Julius Caesar Act 4, scene 3, 218–224
The second is from Macbeth:
Macbeth:
Life’s but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more. It is a tale
Told by an idiot, full of sound and fury
Signifying nothing.
Back in 1998, I heard a trauma surgeon talk about communicating with patients. His words have stayed with me all these years.
The gist of his message was:
Physicians are as a group, are highly educated. A lot of the patients we deal with do not understand medicine, surgery, anatomy or physiology like we do. If we need to explain a procedure, the need for it or a disease process to a patient, we need to keep it simple.
Now that coming from a surgeon is deep!
It’s one of those things I’ve never forgotten. To keep it simple.
One can tell a patient:
“I am going to place a central line in your right internal jugular, float a pulmonary artery catheter and also place an arterial line in your left radial artery. You need that for your aortic valve replacement.”
Or one can say:
“To better take care of you during your operation, I need to place a larger iv in that vein in the right side of your neck. It helps us give you blood faster if you need it. Also, we feed a tube through it into your heart that helps us measure how much blood is being pumped in an out. You also need a better way of measuring your blood pressure. Feel your left wrist. Feel that pulse? That is an artery. I’ll put a small tube in there that will help measure your blood pressure better.”
Sure, the latter takes longer but you don’t have a patient who stares at you after you are done speaking like you just dropped from Pluto! We must all try to talk to patients in terms that are understandable to them. Terms that we take for granted may sound like Greek to most lay people. Even a term as simple as “colonoscopy” has befuddled some patients.
Some steps that can help me are:
I imagine explaining a procedure or even a disease process to one of my older uncles or aunties or to my kids. I break it down to a level they can understand.
I use diagrams that I sketch. I find drawing out the anatomy and pointing structures out and what is going to be done helps immensely. A lot of patients in Kentucky believe epidurals are the number one cause of paralysis in the world. A small drawing of the layers a needle goes through to reach the epidural space and it’s relatinship to the spinal cord helps immensely to allay some fears.
I encourage questions. If a patient can repeat what you said and base a question on that, your work is done.
Do not look at patients with disdain. It is not their fault that they do not understand what a myxomatous mitral valve is. I bet you do not know what Capital Structure Theory is either. A degree of empathy is needed to understand where patients are coming from. Without that empathy, it is difficult to relate to the patients and explain things to them at a level that is understandable.
Once upon a time, a white, middle-aged man was having major surgery at a University Hospital somewhere in the US. The surgery’s nature was such that, he needed the care of two anesthesia providers. On call for the procedure of that nature were two brown-skinned anesthesiologists. Let’s call them Anesthesiologist A and B (AA and AB).
When AA and AB met the patient prior to surgery, he appeared nervous and uneasy and they attributed it to anxiety. Who wouldn’t be nervous before such a big operation? AA asked a nurse to give the patient an anxiolytic.
They saw the patient again about thirty minutes later in the operating room. He was already on the table. While AA got stuff together to place invasive lines, AB exposed the patients upper arms and torso to place external monitors. The sight that met his eyes took him aback. The patient’s upper chest and arms were covered with tattoos. That was not the problem. It was what the tattoos said that rattled him. They were signs, symbols and abbreviations from a rather dark part of this country’s and European history. AB pointed to an abbreviation on the patient’s left shoulder. It was made up of a letter, repeated three times. Even though AB knew what it meant, without knowing why, he asked the patient:
“What do those letters mean?”
“The patient at this point had gone pale and had a sheepish, frightened look on his face. He muttered:
“I was young and stupid then”.
“Is it like a secret fraternity? Can I join?”, AB probed.
There was no answer from the patient. An uneasy silence filled the room.
At this point AA came over, having noticed the tattoos and the exchange. He stood close to the patient on the left side and smiled at the patient.
AB broke the silence:
“I guess it must be really secret. Don’t worry, we will take good care of you.”
And take care of him they did.
The patient did well during the surgery and was taken to the intensive care unit afterwards. About ten days later, he left the hospital for rehab.
What is the point of this rather true narrative?
If two doctors could bring themselves to take care of a man, who probably hates them for the color of their skin and in other circumstances would do them harm, giving him world-class anesthetic care for a complex operation,
HOW HARD IS IT TO BAKE A CAKE OR EVEN MAKE A BOUQUET FOR TWO PEOPLE OF THE SAME SEX WHO WANT TO SHARE THE REST OF THEIR LIVES TOGETHER?
A CAKE? A BOUQUET?
Think about it!
“The universe is made up of stories not atoms”.
– Muriel Rukeyser from “The Speed of Darkness”
She would shuffle in every evening as the sun set, stooped over her old, trusted cane. Her old, haggard body harbored an indomitable spirit, the fire of which lit up in her eyes. To a five-year-old, she was the oldest person in the world.
As she moved slowly across the courtyard, eager eyes would follow her.
She would head for her stool set in the corner of the courtyard like a throne. The dancing flames of the kerosene lamps that lit the courtyard always cast ghostlike shadows on the walls, enhancing the moment in intrigue and suspense.
The minute she sat down, three generations of descendants would form an arc around her stool. She would always cast her gaze over the assembly, as if to make sure no one was missing.
We always sat in suspense, riveted and waiting for the opening lines. We never knew where Storytime with Great-Grandma Jooma would head out to. It could be into the world of Kweku Ananse, about great kings and queens, a fable, an event from long ago or trips over hills and far away. We just waited and knew it would be good.
And then she would clear her throat and go:
“Kwezi wo dze ndze oo!”
And we would respond:
“Wo gye dze wo ara!”
Then even as the red flames of the lamps danced in her eyes, they’ll open up to usher us into her universe. Her universe of stories. Soon it became my universe too.
Over the years, I may have travelled the world, learnt the secrets of science and even marvelled at the stars and planets but at heart, my universe is made of stories not atoms.
After several months of pleading, I was granted an audience. I don’t even know how I got there but all of sudden, I found myself before this large, rather ornate gate. As I looked around, the gate opened as if by remote control. The mansion that was revealed was breath-taking. It arose from the carefully manicured grounds like a symphony from an orchestra.
I walked along the only pathway visible. It was marble! As I walked, I marveled at the landscaping. How expensive it must be to keep that, I thought. The pathway brought me to a massive wooden door. Just as I was about to open it, it swung open. Standing in the doorway was an old man with flowing white hair and a white beard. He beckoned me in. He introduced himself as Peter and asked me to follow him.
Words cannot describe the beauty of the decorations, paintings and statues that graced the mansion. Soon we came to another door and this one opened by itself too. It revealed a large hall. At one end sat a throne.
Peter turned to me and said, “He will be out soon. Sit in that chair and wait. Once he appears, you have thirty minutes. Good luck.”
He turned and walked off even as the door swung shut behind him.
Then I heard a voice go, “Nanadadzie my son, how can I help you?”
I spun around to see an imposing figure sitting in the throne.
Somehow, around him was a certain glow. His face was lit by a broad smile that illuminated the lines of wisdom that gave his face such depth of character. His eyes were deep and seemed to hold a lot of something. I couldn’t put my finger on it.
“Nanadadzie, you have 30 minutes. Use that time well”, he continued.
“Are you God?”, I asked.
“The One and Only”, he answered.
“Where is Allah? I wanted to meet both of you”, I asked.
“I am One and the Same”, he pointed out.
“May I call you just God or Dear God”, I asked.
“Call me Father”, he said.
“Father, do you know the mess going on down there on Earth in your name?”, I asked.
“I know, Nana, I know. It’s OK to call you Nana, right? Most people call you that”, he said.
“Of course you can, Father”, I answered. “So you know there’s a lot of bad things being done in your name and you are fine with that?”, I continued, incredulous.
“Nana, they use my name in vain to do these bad things”, he answered.
“So why do you allow that?”, I asked.
“You humans have free will, you know that right?”, he asked me.
“Father, free will to use your name for the Crusades? The numerous European religious wars? Slavery? Apartheid? Al-Queda? ISIS?”, I asked.
“Nana, the human ultimately has to discover the Truth”, he said.
“But, but the carnage is great. Did you see Brussels? And Paris? Have you seen what Boko Haram is doing in Nigeria? The attacks in Mali, Bukina and Cote d’Ivoire? The beheadings in Syria? Syria? Iraq? 9-11? What truth do you find from such carnage? That religion leads to violence?”, I asked, my voice rising.
“Nana my son, I could with a stroke of my finger, wipe all out. What lesson would that teach mankind?”, he asked.
“That you cannot mess with God. You did that back in the day!”, I volunteered.
“I might have but did it teach mankind anything?”, he asked, looking at me sternly.
“So we have to go through all this pain to learn? To learn what?”, I asked.
“To learn to live together as one”, he replied.
“Father, call me cynical but that isn’t happening. The Church you left down there is in shambles. You heard of all those priests and the kids, right? That was a disaster. Islam has been hijacked. The races hate each other. There are wars everywhere. Large swaths of the population is starving or dying from diseases. And we are supposed to live together as one? I’m sorry but I have no faith that will ever happen”, I declared.
“Nana, do you believe in me?”, he asked.
“Father, to be honest, there are lots of times that I have my doubts”, I offered.
“Nana, you are bound by time and space. I see eternity. Good always overcomes evil. The right shall dominate the wrong”, he said.
“You sound like my late dad. By the way, is he around?”, I asked.
“Yes he is but he is not the reason you are here”, he replied then continued:
“There is always a dark side to light. A bitter side to the sweet. Those who use my name for evil are the dark side of light. Ultimately, the light shines so bright, the darkness is unseen and unheard. Believe and be strong”, he said.
Suddenly, I heard a sound behind me. I turned to see Peter in the doorway.
“It is time”, he said.
I swung around to ask God a last question but the throne was empty.
I sighed and walked out of the hall behind Peter. With each step, I heard a ringing sound. As we neared the main door, it got louder. The minute he opened the main door, the piercing scream of my alarm broke through, waking me up to another morning of life on this Earth with it’s violence, pain and hopelessness. Or is all that leading to a time of peace, love and hope?
That is when it hit me. What I had seen in his eyes. His eyes were full of certainty. Certainty that all will be well. That good will overcome evil. That the right will dominate the wrong. Certainty.
I sat at the edge of my bed and realized that I wasn’t so certain. That good will overcome evil. That the right will dominate. I wasn’t at all but wished I had faith. Wished I believed. I didn’t.
I sighed.
“To err is human, to forgive, divine.”
– Alexander Pope, from “An Essay on Criticism”
Probably, the most important lesson I learnt in all of residency can be summed up in these words:
“It’s not the mistake! It’s what you do afterwards that matters”.
These words have accompanied me all these years, I practice by them, taught that to my residents when I was in academics and pass it on any chance I get. It is not only true in medicine but also in the criminal justice system and even at home with our children and spouses. For this discussion though, we’ll stick to medicine.
To elucidate, we have to take a trip back to 1999.
“To Err is Human: Building a Safer Health System” was a report issued in 1999 by the U.S. Institute of Medicine that detailed medical errors in the US healthcare system and the human as well as financial toll it was exacting. The figures were sobering. Between 44,000 to 98,000 people die each year as a result of preventable medical errors. They have been estimated to result in total costs of between $17 billion and $29 billion per year in hospitals nationwide!
It was pointed out in the report that, system failures and less individual provider mistakes were responsible for most medical errors. The push since has been to reduce medical errors and improve patient safety and the results have been encouraging.
However, the fact remains that physicians are only human and like the saying goes, “To err is human…” and that is where my lesson comes into play.
Sooner or later, every physician is going to make a mistake. Show me a physician who hasn’t made a mistake before and I’ll show you a doctor who hasn’t practiced long enough or doesn’t practice at all.
So if we are prone to make mistakes, shouldn’t there be a readiness to face and deal with these errors when they happen? Beyond the checklists and time-outs, beyond the constant threat of loss of accreditation and fines, shouldn’t we as physician on an individual level be ready to deal with that mistake?
That mentality of “It’s not the mistake! It’s what you do afterwards that matters” takes away the fear that dogs one when a mistake is made. It makes one communicate clearly with the patient if possible and explain what happened and what will be done. It allows one to keep a level head and work alone or with a team to reverse or limit any damage. It also reduces the incidence of lawsuits.
This mentality demands something from the physician. It demands a certain honesty and strength of character. One should be able to say, “I screwed up. Now how do I fix it?” It demands empathy with the patient à la “If it was me…”
I know, it is much easier to sweep things under the rug of unintelligible medical speak or blame someone else but that only stokes the fire of trouble down the road and possible harm to the patient.
To help develop this mentality, a mantra that was drummed into me during residency helps. It was, “What is the worst thing that can happen now and what would you do about it?”
With that kind of mind set, one tends to be prepared for whatever but most importantly, one tries to prevent whatever form happening. One tends to see all those checklists on a personal level and that readiness on a personal level ultimately translates to one on the team level too.
Most physicians do as Hippocrates said and try do do no harm. However since the human is plagued by fallibility, maybe accepting that and factoring it into our daily practice may help. So even as you go about your day, remember, “It’s not the mistake; it’s what you do afterwards that matters.”
Patrice, you illustriuos African son! 55 years ago, you were assassinated while the World watched. The consequences are still felt today. Your words ring so true, even more today: “Third World is a state of the mind and until we change our attitude as Africans, if there is a fourth, fifth and even sixth world, we will be in it.”
― Patrice Lumumba
Somewhere along the walk, I came to a point with forks in the trail. There was one that was clearly marked “To the Abbey”. Then, there were 2 other trails that were unmarked and not even on the map. The first of the two was to my right and seemed to vanish into thick brush. The other looked like it went up a hill to my left. I made a decision to go up the hill.
I started on the trail and it kept going up. Tall trees lined the trail and the ground was covered by a thick carpet of leaves. The wind blew moderately through the trees, swaying them in a synchronized dance that rhymed with the song of the wind. It felt beautiful. Soon, I could see into a valley and bounding down was a big deer. It was so graceful. I kept moving, thinking I had made the greatest decision and totally enjoying the trail. It kept going up. Even higher, I saw another deer bound up and race towards a line of trees that seemed to crest the summit of another hill. The trees undulated gently, like they were opening up to accept the grace of the big animal. It vanished into them in a motion so fluid and graceful, it made me gasp. At this point, the trail had leveled out and I seemed to be at a summit. I was looking down into a beautiful valley. The trees and leaves reflected the midday sun into the most beautiful colors. I went around a bend and suddenly the trail came to a dead end. Just like that. It didn’t go any further. I looked all around to see if perchance there was a fork I had missed – nothing! There seemed to be no path through the thick brush and trees. The trail had ended.
I headed back and as I did, I thought about my decision to come up the trail. It made me think about the paths we sometime take that end nowhere. I thought of the pain and sadness they sometimes bring. However, I also thought of the experience. Then I realized that even though I had taken the path that lead to a dead-end, I had absolutely enjoyed the experience. That if I had to do it all over again, I would come up the trail without a second thought. That even though it had been a detour that lead nowhere, it had been most enriching and fun detour.
So on the journey of life, can one sometime just do a detour for the rich experience it might provide? Definitely! I think the whole journey is more about the experience than the destination. The whole journey is about taking chances and realizing that even if it leads nowhere, the experience might be enriching and fun. That one may get the chance to enjoy and appreciate some of all that life has to offer. To all that is a caveat – just make sure that you can find your way back to the path or a path that leads to where you ultimately are headed and that I think is where most get lost.
