This Doctor is Open For Business

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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

 

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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.

 

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Those Who Love Each Other

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And this, then,
is the vision of that Heaven of which
we have heard, where those who love
each other have forgiven each other,

where, for that, the leaves are green,
the light a music in the air,
and all is unentangled,
and all is undismayed.
~Wendell Berry “To My Mother”

 

 

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To think of a mother’s love strengthened
by the knowledge of a life and light within her
and gratitude for forgiveness that knows no bounds:

~this is heaven where all is grace~

the tangles we have made of our lives
are unraveled, straightened and smoothed,
no longer worry or dismay over mistakes we’ve made

I can only hope I have loved
as I’ve been loved
and forever will be.

 

 

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A Bleeding Heart

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Love your neighbor as yourself is part of the great commandment.

The other way to say it is, ‘Love yourself as your neighbor.’ Love yourself not in some egocentric, self-serving sense but love yourself the way you would love your friend in the sense of taking care of yourself, nourishing yourself, trying to understand, comfort, strengthen yourself.

Ministers in particular, people in the caring professions in general, are famous for neglecting their selves with the result that they are apt to become in their own way as helpless and crippled as the people they are trying to care for and thus no longer selves who can be of much use to anybody. 

It means pay mind to your own life, your own health and wholeness, both for your own sake and ultimately for the sake of those you love too. Take care of yourself so you can take care of them.

A bleeding heart is of no help to anybody if it bleeds to death.
~Frederick Buechner from Telling Secrets

 

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We are reminded every time we hear safety instructions on an airplane before a flight takes off: “in the event of a sudden pressure change in the cabin, oxygen masks will appear – remember to put your own on before helping others with their masks.”   

If we aren’t able to breathe ourselves, we won’t last long enough to be of assistance to anyone around us.  Too often,  sacrificing self-care threatens others’ well-being.

A headline appeared in my email from the American Psychiatric Association this morning: “Physicians Experience the Highest Suicide Rate of Any Profession” – there is rampant depression and burn-out among those who should know best how to recognize and respond to the danger signs — for women physicians, nearly 1 out of 5 are afflicted.   Yet the work load only seems to increase, not diminish, the legal and moral responsibility weighs more heavily, and the hours available for sleep and respite shrink.  In forty years of practicing medicine (my father liked to remind me “when are you going to stop ‘practicing’ and actually ‘do’ it?”),  the work has never gotten easier, only harder and heavier.

I see suicidal patients all day and am immensely grateful I’ve never been suicidal, thank God, but anxiety is embedded deep in my DNA from my non-physician fretful farmer ancestors.  Anxiety becomes the fuel and driver of the relentless physician journey on long lonely roads, spurring us to stay awake too many hours and travel too far when we should be closing our eyes and taking a break to breathe, just breathe.

However, we are trained to respond to anxiety from the first day in anatomy class:
“and while you, Miss Polis, are trying to think of the name of that blood vessel, your patient is exsanguinating in front of you– drip, drip, drip….”

Terror-stricken at the thought I was inadequate to the task of saving a life, it took years for me to realize the name of the vessel didn’t bloody matter as long as I knew instinctively to clamp it, compress it, or by the love of the Living God, transfuse my own blood from my bleeding heart into my patient’s.

I learned well those many years ago:

To save a life, I must preserve my own.

 

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Tempted to Run and Rush

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The duties and cares of the day crowd about us when we awake each day
– if they have not already dispelled our night’s rest.

How can everything be accommodated in one day?
When will I do this, when that?
How will it all be accomplished?

Thus agitated, we are tempted to run and rush.
And so we must take the reins in hand and remind ourselves,

“Let go of your plans. The first hour of your morning belongs to God.
Tackle the day’s work that he charges you with,
and he will give you the power to accomplish it.”
~Edith Stein from Essays on Woman

 

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Rushing headlong pell-mell tumble-bumble into the day is a specialty of mine.  Once I step out the door there isn’t a single moment of quiet breathing space until I step back in the door 12 hours later.  I realize this is a daily choice I make to live this way: no one forces me to see just one more patient (or four) or complete each chart before I leave or make sure I have responded to a hundred messages.

I would not rest well until the work is finished.

Therefore my hour of quiet starts very early in the day, usually before the sun rises or the birds start to twitter, when there is no every-fifteen-minute appointment schedule and the phone remains silent.

However the rising morning does not belong to me: God knows what I’ll need to get through the day.  He reminds me to breathe deeply, find time to smell the tulips, and take a walk with a buddy,  always remembering I’m not alone.

 

 

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Prescribing Good Medicine

 

A good night sleep, or a ten minute bawl, or a pint of chocolate ice cream, or all three together, is good medicine.
~Ray Bradbury

 

 

 

If there is anything I’ve learned in over 40 years of practicing medicine, it’s that I still must “practice” my art every day.  As much as we physicians emphasize the science of what we do, utilizing “evidence based” decisions, there are still days when a fair amount of educated guessing and a gut feeling is based on past experience, along with my best hunch.  Many patients don’t arrive with classic cook book symptoms that fit the standardized diagnostic and treatment algorithms so the nuances of their stories require interpretation, discernment and flexibility.    I appreciate a surprise once in awhile that makes me look at a patient in a new or unexpected way and teaches me something I didn’t know before.   It keeps me coming back for more, to figure out the mystery and dig a little deeper.

I’ve also learned that not all medicine comes in pills or injections.  This isn’t really news to anyone, but our modern society is determined to seek better living through chemistry, the more expensive and newer the better, whether prescribed or not.  Chemicals have their place, but they also can cause havoc.  It is startling to see medication lists topping a dozen different daily pills.  Some are life-saving.  Many are just plain unnecessary.

How many people sleep without the aid of pill or weed or alcohol?  Fewer and fewer.  Poor sleep is one of the sad consequences of our modern age of too much artificial light, too much entertainment and screen time keeping us up late, and not enough physical work to exhaust our bodies enough to match our frazzled and fatigued brains.

How many of us allow ourselves a good cry when we feel it welling up?  It could be a sentimental moment–a song that brings back bittersweet memories, a commercial that touches just the right chord of feeling and connection.  It may be a moment of frustration and anger when nothing seems to go right.  It could be the pain of physical illness or injury or the stress of emotional turmoil.  Or just maybe there is weeping when everything is absolutely perfect and there cannot be another moment just like it, so it is tough to let it go unchristened by tears of joy.

And without a doubt, the healing qualities of chocolate are unquestioned by this doctor, however it may be consumed.  It can fix most everything that ails a person,  at least for an hour or two.

No, it doesn’t take an M.D. degree to know the best medicine.

Just remember: sleep, weep, reap (chocolate!)

 

Trust All This to be True

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Trust that there is a tiger, muscular
Tasmanian, and sly, which has never been
seen and never will be seen by any human
eye. Trust that thirty thousand sword-
fish will never near a ship, that far
from cameras or cars elephant herds live
long elephant lives. Believe that bees
by the billions find unidentified flowers
on unmapped marshes and mountains. Safe
in caves of contentment, bears sleep.
Through vast canyons, horses run while slowly
snakes stretch beyond their skins in the sun.
I must trust all this to be true, though
the few birds at my feeder watch the window
with small flutters of fear, so like my own.
~Susan Kinsolving “Trust”
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photo by Emily Vander Haak
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When I stand at the window watching the flickers, sparrows, finches, chickadees, and red-winged blackbirds come and go from the feeders, I wonder who is watching who.  They remain wary of me, fluttering away quickly if I approach with lens in hand.  They fear capture, even within a camera.  They have a life to be lived without my witness or participation.  So much happens that I never see or know about.

I understand:  I fear being captured too.

Even if only for a moment as an image preserved forever, I know it doesn’t represent all I am, all I’ve done, all I feel, all my moments put together.  The birds are, and I am, so much more than one moment.

Only God sees us fully in every moment, witness to our freedom and captivity,  our loneliness and grief, our joy and tears, knowing our best and our worst.
And because He knows us so well, in Him we must trust.
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photo by Tomomi Gibson

Breathing In and Out

What is there beyond knowing that keeps
calling to me?  I can’t
 
turn in any direction
but it’s there.  I don’t mean
 
the leaves’ grip and shine or even the thrush’s
silk song, but the far-off
 
fires, for example,
of the stars, heaven’s slowly turning
 
theater of light, or the wind
playful with its breath;
 
or time that’s always rushing forward,
or standing still
 
in the same — what shall I say —
moment.
What I know
I could put into a pack
 
as if it were bread and cheese, and carry it
on one shoulder,
 
important and honorable, but so small!
While everything else continues, unexplained
 
and unexplainable.
 
….mostly I just stand in the dark field,
in the middle of the world, breathing in and out…
~Mary Oliver from “What is there beyond knowing”
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.