Category Archives: medicine

On Plumbing and Other Disciplines

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NaBloPoMo 2016, Letters to Patients, Day 3

To My Patients With Diverse Occupations:

What a pleasure and an education to know you!

I think none of you are plumbers, though.  But I remember the first time I met a plumber—it was in college, a friend of a friend.  To this day I wonder if he thought I was a little crazy—I grilled him mercilessly about his work.  Was it like “Moonstruck,” is copper really always better?  What’s the grossest thing you’ve ever seen?  What do you need to know, is there plumbing school?  How do you know when you can’t do a job?  What equipment do you carry around?

I have only ever known medicine, you see.  I resisted at first—so typical, the Chinese kid who wants to be a doctor.  But then I volunteered to be a health aide in college—I got to move into the dorm a week early that way.  And it was inevitable, I was hooked!  So I went ‘straight through,’ as they say—biology/pre-med, no gap years, no real life working experience before medical school.

Traders, dog trainers, book editors, retail managers, accountants, nurses, call center agents, firefighters, small business owners, truck drivers, professors, musicians, actuaries—you all have such interesting lives!  One of my favorite parts of the history is when I get to hear what you do for a living, because it’s so different from my own.  So please be patient when I interrogate you about your work, I’m just so curious!  How do you spend your days?  What makes a great day for you?  What makes it hard?  What are the greatest sources of stress and meaning in your work/career/vocation?  What do you love about it?  Would you choose it again?

This curiosity stems from my deep desire to relate.  In your work, people probably present you with problems.  You apply specific expertise to diagnose the underlying condition.  You determine the most appropriate or attainable solution, and map out a path to achieve it.  You take some responsibility for the result, while recognizing that your coworkers must also participate fully for the team to succeed.  On your best days, the collaborative effort yields not only the desired outcome, but also a deepened connection between people.  It’s not so different for me.

It’s easy to perceive a distance between you and me, between patients and physicians.  Medicine can seem elitist sometimes, what with the onerous entrance exams, the stiff competition for school admission, and the prolonged and grueling training.  But in the end I bet we share more experiences than we realize.  I’m just here to use my little heap of knowledge and skills to help others, and I know that’s what you do, too.

 

On Primary Care

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NaBloPoMo 2016, Letters to Pateints, Day 2

To Those Who Disdain Primary Care:

Maybe you don’t know what you’re missing.

“I don’t need a doctor, I never get sick.”  And yet, optimum health means so much more than the absence of illness.  I am called to steward your health as a whole person.  I value the chance to know you as such.  I seek to understand your temperament, your history, your past experiences, and how they influence your current perceptions and choices.  That is how I help you optimize your health—by reflecting your own patterns back to you, so you may determine how they serve you, and when they need updating.

So often our daily routines take the path of least resistance, like spring runoff tumbling inevitably downhill between the rocks and shrub roots of a mountainside.  Without attention and navigation, topsoil erodes and the landscape can get disorganized, unstable.  But with some intention and guidance, we can channel your energy and activities toward the mighty river of health.  There your strengths and motivation preserve the ecosystem that is your best you, for the long journey of life.

As a general internist, I have the privilege of getting the first call when something takes you down.  I get to hear the story first, to initiate the investigation.  If I know you already, I can apply history and context in the most personalized way.  Together we can examine and understand the mudslide triggers (there’s almost always at least one).  We can make an appropriate plan to slow the erosion, and then rebuild.  With each episode, our tools sharpen.  We become a team.

I relish the chance to help you dig deeper into your own capacities for self-care.  Each encounter is an opportunity to share and connect, in service of your long term health.  I want you to live not just to be an old man or woman, but a STRONG old man or woman.

But to do that, I need to know you starting now.  I need to connect with you early and often, in good times and bad.  It’s a relationship like any other.  I can’t help unless I see, hear, and understand.  There is no substitute for time and contact.  So think about it.  I’m here to help.

On Training

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NaBloPoMo 2016, Letters to Patients, Day 1

To The Patients Who Trained Me:

Thank you, from the bottom of my heart, and God bless you, every one.

To the elderly lady with heart failure, who donated your body to science so that I may learn anatomy:  You were the greatest gift.  Your heart was literally as big as your head, and at the time I just thought it was peculiar.  Now I understand the extraordinary adaptive capability of the human body, and I marvel at it every day.

To the inpatients who endured hours of repetitive interviewing and clumsy physical exams by us medical students, all in the name of teaching:  Your engagement in the midst of your own suffering testifies to the infinite potential generosity of humanity.  Your contribution to medical education cannot be overestimated.

To the kindhearted artist in my resident clinic, the first patient to page me for advice:  You showed me that I knew what I was doing, even in training.  You had classic of sinusitis, and I called in the appropriate prescription.  In a moment of sudden panic I wondered if I should have called my preceptor first.  No, I can do this, I realized.  I’m meant to do this.

To the articulate, confident housewife whose retired husband drove you to me in acute agitation:  I learned from you that life phases never cease to evolve.  Our relationships, however longstanding, hold infinite complexities that manifest in jarring and also predictable ways throughout life.  You taught me that stability is overrated, and also underappreciated.

To the wonderfully kind man, one of my first patients in practice, who came in with the nasal balloon:  Your patience and trust will humble me forever.  The emergency room doctor had placed the balloon for a prolonged nosebleed.  He instructed you have me take it out.  I had never seen such a device before, much less deflated and removed one.  You let me examine it, think it through, and finally just cut the tubing with scissors.  We bonded over that and you continued to teach me about collaboration and sharing between patient and physician all the while I knew you.

To all whom I encountered in those early years:  There are too many of you to name, too many to acknowledge fully.  But every one of you helped make me the physician I am today.  With each new meeting now, each applied principle and physical exam technique, I thank you and honor you, my esteemed teachers.