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Five a.m. is a challenging time for theological discussions.

But for Adam Hill, the 4-year-old son of my surgical colleague Michael Hill and his wife, Monica, the matter was pressing.

“I don’t want to die.”

Monica, rousing from sleep and sensing the existential urgency of the matter, addressed the tow-headed boy standing in the dark next to their bed.

“We are all going to die sometime, Adam. But Jesus brings us the promise that we can live again.”

“Cheez-its?” Adam beemed. “I love Cheez-its!”

“Well, honey, Jesus loves you.”

Suddenly Adam became somber again.

“I’m worried about my brother Owen. I don’t want him to die”

His mother, struggling somewhat to follow this early morning epistemological thread, asked “why are you worried about Owen?”

“He doesn’t like Cheez-its.”

I am sure you, as well as I, are astonished at times by the disconnect between what you think you said and what was heard.

There are procedures that I perform that can be done either with a local anesthetic or a nighty-nite-time-you’re-outta-here general anesthetic. I will explain that a local anesthetic means I will do lidocaine shots to numb up the area. You will be awake. You will not be asleep. You will hear things and you will feel some things. It’s a LOCAL ANESTHETIC.

“OK”, the patient says, somewhat churlishly, “I get it.”

So the day of the procedure arrives, and my patient looks apprehensively around the room. Drapes, trays of instruments, all the accoutrements of a surgical procedure.

“I’m going to be out, right?”


Sometimes patients are overwhelmed by a new cancer diagnosis. They have seen a surgeon, an oncologist, a radiation oncologist, and about every other -ologist in the extant universe before they see me. Each of those providers has suggested no less than four possible strategies, meaning that they have about 1,356 decisions to make.

Four days ago, they were selling hot dogs at their kid’s football game. Today, they can’t hear a thing.

I’ve learned that: a) no one remembers anything they hear in a doctor’s office; b) if they do, they don’t remember it correctly; and c) stressed patients remember even less.

I recently re-certified in Advanced Cardiac Life Support (ACLS), which involved a very lengthy online torture session. Unlike past years, the new program involves a lot of touchy-feely education on communication.

One good point they made was called “Closed Loop Communication.” It means that when you give an order, you make eye contact with the person responsible and ask them to repeat it back to you. This prevents you from getting a short Miller Lite when you ordered a tall Blue Moon.

So how do we close the loop?

I need to explain things clearly, then repeat as necessary. I need to schedule as many follow-up visits as needed to close the loop. I need to listen very carefully so I am hearing you rather than my own echo.

As a patient, you need to listen carefully, sure, but don’t hesitate to ask for clarification or repetition. If the provider seems irritated or impatient, find another. Take advantage of physician assistants or nurses in the office to answer questions that come up later. Don’t sign up for something you don’t understand.

Avoid chat groups, the internet in general, agony aunts, and the person in your book club who was “botched.”

Everything we hear goes through an elaborate network of filters — filters of yearning, hope, fear, denial — before it becomes understood.

Close the loop.

On the other hand there is. …

Cheez-Its and eternal life.