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Date: August 18th, 2014

As many of you know actor and comedian Robin Williams died last week. I am having difficulties processing the loss. There are feelings of anger, sadness and disbelief.

It is weird; a person I have only known through movies has had a profound effect on me.

Robin Williams made a huge impact on my desire to teach, the way I teach and the goal to inspire independent critical/skeptical thinking students.

It must be affecting others in the EM community too. A SGEM listener emailed asking if there would be an episode dedicated to Robin Williams. I was not sure if it would be respectful or appropriate.

As always, when I am not sure of things I check with people I hold in high regard. So I contacted Rob Rogers (I Teach EM) and Rob Orman (ER Cast). They thought it was a good idea and felt it may help all of us and other SGEM listeners heal.

Rob Rogers and Rob Orman

In true SGEM fashion we are going to cover Five of Robin Williams movies. These are must see movies and part of any EM core training. We will discuss why the movie was important to us and to our practice and teaching of EM.

Before we start I think it would be appropriate to read the poem that was to be read at the start of every Dead Poets’ Society gathering.

“I went to the woods because I wished to live deliberately, to front only the essential facts of life, and see if I could not learn what it had to teach, and not, when I came to die, discover that I had not lived. I did not wish to live what was not life, living is so dear; nor did I wish to practise resignation, unless it was quite necessary. I wanted to live deep and suck out all the marrow of life, to live so sturdily and Spartan-like as to put to rout all that was not life, to cut a broad swath and shave close, to drive life into a corner, and reduce it to its lowest terms.” Henry David Thoreau, Walden: Or, Life in the Woods

1) Patch Adams (1998): I learned a lot from this movie as a young doctor. One of the most important lessons I learned was to be myself. I started wearing bright red shoes on shift. Nurses call them my Dorothy slippers. Click my heels twice and say; “there is no place like emerg”. Wearing these crazy red shoes seems to make kids less scared of me. The only contact they may have had with doctors involves needles.

I also learned from Patch Adams that if I just follow my passions and act in the patients best interest things will be OK.

“You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome.”
“Our job is improving the quality of life, not just delaying death.”
“But you can’t control my spirit, gentlemen. You can’t keep me from learning, you can’t keep me from studying. So you have a choice: you can have me as a professional colleague, passionate, or you can have me as an outspoken outsider, still adamant. Either way I’ll probably still be viewed as a thorn. But I promise you one thing: I am a thorn that will not go away”

2) Aladdin (1992): EM docs are like the Genie in Aladdin… “Poof! What do you need, “Poof! What do you need, Poof! What do you need?” Patients often expect us to grant them wishes and perform miracles.

Night shifts “Oi! Ten thousand years will give you such a crick in the neck.”
Call/Sleep Rooms “ Phenomenal cosmic powers! Itty bitty living space!”
ACLS for Asystole “I can’t bring people back from the dead. It’s not a pretty picture”
Writing Narcotic prescriptions “There are a few, uh, provisos. Ah, a couple of quid pro quo.”
People I work with so hard in the ED on a daily basis. Treating critically ill patients. Seeing so much suffering and pain. Sharing these incredibly difficult emotional situations. These are my friends not co-workers. Special kinds of friends who give so much. To them I say “You ain’t never had a friend like me”

2a) Good Morning Vietnam (1987): (Rob Orman’s 2nd choice). Gooooooooood Morning SGEM Listener.

3) Good Will Hunting (1997): The story was similar to how I my wife Barb and just knew she was the one.

“You’re not perfect, sport, and let me save you the suspense: this girl you’ve met, she’s not perfect either. But the question is whether or not you’re perfect for each other.”
“Real loss is only possible when you love something more than you love yourself.”
“Sorry, guys; I gotta see about a girl.”

4) Mrs. Doubtfire (1993): Since having kids there is nothing I would not do to be part of their lives. Robin Williams showed everyone the importance of family, that life was not perfect, parents got divorced, parents make mistake, don’t worry about what other people think and sadness is temporary.

“There are all sorts of different families, Katie. Some families have one mommy, some families have one daddy, or two families. And some children live with their uncle or aunt. Some live with their grandparents, and some children live with foster parents. And some live in separate homes, in separate neighborhoods, in different areas of the country – and they may not see each other for days, or weeks, months… even years at a time. But if there’s love, dear… those are the ties that bind, and you’ll have a family in your heart, forever.”

4a) Awakenings (1990): This was Rob Orman’s 4th pick. “What we do know is that, as the chemical window closed, another awakening took place; that the human spirit is more powerful than any drug – and THAT is what needs to be nourished: with work, play, friendship, family. THESE are the things that matter. This is what we’d forgotten – the simplest things.”

5) Dead Poets’ Society (1989): This movie had the most impact upon me. I identified with both the students and Mr. Keating. There were so many great lines. Encourage students not to conform, find their own voice and be critical/skeptical thinkers.

“Medicine, law, business, engineering, these are noble pursuits and necessary to sustain life. But poetry, beauty, romance, love, these are what we stay alive for.”
“A powerful play goes on and you may contribute a verse. That the powerful play *goes on* and you may contribute a verse. What will your verse be?”
“Boys, you must strive to find your own voice. Because the longer you wait to begin, the less likely you are to find it at all. Thoreau said, “Most men lead lives of quiet desperation.” Don’t be resigned to that. Break out!”
“No matter what anybody tells you, words and ideas can change the world.”
“There’s a time for daring and there’s a time for caution, and a wise man understands which is called for.”
“Now we all have a great need for acceptance, but you must trust that your beliefs are unique, your own, even though others may think them odd or unpopular.”

Physicians and Mental Health:

Studies have demonstrated and increased suicide rate among physicians. This can be seen as early as medical school. Physicians are also more likely to be successfully in their suicide attempts compared to non-physicians. Many factors are felt to be involved in the increased suicide rate including the professional burden. (Eve Schemhammer NEJM 2005)

Various resources are available to physicians. In Ontario, Canada if you are concerned about your own well being/mental health or that of a colleague you can call 1-800-851-6606 (Ontario only).

There are also suicide prevention resources are available across Canada. You can access crisis centres 24hrs a day. There is also a Centre for Suicide Prevention for more information.

In the United States there is a national suicide prevention lifeline. 1-800-271-TALK (8255). They list a number of warning signs for which may mean someone is at risk for suicide.

Talking about wanting to die or to kill oneself.
Looking for a way to kill oneself, such as searching online or buying a gun.
Talking about feeling hopeless or having no reason to live.
Talking about feeling trapped or in unbearable pain.
Talking about being a burden to others.
Increasing the use of alcohol or drugs.
Acting anxious or agitated; behaving recklessly.
Sleeping too little or too much.
Withdrawing or feeling isolated.
Showing rage or talking about seeking revenge.
Displaying extreme mood swings.

Remember, you are not alone and many people have felt suicidal at some point in their lives. Suicide crises are almost always temporary – this too shall pass. Problems look big at first but are seldom as great as they appear at first glance. Don’t loose sight of all the reasons to live. No matter how big the problems seem, how much you are hurting, suicide is not the answer. Help is available so don’t keep suicidal thoughts to yourself.

A Few Final Thoughts:

“Carpe Diem”: Seize the day
“Sucking the marrow out of life doesn’t mean choking on the bone”
“We are not now that strength which in old days, moved earth and heaven, that which we are, we are; One equal temper of heroic hearts, Made weak by time and fate, but strong in will, To strive, to seek, to find, and not to yield.” Lord Alfred Tennyson -Ulysses

Listen to Robin Williams speak about death and grieving. This is from a 1996 movie called Jack. It is about a person born with a disorder causing him to age 4 times faster than normal. Click on the picture to see a Youtube video put together by ModernGreen. It has video clips from Robin Williams movies and the audio clip from the movie Jack.

“Please, don’t worry so much. Because in the end, none of us have very long on this Earth. Life is fleeting. And if you’re ever distressed, cast your eyes to the summer sky when the stars are strung across the velvety night. And when a shooting star streaks through the blackness, turning night into day… make a wish and think of me. Make your life spectacular. I know I did.”

I am skeptical about a lot of things but one thing I am not skeptical about is that Robin Williams, a man I never met, made a difference and changed my life.