.…you mustn’t be frightened … if a sadness rises in front of you, larger than any you have ever seen; if an anxiety, like light and cloud-shadows, moves over your hands and over everything you do. You must realize that something is happening to you, that life has not forgotten you, that it holds you in its hand and will not let you fall. Why do you want to shut out of your life any uneasiness, any misery, any depression, since after all you don’t know what work these conditions are doing inside you? ~Rainer Maria Rilke from Letters to a Young Poet
…difficulties are magnified out of all proportion simply by fear and anxiety. From the moment we wake until we fall asleep we must commend other people wholly and unreservedly to God and leave them in his hands, and transform our anxiety for them into prayers on their behalf: With sorrow and with grief… God will not be distracted. ~Dietrich Bonhoeffer in Letters from Prison
Every day I see college students who are so consumed by anxiety they become immobilized in their ability to move forward through the midst of life’s inevitable obstacles and difficulties. They become so stuck in their own overwhelming feelings they can’t sleep or eat or think clearly, so distracted are they by their symptoms. They self-medicate, self-injure and self-hate. Being unable to nurture themselves or others, they wither like a young tree without roots deep enough to reach the vast reservoir that lies untapped beneath them. In epidemic numbers, some decide to die, even before life really has fully begun for them.
I grieve for them in their distress. My role is to help find healing solutions, whether it is counseling therapy, a break from school, or a medicine that may give some form of relief. My heart knows the ultimate answer is not as simple as the right prescription.
We who are anxious must depend upon a Creator who does not suffer from attention deficit disorder and who is not distracted from His care for us even when we turn away in worry and sorrow. We magnify our difficult circumstances by staying so tightly into ourselves, unable to look beyond our own eyelashes. Instead we are to reach higher and deeper, through prayer, through service to others, through acknowledging there is power greater than ourselves.
So we are called to pray for ourselves and for others, disabling anxiety and fear and transforming it to gratitude and grace. No longer withering, we just might bloom.
Beauty, to the Japanese of old, held together the ephemeral with the sacred. Cherry blossoms are most beautiful as they fall, and that experience of appreciation lead the Japanese to consider their mortality. Hakanai bi (ephemeral beauty) denotes sadness, and yet in the awareness of the pathos of life, the Japanese found profound beauty.
For the Japanese, the sense of beauty is deeply tragic, tied to the inevitability of death.
Jesus’ tears were also ephemeral and beautiful. His tears remain with us as an enduring reminder of the Savior who weeps. Rather than to despair, though, Jesus’ tears lead the way to the greatest hope of the resurrection. Rather than suicide, Jesus’ tears lead to abundant life. ~Makoto Fujimura
33 When Jesus saw her weeping, and the Jews who had come along with her also weeping, he was deeply moved in spirit and troubled. 34 “Where have you laid him?” he asked. “Come and see, Lord,” they replied. 35 Jesus wept. 36 Then the Jews said, “See how he loved him!” John 11:33-36
Daily I see patients in my clinic who are struggling with depression, who are contemplating whether living another day is worth the pain and effort. Most describe their feelings completely dry-eyed, unwilling to let their emotions flow from inside and flood their outsides. Others sit soaking in tears of hopelessness and despair.
This weeping moves and reassures me — it is a raw and honest spilling over when the internal dam is breaking. It is so deeply and plainly a visceral display of humanity.
When I read that Jesus weeps as He witnesses the tears of grief of His dear friends, I am comforted. He understands and feels what we feel, His tears just as plentiful and salty, His feelings of love brimming so fully they must be let go and cannot be held back. He too is overwhelmed by the pathos of His vulnerable and visceral humanity.
Our Jesus who wept with us becomes a promise of ultimate joy.
There is beauty in this: His rain of ephemeral tears.
They work with herbs and penicillin. They work with gentleness and the scalpel. They dig out the cancer, close an incision and say a prayer to the poverty of the skin.
…they are only human trying to fix up a human. Many humans die.
But all along the doctors remember: First do no harm. They would kiss if it would heal. It would not heal.
If the doctors cure then the sun sees it. If the doctors kill then the earth hides it. The doctors should fear arrogance more than cardiac arrest. If they are too proud, and some are, then they leave home on horseback but God returns them on foot. ~Anne Sexton “Doctors” from The Awful Rowing Toward God.
Let me not forget how humbling it is
to provide care for a hurting person
and not be certain that what I suggest
will actually work,
to be trusted to recommend the best option
including tincture of time,
wait and see,
try this or that.
Like other physicians who tumble off
at a full gallop, having lost balance
between confidence and humility,
I sometimes find myself unseated and unsettled,
returning on foot to try again to make a difference.
It may not be rabbit season or duck season but it definitely seems to be doctor season. Physicians are lined up squarely in the gun sights of the media, government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim. It’s not enough any more to wear a bullet proof white coat. It’s driving doctors to hang up their stethoscope just to get out of the line of fire. Depending on who is expressing an opinion, doctors are seen as overcompensated, demanding, whiny, too uncommitted, too overcommitted, uncaring, egotistical, close minded, inflexible, and especially– perpetually late.
One of the most frequent complaints expressed about doctors is their lack of sensitivity to the demands of their patients’ schedule. Doctors do run late and patients wait. And wait. And wait some more. Patients get angry while waiting and this is reflected in patient (dis)satisfaction surveys which are becoming one of the tools the industry uses to judge the quality of a physician’s work and character.
I admit I’m one of those late doctors. Perpetually 20-30 minutes behind.
I don’t share the reasons why I’m late with my patients as we sit down together in the exam room but I do apologize for my tardiness. Taking time to explain why takes time away from the task at hand: taking care of the person sitting or lying in front of me. At that moment, that is the most important person in the world to me. More important than the six waiting to see me, more important than the dozens of emails, electronic portal messages and calls waiting to be returned, more important than the fact I missed lunch or need to go to the bathroom, more important even than the text message of concern from my daughter or the worry I have about a ill relative.
I’m a salaried doctor, just like more and more of my primary care colleagues these days, providing more patient care with fewer resources. I don’t earn more by seeing more patients. There is a work load that I’m expected to carry and my day doesn’t end until that work is done. Some days are typically a four patient an hour schedule, but most days my colleagues and I must work in extra patients triaged to us by careful nurse screeners, and there are only so many minutes that can be squeezed out of an hour so patients end up feeling the pinch. I really want to try to go over the list of concerns some patients bring in so they don’t need to return to clinic for another appointment, and I really do try to deal with the inevitable “oh, by the way” question when my hand is on the door knob. Anytime that happens, I run later in my schedule, but I see it as my mission to provide essential caring for the “most important person in the world” at that moment.
The patient who is angry about waiting for me to arrive in the exam room can’t know that three patients before them I saw a woman who found out that her upset stomach was caused by an unplanned and unwanted pregnancy. Perhaps they might be more understanding if they knew that an earlier patient came in with severe self injury so deep it required repair. Or the woman with a week of cough and new rib pain with a deep breath that could be a simple viral infection, but is showing potential signs of a pulmonary embolism caused by oral contraceptives. Or the man with blood on the toilet paper after a bowel movement finding out he has sexually transmitted anal warts when he’s never disclosed he has sex with other men, or the woman with bloating whose examination reveals an ominous ovarian mass, or finding incidental needle tracks on arms during an evaluation for itchiness, which leads to suspected undiagnosed chronic hepatitis.
Doctors running late are not being inconsiderate, selfish or insensitive to their patients’ needs. Quite the opposite. We strive to make our patients feel respected, listened to and cared for. Most days it is a challenge to do that well and stay on time. For those who say we are being greedy, so we need to see fewer patients, I respond that health care reform and salaried employment demands we see more patients in less time, not fewer patients in more time. The waiting will only get longer as more doctors hang up their stethoscopes rather than become a target of anger and resentment as every day becomes “doctor season.” Patients need to bring a book, bring knitting, schedule for the first appointment of the day. They also need to bring along a dose of charitable grace when they see how crowded the waiting room is. It might help to know you are not alone in your worry and misery.
But your doctor is very alone, scrambling to do the very best healing he or she can in the time available.
I’m not yet hanging my stethoscope up though some days I’m so weary by the end, I’m not sure my brain between the ear buds is still functioning. I don’t wear a bullet proof white coat since I refuse to be defensive. If it really is doctor season, I’ll just continue on apologizing as I walk into each exam room, my focus directed for that moment to the needs of the “most important person in the whole world.”
And that human being deserves every minute I can give them.
Astonishing material and revelation appear in our lives all the time.
Let it be.
Unto us, so much is given.
We just have to be open for business. ~Anne Lamott from Help Thanks Wow: Three Essential Prayers
I have the privilege to work in a profession where astonishment and revelation awaits me behind each exam room door.
In a typical clinic day, I open that door up to thirty plus times, close it behind me and settle in for the ten or fifteen minutes I’m allocated per patient. I need to peel through the layers of each person quickly to find the core of truth about who they are and why they’ve come to clinic that day.
Sometimes what I’m looking for is right on the surface: in their tears, in their pain, in their fears. Most of the time, it is buried deep, often beneath a scar I must search to find. I need to wade through the rashes and sore throats and coughs and headaches and discouragement to find it.
Once in awhile, I actually do something tangible to help right then and there — sew up a cut, lance a boil, splint a fracture, restore hearing by removing a plug of wax from an ear canal.
Often I find myself giving permission to a patient to be sick — to take time to renew, rest and trust their bodies to know what is best for a time.
Sometimes, I am the coach pushing them to stop living sick — to stop hiding from life’s challenges, to stretch even when it hurts, to get out of bed even when not rested, to quit giving in to symptoms that are to be overcome rather than become overwhelming.
Always I’m looking for an opening to say something a patient might think about after they leave my clinic — how they can make different choices, how they can be bolder and braver in their self care, how they can intervene within their own finite timeline to prevent illness, how every day is just one thread in the larger tapestry of their lifespan.
Each morning I rise early to get work done at home before I actually arrive at my desk at work, trying to avoid feeling unprepared and inadequate to the volume of tasks heaped upon each day. I know I will be stretched beyond my capacity, challenged by the unfamiliar, the unexpected and will be stressed by obstacles thrown in my way. I know I will be held responsible for things I have little to do with, simply because I’m the one who often acts as decision-maker.
It is always tempting to go back to bed and hide.
Instead of hiding, I go to work as the exam room doors need to be opened and the layers peeled away. I understand the worry, the fear and the pain because I have lived it too. I know the limitations of a body that wants to consume more than it needs, to sleep rather than go for a walk, to sit rather than stand.
Even now in my seventh decade of life, I am continually learning how to let it be, even if it is scary. It is a gift perhaps I can share.
No matter what waits behind the exam room door, it will be astonishing to me.
I’m grateful to be open for business. The Doctor is In.
I’m reminded daily about how little I know and understand. I work with people who are suffering, whose symptoms may fit prescribed diagnostic criteria but yet defy explanation or reason. They care about what relief I might offer rather than a label that names the illness.
Like so much in medicine, what I witness daily is unexplained and unexplainable. What I do know I carry with me, small and honorable and shareable. I offer it up to each patient, one after another: here is what I think might help. here is your next step to take. here is the hope that goes with taking each breath, the next and the next.
Even when standing in the dark, as we all do at times in our life, we just keep breathing. In and out. In and out. We are filled even when empty.