Steven F. Isenberg, Indianapolis, MD IN suspect that we have all been there, at least once. A struggling, courageous patient, friend, or family member battles an acute or chronic disease, pain, or disability. As physicians, perhaps we view this from a unique perspective-surely, it would seem, we could do more to help. And if we cannot help, what can we do to express our admiration for the courage, or mettle, it takes to battle for your life? That is where I found myself one day in 2003 when a single, spontaneous gesture of compassion changed my life and that of many others. I had just completed the Chicago Marathon when I learned that a friend (and patient and colleague) had been re-admitted to the hospital. Enduring several previous malignancies-some that I had treatedand polymyositis that flared with each of them, this previously vibrant internist/anesthesiologist was_nowpost-operative from prostate cancer surgery. In spite of a darkened room, intrave- I nous fluids, and the smell of sickness, Lesgreeted me with his customary robust spirit. I was caught between my frustration with his sickness and my overwhelming respect for his courage. Spontaneously, I opened my briefcase, removed my Chicago finisher's medal, and hung it around his neck. Giving him my medal seemed to express my respect for his mettle. I was not completely sure what it meant to him until after he died. His family told me that he treasured it as much as anything he had ever received. I began giving my other medals to more patients. Before long, my passion evolved into a non-profit organization, Medals4Mettle (www.medals4mettle. org). M4M now has chapters in 24 states and around the world. Endurance athletes from around the world have given more than 11,000 medals, complete with new, brightly colored M4M ribbons. Individual medal awards and numerous .hospital eVents are taking place nearly every month. In April 2009, I visited the historic London hospital Great Ormond Chil- dren's Hospital (GOSH)the day before I ran the London Marathon. M4M had shipped several medals (Donald Duck, Mickey Mouse, Goofy,etc); to GOSH, donated by Disney Marathon finishers, complete with new M4M ribbons. I arrived expecting a media show much as I had experienced several times in the U.S.In fact, local celebrities and others usually passed out the medals while I was busy administering M4M out of my medical office. But for a variety of reasons, the London media did not make it. It seemed that M4M had yet another experience planned for me. For over two hours, I walked through the historic units at GOSHduring family visitating hours on a Saturday morning after doctors' rounds. I passed out about 50 medals, visited with patients, their exhausted families, and the dedicated nurses who cared for them. I was a marathon runner and an American, not a physician. There was Georgie, an eight-year-old whose seizures had just stopped after 18 continuous days. His mother cried when he received the donated Disney medal. His father and I talked about how Georgie loved to watch the London marathoners run by their home in Greenwich. Georgie, of course, was not going to be home for the 2009 London Marathon, but he did receive his own medal. Georgie's parents, who wanted to talk about anything other than his illness, had promised him a trip to Disney some day. That Saturday, he received a small piece of Disney from a marathoner who donated a hard-earned medal, and from the many volunteers who make it possible for Medals4Mettle to continue its mission. I met Isaac and gave him an amazing medul that had a compass inside. When I first passed his room, he was too sick for any visitors. When he realized there was a compass in the medal, his smile lit up the room. In addition, I witnessed a 17-year-old girl with kidney disease cry and then smile when she received a medal. I could sense her justifiable frustration that she was 17 and stuck in a children's hospital on a Saturday morning. She wanted to know my number so she could follow my run during the London Marathon. I visited a blind child, who rapidly reviewed the present with her fingers, and then smiled when she realized it was hers. The children with tracheostomies and permanent ventilators suspended their medals above their beds and, as we approached units, the buzz about our visit preceded us with ambulatory patients greeting us in the halls. I was the one who received the biggest gift that day. When medicine is your profession, it is easy to miss some of what is going on around us. I can tell you that these children and their tireless families rely upon, and deeply respect, their nurses and physicians. I left with renewed inspiration about my career as a physician and founder of Medals4Mettle. There should be no debate about this aspect of healthcare, wherever one might be in the world. The doctor/patient relationship must be preserved, for all of us. Four ways to renew Phone: 1-877-722-6467 (US) 1-703-836-4444 (lnt'l) Fx: 703-684-4288 (US) Monday - Friday,8:30am - 5:00pm EST Online: www.entnet.org/renew Mail' AAO-HNS PO Box 632848 Baltimore, MD 21263-2848 AMERICAN ACADEMY OF OTOLARYNGOLOGYHEAD AND NECK5URGERY If you would like to witness this incredible feeling, email me at sisenberg@good4docs.com and 1will put you in touch with a local Medals4Mettie coordinator. Youmight consider taking off the scrubs, the white coat, or tie, and just visiting with these patients and their families. Medals4Mettie made it possible for me to gain a unique perspective at GOSH.1am certain it will inspire you, and others you might bring with you, as I know it will put a smile on the recipient you are visiting. As we say at M4M: "Someone is in a tougher race than you are right now." M4M celebrates our collective human courage. London took us one step closer to our vision of medals as the international, trans-cultural, compassionate currency of good will and support among human beings. To learn more, visit us at www.medals4mettle.rog. Dr. Isenberg was honored at the 2009 AAO-HNSF Annual Meeting & EXPO with the first Arnold P. Gold Foundation Award for Humanism in Medicine. oro ill When you joined the AAO-HNS. you showed the otolaryngology world your commitment to the highest ethical principles of the profession. Each year you renew your membership, you ensure that your Academy succeeds in representing the specialty as a prominent and prestigious influence in medicine. AAO-HNS membership renewal ensures that you'll continue to have: • Otolaryngology-Head and Neck Surgery. best peer-reviewed journal in the specialty; • A voice on important socioeconomic policy issues and debates on Capitol Hill and alongside our grassroots members in state legislatures, to protect and strengthen the profession; • Continuing medical education through meetings, self-instruction products, and AcademyU, our online learning platform, available to members anytime, anyplace, and at no additional cost; • Invaluable business of medicine resources to help you manage your practice effectively and with an eye toward new trends within the specialty; • Deep discounts on educational products and programs like our Annual Meeting & OTO EXPO; and • A network of career resources, from the patients and peers you reach through our online "Find an ENrdirectory, to the HEALTHeCAREERS Network online job bank. Empowering otolaryngologist-head and neck surgeons to deliver the best patient 1650 Diagonal Road, Alexandria, Virginia 22314-2857 care U.S.A. ! I