Ignore evidence inconsistent with your view

In fact, there was a certain pride and gallows humor, with jokes like the problem with every-other-night call is that you miss half the cases! Residents gave it their all, remaining remarkably conscientious even without sleep. One senior pediatric resident who supervised me looked for things to do well beyond what the patient came in for. During nights, I would try to finagle a way to get at least an hour of rest before a long post-call day that might not end until seven or eight o�clock. But that was rarely an option with Dr Ivory, who drove her interns as hard as she drove herself. Nothing was back-burnered. Whether a child was admitted with an asthma attack or a concussion, she�d want a full review of the vaccination history before morning rounds, to see if the immunizations were up to date. That could require running down to the medical records department to locate the file (this was before the advent of the electronic medical record) as more patients flowed into the emergency department. The sense of being in a living relationship returned--hard and frustrating at times, but meaningful. I made a mistake at work, Belinda told me, and I was afraid it would have bad consequences. My first impulse was to call Justin. In the past I would have vetoed that thought. But instead of starting my mental gymnastics to protect myself, I tried to enjoy the feeling of wanting to reach out to him, and to even feel grateful for it. I ended up calling him, and I consciously kept the edge out of my voice. I said simply that I needed his help. He tried to help me. I felt closer to him. She realized how much she'd focused on their relationship as the central problem in her life. Hormones are another component of the body that would not be possible without fatty acids, which are the building blocks of fats. Many of the hormones in our body are referred to as lipid-derived because they are made from fats.

On a cellular level, fat is even more important. All cells have an outer wall composed of a lipid bilayer that allows them to maintain separation from extracellular materials. Without these lipid bilayers, there would be no life at all. That�s what I call essential. Additionally, we require fats to absorb certain nutrients. The vitamins A, D, E, and K are referred to as fat-soluble vitamins because they literally cannot be absorbed without first being surrounded by fat. Unlike the other vitamins, which are water-soluble, these four can be stored in the body�s fat tissues. Fat is also an important source of energy for the body, and for maybe as much as two thirds of the population, it should be the most important and preferred fuel source. She also requested I order lots of tests to look for rare conditions, and then follow up on the results right away. I found that if I did everything she wanted, she�d look at me approvingly, which I craved. This perfectionist tendency is cultivated in medical school, where tests, typically multiple-choice, focus on minutiae, and where the attending physician might ask you anything about your patient�s medical history, lab values, and so on. On the surface, such an exacting standard seems good for patient care. After all, who doesn�t want a doctor who is full of facts? And doesn�t hierarchy and a boot-camp environment foster exactitude, endurance, and discipline? It does. But the problem with obsessive behavior is that it represents a loss of perspective that comes with a price. Sure, if you keep checking whether your stove is on or your garage door is open, you might conceivably find one day that it is, but at what opportunity cost? What�s left out of patient care as a result of such behavior? It was liberating to wrest her mind from the tally sheet of slights, to choose to see herself and Justin as square with each other. Her disappointments didn't evaporate;

they'd probably always be there. But when she stopped treating him as if he had already disappointed her, he was happy to get along and didn't seem to have any interest in loading up ammunition of his own. Whereas in the past she might have viewed that as evidence that he didn't care enough, she was glad, and even a bit admiring, of his lack of interest in holding a grudge. I've been editing old videos of the kids when they were little, Belinda said. I have adorable footage of them at two and four, then four and six, then six and eight. While I watch, I also remember the stories I was playing in my head at the time--resenting my sister-in-law, or feeling mad at my husband. I think to myself, so much of that beautiful time went by with me stuck in my head, distracted from the miracle that was playing out in front of me. How I regret it. Fat provides nine calories per gram, over twice what protein and carbohydrates provide. It is also the only of the three major macronutrients that does not induce an insulin response in the body. This, as you will see in later articles, is a very important feature of fat metabolism for long-term optimal health. Your body understands the value of fat as fuel so well that it utilizes fat as long-term energy storage. The fat tissue on our bodies is made up of adipocytes packed full of triglycerides. Triglycerides are the body�s long-term storage solution for energy that is not immediately needed. Certainly some of our body fat comes from dietary fat, but for most people eating the Standard American Diet (SAD), much of the fat tissue on their bodies is actually excess carbohydrate that the body has converted into fat. That�s right�excessive carbohydrate is easily turned into body fat. Structurally, fat is fairly simple: it is a long chain of carbon atoms bound together with hydrogen atoms attached to the top and bottom of each carbon. If every available spot along the chain is filled, we call this saturation, and those saturated chains are called saturated fats. What�s left out is the individuality of the patient. We did things to people without finding out what challenges they were facing and what they most needed from us.

Medical students and residents are immersed in a task-driven culture that objectifies the patients we are supposed to care about. At work I�d make long lists and then feel satisfied as each item got checked off, particularly on post-call days when tucking all the patients in, as we called it, was the only way to get out�like parents who, after putting their children to bed, could finally rest. The first priority every morning was to discharge patients so their beds could be filled with new ones. A delay occurred if we had to meet with their families to discuss, for instance, whether they could return home or needed to go to a nursing home. One of the disincentives to spending time with patients was that doing so cut into time for completing tasks. Task completion drove us and was the measure of our success. How did such a state of affairs come to pass? First, it�s important to acknowledge that practicing medicine really does require following a lot of steps. And then I tell myself, the only solution is to be awake to the miracle now. LIFE IS LIVED forward, but self-knowledge takes time and experience. We all come to marriage with the completely valid hope of being loved for ourselves. We have the right to expect love, and the responsibility to give love. That is the sacred human compact at the heart of marriage. It's what we strive to commit to, honor, nurture, and remember, in good times and bad. My advice to every newlywed, to every new parent, and to every busy work-family juggler is don't let that die. Once it dies, once you've closed your heart, it's really, really hard to open it back up. It may prove impossible. Like everything else in life, investing early works better than trying to catch up later. Any spot along this carbon chain that is not bound by two hydrogen atoms is called an unsaturation point. Fats with only one unsaturation point are called monounsaturated fats and fats that have more than one are referred to as polyunsaturated fats.

Makes sense, right? If you�ve ever wondered about why omega-3 fats and omega-6 fats (also known as fatty acids, or n- fats) are named that way, well, it is also because of their structure. Fats are named by where their first unsaturation point occurs. So on omega-3 fats, the first carbon that is not paired with hydrogen atoms is the third. This does not give any indication as to how many saturation points there are, just where the first one occurs. And finally, what is a trans fat? For our purposes, a trans fat forms when an unsaturated fat has been artificially converted into a saturated fat by the addition of hydrogen atoms. That�s why anything that has partially hydrogenated oils will contain trans fat. When patients are admitted to the hospital, the doctor�s orders specify everything that happens, including what they will eat (diabetic diet), their activity level (up in chair), how often they�ll be awakened at night (vitals), and what will happen if they stop breathing (code status). This all keeps staff busy. And when the various scans and blood work come back, the resident has to piece it all together to figure out what to do next. While challenging at first, it soon becomes routine. I remember the first time I admitted 12 patients during the night�the maximum allowed per call shift�with two interns under my supervision, and experienced the satisfaction of knowing that I knew what I was doing. I imagine it�s similar to the pilot in training who gets to a point where they realize they�re not likely to crash the plane, even in bad weather. Physician and pilot have, respectively, achieved competence. However, a plane is an object, and a patient is a person. Philosopher and theologian Martin Buber distinguished between two ways of experiencing the world: as I-It or as I-Thou, with the former referring to the manner in which we relate to people as if they were objects and the latter as how we should strive to relate to them as people. Unfortunately, we are prone to relate to others as objects once they have labels. Every single day, it's important to look at the long game, and to keep your eye on what you want: to give and receive love. But when marriages die, I don't believe that it is only out of neglect or error.