For Want of a Hammer

Because I was thought to be precociously smart, or perhaps smart-ass, I was tested for and sent to kindergarten at age 4. My birthday was in November. I was always the youngest and littlest kid in the class. When we lined up by height for school pictures I was always last in line.

Because I was young and little and smart I tended more towards science and math clubs than sports. I played baseball almost every summer from age 5 onwards but was terrible. My dad came to every game to watch me play right field and/or sit the bench.

Because I was smart and tended more towards science and math, I was enrolled in the Gifted and Talented program starting in 7th grade, which meant I went to Center Jr High across town instead of Albion like everyone else in my neighborhood. The special-ed kids also went to Center and we rode the same bus. Sometimes I would laugh at them or with them, but more often I sat and tried to talk to them or help them understand stuff.

Because I was enrolled in the Gifted and Talented program at Center Jr High I was among the first group of kids in Strongsville in 1979 to take a computer class. There was one Tandy TRS-80 and one Apple II in Mr. Daugherty's classroom. 

Because the Apple II had an intrinsic elegance that the TRS-80 did not possess, I did all my 7th grade computer work on the Apple II. Most of the other kids used the TRS-80. Both of them required writing programs in BASIC.

Because my Gifted and Talented trajectory carried me through to AP classes and science and math clubs in high school, I went on a field trip in 10th grade to Case Western Reserve University where we visited the Biomedical Engineering Department and saw scientists creating artificial vision and bionic arms.

Because I was smart and good at math and science and had seen the amazing things the scientists at Case Western Reserve University were doing in the Biomedical Engineering Department, I decided I was going to Case Western Reserve University to become a biomedical engineer.

Because we had a neighbor that lived behind us that did not know us very well but knew that I rode the short bus to school, she once told my mom how impressed she was to hear that I had been admitted to Case Western Reserve University to become a biomedical engineer. My mom simply said "Yes we're very proud of him."

Because I went to Case Western Reserve University to become a biomedical engineer I was assigned to a room in a suite in Glaser dormitory with 5 other guys who also wanted to become engineers. That first year my suitemates were Mike, Matt, Vern, Clark, and Lee. Because I had a serious girlfriend that first year, I didn't get to know these guys as well as I should have until the next year.

Because these guys wanted to become engineers they were also smart and good at math and science and also so clever and hilarious that I laugh even now thinking of some the things we did. Matt had an original Apple Macintosh 128K and used to get up early in the morning to do nothing but rearrange the file and folder icons around on the desktop. Because I appreciated the intrinsic elegance of the Apple Macintosh 128K, I used sit on Matt's bed and watch him do this. Sometimes he would open a file in MacPaint which was a 2-bit pixelated picture of a nude Japanese woman.

Because two of my suitemates were named Clark and Lee, and they were amusingly foreign, we would insert their names into songs which included the words "you and me," such as "It's only Clark and Lee and they just disagree" or "Say Clark, say Lee, say it together, that's the way it should be." Needless to say I still do this today and it makes me at least smirk, but often LOL.

Because I was smart and good at math and science, I performed very well academically in the first two years of prerequisite courses necessary to become a biomedical engineer at Case Western Reserve University, I was able to start taking biomedical engineering courses and was also required to select a humanities track at the beginning of my junior year. 

Because I was required to select a humanities track at the beginning of my junior year, and the director of the medical anthropology track had the amazingly cool name of Atwood Gaines, I chose to enroll in the medical anthropology track to fulfill my humanities obligation at Case Western Reserve University while becoming a biomedical engineer.

Because I found the introductory biomedical engineering courses at the beginning of my junior year so painfully dry, boring, and far removed from the artificial vision and bionic arms I had seen on my field trip to Case Western Reserve University as a sophomore in AP science classes when I was in 10th grade, and the world of medical anthropology that Atwood Gaines introduced was so rich, fascinating, and vibrant, I changed my major to medical anthropology.

Because Case Western Reserve University was not, as its name might imply, a military school, but rather a result of the 1967 merger of Case Institute of Technology and Western Reserve College, changing majors from engineering to anthropology was not at all a problem. This resulted in my changing from a "Casie" to a "Reservie" and experiencing some harsh razzing from nerds.

Because I changed from a "Casie" to a "Reservie" and changed my major to medical anthropology, I took an actual 9-week college course called "The Anthropology of Rock and Roll." This course existed solely so that Atwood Gaines could noodle on his guitar and explain in detail over a 9-week period how he believed Eric Clapton single-handedly transformed the blues to rock and roll. Tom Petty was not mentioned a single time in this course, much to the dismay of my friend Dave Sfeir. I received a grade of "C" in "The Anthropology of Rock and Roll." 

Because I had been dumped by my girlfriend, who incidentally was the winner of the Miss Korea Chicago Pageant 1986, and I am not making that up, I spent a large part of my sophomore and junior years making great friends with my dormies and "finding my path" via changing majors, taking courses such as "The Anthropology of Rock and Roll," drinking alcohol, being obsessed with One Life to Live, and endlessly watching a grainy VHS tape containing bootlegged copies of Sixteen Candles, Ferris Bueller, and Rebel Without a Cause.

Because I spent a large part of my sophomore and junior years "finding my path" via changing majors, taking courses such as "The Anthropology of Rock and Roll," drinking alcohol, being obsessed with One Life to Live, and endlessly watching a grainy VHS tape containing bootlegged copies of Sixteen Candles, Ferris Bueller, and Rebel Without a Cause, my GPA was suffering.

Because my GPA was suffering and I was about to graduate with a BA in anthropology, I realized I needed to stay in school.

Because I realized I needed to stay in school and I was a good writer, I was able to create a beautiful and compelling essay describing how my GPA suffered during my junior year due to the life-altering realization that engineering was not in fact my destiny, but that in fact I was meant to be a doctor who would approach patients with an intrinsic empathy, humanity, and understanding of their unique personal and cultural perspective, which would in fact contribute to their healing.

Because Case Western Reserve University had a very progressive patient-centric School of Medicine with a unique curriculum based on the concept that doctors should approach patients with an intrinsic empathy, humanity, and understanding of their unique personal and cultural perspective, which would in fact contribute to their healing, I was accepted to attend Medical School at Case Western Reserve University.

Because I was accepted to attend Medical School at Case Western Reserve University, my grandmother sent me money to buy a computer of my own, and I found a used Macintosh 512K for $1000. Because I appreciated the intrinsic elegance of the Macintosh I would get up early in the morning to do nothing but rearrange the file and folder icons around on the desktop. 

Because it would not fit onto a single 3.5" floppy disk, I did not have the MacPaint picture of the nude Japanese woman. Now that I've Googled her up I see she isn't as nude as I remember.

Because I attended Medical School at Case Western Reserve University I learned that it was actually true and critically important that doctors should approach patients with an intrinsic empathy, humanity, and understanding of their unique personal and cultural perspective, which would in fact contribute to their healing.

Because my first clinical rotation in third year at Case Western Reserve University School of Medicine was Pediatrics, and I was very nervous about having any sort of credibility taking care of older children with serious illnesses, I chose to do my inpatient month on the NICU step-down floor at Rainbow Babies and Children's Hospital.

Because I chose to do my inpatient month on the NICU step-down floor at Rainbow Babies and Children's Hospital during my Pediatrics rotation at the start of my third year at Case Western Reserve University School of Medicine, I worked with a first year neonatology fellow named Dr. Brenda Hook who always talked about how they did things in Galveston, where she had done her pediatrics residency. I had never heard of Galveston before I met Dr. Brenda Hook.

Because you cannot avoid things indefinitely at Case Western Reserve University School of Medicine, I was eventually required to do pediatrics rotations with older children as well as all the other rotations in all the other specialties, and found that I did have a special knack and love for Pediatrics. And the kids actually seemed to find credibility in my Doogie Howserness. Sometimes I would laugh at them or with them, but more often I sat and tried to talk to them or help them understand stuff.

Because I came to have a special knack and love for Pediatrics, I did several more electives and an acting internship in various pediatric specialties. Throughout my 4th year I saw lots of different kids on lots of different inpatient and specialty service rotations including one 8 year-old boy named Michael.

Because Michael had recurrent prolonged fevers, joint pains, swollen lymph nodes, he was being seen in rheumatology clinic when I was on that elective. Because I was the student who did the original full history and physical in clinic and discovered through the workup that he actually had lymphoma, and because I had learned by attending Medical School at Case Western Reserve University that it was actually true and critically important that doctors should approach patients with an intrinsic empathy, humanity, and understanding of their unique personal and cultural perspective, which would in fact contribute to their healing, and because I had credibility with this older child with a serious illness, my team trusted me to lead the conversation where this diagnosis was revealed to Michael and his family. Michael's mother was on hospice care for terminal cancer.

Because Michael was in the hospital a lot the following month when I did my acting internship on the heme-onc service, I played a lot of games and did a lot of puzzles with him, and often slept on a cot in his room at night instead of the call room because his mother was on hospice care for terminal cancer and could not be there.

Because I saw Michael all the way through from his diagnosis to his mother's death to his final chemo party, I decided I wanted to be a pediatric oncologist.

Because I wanted to be a pediatric oncologist I determined it essential that I find a smaller pediatric residency program that would give me a solid foundation in general pediatrics before I went on to fellowship training. 

Because I wanted to find a smaller pediatric residency program that would give me a solid foundation in general pediatrics before I went on to fellowship training, I requested application information from the Pediatric Residency Training Program at The University of Texas Medical Branch in Galveston, Texas.

Because I had heard Dr. Brenda Hook talk many times about how they did things in Galveston during my inpatient month on the NICU step-down floor at Rainbow Babies and Children's Hospital during my Pediatrics rotation at the start of my third year at Case Western Reserve University School of Medicine, I met with her and she assured me that the Pediatric Residency Training Program at The University of Texas Medical Branch in Galveston, Texas would suit my needs perfectly.

Because Dr. Brenda Hook assured me that the Pediatric Residency Training Program at The University of Texas Medical Branch in Galveston, Texas would suit my needs perfectly, I interviewed there and spent the day meeting amazing and wonderful people and spent the weekend falling in love with the little island city.

Because one of the amazing and wonderful people I met on my interview day, the Department Chair Dr. Pearay Ogra, had some sort of supernatural abilities, he said to me during my interview, "Well, pediatric oncology sounds like a nice idea, but you never know what will happen. You may come here, meet a nice Galveston girl, get married, have a few kids and decide to stay and have a career here in pediatrics."

Because it was 1993 I called my mother from a pay phone near the beach and said "This is going to be the place."

Because this was going to be the place, I ranked The University of Texas Medical Branch at Galveston, Texas #1 on my list. I was thrilled when I opened my envelope on Match Day and discovered that The University of Texas Medical Branch at Galveston, Texas was indeed going to be the smaller pediatric residency program that was going to give me a solid foundation in general pediatrics.

Because it was a smaller pediatric residency program that was going to give me a solid foundation in general pediatrics, within the first few months of residency at The University of Texas Medical Branch at Galveston I met even more amazing and wonderful people, many of whom I am lucky enough to still count among my dearest friends, trusted colleagues, and sage mentors some 20 years later.

Because not everyone can be a dear friend or trusted colleague, one of my fellow interns in the Pediatric Residency Program at The University of Texas Medical Branch at Galveston was often unreliable and frequently called in sick. I had to cover her call for the inpatient service on December 9, 1993.

Because I was covering call for the inpatient service on December 9, 1993, I was summoned to the ER to evaluate a patient for admission and saw perhaps the most beautiful girl I had ever seen working as a tech. She had standard-issue blue scrubs on yet somehow she was literally glowing. Despite my Doogie Howserness and being nervous about having any sort of credibility with approaching such an amazingly beautiful girl, I rolled my chair right up next to her and struck up a conversation.

Because she was a nice Galveston girl she talked to me and said she was a GEMS Paramedic working overtime in the ER to make some extra money to buy a house of her own. She wrote her phone number, mom's phone number, work number, and pager number on the back of a prescription and told me I should come for a ride-along on the ambulance with her some time. As I walked back up to the inpatient floor with my upper level resident Rima Chamsedine, I said "I am going to marry her."

Because I married her, we had a few kids and I decided to stay and have a career here in pediatrics. 

Because I decided to stay and have a career here in pediatrics, I have taken care of thousands of children with an intrinsic empathy, humanity, and understanding of their unique personal and cultural perspective, which I hope has in fact contributed to their healing.

Because I decided to stay and have a career here in Pediatrics, my first job out of residency was in the newly opened Pediatric ER at The University of Texas Medical Branch at Galveston. I came to know the pediatric residents very well through working with them on 12-hour long night shifts, where you can really get to know somebody. Sometimes I would laugh at them or with them, but more often I sat and tried to talk to them or help them understand stuff such as doctors should approach patients with an intrinsic empathy, humanity, and understanding of their unique personal and cultural perspective, which would in fact contribute to their healing

Because I worked in the Pediatric ER at The University of Texas Medical Branch at Galveston I worked side-by-side with Dr. Russell Miller who taught me more about medicine and life than anybody I have ever known. He had the uncanny ability to clearly frame any issue, any issue at all, into 3 simple bullet points. I wish I had somehow offered the same to him when he needed it, and even more selfishly wish he was here now to help me clearly frame my current issue.

Because I had credibility with the residents and knew them well, had an intrinsically elegant PowerBook, was the only person in the late 90s who knew how to use Powerpoint and Photoshop, and was a smart-ass, I became the de facto creator of the annual "Resident Roast" to be presented at their graduation from the Pediatric Residency Program at The University of Texas Medical Branch at Galveston each year.

Because I presented the annual "Resident Roast" each year, the Camp Director of the Rainbow Connection, who happened to also be the Child Life Specialist at the Children's Hospital at the University of Texas Medical Branch at Galveston, and the Assistant Camp Director of the Rainbow Connection, who happened to also be the Residency Program Coordinator for the Pediatric Residency Program at The University of Texas Medical Branch at Galveston, approached me about creating a 20th anniversary slide show to be presented at The Rainbow Connection Camp for Children with Cancer and Blood Disorders in the summer of 2003.

Because I created the 20th anniversary slide show which was presented at The Rainbow Connection Camp for Children with Cancer and Blood Disorders, and I still had a special interest in children's oncology because of patients like Michael who I saw all the way through from his diagnosis to his mother's death to his final chemo party, my whole family came to the Rainbow Connection 20th Anniversary party that year.

Because my whole family came to the 20th Anniversary party at The Rainbow Connection Camp for Children with Cancer and Blood Disorders, I joined the board of directors and became the camp physician and medical director for this organization and have attended camp along with my kids ever summer since.

Because I am the camp physician for The Rainbow Connection Camp for Children with Cancer and Blood Disorders I have become a part of a family of very special people. I have seen kids fight against, win against, and lose against cancer, but each with amazing courage, joy, and grace.

Because I have seen kids fight against, win against, and lose against cancer, but each with amazing courage, joy, and grace, I am determined to do the same myself. 

Because I still have credibility with the residents in the Pediatric Residency Program at The University of Texas Medical Branch at Galveston, sometimes laugh at them or with them, but more often sit and try to talk to them or help them understand stuff, I became the Program Director for the Pediatric Residency Program at The University of Texas Medical Branch at Galveston just a couple months ago. 

Because I see them every day and try to have an open-door policy as much as possible, even through the last few difficult weeks, the residents feel comfortable to laugh at me or with me, but more often sit and try to talk to me or help me understand stuff. This week one of the residents came to my office to tell me that the expression I was trying to use in morning report was not "For want of a hammer," but actually "For want of a nail."

Now I will make like a tree, and get out of here.

-kpb 9/13/13