Monthly Archives: June 2015

Bring What Ya Got

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“Mei-Mei, do you want more cereal?”  I asked, during one of our usual hurry-or-we’re-going-to-be-late-but-don’t-rush-eat-properly school day mornings.

“Mmmuhhmmhuh,” I heard, as she faced the back porch where a squirrel had skittered across.

“What?”

“Mmmuhhumhuh,” I heard again.  Was her mouth full of food, or did I need my hearing checked?

“Mei-Mei!  Do you want more cereal, YES or NO?”

“I said yes!”

“Mei, you need to actually say, yes or no, and face people when you speak, so they can actually understand you.  It’s how we show respect. Got it?”

“Got it.”

“What did I just say?”

“Answer yes or no and face you when I talk.”

…Minutes pass, coffee, cereal, packing lunch…  “Mei, do you want applesauce in your lunch?”

“Mmmuhhumhuh.”

I’ll admit I lost it a little just then.  We just had this conversation, no?  How many times do I have to say it (this was not the first)?  I managed to not make her feel too bad, but frustration loomed over us both as we lugged our backpacks out the door.  In the car she mused, “Sometimes I think people expect me to be perfect.”  Ouch.  How nice of her to couch it in general terms to spare my feelings.  After acknowledging that ‘people’ in fact included me, she gave another example.  “My teacher, Mrs. Blank, says nobody’s perfect, but then she gets mad when we do things wrong.”  What’s up with that?

I know I’m not perfect, and I get mad at myself when I make mistakes—the self-talk can be downright abusive at times.  My patients know they are not perfect, and I witness how they shame themselves over their unhealthy habits.  How exhausting and unnecessary.  None of us should be this hard on ourselves.  And we still need to reconcile our behavior: If we’re not aiming for perfection, then what?  Why bother, what is the goal?  How do we move on from our mistakes?

After a particularly dismal volleyball practice my freshman year in high school, I thought for sure they would kick me off the team.  At 5’2” and more of a math nerd than an athlete, I considered it a miracle that I got to play at all, and I felt I had to prove my worthiness again every day.  The varsity coach, Bubba, gave me the best possible gift in these words: “Bring what ya got.”  Every day, just do your best.  Some days will be better than others, and as long as you bring what you have and offer it humbly, nobody can ask any more of you.  You are worthy already, and you can still work hard toward improvement—of skills, teamwork, self.  Wow, you mean you won’t throw me away if I have one hard day (week, month, year, life)?  How comforting, how liberating!

I said some fumbling version of this as we pulled up to the school that morning.  “Just do your best, try to remember why we do these things,” or something like that.  I didn’t want her to feel bad about herself all day because of one mistake, or worse, feel that it would somehow cost her my love.  I’m grateful for the reminder.  When I see shame in my patients’ faces, having lost no weight and with cholesterol numbers as high as ever, I can remember that we’re all just doing our best every day.  What got in the way?  What do they need to reset and restart?

How can I help?

More Than Enough Love

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If you’ve ever been pregnant, you may recall the mental and emotional acrobatics of swinging hormones.  If not, just imagine turning suddenly and severely manic-depressive, while watching your body metamorphose on a daily basis into something unrecognizable and terrifying, all of it utterly out of your control.

I sat in the dining room of our new home, staring blankly at the warren of boxes to be sorted and unpacked.  Well into my third trimester with #2, I felt whale-like and exhausted.  My son was almost four years old, the center of my universe.  Suddenly, panic: What am I doing?  This is crazy!  How could there possibly be enough love for more than one?  I could not fathom loving any other the way I loved him, the single focus of my entire sphere of existence.  Thankfully, the moment my daughter was born, I immediately understood the true miracle of parenthood—love is infinite.  My sphere simply grew to an ellipsoid.  There was more than enough love, and space in my heart, for both of them and more, easily.

As physicians, we possess a similarly infinite capacity to love our patients.  Sometimes we have to work much harder to feel it, though.  Like parenting, the path of medical practice is not paved with lollipops and ice cream.  It’s more like an uphill dirt road with pits and grooves, erratic weather, and hairpin turns that make you dizzy and nauseated.  It can also offer astoundingly beautiful scenery along the way—like parenting.  Most of us come to medicine thoughtfully, and few could withstand the crucible of training without some enduring core of dedication and calling.  Parent-love feels innate, encoded.  You stick with it through the hard parts, driven by something primal.  Doctor-love, while also born of the internal and deep, requires more conscious intention to maintain.  This commitment feels far more vulnerable to external forces.  Physicians’ social and emotional exhaustion can lead to disengagement, hardening, and reticence to a system we feel impotent to change.  We get burned out, and everybody suffers.

When we dig deeper, though, and uncover the original reserves of humanity and compassion that first called us to this work, when we nurture and cultivate them, we find the love.  We not only survive, we thrive.  Everyone benefits—ourselves, our patients, colleagues, family, communities—we can literally save the world.  We can achieve this by reaching out, sharing stories, judging ourselves more gently, and withholding our negative judgments of others.

A doctor’s medical practice, like life itself, will go through phases.  The focus may change over time, and the fundamental mission remains the same.  Why do we do this work?  The answer holds the key to our fulfillment, if we can remember it through the hard parts.

Like parents, we physicians share the hard dirt road, and traffic can get heavy.  We can choose to ride alone, or with a cooperative group that takes care of its members, and doesn’t leave anyone behind.  We can share the vistas, take pee breaks, and pack healthy snacks.  If we build our riding tribes right, we can ensure that each of us has more than enough love for the journey.

Anything else?

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Do you always feel comfortable asking your doctor all of your questions?  I thought I did, until late one summer, when my legs suddenly started to itch.  It began on the lower aspects of both shins and spread steadily, up to my knees, then my thighs, and then my arms, with little pink bumps.  The itching was moderate, I could still get through my day, but I didn’t know what it was.  After a few weeks I made an appointment with dermatology.

I was a model patient—told my story in chronological order, all the pertinent details laid out neatly for the resident who saw me first.  I made his job easy; he appreciated that.  We both surmised that it probably wasn’t anything serious, maybe viral, and would likely resolve with time and some steroid cream.  The attending entered several minutes later, having heard the story outside of the exam room.  We all agreed on the diagnosis and treatment, easy-peasy.  I felt proud for keeping their clinic on schedule.

Then I suddenly remembered other bumps on my hands that I had always wanted to ask a dermatologist about.  Present for years, there were just a few—pinhead or smaller, round, translucent nodes on my palm, which would always grow back a few days after I pinched them off.  I showed them to the attending doctor and asked what they were.  He said they were nothing, and that I could just live with them.  And that was that.  I only realized later how unsatisfied I felt.  What were they?  What caused them?  What should I expect, would they ever go away?  I just wanted to know, to learn.  He didn’t really answer my question (though I suspect he thought he did), and I felt too sheepish to ask anything more, as if I were wasting his time.  I can’t blame him entirely—he was not intentionally dismissive or rushed; actually he was perfectly pleasant.  But something made me shut up when I really wanted to engage him.  It fascinates me to this day: I am a doctor; I gave my doctors what they needed from me, and could not get what I needed for myself.  The rash resolved with ointment and my hand bumps persist.  I still regard them with annoyed curiosity, and remember that encounter.  It was humbling, to be sure.

By contrast, my kids’ allergist regularly invited me to ask questions.  He knew my background, and explained things to me in a collegial way.  He would then speak to my kids in language that they could understand.  I always came prepared for his appointments, a list of events and questions in hand.  Toward the end of every visit he always asked, “Anything else?”  No, we’re good.  Some more small talk, follow up plans…  “Anything else?”  Umm, no, thanks, I think we got it.  Prescriptions, parking validation…  “Anything else?”  Really?

At first I started to wonder, ‘Am I missing something?  Is he hinting at me?  What else, there must be something else, think, woman!’  And, ‘Does he have some kind of tic?’  Then I realized: He made an intentional practice of making it safe for patients to ask questions. He understood how patients got tongue-tied in his presence, and made repeated, conscious efforts to untie us.  Brilliant!  Maybe it cost him a few extra minutes each visit, maybe not.  His sincere interest in my concerns, though, earned him my trust and respect.  As a fellow physician, I know the value and rewards of that.  And now I ask my own patients often, “Anything else?”