Category Archives: physician

Death Comes Closer

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NaBloPoMo 2020 – Today’s Lesson

How many more before it’s over?

This weekend I felt the Reaper’s cold breath over my shoulder again.  It came last 20 years ago, when I left residency for a week and flew to Taiwan, where my grandmother was dying.  The ICU at the teaching hospital in her city was positively rudimentary compared to where I was training.  She was intubated but fully awake, and rolled over before the doctor even had to ask, so he could listen to her failing lungs.  That was Po-Po, always making life easier for others, even at the end of her own. 

Imminent death agitates and disorients like nothing else.  In training I learned to detach just enough to be objective.  My elders modeled the compassion and empathy required to shepherd both patients and families through the passage.  In the emergency department and ICU, and on the cancer floor, we observed a calm, professional reverence for the end of life.  But only a few patients might die on any given month-long rotation.  Today my friends in these specialties witness death, sometimes multiple, often gruesome, on a daily basis.  They risk their own lives, and serve also as intimate messengers and chaplains, in service of helping soul after soul ascend in peace, if that’s even possible. 

When it was my Po-Po, I was beside myself.  I cried non-stop the whole 15 hour flight stateside.  And then I went back to work. 

Tonight I pray for all of us, especially our healthcare heroes.  Death will likely claim someone in each of our circles before this pandemic is over, if it hasn’t already.  I wish I could do more to halt the unyielding march.  But how many times can I say mask and distance?  It’s futile.

Credentials and Credibility

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NaBloPoMo 2020 – Today’s Lesson

Who do you trust?  Why? 

Margo and I were friends.  So when she recommended Christine as a life coach, I trusted enough to make the call.  I had no idea what a life coach was; “CPCC” was meaningless to me.  But after the intake call, her credibility and expertise were well-established, and she has been my coach ever since.  That was 2005.

I spent $900 and a weekend on Zoom last month for Ozan Varol’s Moonshot Academy.  I trusted in the value of the experience based on my interaction with Ozan’s Inner Circle to date—for two days I would give and receive peer coaching in a creative and challenging environment.  And bonus, I met Andrew, Kes, and Nicole.  Each of us aims to learn, share, expand our horizons, and do more good, hallelujah!

Kes’s last blog post goaded me to differentiate between credentials and credibility—my own and others’ alike.  Do I deserve your trust in clinic just by virtue of my MD?  What about when I speak and write on communication and leadership?  Why should you trust me?  Why should I trust you?

What are credentials?  My list includes education, work/life experience, recommendations/references, and body of work (eg peer reviewed publications). 

What establishes credibility?  My list: Attitude (humility, honesty, curiosity, reciprocity); consistency and integrity; purpose; quality of relationships (and thus references).  Christine’s credentials are solid.  Like any good professional she expands her expertise with continuous study.  But her credibility stems from her honesty and integrity—who she is.  It’s why I refer patients and friends.  Their feedback glows, and Christine’s credibility expands.

So perhaps credentials are superficial—what we’ve done, what’s immediately visible…  And credibility is deep—who we are, what we’re about.  I know which is more important to me.

What a Privilege

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NaBloPoMo 2020 – Today’s Lesson

I’ve said it before and I’ll keep saying it:  People are suffering.  Not everybody, but many, and many pretty badly.  A prolonged global pandemic, unprecedented political polarization, escalating agitation for social justice—any one of these would be enough to push us over the edges of our sanity, and yet here we are, surviving all three and more.

I know it’s a challenging day when I’ve handled three phone calls before getting out of the car at work in the morning, and in the afternoon I think Hallelujah and give joyful thanks for one patient’s globally negative Review of Systems and another’s 95% oxygen saturation.  But this is also the most fulfilling day.  I did good work today.

Like most primary care doctors, my message volume has increased by about 30-50% in recent months. Complex questions and issues require time and patience to think and talk through. Many cannot be readily answered or solved, and the uncertainty calls out all of our anxieties and defenses, insecurities and grievances. Every patient experiences this historic moment in a unique and acute way. As the storm rolls over the neighborhood, I see it land on each doorstep, knowing what’s already in the house—how the furniture is arranged, what’s in the closets, maybe even the state of the foundation. I am allowed inside, invited to inspect and advise.

What an amazing privilege to be a physician in this moment, to witness, and to help.  This is absolutely what I signed up for, what I’m called to, and what I trained for.  I promise to do my best, and we will get through it together.