When Being Broken Means Becoming Better

Jul 6, 2021 by

17 years ago on July 1, 2004, I put on my first long white coat, clipped a bulky black pager to its left front pocket and snapped a picture of myself standing before a full-length mirror.  

It was my first official day as a doctor.  

I started intern year of residency at Westchester Medical Center equipped with two black pens, three pocket-size “quick reference guides” and giant grey PalmPilot to look up every medication I was now legally allowed to prescribe. I had a naïve belief that four years of undergrad and four years of medical school had properly prepared me for this day, the day I would start changing the world, one patient at a time.  

I was so wrong.  

The next three years gutted me of everything I thought I knew, and then proceeded to shatter my very sense of self into a million worthless pieces.  

The days were long, the night shifts were longer, and whoever thought the 80-hour work week was doable had clearly never done one, much less three consecutive years of them.  

It seemed as if every day was a loss, and only seldom was there a win. The harder I worked, the more I failed.   

There was a limit to how many times I could say “I am sorry, there was nothing more we could do,” before I began to ask myself “is this really the place I am supposed to be?”  

I had lost hope in hope.  

But then slowly (so very slowly) residency stopped breaking me, and it was then I began building this doctor that I have become.   

And so what have I become? To start, I am a doctor who works tirelessly, I am a doctor who acquires wisdom, and perhaps, most important of all, I am a doctor who is (once again) filled with hope for every patient- regardless of circumstances, regardless of diagnosis and regardless of their often times terminal condition.  

And in the 14 years since completing residency I of course have been shattered again and again. Those first 6 months of 2020 alone left me in terrified pieces as I continued to care for patients- my most pervasive thought being “if I die now, my daughter Heather will never remember my face.”    

But now, instead of rebuilding the parts of me which were destroyed, I hand those fragments over to my patients and say “here, this is me, this is the part of me that cares for you. Carry it and know that in this, you are not alone.”  

I don’t know everything, and I know I never will, but I know that I am a very good doctor. 

To all of those who have entrusted themselves to my care… thank you, it has truly been an honor.  

And today, July 1, 2021, I can say with all confidence that I do change our world every single day, one patient at a time.  

Sarah Mildred Gamble, DO, is a Board-Certified Internal Medicine physician. In 2010 she founded Greenwich Pure Medical, LLC, a concierge medical practice in Greenwich, Connecticut. For the past 7 years, she has been consistently recognized as a Castle Connolly Top Doctor in the New York Metro Area and as a Top Doctor In Concierge Medicine Across America. Her clinical interests and expertise focus on personalized primary medical and primary preventative care. She enjoys gardening (for which she has little skill), gluten-free baking (frequently lacking in taste) and trying to keep up with her 4-year-old daughter (which has proven to be quite difficult at the age of 45). Her website is www.GreenwichPureMedical.com and she can be followed on Instagram @greenwichpuremedical  

Thank You,  

Sarah Mildred Gamble, DO 
Board Certified Internal Medicine Physician 

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“front line”

Apr 26, 2020 by

I lay in bed on this beautiful Sunday morning telling myself I should be outside with my daughter.

I have so little time with her as it is.

I can hear her laughing as daddy builds the new water table I bought last week.

But Heather doesn’t understand that I give gifts to show my love.

All she sees is daddy putting it together and daddy playing with her in it. 

I can’t get out of bed.

I’m tired from mourning the life I once knew. 

The life of a doctor before COVID-19. 

Neighbors walk by, friends send texts, the media states over and over “thank you doctor, thank you for being on the front line.” 

But I now know there is a vast difference between the “front line” and the “front front line.” My “front line” is quite simply this…sit day after day alone in my office and FaceTime my patients- desperately trying to manage issues that only one month ago required extensive face-to-face visits.

I FaceTime my patients and watch them cough and sweat and shake and cry and struggle while begging me “can’t you do anything to help?”

I cannot. And then twice, perhaps three times a day, I dress myself in head to toe hazmat gear to care for patients whose clinical condition can no longer be managed over the phone.

Those times, I am so very afraid. How do I still “put patients first” when their very presence riddles me with fear?

The chaos is unmanageable.

My “front-front line” is quite simply this…I wait. I wait for a few more of my colleagues to fall sick and Jesus God, how can this even be real- to die.

So that once there are too few to serve, the hospital powers that be will telephone and say “Dr. Gamble, we need your help on the “front-front line.”

I am heartsick at what is happening to my friends, to my patients and to my colleagues.

Such irreplaceable loss.

I am paralyzed.I am powerless. I am afraid.I don’t want to die.

I don’t want my daughter to grow up not even remembering who I was. Or maybe she would only have memories of a mother who wouldn’t hug her until she had showered “the virus” away.

If I am lucky perhaps she will remember how we would lay in bed at night to read a few short stories and sing Disney songs until one of us fell asleep…If I die now, she will never remember my face.

And yet (and yet), in the ugly and intubated face of my COVID-19 fear- I will help, I will not give up and I will never, ever walk away. My little girl’s laughter drifts through my bedroom window, saying “Mommy come play with us.”

That little voice is so much more important than my COVID-19 fear.

So I kick off the covers and place both feet on the floor.

Before standing I muster the courage to reach over and check my phone. There are no missed calls from the hospital and no desperate emails stating “it’s time.”

Good.

I am a doctor who is nothing more than human in the time of COVID-19.“

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Healthy Meal Prep

Mar 25, 2017 by

Meal Prep: A Helpful Healthy Eating Strategy

Chopped vegetables on a cutting board for meal preparation, including acorn squash, Brussels sprouts, carrots, and kale, as well as white beans and dried farro.

Who hasn’t left work late with a growling stomach but little energy to shop and cook? A busy schedule is one of the top reasons why people choose quick takeout meals, which are often calorie-laden and a contributor to expanding waistlines. [1-3]

Now, imagine a different scenario where within a few minutes of walking through the door you have a delicious home-cooked dinner, and perhaps even lunch packed-up for the next day. Amidst hectic weekday schedules, meal prep or meal planning is a great tool to help keep us on a healthy eating track. Although any type of meal prep requires planning, there is no one correct method, as it can differ based on food preferences, cooking ability, schedules, and personal goals. Here are some examples:

  • If you now eat fast food or takeout several nights of the week, your goal may be to choose a specific day of the week to create a food shopping list and hit the grocery store.
  • If you already food shop once a week and have basic cooking skills, your goal may be to choose one day a week to do most of the cooking, or try a new recipe.
  • If you already cook some weekday meals for your family, you might decide to create a schedule so that you are not deciding last minute what to make and to ensure you have the needed ingredients on hand.

Some benefits of meal prep:

  • Can help save money
  • Can ultimately save time
  • Can help with weight control, as you decide the ingredients and portions served
  • Can contribute to an overall more nutritionally balanced diet
  • Can reduce stress as you avoid last minute decisions about what to eat, or rushed preparation

Prepping for Meal Prep

  • Discuss with your family what types of foods and favorite meals they like to eat.
  • Start a monthly calendar or spreadsheet to record your meal ideas, favorite recipe sites, and food shopping lists.
  • Collect healthy recipes. Clip recipes from print magazines and newspapers and save in a binder, or copy links of recipes onto an online spreadsheet.
  • Consider specific meals or foods for different days of the week. Remember Wednesday as Prince Spaghetti Day? Some families enjoy the consistency of knowing what to expect, and it can help to ease your meal planning. Examples are Meatless Mondays, Whole Grain Wednesdays, Stir-Fry Fridays, etc.
  • Start small: Aim to create enough dinners for 2-3 days of the week.

Getting Started

  1. Choose a specific day of the week to: 1) plan the menu, whether week by week or for the whole month, and write out your grocery list 2) food shop, 3) do meal prep, or most of your cooking. Some of these days may overlap if you choose, but breaking up these tasks may help keep meal planning manageable.
  2. As you find favorite ‘prep-able’ meals, or your menus become more familiar and consistent, watch for sales and coupons to stock up on frequently used shelf-stable ingredients like pasta, rice, and other whole grains, lentils, beans (canned or dried), jarred sauces, healthy oils, and spices.
  3. On your meal prep day, focus first on foods that take the longest to cook: proteins like chicken and fish; whole grains like brown rice, quinoa, and farro; dried beans and legumes; and, roasted vegetables.
  4. Also consider preparing staple foods that everyone in the family enjoys and which you can easily add to a weekday meal or grab for a snack: washed greens for a salad, hardboiled eggs, a bowl of chopped fruit, cooked beans.
  5. If you prefer not to pre-cook proteins, consider marinating poultry, fish, or even tofu on your prep day so that you can quickly pop them into the oven or stir-fry later in the week.
  6. Multi-task! While foods are baking or bubbling on the stovetop, chop vegetables and fresh fruit, or wash and dry salad greens for later in the week.
  7. When you cook a recipe, make extra portions for another day or two of meals, or to freeze for a different week. Be sure to date and label what goes in the freezer so you know what you have on hand.
  8. For lunches, get a head-start and use individual meal containers. Divide cooked food into the containers on prep day.

Storage

Meal prep can save time and money if you are preparing just enough for what is needed the following week. Refrigeration and freezing are an important step to successful meal planning. However, forgotten food such as produce hiding in a drawer or a stew stored on a back shelf in an opaque container for too long can spoil and lead to food waste. Label all prepped items with a date so that you can track when to use them by. Rotate stored items so that the oldest foods/meals are kept up front. Store highly perishable items like greens, herbs, and chopped fruits front-and-center at eye-level so you remember to use them.

When it comes to freezing, some foods work better than others. Cooked meals tend to freeze well in airtight containers. Foods with high moisture content, such as salad greens, tomatoes, or watermelon, are not recommended as they tend to become mushy when frozen and thawed. Blanching vegetables for a few minutes before freezing can help. However, if the texture of a frozen food becomes undesirable after thawing, they might still be used in cooked recipes such as soups and stews.

The following are recommended times for various cooked foods that offer the best flavors, maximum nutrients, and food safety.

Refrigeration at 40°F or lower
1-2 days: Cooked ground poultry or ground beef
3-4 days: Cooked whole meats, fish and poultry; soups and stews
5 days: Cooked beans; hummus
1 week: Hard boiled eggs; chopped vegetables if stored in air-tight container
2 weeks: Soft cheese, opened
5-6 weeks: Hard cheese, opened

Freezing at 0°F or lower
2-3 months: Soups and stews; cooked beans
3-6 months: Cooked or ground meat and poultry
6-8 months: Berries and chopped fruit (banana, apples, pears, plums, mango) stored in a freezer bag
8-12 months: Vegetables, if blanched first for about 3-5 minutes (depending on the vegetable)

Ready to get started? Below are some recipes that lend well to bigger batches—and don’t forget that the Healthy Eating Plate can serve as a helpful menu planning guide. Happy prepping!


References

  1. Fryar CD, Ervin RB. Caloric intake from fast food among adults: United States, 2007–2010. NCHS data brief, no 114. Hyattsville, MD: National Center for Health Statistics. 2013.
  2. Lachat C, Nago E, Verstraeten R, Roberfroid D, Van Camp J, Kolsteren P. Eating out of home and its association with dietary intake: a systematic review of the evidence. Obes Rev. 2012 Apr;13(4):329-46.
  3. Nago ES, Lachat CK, Dossa RA, Kolsteren PW. Association of out-of-home eating with anthropometric changes: a systematic review of prospective studies. Crit Rev Food Sci Nutr. 2014;54(9):1103-16.

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How Concierge Medicine Saved My Life

Mar 20, 2017 by

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HOW TO GET BETTER POSTURE IN 3 WEEKS

Sep 12, 2016 by

Are we texting our way to back pain?   As we spend more and more time hunched over our 1-devices we’ve become a nation afflicted with what is now being called, ‘Text neck.”  Slouching can be a prequel to long-term back, shoulder and neck pain,

Seems our mothers were right when they told us to stand up straight! Not only does good posture help you avoid these pain problems, it can also help improve your digestion, reduce stress and, even give you a shot of confidence.

From health.com, here’s a very do-able and sensible approach to become better aligned.  Try and implement as many of these moves as you can on a daily basis.

sitting_at_computer_cartoonWeek 1:

Good posture may feel awkward at first if you’ve trained your body to slump, explains Rami Said, a physical therapist at Columbia University Medical Center. Take a few moments every day to learn how correct posutre feels.

Stand taller: Evenly distribute your weight between both legs, with your feet parallel under hips and shoulder blades pressing down and back. Engage your glutes and core so your pelvis is stable beneath your ribs but not tucked under.

Sit smarter: Keep your earlobes above shoulders and shoulders above hips; allow a slight curve in the lumbar spine. Your feet should be flat on the floor and lower back against the chair (add a rolled-up towel if your back doesn’t touch).

Sleep straighter: Try to fall asleep on your side or back to help your spine stay more neutral.

 

Week 2: Tweak your routine

“Everyday habits make maintaining good posture much trickier,” says Jill Miller, founder of Yoga Tune Up. Do this instead:

Bag it better: Heavy purse? Change the shoulder you’re carrying it on every 10 minutes.

Ditch text neck: Keep your shoulders back and head lifted when checking your phone by holding it closer to eye level.

Stay down-to-earth: If stilettos put strain on your lower back, wear them for two-hour periods and take sitting breaks.

Week 3: Build strength

Do each of these moves daily to improve your muscle memory and overall alignment.

Shoulder stack: Every 30 minutes, bring your shoulder blades down, then back. Hold for two to three seconds. Repeat five times.

Pillow pose: Lie facedown on the floor and place a firm pillow under your abdomen. Take slow, deep breaths into the pillow for a few minutes.

Proper squat: Stand tall, feet slightly wider than hip-width, then lower into a squat. Extend your arms overhead, palms turned slightly backward to engage your upper back. Do as many 30- to 60-second squats as you can. Do not allow your spine to round or bend.

 

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