Category Archives: medicine

Stay Connected

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NaBoPoMo 2021:  Do Good, Kid

My friend Liz is amazing.

We met just as I was leaving my last practice 7 years ago, and I knew right away I had to grow this relationship.  She is an elder sister in the profession—a wise, compassionate, generous, empathic, smart, thoughtful, and loving physician and teacher.  After I had the privilege of presenting to her and her amazing colleagues on physician burnout (really, they schooled me that day), Liz showed me the inner world of primary care in a correctional facility.  We toured incredibly aged buildings.  Liz explained the frustrating limitations of working in a jail environment and the difficulties arranging optimal follow up when detainees are released.  But most of all, she showed me what true, deep respect for every person’s dignity, no matter how vulnerable, looks like.  Holy cow, I will never forget that day. 

Liz is also a deeply spiritual person.  She wrote the chapter on spiritual resources for Jewish healthcare professionals in Judaism and Health.  After our day together at the jail, we kept trying to meet again.  I wanted to learn more about Judaism and how she lived it—personally, professionally, and in community.  But my kids were little and the weather was bad on the nights we planned to meet, or something would come up, or- or- or…  It just never worked out.  But as physicians of deep faith, we both always knew we would connect again someday.

We kept in touch all these years mostly through occasional emails, and then YAY Facebook, especially the Physician Moms Group!  By far the most valuable thing about social media is sharing photos and reading life updates.  It really makes you feel like you’re in your friends’ lives up close, going through all the ups and downs, sharing joys and sorrows, witnessing from afar.  When I posted recently about a freak out I had over Daughter’s anaphylactic food allergy, Liz reached out.

We met in her neighborhood, which happens to be my old college stomping grounds.  We walked all over campus and caught up, shared stories, commiserated, and bonded, just like we always knew we would.  I got a copy of the book with a bonus printout of her favorite poem, “The Seven of Pentacles” by Marge Piercy.  I will return the love with my favorite book of poems so far, To Bless the Space Between Us by John O’Donohue. 

The space between us, indeed.  So near, just across town, yet so far, 7 years, and yet so near still, always connected in spirit through the years, light and strong, like dental floss or fishing line… We stayed connected, patiently, faithfully, knowing that divinity operates on its own schedule, and that when we could finally meet again, it would be powerful and lovely. 

And so it was.

It will not be another 7 years, this we know.  And it was well worth the wait.

Ask For Help

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NaBloPoMo 2021:  Do Good, Kid

I bet most practicing physicians can remember a time in their training when, not totally sure of what they were doing, they had to choose:  Ask for help, or go it alone?

Medical culture can give a learner some serious psychological whiplash.  In training, we are told at the same time explicitly that we should ask for help (we are novices, after all), and also implicitly that we should already know everything, that asking for help is weak and makes us inadequate.  It can be a dangerous paradox to navigate, especially when patients’ lives may be at stake.  Do I really know what I’m doing?  I know this attending will make fun of me for asking, say it’s a stupid question.  Is it a competence or a confidence problem?  Do I risk diminishing my reputation or making a mistake?  Bad things happen when we choose pride over safety.

* * *

I need for some extra help at home, but it’s not conventional.   Care.com has not been helpful.  Then EUREKA, it occurs to me, I have a whole network of smart, connected, creative friends whose combined life experience could yield some shining hidden treasures in this hunt.  So I queried them all at once via email; the response was immediate, and just the trove that I needed.  Considerations here, resources there, and insightful questions that broadened my perspective on what I need.  When we ask for help from a loving community or tribe, we get so much more than information.  We receive encouragement and learn about our friends.  We strengthen our connections, which feeds both the helpers and the helped in meaningful ways that really last.

* * *

One profound benefit of COVID, if you could call it that, is significantly improved access to metal healthcare.  The isolation and loneliness, the utter chaos wrought by pandemic living, has pushed so many of us to the edge of our sanity.  But precisely because of the pandemic, now we can do our therapy sessions remotely, by phone or video.  No more carving out commute and parking time once a week, among other obstacles.  Pre-COVID, therapists and medical clinicians were never reimbursed adequately for remote care, so we thought it could never be done, no matter how much it would serve both practitioners and patients.  Non-synchronous, online psychotherapy thankfully had its advent in recent years, so now more people can connect with mental health professionals from home or work, at their own convenience, making contact exponentially easier.  Cost and availability still keep many from getting the help they need, but many more are connecting now than before.  I have said for a while now that we should each just be assigned a therapist at birth.  Life is hard, and we don’t always learn the coping skills we need from our families or at school.  Mental health professionals today are like fifth generation hardware store owners—they possess evolving and historical knowledge.  They wield myriad tools to help us solve problems; they can show us how our own plumbing works.  They help us learn which hammer or wrench to choose when we see, hear, or feel something off in our house.  But we have to seek them out, to ask for their help.

What have you been facing all alone lately?  Who could help you?  When will you ask them?

Meaning Indeed

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Do you not just love when insights occur in rapid and acute succession?

I had ‘Rubik’s cubed’ the last post for a few weeks before finally sitting down to write and publish it last Tuesday. The smoke signal idea came to me while typing—it felt almost tingly, like the most pleasant and rewarding epiphanal effervescence. And here just now I’m only describing that sensation for the first time. How fascinating. Little did I know last week that my own smoke signals have long smoldered in the distance. Since musing about the physical sensations of meaning, I’m suddenly noticing my own, left and right.

I’ve had two prolonged absences from in person clinical work these two years. The first was 2.5 months externally mandated by pandemic lockdown in 2020. The second, ending as of 10 days ago, was a 5 month personal leave. In each case I did my homework prior to returning, reviewing charts and schedules, contacting colleagues for sign out (the verbal transfer of care between clinicians who share patients). Both times I felt ambivalent, missing the nearly 24/7 control over my own schedule (or the illusion of it, anyway), and also anticipating the gratifying interactions of in person clinic.

In June last year, the joy of return enveloped me like the warm, welcoming hand of a soft spring breeze. I had completed the interview part of my first face to face visit since March. We got to the exam room and I did my usual head and neck assessment. I put my stethoscope earpieces in and placed the diaphragm against the patient’s chest. That first heartbeat may have been the most soothing sound I had heard in years. The soft, rhythmic, unobtrusive yet vital thudding of the heart of a live person—a person in my care—wow. I can’t remember if I actually got goosebumps then. But I get them now just thinking of that moment. I had not realized how much I missed hearing it, or how much it meant to me. I lingered an extra second or two just listening, feeling a deep joy and relaxation, a settling of my soul even, maybe. It was profound and totally unexpected.

This time it was a conversation. It’s such a privilege to know people in the intimate space of their health, to appreciate them as whole people, body, mind, and often spirit. In executive health we get the bonus of relating our patients’ whole person health to their roles and responsibilities as designated leaders at work. This intersects also with relationships in their families and personal tribes, just as it does for all of us. Toward the end of an interview last week, once again I felt overwhelmed by a deeply grounding, relaxed and yet energizing sensation. My patient and I were talking, engaging, exchanging ideas and observations, relating, as fellow humans. It felt paradoxically expansive and distilled at the same time, like I had dropped right into, and was operating directly from, my core, best self. I was right where I was supposed to be, doing and saying exactly what I was meant to do and say, right in that moment. I could only marvel inwardly and briefly in real time, as the encounter moved on. It was not until later in the day that I was able to name the emotion as sheer joy. I was lighter on my feet, uplifted in my chest, feeling positively buzzed.

Wow, it’s already the end of October. NaBloPoMo is almost upon us (well, upon me, I guess, as there is no longer an official November event–but this will be my 7th consecutive attempt), and I feel ready! The theme this year is personally meaningful to me (stay tuned for the reveal), and I look forward to the challenge. So good to be back, friends. Onward.