Greater Louisville Medical Society
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November 2013
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If you missed my Halloween poem, "How the Ghost Stole Pain Care," check it out on Vimeo here.
Louisville Medicine
November 2013
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Seeing Aye to Aye
 
I don't know why I did it,
I don't know why I enjoyed it,
and I don't know why I'll do it again!
-Bart Simpson

The story goes that Abraham Lincoln once held a cabinet meeting with his "team of rivals," a group of strong-willed and ambitious men, many of whom thought they could better fill the role of President. Lincoln asked for all those in favor of the Emancipation Proclamation to say "aye" and all opposed to say "nay." The only "aye" came from President Lincoln, prompting him to declare: "The ayes have it."

Honest Abe could get away with that.

Recently a team of rivals held a board meeting in my head. It went like this:

Frontal Cortex:
It is my duty to call to order this emergency meeting of the Cranial Board of Directors for James Patrick Murphy. We have one pressing item. To bring you up to date, we are at the Indiana State Capitol to testify before the Medical Licensing Board. Astonishingly, we have been granted only 90 seconds to present our recommendations on how to improve the Emergency Pain Regulations. We have already appropriated ample factual data, but a new motion has just been made to chuck that plan and proceed with a play on emotion. Is there any discussion?

(A hand quickly goes up.)

The chair recognizes the Temporal Lobe.

Temporal Lobe:
We have been in that assembly room almost four hours, and I have not heard nor can I recall any other presenter testifying with emotion. Our taking such a tack would be unprecedented. 

Frontal Cortex:
Can someone else offer an opinion? Hypothalamus? Hypothalamus? Are you awake?

Occipital Lobe:
Can't you see that Hypothalamus is unconscious? 

Frontal Cortex:
No, seeing is your job. Don't be so hormonal.

Occipital Lobe:
I'm not about hormones. Hypothalamus taps that keg.

Brain Stem:
I'll admit I drink the hypothalamic Kool-Aid. It allows me to make the heart race, the skin crawl and leave you breathless. If we go down this emotional highway, expect all of the above. I'm just sayin'.

Frontal Cortex:
Fair enough. We have not heard from the Limbics yet. 

Limbics:
You want emotion? I can get you emotion. I can get you emotion, believe me. There are ways, Frontal. You don't wanna know about it, believe me. 

Reward Circuit:
If it feels good, I say do it. I can be very persuasive and persistent. If I really want something, I won't let up. Sometimes I won't let up even when I know it will hurt. I call that hurtin' good. 

Frontal Cortex:
Each of you is a crucial member of our Board. Depending on the situation, any one of you might take charge. Back when we were first introduced to our future partner, I practically turned over my command to the Limbics for good.

Reward Circuit:
I was in on that too.

Occipital Lobe:
I saw her first.

Brain Stem:
That was a busy time for me.

Temporal Lobe:
I remember it well.

Hypothalamus (waking up):
I provided the libations. 

(Dramatic pause.)

Frontal Cortex:
There is a motion on the floor. A decision must be made ... a conscious decision. All in favor of asking our Department Of The Right Brain to quickly craft a creative message we can deliver with passion in 90 seconds, say "aye."

(Only Frontal Cortex says "aye")

All opposed?

Everyone else (in unison):

Nay!

Frontal Cortex:
The ayes have it!

The End

Epilogue:

On September 25, 2013, this drama actually played out in my head...and in real life. I had arrived at the Indiana State Capitol expecting ample time to present my recommendations for improving Indiana's new pain regulations. I was shocked when I learned I would be given only 90 seconds! How could I adequately defend lowering the morphine equivalent threshold in a mere 90 seconds?

Emergently my Cranial Board of Directors met. My limbics were stoked. The motion for emotion passed. My frontal cortex did not veto. And, heart pounding (brain stem at it again), my actions spoke as loud as my words.

I left the podium, ditched my microphone, approached the board, and - rather than stutter through a barrage of statistics - I showed each member an iPhone-view of my daughter's badly mangled car. I said that two days earlier I received the call no parent wants to get. I asked each member (they were all men) to imagine how he would feel if his child was denied pain care after a trauma like that. Connecting eye to watery eye, I challenged each to do his best to make the pain regulations fair for all, and that my specific recommendations would be coming later in an email. Returning to my seat, I wondered if I my right brain decision had been the right decision.

Like Bart Simpson, I can never be 100 percent sure why I do what I do. My Cranial Board of Directors - noble in reason, infinite in faculty - meets behind closed doors. My frontal cortex has veto power, but everyone in that boardroom has a say. I do know the best decision is always the honest decision, regardless of whether they see "aye to aye."

I think Abe would agree with that.


Let's Connect 

Sincerely, 
James Patrick Murphy signature
James Patrick Murphy, MD, MMM
GLMS President 

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