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?”

Beyond the Rant

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For the better part of 20 years, I have had the humble privilege of working with medical students.  Whenever I spend time with them, I learn at least as much as I teach, and I come away inspired.

This day was no different, and I will never forget it.  We gathered in the stark conference center for a day-long communication skills workshop—physicians, nurse practitioners, residents, and medical students.  The facilitators came from the Alan Alda Center for Communicating Science; if you ever have a chance to learn from them, I highly recommend it.  I could almost palpate the group’s shy, tense, anticipatory excitement—this was a high-potential learning situation.  After time-travel role playing, imaginary ball-throwing, and Zip-Zap-Zopping with abandon, we relaxed into the liberated format that is improv-based learning.  That’s when I experienced an unqualified quantum leap in consciousness.  It came in the form of a rant.

The instructions:

Partner A: Rant rant rant, HARD, about something that really makes you angry—that truly enrages you, nothing small.  Not allowed to make it up, must be honest, let loose.  Yell, stomp, swear, etc., for two minutes straight.

Partner B: Listen, be present, no talking.  Introduce A to the group afterward.  The catch:  At no time during the introduction should the group be able to tell what A ranted about.

I paired up with Erik, a fourth year medical student.  I did the rage gods proud as I cursed and flailed for two full minutes about the victim mentality.  Your parents ignored you?  Your boss is a jerk? You’re stuck in a dead-end job in a crime-ridden city, hovelled in a grungy apartment with no view, and it’s all someone else’s fault?  Suck it up!  And on it went.  Erik stuck with me through it all, looking me straight in the eye and never flinching.  He introduced me thusly:

“This is my friend Cathy.  Cathy believes strongly, with her whole being, that each and every person has the strength and capacity to overcome any adversity, and lift himself out of whatever situation holds him back.  She believes in people, and wants to see them succeed, no matter what the circumstances.”  Nailed it.  What a powerful thing, to have someone distill and give voice to my core value, and after I had just raved like a lunatic, no less.  I had never met Erik before that exercise, and I felt an instant bond.  He saw me, and showed me a part of myself that I had not seen before. I am proud to know him.

Often when we witness ranting, we pile on and trigger an avalanche of mutual self-righteousness, or we unwittingly invalidate the person by arguing a counterpoint.  The practice of listening beyond the rant, hearing the core value, and then reflecting it, serves a higher calling.  It connects, validates, and settles.  It offers the ranter a mirror, an opportunity for self-reflection and awareness.  If we practice consistently, on each other and ourselves alike, we can hardly help but emerge transformed.