I think of the story of the storm and everyone waking and seeing the distant yet familiar figure far across the water calling to them…
…so that when we finally step out of the boat toward them, we find everything holds us, and everything confirms our courage, and if you wanted to drown you could, but you don’t because finally after all this struggle and all these years you don’t want to any more you’ve simply had enough of drowning and you want to live and you want to love and you will walk across any territory and any darkness however fluid and however dangerous to take the one hand you know belongs in yours. ~David Whyte from “The Truelove” in The House of Belonging
Yesterday was the wrap-up to my thirtieth academic year working as a college health physician. Despite budget challenges, inadequate staffing, a higher severity of illness in a patient population with burgeoning mental health needs, our staff did an incredible job this year serving students and their families with the resources we do have.
Reaching the end of the school year is always poignant: we will miss the graduating students we have gotten to know so well over four or five (or six!) years, while we watch others leave temporarily for the summer, some to far away places around the globe.
We weep for those who have failed out, given up or fallen away from those who care deeply about them, some never to return to school again, and a few giving up on life itself. They did not take the hand offered to guide them through, even though they tired of drowning.
In my work I have tried to do what is needed when it is needed no matter what time of the day or night. There are obviously times when I fall short– too vehement when I need to be quiet, too urgent and pressured when I need to be patient, too anxious to do something/anything when it is best to simply do no harm.
I can only hold out my hand and wait.
Each year I learn enough from each patient to fill volumes, as they speak of their struggles, their pain, their stories and sometimes hearing, most tragically, their forever silence.
I honor you, our students, on this day, to confirm your courage stepping out from the safety of the boat — not to drown, never to drown — but wanting to live, wanting to love, wanting to move healthier, better equipped and joyful into the rest of your lives.
Just take the outreached Hand that belongs in yours.
Will there really be a “Morning”? Is there such a thing as “Day”? Could I see it from the mountains If I were as tall as they?
Has it feet like Water lilies? Has it feathers like a Bird? Is it brought from famous countries Of which I have never heard?
Oh some Scholar! Oh some Sailor! Oh some Wise Man from the skies! Please to tell a little Pilgrim Where the place called “Morning” lies! ~Emily Dickinson
You are the future, the immense morning sky turning red over the prairies of eternity…
You are the meaning deepest inside things that never reveals the secret of its owner. And how you look depends on where we are: from a boat, you are shore, from the shore a boat. ~Rainer Maria Rilke, from Love Poems to God from the Book of Hours
I know now what weariness is when the mind stops and night is a dark blanket of peace and forgetting and the morning breaks to the same ritual and the same demands and the silence. ~Jane Clement from No One Can Stem the Tide
I head to clinic this morning knowing from now on my work will feel different after today, no longer the same ritual, no longer the same demands.
Mornings will be more resonant, depending on where I am: from the boat I no longer must be shore, from the shore I no longer need to row the boat.
I can simply be what the patient needs in the moment and the patient is all I need.
If you want to identify me, ask me not where I live, or what I like to eat, or how I comb my hair, but ask me what I am living for, in detail, ask me what I think is keeping me from living fully for the thing I want to live for. ~ Thomas MertonfromMy Argument with the Gestapo
As a patient waiting to see my health care provider, I would adapt Merton’s template of personal revelation this way:
If you want to know who I am, ask me not about my insurance plan, or what is my current address, or whether I have a POLST on file, or whether I have signed the Notice of Privacy Practice, or whether I’ll accept a message on my phone — but ask me what I am most concerned about, in detail, ask me what I think is causing my symptoms and what I think is keeping me from eating healthy, exercising regularly, and choosing moderation in all things so that I can live fully for the thing I want to live for.
As a physician in the midst of a busy clinic day, I struggle to know who my patients are beyond their standard medical history and demographics. One of my goals in our primary care clinic, now sixteen years into electronic medical record (EMR) use, is to create a way for our patients to provide their personal history online to us via their password secured web portal. These are the questions our clinic staff may not have opportunity to ask or record during clinic visits. Having the patient personally document their social history and background for us to have in the chart –in essence, telling us their story in their own words–can be very helpful diagnostically and for individualizing the best treatment approach for each unique individual.
There needs to be an “About me” section in the EMR that would contain biographical and personal history information the patient could provide online via writing or video.
Tell us about yourself This is your own personal history in your own words to be added to your electronic medical record in the folder “About Me”. You can edit and add information at any time via this secure patient portal to update it.
We want to know your story. Only you can tell us what you think is most important for us as your health care providers to know about you. We may not always have the time to ask and document these detailed questions in a brief clinic visit, so we are asking for your help.
Why do we want to know your non-medical background as well as medical background?
We evaluate a patient’s symptoms of concern but we also are dedicated to helping our patients stay healthy life long. To assist us in this effort, it is very helpful to know as much about you as possible, in addition to your past medical history. It is crucial also to understand your family background and social history. We want to know more about your personal goals, and what you think may be preventing you right now from living fully for the things you consider most important to you.
This is your opportunity to tell us about yourself, with suggested questions below that you can consider answering. This information is treated as a confidential part of your medical record, just like all information contained in your record. You can add more at any time by returning to this site.
1) Tell us about your family—who raised you and grew up with you, and who currently lives with you– including your racial/ethnic/cultural heritage. If relevant, tell us whether you have biological beginnings outside of your family (e.g. adopted, egg donation, surrogate pregnancy, artificial insemination, in vitro fertilization) Provide information on any illnesses in your biologic family.
2) List the states or countries you have lived in, and what countries outside the U.S. you have lived in longer than a month. Have you served in the military or another government entity, like the Peace Corps?
3) Tell us about your educational and job background. This could include your schooling or training history, paid or volunteer work you’ve done. What are your hobbies, how do you spend your leisure time, what are your passions and future goals. Where do you see yourself in ten years?
4) Tell us about your sexual orientation and/or gender preference.
5) Tell us about your current emotional support system—who are you most likely to share with when things are going very well for you and especially when things are not going well.
6) Tell us about your spiritual background, whether you are part of a faith or religious community and if so, how it impacts your life.
7) Tell us what worries you most about your health.
8) What would you have done differently if you could change things in your life? What are you most thankful for in your life?
9) What else do you feel it is important for us to know about you?
Thank you for helping us get to know you better so we can provide medical care that best meets your unique needs.
As our clinic is moving to an updated EMR, I’m interested in hearing feedback from patients and health care providers. What additional questions would you want asked as part of personal history documentation in a medical record?
Electronic medical records allow us, as never before, the ability to share information securely between patients and their health care providers. Patients want to tell us their story and we want to know more about them.
It is time we asked them and truly listen to what they have to say.
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.
Now a red, sleepy sun above the rim Of twilight stares along the quiet weald, And the kind, simple country shines revealed In solitudes of peace, no longer dim. The old horse lifts his face and thanks the light, Then stretches down his head to crop the green. All things that he has loved are in his sight; The places where his happiness has been Are in his eyes, his heart, and they are good. ~Siegfried Sassoon from “Break of Day”
I am growing older along with my horses. I think of them out to pasture throughout my workday as I continue to climb in the harness to pull the load as fast and hard as I can muster, returning home in the evening sore and weary.
I think of them with the morning sun on their withers, the green blades under their feet, as they search for the sweetest tender patch to munch.
They remind me to bring the calm of the pasture inside to balance the noise and bustle and troubles found in the clinic. There still is peace and light to be found; I have only to look for it.
“To practice medicine with good spirit does not mean to be in a place where there is no noise, trouble or hard work. It means to bring your calm and loving heart right into the midst of it.” from www.theheartofmedicine.org
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a calling out to the others to see if they’re there; ~Dermot Healy from A Fool’s Errand
We are here to witness the creation and abet it. We are here to notice each thing so each thing gets noticed. Together we notice not only each mountain shadow and each stone on the beach but, especially, we notice the beautiful faces and complex natures of each other. We are here to bring to consciousness the beauty and power that are around us and to praise the people who are here with us. We witness our generation and our times. We watch the weather. Otherwise, creation would be playing to an empty house.
~Annie Dillard from The Meaning of Life edited by David Friend
By the time Saturday rolls around, I am overwhelmed by the amount of “noticing” I needed to do in the course of my work that week. Each patient, and there are so many, deserves my full attention for the few minutes we are together. I start my clinical evaluation the minute I walk in the exam room and begin taking in all the complex verbal and non-verbal clues sometimes offered by another human being.
How are they calling out to me?
What someone tells me about what they are feeling may not always match what I notice: the trembling hands, the pale skin color, the deep sigh, the scars of self injury. I am their audience and a witness to their struggle; even more, I must understand it in order to best assist them. My brain must rise to the occasion of taking in another person, offering them the gift of being noticed and being there for them, just them.
This work I do is distinctly a form of praise: the patient is the universe for a few moments and I’m grateful to be watching and listening. When my patient calls out to me, may they never feel they are playing to an empty house.
Enter autumn as you would a closing door. Quickly, cautiously. Look for something inside that promises color, but be wary of its cast–a desolate reflection, an indelible tint. ~Pamela Steed Hill from “September Pitch”
The door of summer has closed quickly behind me;
I am back to long days and interrupted evenings,
of worried voices and midnight calls with over-the-phone sobs,
of emergency room referrals and work-them-in schedules.
I want to tell them it’ll be okay, hug away their anguish
despite the encroaching lengthened nights;
that winter coming does not mean
the end of all.
It takes a background of darkness
for the light to shine brightest
Shadows are borne from illumination~
It will be okay, even now, even so.