Love Letter to My MD Classmates

My first stethoscope, retired now after 29 years.

Congratulations, Pritzker School of Medicine Class of 1999! It’s been 25 years.

Look how far we’ve come! Many of us were babies when we started–in our early 20s, brains not even fully formed, enrolled straight out of college, innocent and arrogant at the same time. Now some of our own children are that exact age, and we look at them hiding knowing smirks. Oh, they’ll learn life in good time, these kids.

Being with so many of you this weekend, some not since we graduated, filled my heart with such expansive warmth and joy. We are all now still who we were then–same smiles, postures, mannerisms, quirks. And we have all definitely ‘matured.’ Some of us now sport lighter hair and heavier bodies. Others, damn you, exhibit no observable physical changes. Our greatest acquisition, however, is our hard-earned wisdom and character–that which can only come with lived experience. Med school was no joke, and residency a trial by fire. We have all witnessed life at its first and last breaths, and among all of us, everything in between. We listen, watch, palpate, percuss, incise, excise, medicate, compress, intubate, ventilate, inject, evacuate, saw, cauterize, staple, and suture. We research, write, present, teach, and lead. We are the experts in our fields. And yet, our age and work have taught us humility, made us reverent, lifelong learners first. As technology accelerates and we increasingly inhabit a world of human creation, with which we are not physiologically equipped to cope, we, the Class of 1999 and our colleagues of other years, persist in our oath to care for our fellow humans to the best of our ability. We commit to Helping however we can, to comforting even when we cannot relieve or cure.

I feel a kind of double vision, seeing us as we were then when I look at us now. The playful comaraderie, the stories, the shop talk–it’s as if no time has gone by–we are still us, Pritzker ’99. This is how deep, bonded belonging feels. How many of us marveled repeatedly this weekend over tacos, drinks, snacks, and dessert at the special-ness of it all? We are a tribe within a tribe, a cluster of diversity unified over time, experience, and age. Differences between and among us in youth feel almost irrelevant now, frictions dissipated, shared memories cemented. Interdisciplinary stereotypes and tensions evaporate among us as classmates. We knew and know one another first as whole people, in the same boat from the outset, rowing together, ever forward. HA! We grew from undifferentiated, pluripotent stem cells into fully functioning end organ tissues, now differentiated and still attuned to one another–like a nascent, then seasoned orchestra playing an ever larger and more complex repertoire.

OH, how I reveled in the hugs, the smiles, the recollections, reflections, and communion, the hopes and plans for future sustained connection. It felt honest and vulnerable, soft and strong, professional and personal–safe–one of you said it felt like coming home. Yes.

*sigh*

I had no idea 25 years ago that it would feel this way now. It’s the best, most heartwarming surprise. I wrote about our 20 year reunion, which I only just now remembered. Clearly, these events move me immediately and deeply, this time even more so than last.

My greatest wish for us all, my dear classmates, is that we may continue bravely, wholeheartedly, generously, joyfully, and humbly, on the mission of our esteemed profession, for many years yet. My greatest hope is that we maintain and tighten our bonds, holding one another up in spirit across the miles and over the coming decades. My greatest joy is that we may stay connected, no matter what happens in our careers and lives.

Peace, love, and light to you all. May our collective affection and bond call forth the best in us, for ourselves, our patients, loved ones, institutions, and all of humanity that we have the privilege to touch.

To Comfort Always

Joseph Carey Merrick; Written by Michael Howell and Peter Ford, Narrated by Steve West

Sometimes a book affects you.

You already know parts of the story
Because it’s legend
And you know it’s sad
You just don’t know how sad
And you usually avoid such things

And then you see
That your favorite voice actor narrates the True History
And it’s also about the doctor
Who did good
By a patient, a lovely man
Whom the world had degraded and abandoned
So you decide to endure
Because you know the voice
And you trust it to shepard the account
With respect and dignity

And through the tragedy
That almost brings you to tears
Because how can people be so cruel
How can one person endure so much
And never harbor bitterness, resentment, or rage

Through all of that
The line that shines most brightly
That calls to your physician, helper, human soul
Is one you have not heard in years
When you should probably recite it yourself daily:

“To cure sometimes, to relieve often, to comfort always.”

These days people expect
Cure often if not always
Relief, when incomplete, disappoints

And Comfort, well, what does that even mean
In an age when physician-patient
Relationship is defined more and more
By transaction than by
True and deep human connection

And yet
Stories like this inspire, reassure and
Comfort us
Who do it for the connection
Because in the end
It’s worth every effort

————-

The True History of the Elephant Man: The Definitive Account of the Tragic and Extraordinary Life of Joseph Carey Merrick
Written by Michael Howell and Peter Ford
Narrated by Steve West

Due to horrible physical deformities, he spent much of his life as a fairground freak. He was hounded, persecuted, and starving, until his fortune changed and he was rescued, housed, and fed by the distinguished surgeon, Frederick Treves. The subject of several books, a Broadway hit, and a film, Joseph Merrick has become part of popular mythology. Here, in this fully revised edition containing much fresh information, are the true and un-romanticized facts of his life.

©2010 Skyhorse Publishing, Inc. (P)2012 Audible, Inc.

*I have no interests in any entities mentioned in this post


Medicine: The Science and the People

The Quad, UChicago

Friends, have I told you all lately how much I love my work?

Nerding out over the science is just so fun, even more so because I don’t have to be the one doing the research. I just get to benefit from it! That we can know the chemical mechanism of how hemoglobin’s oxygen affinity changes with altitude, how sodium and calcium channels work in kidney and muscle cells, and how caffeine and adenosine affect the brain–how amazing is that? And that neuroscientists like Adrian Owen have figured out how to communicate with locked in folks by putting them in a functional MRI machine, asking them yes or no questions, and having them answer by imagining either playing tennis or walking through their house–I mean how crazy awesome is that?? And did you know the father of modern scientific surgery started out as a body snatching anatomist? 

OH the science, I just get giddy about it–pretty much daily!

And in the end, it’s still about helping people–helping the person in front of me right now. The best way to do that is to apply all of that vast knowledge and expertise to the human I’m with today, in their current circumstances, phase of life, and psychophysiologic state. I get to take all of the science I can possibly comprehend and use it to help you, the unique individual. *sigh* *gawk*

I cannot do any of this without knowing you. How do I know you? I query and observe. I attune and attend. I stay quiet, I listen, watch, feel. I try not to interrupt. I ask open, honest questions, and I wait for you, your whole self, to emerge. I look and listen to understand your experience from your own point of view. I do my best to self-regulate, and not project my own judgments and prejudices onto you. It’s so much all at once–I have to be slow and quick at the same time, hearing, seeing, retaining both your output and my own processing, holding it all to let out with appropriate filters and timing–and I love it all!

You know your body and mind (to the extent that you can). I know the body, some of the mind, and a lot of science (as well as I can). You know some of your own patterns, I know some patterns from thousands of patients seen over twenty years. We can, together, apply our collective and collaborative knowledge and awareness to your current context, in service of moving you toward your goals. Only you can decide what actions are worthy of your time, energy, and resources; only you can reassess and alter those equations.

My wish for you is to have the fewest possible regrets at the end of your life, whenever and however it happens. How can I help? How can the science help? How can it not? How can science actually make it worse? 

Medicine is the practice and discipline of lifelong learning of the science, yes. And its core is about caring for people. We make the journey together, my patients and I. What do we share? Here’s my list:
Information
Interpretation
Responsibility
Respect
Privacy
Relationship
Power
Agency
Decision making

We are humans in relationship–with ourselves, with one another, with our environments. It’s all so much, so dense and complex. And yet in the room with you, talking with you, examining you, I can usually distill to one or two central concerns and objectives, for now and the future. It’s gratifying for us both, and it keeps us connected, strengthening our relationship over time and shared experience.

I can hardly think of a better way to spend my professional life.