July 2005 Edition Vol. 5 Issue 5
A free Internet Newsletter publication for all CIM Alumni and friends.
Clem S. Estrera, Jr., M.D.
Ma. Belen Rosales, M.D.
Ray Castillejo, M.D.
The scene inside the operating room is surreal. You don’t see the patient Mr. Rodriguez. But at the center of the room under a flood of blinding, white light is a table where he is lying beneath layers of blue sheets and drapes. On his sides stand human forms blue capped, masked and gowned, steadfast and still except for their busy hands. Surgical instruments are neatly arranged on a table nearby. Hanging lights, machines and monitors make the big room look small. The place is quiet, interrupted only by sudden beeps of monitors, clinking of instruments, and occasional mumblings from the table. It seems inanimate and impersonal.
Make no mistake, this seemingly detached environment provides the most coordinated care a patient could receive from expert professionals. Here technicians, nurses and doctors are highly qualified and skilled in their assigned roles in a heart operation. The room becomes a sanctuary where rituals are performed, rituals of scientific skill and knowledge. But, during lighter moments you will hear pop, country or classical music piped into the air-conditioned room like other OR’s in the hospital.
The soft, mellow music from Lite FM is lost in the loud whirring of the sternal saw. The surgeon is splitting in half Mr. Rodriguez’s breastbone, also called sternum. This is spread apart to bring his heart into view. From one side of the split bone, the surgeon takes down the internal mammary artery, which runs down in the same direction a couple centimeters to its border. A special device called harmonic scalpel he uses leaves a clean and bloodless field of dissection. At the same time, working down on the legs a physician assistant is harvesting a vein.
“Give Heparin, please,” the surgeon tells the anesthesiologist.
An absolute necessity in the use of the heart-lung machine, Heparin is a blood thinner that prevents blood from clotting in the filters and reservoirs of the machine.
The surgeon inserts cannulas into the aorta and the right atrium through purse-string suture-tourniquet, which he tightens to secure them. Then he connects these cannulas to a bubble-free, primed and heparinized circuit of the heart-lung machine.
“Start exchange,” he instructs the perfusionist. This refers to the exchange of gases in the heart-lung machine.
“Exchange started,” answers the perfusionist as he revs up the heart-lung machine to maximum flow calculated for Mr. Rodriguez.
The machine looks like a car-dashboard console with all sorts of pressure gauges and flow meters. An array of plastic tubings channels the direction of blood flow from the patient to the machine and back to the patient. The machine drains blood from the patient, extracts its carbon dioxide, enriches it with oxygen, cools it down or warms it up as the need arises, then pumps it back. Before heart-lung machines became routine in open-heart operations, the pioneering surgeon Lillehei in patching holes in the heart used another person as “human” heart-lung machine in a technique called cross-circulation. The same principle holds for the alternative but temporary circulation to sustain life in the other important organs of the body, when the heart is deliberately stopped in order to facilitate the creation of the conduits.
“Cross-clamp IS on,” announces the surgeon.
The aorta is cross-clamped between the heart and the return cannula insertion. This instantly shuts off blood supply to the heart. The surgeon makes sure the perfusionist hears this. From this time on the heart does not receive oxygen and nutrients. This critical period is timed, more than two hours may be harmful.
The heart comes to a standstill as it receives injection of blood cardioplegia, a very cold solution of potassium mixed with blood. The heart is also cooled down to a few degrees just above freezing to minimize injury that may result from shutting off its blood supply.
The cut-end of the internal mammary artery harvested and the veins taken from the legs are sewn to the tiny vessels around the heart where blockages are noted. The blockages were determined before surgery in a special X-ray procedure called coronary angiogram. Then the opposite ends of the veins are sewn to the aorta. These grafts will open new access routes of blood for the starving heart muscles beyond the blockages, they bypassed.
Nowadays mending a broken heart this way may be as amazing as it might sound sophisticated. It deserves to be. The way we remedy ailments of the heart evolved for many years. It is still a continuing process especially in safety and reliability. About 300,000 heart bypass operations a year are performed in the United States alone.
Who would think today that stitching blood vessels together would win Alexis Carrel a Nobel Prize for Medicine in 1912? It has become trite and routine. It is the basic technique in mending hearts. Thanks to modern technology, very fine plastic threads, finer than a baby’s hair but stronger than a strand of manila rope, made almost microscopic stitching possible. Heart operations may involve basically connecting conduits in the right places as a plumber would, or fixing or replacing leaky valves when necessary. But, of course, a heart bypass operation is a major task, and risky, too.
When the sewing of the bypass grafts is completed, the heart surgeon releases the cross-clamp from the aorta. The heart circulation is restored. In addition the grafts bring more blood to the previously starving heart muscles.
Stressful anticipation preoccupies the surgeon at this point. Rightfully so. As precise and scientific open-heart surgery is; many factors could turn around the outcome less than expected, sometimes even catastrophic.
“I have done my part,” a surgeon might say, “I leave the rest to God.”
Then it happens right before his eyes, the amazing work of God. The heart once still and cold starts to quiver. The quivering becomes more vigorous. He feels it in his hands like a bag of worms wriggling. As the heart gets warmer, the quivering suddenly stops. A uniform surge of energy spontaneously shudders. The heart contracts, then it relaxes, first weak and slow. The heartbeat comes on strong and stronger, fast and faster. Beep. Beep. Beep. The overhead monitors display normal waveforms in the electrocardiogram.
“Pump off!” the surgeon gives the order.
The perfusionist gradually slows down the heart-lung machine from the controls, monitoring how the blood pressure holds. Then he stops it completely. Once tethered to life support the patient is now on his own. The pressures are normal and holding. This is the defining moment of a successful heart operation.
The cannulas are removed. Protamine the antidote of Heparin is given. It reverses the blood thinning effect of Heparin but it will not stop bleeding from loose stitching or obscure, tiny “pumpers”. The extent of the operation requires a closer review of the operative field before the breastbone is wired back together. In this era of Plavix and Aspirin taken as preventive blood thinning medications to prevent a heart attack, this part of the operation has taken in some cases half the time it takes to do the whole operation.
After the heart bypass operation, in the Surgical Waiting Room the surgeon meets the family of the elderly Hispanic man he just operated on.
“The surgery went well, Mrs. Rodriguez. We did three veins and one internal mammary artery just as we planned to do. I explained this to you before. Wait here for the nurses to call. You will see your husband in the Recovery Room when they are ready.”
“Muchas gracias, Doctor,” says the tearful wife as she takes the surgeon’s hands together and kisses them.
As he comes out from anesthesia in the Recovery Room, Mr. Rodriguez shows a look of relief, notwithstanding the obvious pain he is in. His sense of gratitude is overwhelming as tears roll down his cheeks. He sees his family for the first time after surgery.(To be Continued )
CONGRATULATIONS to Janet Go, daughter of Engr. Jimmy Go and Dr. Corazon Ong-Go of the CIM Class 1971. Janet recently graduated from Stanford University June 12, 2005 with a Master Degree in Learning Design and Technology.
In the U.S., to raise one child successfully through college to become an independent professional adult is no ordinary feat. It takes not just money but a lot of patience, prayers, and emotional strength, support and stability. Although such feat is filled with promise, there are no guarantees. There is only hope. But for certain, it changes your life for good.
Parents who are able to raise two children successfully through college to become independent professional adults deserve a lot of admiration. It's a job that requires a high-wire balancing act. It's very taxing. It's financially, emotionally and spiritually tough, rough, and provides little time for laughs. It makes cardiac bypass surgery look like a piece of cake. Every problem, big or small, is fraught with sleepless nights, headaches, worries, anxieties and indigestions. It's stressful, and it could very well be a significant factor for developing high blood pressure. If there is one thing that can make you grow old fast, this is it. But the great pride that your kids give you far outweighs any of your own selfish pleasures. The warm glow of pride, loving feelings, laughter and lightness you feel when you march with them on stage for the last time to receive their diploma which is basically a ticket to freedom or more like your certificate of retirement from the pressures of life, makes everything worth it.
So being able to raise three children successfully through college to become independent professional adults is simply outstanding; it makes you as a parent outside looking in wonder how in the hell did the parents of these children do it. And for all of these three kids to graduate from one of the top colleges in the U.S., and all on the top of their class is just phenomenal. It's something most parents can only wish for and dream of.
I don’t know how Mr. Joseph and Dr. Fortunata Tan Tieng of the CIM Class 1971 did it, but they did. Certainly the Tiengs are blessed with good gene, but there are many parents out there with terrific designer gene whose child or children are still wandering in the dorms, rooms and hallways in school like they are lost, jumping from one major course to another. It's like they are being chased by something they want to escape from, but like a shadow, it keeps following them.
Whatever Joseph and Fortunata did in raising their children, it must have been very effective. They must have done things right, whatever “right” means, or they must have done something that definitely worked, whatever that is. What they have done could be what raises their children above the rest.
All the Tieng’s three children went their way to achieve their profession in a way as though they simply wanted to say, "Mom and Dad, I'll make you proud of me." And so they did. Their dreams did not fade. The last but definitely not the least to graduate is Arlene.
Arlene has received her Doctor of Medicine Degree from the Albert Einstein College of Medicine of Yeshiva University, Bronx, New York during the commencement exercises last June 1, 2005 held at the Avery Fisher Hall of the Lincoln Center, New York City. She is now an intern and resident in Medicine at the Montefiore Medical Center in the Bronx, NY.
Arlene is an NYU graduate double major in Chemistry and Religious Studies, Magna Cum Laude. She finished her preparatory school as valedictorian from Immaculate Heart Academy in Washington Township, NJ and St. Anne School, Fair Lawn, NJ. Arlene has two brothers: Joseph John who is an NYU computer Science graduate and now a senior programmer at Citigroup, and Jimmy who is a high school valedictorian of Bergen Catholic High School and who graduated college from Princeton University. He is now a business analyst at McKinsey & Co., consultants.
In Medical College, Arlene graduated with honors in Radiology and Rheumatology. In her Evaluation of Clinical Performance and Professional Attributes, the Narrative Summary stated that “Arlene earned a grade of Honors during her sub-internship. She received a rating in the outstanding range in all categories of evaluation. One of her attending residents noted: ‘Arlene was a wonderful member of our team. She always wore a smile on her face and never showed the wear of the sometimes-thankless job. She handled the role of primary care giver to some very complex patients with the maturity often lacking in a fourth year student. On multiple times she brought in articles to teach the entire team about the information she had learned. Over-all, Arlene was a pleasure to work with and deserves a grade of Honors.’ One resident agreed, ‘Arlene deserves a grade of Honors. She is organized, efficient, and thorough; she performs consistently at the intern level. She critically thinks about the management of her patients. Most importantly she clearly cares about her patients and their families.’ Her Evidenced-Based Medicine Journal Club showed obvious very hard work and was very thorough.”
A Phi Beta Kappa and Phi Lambda Upsilon (Chemical Society), Arlene received several honors and awards. She received the Academic Excellence Award from the Philippine Community Center Foundation of NJ, NYU Chemistry Alumni Award, NYU Trustees Scholarship, NYU Dean’s List and Kathleen Farley Memorial Award for Outstanding Achievement in Music. Recently, she was presented an Outstanding Medical Student Award by the Philippine Chinese American Medical Association.
Active in school activities, she is past president of the Asian Pacific American Medical Student Association, Albert Einstein chapter, and a past national secretary. At NYU she was a General Chemistry Teaching assistant and she volunteered at St. Vincent Medical Center in New York City.
Her interests include, playing piano, sketching portraits, exercising, singing and travels.
Well, Arlene, from the ASOCIMAI whom your Mom is a member, CONGRATULATIONS!
A baby camel turned to its father and said: “Dad, why do we have humps on our back?”
“Well, son,” replied the father, “our humps contain the fat necessary to sustain us through all the days when we’re out in the desert.”
“Oh,” said the baby camel. “Dad, why do we have long eyelashes?”
“They’re to protect our eyes from the sandstorms which rage in the desert.”
“Fine. Dad, why do we have big padded feet?”
“Because the sand in the desert is very soft and we need big feet so that we can walk on the sand without sinking.”
“Thanks, Dad. So what are we doing in London Zoo?”
A man with an alligator went into a bar and asked the bartender: “Do you serve lawyers here?”
“Good. I’ll have a beer and my ‘gator will have a lawyer.”
A girl on vacation in Spain headed for the hotel roof for some sun. On her first day up there she wore a bathing suit but since there was nobody around, on the second day she removed it in order to acquire an all-over tan. She was lying on her stomach when she heard someone running up the stairs. She quickly pulled a towel over her and was confronted by the assistant hotel manager.
“Excuse me,” he said. “The hotel doesn’t mind you sunning yourself on the roof, but we would appreciate it if you wore a bathing suit as you did yesterday.”
“What’s the problem,” she asked. “No one can see me up here.”
“That’s not quite true,” he replied. “You’re lying on the dining room skylight.”
There is a parable that I think most of us must have read or heard. It was circulating in the e-mail a couple of years ago. It’s about a man who was caught in a flood. While the water was still about a foot high, a rescue truck offered to help him evacuate. He refused, saying, “God will provide.”
Then the levee broke and the water got so high that the man had to climb onto the roof. A couple of men with their motorboat came by and urged him to get aboard. But again the man refused: “God will provide.”
Soon the water rose so high that the man had to climb to the top of the chimney but the water swept him away. He yelled at the top of his lungs to the sky, “God, why have you forsaken me?”
A helicopter pilot who was maneuvering to rescue the man heard him and yelled back, “God sent you a truck, then a boat, and now this helicopter. Now, use the arm God gave you to grab this rope.”
Faith, if devoid of common sense, could make you drown. But don’t you think the man reminds you of someone you knew of? Someone who keeps wishing for breaks that others are getting, and keeps on whining because he is not getting any? Yet even if he has the opportunities that could help him get what he wants, he doesn’t do a damn thing. Instead, he’d spend his time waiting and wishing that someone would provide him what he wants, or some miracle would happen right before his eyes and like magic, his life would change for the better. It’s like he is living in a make-believe world - a world in which he keeps eating ice cream and expects to lose weight, or a world in which he believes that if he just flaps his arms hard enough, he’ll fly.
Whether we are aware of it or not, God has already provided us everything – the earth is full of resources and our head is full of brains. All we need to do is recognize our ability to think in order to make use of these resources the way God intends us to do. But like the Scarecrow, Tin Man and Lion in the movie The Wizard of Oz who went with Dorothy because they wanted and expected the Wizard of Oz to give them one thing they thought they needed, only to find out they already had what they were looking for, many of us, too, look for something we already have. The reason why we don’t see that something and can’t find it is because we are looking for it in all the wrong places.
Most of what seems to happen to us, happens, not because we are destined to such event, circumstance or situation, but all because of something we created, directed, influenced, approved, or allowed to happen. Yet particularly when it comes to our own unpleasant situations, many of us believe otherwise that we are not responsible for them, at least not fully. I guess one reason is because we rarely, if ever, prepare ourselves to deal with unavoidable ups and downs and unexpected twists and turns that have a way of scuttling our best-laid plans. Having gotten used to getting what we want, many of us ignore the inevitability of pain and disappointment. When pain and disappointment develop, we are unable to accept them as parts of a normal life and thus we struggle with them. They make us upset.
In these day and age, society everywhere is constantly providing an environment that grows more and more whiners and wimps who consider themselves victims of some unfair social forces and all too ready to pass off responsibility to someone else. These people believe in blaming their personal shortcomings, their own irresponsible behaviors and other social ills on circumstances beyond their control or on others like on corrupt politicians, greedy companies, filthy rich, economic hardships, uncaring family and friends, and every manner of psychological dumping syndrome as though doing so would give them a sense of well-being and improve their life’s situation. Indeed it’s always easier to find a jerk to blame for our disappointment and unhappiness than to take personal responsibility.
But when we don’t take personal responsibility for knowing or for being aware of our choices and for recognizing what choice helps us or what choice hurts us, we end up leaving our lives to chance, and chances are, we’re going to get hurt, get disappointed or become unhappy. Personal responsibility is not an obligation or something we have to do. It is merely the basis of our determination to willingly accept life, and to do the best we can to fulfill ourselves within it. Wanting, wishing, worrying, and whining won’t do us any good, and blaming in particular is counterproductive because it’s tantamount to relinquishing our power to the person we blame. Blaming readily leads to disagreement, and because of blaming, a minor disagreement is all too often enough to ruin a great relationship. Our sense of well-being, however, mainly depends on our ability to make the best of every situation, not on our ability to create blames and excuses, or to indulge on self-pity.
So if we want to control our own destiny instead of leaving our life to dance with chance, we have to take personal responsibility in the management of our own minds, for it’s the only way to take control over our lives; to change what we would like to change to become a better person; to re-write our own life’s script so that we are no longer the results of yesterday’s script where anger, envy or jealousy makes choices for us - but become someone governed by personal choices that involve reasons, not reflexes; compassion, not hot emotions; thoughtfulness, not impulsiveness. We have to have the will to be better that no negative emotion can withstand that will.
This poem by Rudyard Kipling was sent to me by my daughter last week. She wanted to share it with me because she said that it reminds her of me. It’s a great poem that I’d like to share with you all.
If you can keep your head when all about you
If you can dream – and not make dreams your master;
If you can make one heap of all your winnings
If you can talk with crowds and keep your virtue,
Keeping the faith
Seriously, do you think your life is easy? I certainly don’t, as far as mine is concerned. In every life situation, in a job or in a relationship, there’s going to be some turbulence. Problems are inevitable. It doesn’t matter who you are, problems have a way getting into your life. How many times have you been presented with seemingly endless stream of problems that just came to your life unexpected and that affect the flow of your previously scheduled activities? It drives you crazy as one situation after another crop up and mess up your plans. How many times you feel like you’re at the end of your rope? You feel exasperated and exhausted. And as the problems consume you, you have no time for fun things and even romance. Relationship becomes driven by tension rather than by touching; intensity rather than intimacy; stress rather than sex.
Life is never easy. I don’t think God intended for anyone of us to simply waltz through life, have a cake and eat it too. No, I don’t think so. Otherwise the Bible would not have given us the story of Job that reminds us, by the way, that despite problems and difficulties, tragedies and miseries, if we keep our faith, endure and persevere, we’d make it through.
The story of Job is actually a good story, a story that always makes me grateful of my life because I don’t think I could survive being subjected to even half of the problems and miseries that Job had to undergo. Compared to Job’s life, mine is a piece of cake. I’m sure there are many Jobs out there. Imagine at one time in his life Job lost all his sons and daughters in a freak accident. Then he lost all his livestock which was his livelihood, and then he was plagued with boils all over his body. And to make it even worst, his wife suggested, “If I were you, I’d curse God and just die.” Talk about spousal support. But Job refused to do it. Instead, he vowed before his wife, “You make your choices and I’ll make mine.” Indeed we all have choices. Good for you, Job!
You’ve probably noticed certain people who’ve lost everything, and then few or several years later, they’re back on top again. If you ask them, many of them would tell you that they keep their faith in a power higher than themselves. If you love basketball and watch the NBA games with certain regularity, you'd probably never forget Larry Bird of the Boston Celtics, 6' 9 ˝" playing forward who never ceased to amaze you with buzzer-beater shots and incredible look-away passes. But his life hadn't been easy. When he was eighteen, his father committed suicide. When he played college hoops, his coach told him he was not made for pros, and when he sought a career in professional basketball, he was told that he'd never be able to keep up. Then he faced countless injuries, operations on both heels to remove spurs, and a major back injury. Yet despite it all, he remained invincible on the basketball court. He attributed his feat to a combination of enthusiastic physical and spiritual energy.
Terry Anderson, an American who was held hostage in Iran for a long time said: “We come closest to God at our lowest moments. It’s easier to hear God when you are stripped of pride and arrogance, when you have nothing to rely on except God. It’s pretty painful to get to that point, but when you do, God is there.” This reminds me of a story of a man who thought God had deserted him during a most troubling time because he only saw one set of footprints along the difficult path he had just walked. When he asked God why He wasn’t with him when he needed Him the most, God told him that he had only seen one set of footprints because He had been carrying him.
So as long as you keep your faith and think of ways to get out of your predicaments or believe that there are solutions to your problems instead of letting your problems get the better of you and upset you, you’d make it through no matter how hard or difficult the struggle you undergo. Just don’t look up to the sky and ask God, “Why me?”, or you’d only get a reply, “Why not!” and the struggle is lost before it is even began.
The most difficult part in almost every difficult situation is to decide what to do. It's a struggle fraught with anxiety and uncertainty; fear, frustration and anger; and any other combination of negative emotions. It's like having a cobra or a poisonous snake loose in the house. You couldn't relax. But unless you calm down, you're only bound to step on it. The only question is - when.
But once you learn to really have faith strong enough to be able to “let go and let God,” and thus have that attitude of live and let die, you’d lighten up. You'd think of taking it easy, take a walk, or jog, or just sleep. You may not find a solution to your problem afterward, but what you may find is another way of looking at the problem. You see your problem in a whole new light. This gives you the courage to make decision and act. It's like having a divine revelation that has adjusted your brain from being too emotionally charged, keeping energy from rushing into your nerves and synapses but allowing it to flow only in a slow and more calculated fashion to enhance your mental clarity. Epictetus once said, “When you have shut the doors, and darkened your room, remember never to say that you’re alone; for God is within…” In other words, be not afraid.
A thought, experience, and observation
Looking back to the time when we came to the U.S. some 30 years ago, my wife and I had almost nothing financially to begin with but had high hopes, excitement and enthusiasm for a better future. We were just being able to meet the basic daily needs like a student surviving on Ramen Noodles and Beef Jerky's for the next couple of years. Yet despite just a stipend for a salary that was just above the poverty line during that time, and despite car payment because car was essential and the fly-now-pay-later plan that ate most of our budget, within two years we were able to pay off our debts and even save some money. Now we have more debts although also have more offers for more debts. Visa and Master Card are crazy about us.
But like cocaine that comes with a high and then a low, affluence comes with the delight and then the debts and worries. Thus I often think that less is probably better because what we don’t own, we don’t have to make payments on, pay insurance on, maintain and worry about. But then, without big ambitions and high aspirations, or without taking risks to pursue dreams or taking chances for progress, life is probably not worth living.
Progress is essential. Man cannot live by rice alone. He needs tinula, inun-unan, pinirito, eskavitsi, sinugba, lechon, etc. But it's when you neglect and sacrifice family relationship for material or monetary rewards that you’re going to have more problems and crisis in your hand, if not regrets and unhappiness later on your deathbed. Is it worth it?
Have you heard of Peter Lynch or read about him? Peter Lynch is the investment superstar who successfully built Fidelity Magellan Mutual Fund. Many of those who invested their retirement fund on his Magellan Fund when it started had already retired long time ago. Peter Lynch stunned Wall Street when he decided to give up his prestigious position and hefty salary in millions of dollars including bonuses. Even though he had everything he had always wanted, he realized he was not happy. So he went from picking stocks to packing lunches for his daughters because he said, “I don’t know anyone who wished on his deathbed that he had spent more time at the office.”
Well, we all have problems and difficulties. Don’t you agree? No matter how we simplify our lives, there are always problems and difficulties. It’s just that when we look at others, their life seems easy compared to ours. Yet we really don’t know what’s going on inside their houses or in their family. Do we? So if anything, don’t make a mistake of thinking that you’ve got more and bigger problems than others, or you’re going to be unhappy with your life.
I used to have a neighbor, a physician few years younger than me in private practice who also owned a convenient clinic and whose wife was a lawyer. They had a couple of children who used to play with my children. They were a very nice family and a good neighbor; courteous and kind, and with their affluence, they looked happy all the time. When our hospital was threatened for closure, our good neighbor came to me and offered me a job to work in his convenient clinic anytime I wanted to. His act of kindness touched me in a deep way. It’s like being graciously given a gift by someone who really cares about you. Because his family life seemed so easy compared to mine, he would sometimes make me feel bad about myself as I struggled with my own problems, trials and tribulations.
Few years later, while their children were still young, our neighbor got divorced, and the once happy family faded like a photograph in a fire. It’s as if in a blink of an eye, their destiny was tapped by a malignant wand; the splendor of affluence has turned into a sad situation, like a warm “hello” that turned into a sad “goodbye.” Because it was none of my business, I stayed away. After all, it’s a kind of situation that I have nothing to offer. Also, it was clear that they wanted privacy. So the weekend morning greeting as we each pick up the newspaper on our driveway was gone. Their children separated; the daughter lived with the mother and the son lived with the father. Since then I’ve never heard of them anymore, let alone from them, until several years later when I read the wife’s obituary. The wife died of cancer.
As good as it gets
Even if I had been seasoned and steeled by the experiences of a rough and tumble life, there were times of crisis in my life in which I began to wonder what if things will simply stay the same. What if life is like this from now on? Is this all I can look forward to? Is this as good as it gets?
In the movie As Good As It Gets, Jack Nicholson plays a brilliant writer and is obviously well-off. He basically can afford anything he wants that he eats in a restaurant every meal of every day. But he is unable to enjoy any aspect of his life because of the emotional turmoil he lives with day after day. He has an obsessive-compulsive personality that is characterized by irrational rigidity. He was obsessed with cleanliness and sterility. It seems like to him, everyone’s hands are contaminated and everyone’s feet are wet or dirty. He reminds you of someone who follows your footstep with a vacuum cleaner when you walk on the carpet with your shoes on. Many of these obsessive-compulsive individuals keep their apartment, office, or house extraordinarily neat and clean, glistening like a mirage in the mind of a complicated man.
The title of the movie comes from the scene where Jack Nicholson is walking out of his psychiatrist’s office, into a waiting room full of people who, presumably like him, are in need of therapy and thus are waiting to see their psychiatrist or therapist. Before he walks out the door, Jack Nicholson stops and says to everyone in the room, “What if this is as good as it gets?”
In every endeavor we decide upon, there are always problems and difficulties, and even crisis. If we are preoccupied with our difficulties in whatever endeavor we are embarking on, it’s easy to want to give up even before we start. It’s easy to think that hanging in there isn’t worth the effort. It’s easy to conclude that this is as good as it gets. And if we spend our lives looking only at our problems, it’s easy to be overcome with self-pity. Nothing in life costs more than self-pity. Self-pity leads you to waste your time, energy and even money just to feel sorry for yourself. It's like a demon that comes to you to claim its prize. In his song Better Days, Bruce Springsteen sings – “Every fool’s got a reason for feeling sorry for himself and turning his heart to stone…”
In building muscles, how much weight we lift is not as important as how many repetitions we do. It’s the repetitions that make your muscles bulge, tough and tight like those of Rambo. In building faith and confidence, the weight of our problems is not as important as how many times we lift it. And it’s by enduring and surviving the last crisis that we build faith and confidence to handle the next.
Barbara Rose, speaker and author, said: "Even the most daring and accomplished people have undergone tremendous difficulty. In fact, the more successful they became, the more they attributed their success to the lessons learned during their most difficult times." I always tell my children that it’s necessary to experience both success and failure, for built into each is the ability to grow stronger and wiser. If they give up at the first encounter or experience of failure and the first rush of doubt, then that’s when their life is as good as it gets. Thus if there is one thing they have to keep in mind, it is that as long as they endure the problems and failures in their life or in whatever they do, keep pushing harder and persevere, life isn’t as good as it gets. It gets better and better. (To be Continued )