Tag Archives: health

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?”

The Best of Both Worlds

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I met my husband my second day on campus at Northwestern University, 1991. He started one year ahead of me; I met him in the bookstore. He was an established  molecular biology major, having years of laboratory research experience behind him already. I, too, decided to major in biology, but with a concentration in physiology. The micro and the macro–that may describe us in a nutshell: Both awed by the mysterious and yet completely logical ways of the body—the ultimate integrated system—but from opposite ends of the spectrum. We trained at the University of Chicago, that mecca of hard core basic science. Research and discovery of the fundamental mechanisms of disease—much of it at the molecular level—still thrills him, and leaves me positively lethargic. Show me how people transform health through relationships and beliefs, how the mind and body are connected in ways we cannot measure—that seizes my attention.

Today my husband specializes in orthopaedic tumors and joint replacement, and I do primary care. Much of his professional world consists of binary decision making: operate or not, the experiment proved the hypothesis or not. I like exploring multiple solutions for a particular problem, withholding judgment, and trying one approach at a time. Personally, he likes to be alone; I love people, the more the better! He makes decisions based largely on data and devoid of emotions, whereas I root my decision trees firmly in how I feel about the issue at hand. I seek color, texture, and meaning in everything around me; his needs are pragmatic, functional, and stoic.

And yet, what seems contrasting and opposed turns out to be, in every sense of the word, complementary. For the most part, we both balance objective and empathic information when making decisions. But when my emotions run high and objective data look fuzzy, he points out the practical implications of my choices. When he faces decisions that impact relationships, I help him identify core values that lead him to settle on one side of an issue with confidence. When both people in a relationship are free to be fully themselves, without fear of judgment or ridicule, their differences, and respective strengths, hold each other up.

The most interesting conversations we have about work revolve around teaching.  As a surgeon, his primary charge is to prepare his trainees to be technically excellent in the operating room, to carry out patient care decisions with confidence and resolve. Nobody wants a wishy-washy surgeon. My teaching focuses on fostering empathy, role modeling excellent listening skills, and showing students that no matter what specialty they choose, their patients will always need to feel seen, heard, understood, and cared for. In primary care, the old saying, “They won’t care how much you know until they know how much you care,” has explicit meaning. I like to think that because of me, my husband models more mindful interpersonal skills for his residents and students. And because of him, I try always to incorporate evidence and concrete, goal-oriented rationale in my decision making. We influence each other for the better.

The long-standing tension between surgeons and non-surgeons remains a fact of life in medicine today.  Stereotypes peg internists as ruminating and indecisive, and orthopaedists as dull-witted, mallet-wielding carpenters. This territorial, oppositional culture can be insidious and damaging.  How can we do best by our patients if we cannot get along ourselves?  In our ‘mixed’ marriage, I see us bridging this gap.  I hope it translates to better patient care. For ourselves, at least, it makes for interesting dinner conversation and a shared love for our work. And we would not have it any other way. Footnote: I first published this post on the American Holistic Medical Association blog in 2012.