Tired and hungry, late in the day, impelled to leave the house and search for what might lift me back to what I had fallen away from, I stood by the shore waiting. I had walked in the silent woods: the trees withdrew into their secrets. Dusk was smoothing breadths of silk over the lake, watery amethyst fading to gray. Ducks were clustered in sleeping companies afloat on their element as I was not on mine.
I turned homeward, unsatisfied. But after a few steps, I paused, impelled again to linger, to look North before nightfall-the expanse of calm, of calming water, last wafts of rose in the few high clouds.
And was rewarded: the heron, unseen for weeks, came flying widewinged toward me, settled just offshore on his post, took up his vigil. If you ask why this cleared a fog from my spirit, I have no answer. ~Denise Levertov “A Reward” from Evening Train.
~Lustravit lampade terras~ (He has illumined the world with a lamp) The weather and my mood have little connection. I have my foggy and my fine days within me; my prosperity or misfortune has little to do with the matter. – Blaise Pascal from “Miscellaneous Writings”
And so you have a life that you are living only now, now and now and now, gone before you can speak of it, and you must be thankful for living day by day, moment by moment … a life in the breath and pulse and living light of the present… ~Wendell Berry from Hannah Coulter
Worry and sorrow and angst are more contagious than the flu. I mask up and wash my hands of it throughout the day. There should be a vaccination against unnamed fears.
I want to say to my patients and to myself: Stop now, this moment in time. Stop and stop and stop.
Stop needing to be numb to all discomfort. Stop resenting the gift of each breath. Just stop. Instead, simply be.
I want to say: this moment, foggy or fine, is yours alone, this moment of weeping and sharing and breath and pulse and light.
Shout for joy in it. Celebrate it.
Be thankful for tears that can flow over grateful lips just as rain can clear the fog. Stop holding them back.
Just be– be blessed in both the fine and the foggy days– in the now and now and now.
Vast whisp-whisp of wingbeats awakens me and I look up at a minute-long string of black geese’ following low past the moon the white course of the snow-covered river and by the way thank You for keeping Your face hidden, I can hardly bear the beauty of this world ~Franz Wright from “Cloudless Snowfall”
A psalm of geese labours overland
cajoling each other near half…
The din grew immense. No need to look up.
All you had to do was sit in the sound
and put it down as best you could…
It’s not a lonesome sound but a panic,
a calling out to the others to see if they’re there;
it’s not the lung-full thrust of the prong of arrival in late October; not the slow togetherness
of the shape they take on the empty land on the days before Christmas:
this is different, this is a broken family, the young go the wrong way,
then at daybreak, rise up and follow their elders again filled with dread, at the returning sound of the journey ahead. ~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
I am overwhelmed by the amount of “noticing” I need to do in the course of my work. 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 offered by another human being.
How are they calling out to me as they keep their faces hidden?
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. May I always look for the beauty in their hidden faces.
O come, thou Dayspring, come and cheer our spirits by thine advent here; dispel the shadows of the night, and turn our darkness into light. ~from O Come O Come Emmanuel
Moonless darkness stands between. Past, O Past, no more be seen! But the Bethlehem star may lead me To the sight of Him who freed me From the self that I have been. Make me pure, Lord: Thou art holy; Make me meek, Lord: Thou wert lowly; Now beginning, and alway: Now begin, on Christmas day.
~Gerard Manley Hopkins
I leave home in darkness to go to work and come home in darkness in the late afternoon. It seems for days on end the sun never shines as I’m tucked away with patients in clinic consult rooms hearing their own struggle against the darkness.
Where is the light that I promise to each of them if I can’t feel it myself?
Yet Glory is present in the darkest place and the Light has come.
I will remember His promise.
Even in the darkness I know His face.
He knows I know.
Out of the depths of silent night
Immanuel, come hear our cry
Our grief is strong, our burdens great
The night is long and hope is faint
You came to set the captives free
A Morning Star of joy and peace
Why does this darkness feel so deep?
Why can’t our weary spirits see?
Glory in the darkest place
Glory, let Your mercy reign
Out of the depths of silent night
A Savior born, a mother’s sigh
The darkness trembled at this Star
A beam of hope for troubled hearts
You came to make Your blessings known
And bear our curse of death alone
You came to share our suffering
So in our sorrow, we could sing
Glory in the darkest place
Glory, let Your mercy reign
Glory in the darkest place
Glory, let Your mercy reign
Flee for a while from your tasks, hide yourself for a little space from the turmoil of your thoughts. Come, cast aside your burdensome cares, and put aside your laborious pursuits. For a little while give your time to God, and rest in him for a little while. Enter into the inner chamber of your mind, shut out all things save God and whatever may aid you in seeking God; and having barred the door of your chamber, seek him. ~Anselm of Canterbury: The Major Works
Yesterday I needed to leave work early;
near tears, physically spent, too fried
to keep listening, problem solving, comforting.
I needed to feel something other than needed.
I needed neediness myself — a sorry place to be.
It’s happened before, many times:
middle of the night mothering a vomiting child,
middle of the night mothering a frail mother,
middle of the night worried about the world.
Yet morning comes because God never left,
maybe not bright and shining and wondrous
maybe a weeping rock,
but if I gently close the door to all that is not God,
I will find Him looking for me.
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.