About

My name is Mike Therrien. I am a renaissance man. I know a little bit about a lot of things. I know a great deal about a very few fields. I have had  life-defining and self-altering experiences at odd times during my 57 years on this planet. I believe it is time to share my thoughts about my journey through life with a wider group of people — you, my audience.

I am not really new to blogging. In 2010 I found myself practicing intensive care medicine in  a combat hospital in Iraq — at 55 years old. I needed to tell my friends and family about what I was going through and to try to put this bizarre sojourn in some perspective for myself. I created a private photo blog to share those 200 days with those closest to me. Much to my amazement, I found that others found my posts fascinating, well-written, and moving. I personally found writing them to be therapeutic and calming. I write now with hopes of reproducing that magic.

I have known since age 5 that I wanted to be a doctor. It is my calling. Today, more than ever, I believe with unshakable resolve that I was put here to heal and comfort. How I have carried out this mission is the real story.

I am a cardiologist and critical care physician. I graduated from medical school 31 years ago. I was a medical school professor for a very long time. My friends will tell you that I went down seemingly strange and misguided paths while practicing — getting degrees in medical management and health law to help me fight off those I maintained were interfering with my perception of how medicine SHOULD be practiced.

After 27 years, I burned out. I had travelled so far down those distracting roads, I lost my way. I was no longer healing, no longer teaching how to heal. I needed a re-start, a defibrillation. I became a medical officer by direct commission in the United States Air Force and found myself literally running after 27 year old fellow officers in the service of the Nation. It was then they sent me to Iraq.

Now my military journey has come to a close — my obligation was completed on 19 October 2012. I have a new position helping to take care of our Nation’s veterans in New England. Come with me as I travel down this next road and read what is on my mind. And tell me what YOU think!

Mike

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Lost

Written in June, 2012

I had an 80 year old lady in my office today accompanied by her two daughters. She was referred to me several weeks ago because she was fainting several times a day. Remarkably, she did not injure herself during these events. Her primary care doctor sent her to me. When I first met her she said, almost immediately upon entering my office door, “I think I am fainting because the medicine THEY have me on is making my pulse too low. It’s below 50 most of the time”. I think it was Osler who admonished us nearly a century ago that if you listen to the patient, the patient will TELL you what is wrong with her.

I am a pretty smart doc. I listened to her. I re-adjusted one of her medicines. Her drug regimen seemed to me to be a very odd and strange potpourri of potent chemicals. When she came back today she was happy. Her pulse was 80 and she had not fainted in many days. Good. A victory easily won. The battle before us now was trying to sort out the polypharmacy she was taking. Again, she had told me during our first meeting what the root cause of her problem was — the medicines THEY had her on.

My patient was frustrated. She told me that over the last four years she had been assigned no fewer than five PRIMARY care doctors. “You see them once, then they are gone. They go from base to base so fast. Then they send them off overseas for months and when they come back they don’t remember you. You have to tell your medical story over and over again. No one has time to listen to you. You get LOST!”

Then she asked me the most telling question of all . . . “When are YOU going?”

“I’ll be leaving in five months. It is time to go home”, I responded.

“Well, at least you have an excuse. You must be retiring.”

When doctors of my rank talk of “going home” it usually means they are at the end of their 20 year stint for retirement benefits in the military. I did not have the heart to try to explain to her that I was leaving her after only four years in the military.

Her story is so common in the military health system, especially when it comes to care of the elderly retirees. Their doctors or providers move very quickly and seldom stay in one place more than three or four years. The pressures of deployment during wartime exacerbate and magnify this Brownian motion. As a result, the patients lack longitudinal care. They do not have a consistent care giver who gets to know them, work with them, learn from them, and find out who they are over years. Her helter skelter medication list reflected perfectly the number of primary care providers she had been subjected to in a very brief period of time. That list had never been tailored, trimmed, and designed by a single doctor for a single patient. It was medicine by incident upon incident upon incident by doc after doc after doc.

Indeed she was lost. She was lost in a system not designed for a large population of the frail elderly. This system was designed to deliver care to rather young troops, troops on the move. The elderly retirees, in my opinion, have been shoe-horned into this system. As a result, the care is fragmented, inefficient, expensive and in some cases unsafe (I am a patient safety expert, by the way. I have earned the right to use the dreaded “unsafe” word).

We need a better approach for these older folks. We owe a great debt, as a Nation, to these veterans and their dependents. Surely we can do better by them. Morally, we MUST do better by them.

 

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“The Reports of my Death are Greatly Exaggerated”

Mark Twain wrote the above words upon reading his own obituary in a widely read newspaper.

I have not posted here in quite a while because life has been a maelstrom!

I have now left the military with the completion of my active duty obligation on 19 October. My wife and I have returned to our New England home after fours years away and it has been grand. I survived the moving (barely) and we are still opening boxes to find stuff. We have even had to put some things in storage because we ran out of room in the house. In the coming months, this will rectify itself, I am sure.

On 13 October, I thought it might be a good idea to work on some of my ham radio antennas. This involved using a ladder on my roof. Needless to say, it was NOT a good idea. I shattered my left ankle and had emergency surgery to repair, plate, screw and otherwise clean up the mess. I have a great surgeon. All is proceeding well but I have weeks more of recovery ahead of me.

Several days after the “catastrophe”, I finally began work at my new position taking care of veterans in this region. I am using my physician executive toolbox this time and not my stethoscope. It is just amazing to me that I have acquired all these skills that I can pull out and use when I need them. As time goes on, I realize I have had very little real control over my career — some higher power is in charge and plopping me in places where I am needed or where I can learn something. I am enthused about this new job. What awaits?

I hope those of you affected by Superstorm Sandy are managing, rebuilding and staying safe. You are all in my thoughts. Happier days will soon arrive.

Will try and be a better blogger! Thanks for continuing to read and follow me along.

 

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“You are a part of my brain”

I have about two weeks left in the Air Force now.

Things are winding down and I am in this netherworld — not really here and not really gone.

Suddenly outside my office is an apparition from Balad. I have seen this smiling face so often over the last two years during good times, hard times and VERY BAD times. Usually her face is in a photo or in a memory or in a thought. Every once in a while, she graces my office with her real, live face. I cherish those visits.

Today’s visit may be the last for quite a while but I somehow know that she will show up again at my door when I least expect it. I do not think of this as a good-bye.

We caught up on our lives, events, trials, tribulations and joys. It was just as if we were sitting in that ICU in the desert of Iraq. We were just continuing a conversation we had dropped for a moment. Toward the end of our chat I mentioned that as my life goes on I will never forget her or all the others we met and worked with at 332 EMDG/ICU. “You are a part of my brain. All of you are a part of my brain.”

True. However I should have ALSO said, “You are a part of my heart. You ALL are a part of my heart forever.”

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Moving

I hate moving.

No, I DETEST moving.

I have been fortunate. I have only moved several times in my life — college, medical school, home in Connecticut where I stayed for 27 years. Then we came down to Maryland in 2008 and now we are moving back to Connecticut.

I detest moving.

To me, it feels like societal disruption and upheaval. I am in a state of constant PANIC. What to throw out, what to save, where do I pack some items, what do I leave for the professional movers. My life is in front me, bare and unvarnished. Memories, the vast majority good but some incredibly traumatic and disquieting. I am forced to face the past and would rather not dwell on it. If I work hard enough on MOVING, I do not have time or energy to ruminate. However, at 0300 hrs the dreams and nightmares intrude and I am up to ward them off. An hour later I return to bed and try to get sleep. The next day, the cycle repeats.

I detest moving.

I know that within 24 hours of actually moving back home, the uproar and committee arguments in my brain will dissipate and then disappear. I have 30 days to endure this torture, though. Sometimes I think I should just surrender and stay put in the present house. Then reason intervenes and I am back packing boxes, rifling through papers and thinking about what an adventurous and mad journey the last four years has been.

I should not have waited until I was 53 years old to do this. I am too old for all this craziness.

But, as my wife continually tells me, when have I ever lived the way normal people do?

I detest moving. I swear I will NEVER do it again.

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Housekeeping

I am a novice when it comes to social media. In fact, it scares me! Anyway, I am attempting to do some things with my Twitter account and this blog. Please bear with me as I muddle along my learning curve.

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It’s a Wrap . . . almost

Labor Day, 2012. Four years ago on this day, I was in a state of panic. I had made this crazy decision to enter the military and leave everything behind. Everything that we had done and accumulated over 27 years, we essentially mothballed. What I did not realize is that I was doing the same thing to my heart and soul. It would take several more months and a trip to the war zone to learn all about that.

Two years ago yesterday, I flew out of Iraq and ended my tour of duty there. I had a smile on my face during that whole flight in the C-130 despite the heat, cramped quarters, noise, vibration and “battle rattle”. It did not matter. I knew I had done a good job and I was now returning home to loved ones and reality. Ah, but reality is only a state of mind. It would take a few more months to come to grips with that concept.

Now, I have 30 days before I end my military sojourn. I go on what the military euphemistically calls “terminal leave” and then I “separate”. These terms invoke visions of death and end-of-life care for me! However, I know better. I spent 53 years in the civilian world and only 4 years in the military. I am excited and delighted to “separate”. I did what I set out to do, even more, and return to the “real world” banged up but a far better person with a renewal of purpose, mission and peace. I do not dread separation. I CANNOT WAIT!

I will miss my troops, though. Everyone I served with. Everyone I worked with. All those in the deserts of Southwest Asia, all those in the jungles of Washington, DC. Working with these gallant warriors was, by far, the best experience of my military “career”. I doubt I shall ever have an experience quite as intense again. I do not think I WANT and experience that intense again. I want to gracefully slip into the next phase of my life and prepare for the bliss of retirement.

Most unexpectedly, I have found new work to occupy my time. Suffice it to say, I will work with my fellow veterans and toil ceaselessly to minister to their health and bind up their wounds. I think it is another one of those missions from the Master Physician. I cannot decline.

Tomorrow morning, I fight a new battle. I must annihilate this thing called the “outprocessing checklist”! It was NOT EASY to get INTO the military at my ripe old age. It is HARDER getting out and no one seems inclined to help. I am, once again, on my own but I know that somewhere, somehow an Airman will come to my aid just when I least expect it.

Finally, the photo attached to this post was taken at the National Museum of Heath and Medicine this weekend. I apologize that I had to take it through the display case glass. I was struck by the statement. I was even more stunned that Calvin Coolidge was the author. It turns out that I will soon have an attachment to Coolidge. More on this in the future.

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Musings in the Auditorium

Two days ago I was at a national medical conference, sitting in an auditorium watching a live cardiac procedure on a large video screen. The procedure was being performed on a patient many miles away and I was seeing the operation as it was being performed.

Additionally, the procedure was a replacement of the patient’s aortic valve using a relatively small device being placed in the “heart” through a small incision in the patient’s upper leg. No opened chest, no general anesthesia, no heart-lung pump, no cardiac surgeon.

I truly believed I was in some sort of alternative or parallel universe. How was all this happening? When did we actually have the madness to believe we could replace heart valves without opening the chest?

This incredible experience led me to think — an often dangerous activity for me.

Four days ago I began my 27th year of practicing medicine and cardiology. When I graduated from medical school over 31 years ago, we had never heard of HIV. We were only dimly aware of some odd and strange cases of infections seemingly associated with immune deficiency in adults that were being seen in some of our hospitals. 50% of people having a heart attack would die either before they made it to a hospital or while in the hospital. Stomach and intestinal ulcers were treated by a surgeon in the operating room. Kilogram babies could not survive outside the womb. Hip replacements were amazing surgeries and only a few orthopedic surgeons did them. I had never heard of anything called “percutaneous transluminal coronary angioplasty”.

I thought I wanted to be a neonatologist.
Or maybe a pediatric surgeon.
Or maybe a pediatric cardiovascular surgeon.
Or maybe a neuroophthalmologist.
Or maybe a traumatologist.
Or maybe . . .

I NEVER thought I wanted to be a military officer!

What things I have SEEN! What skills I have acquired. What things I have done to make people well, better, cured or more comfortable.

Where have all those years gone? How is it I have lived through all this amazing progress and technological revolution in medicine?

Yet, I still rely on my stethoscope, my hands, my old brain. They seem to have done well by me and my patients. Indeed, many times they have succeeded when all that technology failed or was not there.

I wonder what Sir William Osler, arguably the father of “modern” North American medicine, would say about all these things that have happened to his beloved profession in the last century? Would he be pleased or thrilled or saddened or angry?

It has been a great career for me over these three decades.

Do I have one more decade left in me?

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At the River

I write sitting on the banks of “our” river on the back boundary of our farm. I am the only one here. The weather continues to be idyllic. The river is low and rolls lazily in front of me, in no great rush to ultimately reach the Long Island Sound. The small gnats are hatching on the surface offering themselves up to the small mouth bass that I know are lurking beneath, awaiting lunch. I should be out there with fly rod in hand but that will need to await another day.

I look around at our little campsite here. Immediately I remember the wife and I spending long weekends and holidays in tents. Campfire blazing, music playing on the radio, marshmallows, roasting on the coals. Two small girls are running around playing with toys, dolls and their beloved dog who cannot get enough of swimming in the river. They became grown up women on the banks of this river.

One daughter will soon graduate from physician assistant school and join the ranks of healers who I so revere. The other daughter is doing Schweitzer’s work in Africa, following that inner voice that none of us can really comprehend.

I am content here.

It is time to come home and spend more days like this at the river.

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“Field Day!”

I am an amateur radio operator licensed by the FCC since 1993. Most people know us as “ham” radio operators (NOT to be confused with CB). Each year, on the last full weekend of June, most operators participate in Field Day, sponsored by the American Radio Relay League. The League is the hobby’s national organization for development and continuance of the hobby. During Field Day we literally take to the fields across the nation to practice radio communication in sparse and austere environments as a readiness exercise to prepare for disasters and emergencies.

Field Day, however, is more than just an exercise. It is a weekend of fellowship, joy, good times and just plain fun. This weekend was the first Field Day that I have participated with my radio club since 2007. I went on leave, headed up to Connecticut and made a surprise visit to the Field Day site. My were they ever surprised! I was clean shaven, had a conservative haircut and looked fit — a far cry from five years ago! We had a great time trading notes, stories and rekindling friendships. Oh, we also did a lot of radio.

Each Field Day since 2004, though, we have had moments of sadness and grief. One of our great friends died just before Field Day that year at the age of 49. He dropped dead in his garden. Jim was a great radio operator, a great friend and he LOVED Field Day. We joked that he was the General who organized our campaign every year. A month before Field Day he would start calling people on the phone to arrange for radios, antennas, tents, wire, rope, cable and the like. When he called you he never said, “Hello”. Instead he would yell, “Field Day!” In 2004, the phone went silent.

For two years after that, we all would meet at midnight during Field Day around one of our antenna towers and toast Jim and our memories of him. All of us would shed a tear for the loss of our friend far too soon, far too young.

Today, as I left the Field Day site, I looked up into the beautiful Connecticut sky which was punctuated with the outlines of antennas of aluminum and copper. I whispered, “Jim, I think I feel you are here. Have a good Field Day.” I started my car and then looked up. Standing next to my door had suddenly appeared another ham I had not seen in years. I stopped the car and reminisced with my friend, Bob. As we talked, Bob and I spoke of Jim. Then Bob reminded me that he was the only club member who had used Jim’s FCC license call sign on the air since his death and was the person who handled all the contact information for Jim’s call.

I smiled. Jim had found a way to let me know that indeed he was enjoying the radio this weekend.

Jim . . .

FIELD DAY!

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“No Man Left Behind”

Yesterday morning I went to physical fitness training with my squadron at 0645. I have a love-hate relationship with this activity. I hate the training but I love the setting and what happens there during the session.

In the Spring, the track we run on (in my case walk since I am nearly useless running with my knee problems) is not far from the flightline. The sun rises just over the horizon of the airfield and is a brilliant yellow reflecting in the clouds, revealing the azure sky. The aircraft are sitting out on the tarmac, sparkling and pristine, ready for a new day. Sometimes the hangars are open allowing us to peek into them to see the Airmen preparing the planes as we run. It always brings a catch in my throat. I think, “This is why I chose the Air Force and not the Army or Navy.”

There is more to this ritual, however. Ever since initial officers’ training in Alabama in the Fall of 2008, I have ALWAYS run at the tail end of the pack. I cannot keep up with the 25 year olds, even when my knees were healthy. In Alabama the “kids” (lieutenants, captains, and a few majors) would be all done running and waiting for me to cross the finish line. I would be huffing, puffing, ready to collapse and a few yards away from the line when I would begin to hear the noise. Clapping, yelling, screaming, whistles — “Come on, Colonel! You can do it. Keep going! Don’t give up!” And I would NOT give up. I kept running. I would make it but never fast enough to pass the test. That would have to wait until the Spring of 2009 when I finally did it at my base. They screamed, yelled, clapped and whooped with glee, this new set of “kids”. All I could do was say, “Are you sure I did it?”

I have never experienced anything like this before the military. It moves me each time it happens.

Other things happen on that physical training track. Troops come and walk with me at the end of the pack. They willfully give up practicing for their own tests to walk with me and chat. They ask me how am I doing? Why did I “come in”? Is it true you were a medical school professor? What should I do with this patient? Where did you live before? Do you have kids? I have had more meaningful and touching conversations on the track than I can count.

Then, occasionally, my commanders come to walk with me. They never ask me if I can pass the PT test in a few weeks. They ask, “How are you doing? How did things go this week?” I have spoken to my commanders more on the track, I think, than in any other venue.

In December of 2008, when I had just arrived at my base, I was running during a fitness session. Again, I was FAR at the end of the track. I was having a very bad running day. All of a sudden, I realized I could hear running feet BEHIND me. The Senior Master Sergeant who was the “first shirt” of my squadron had run the course and then re-run the course to look for stragglers. Here I was. He ran with me. He gave me hints on how to pace and run. He asked me what it was like to practice medicine. He ran WITH me. I apologized for taking so long and for my poor performance and urged him to run forward and get with the rest of the squadron. He looked over at me and said, “Sir, no man is ever left behind. We will finish together.”

And we did. And the crowd applauded.

In the ensuing months, I saw this behavior recur. It is not lip service, it is reality. I have seen it everyday in small ways and in big ways. I saw it in Iraq when troops would come in with a wounded colleague and absolutely refuse to leave the bedside — “Sir, he’s my battle buddy. I cannot leave him.” So, they stayed. I have seen it when people were sick stateside and needed help. I have experienced it when I needed help. I have NEVER been left behind.

This is one of the most important things I have learned in the Air Force. I would not have come to understand how important it is to never give up on someone had I not been forced to run on those tracks. Maybe I have finally started to come to grips with the thought that there WAS a redeeming value to those PT tests after all.

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