Tag Archives: personal growth

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.

Holding the Space for Our Suffering to Heal Us

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Hello again, dear friends.  Peace, love, and joy be with you on this, the autumnal equinox.

This post marks the conclusion of the Healing Through Connection Summer Series, 2016:  Holding the Space.  The story I will tell is important to me, and I love that it’s the series finale.  I wish I had posted on the last day of summer, but the first day of fall is okay, too.  Two days ago I was privileged to witness a whole lot of people, hold a whole lot of space, for a whole lot of suffering.  And I posit that we all came away better for it.  I invite you to sit back, get comfy, and take your time with this one.  I’m feeling particularly fulfilled as I sit to write, and I hope to convey the deep gladness I gained from the experience.

***

It was day three of the International Conference on Physician Health, in Boston.  I had anticipated this meeting giddily for nine months.  From the moment I heard the call for abstracts, through the iterative preparatory steps, to the final emails, texts, PowerPoints, and conference calls with collaborators, through the personal connections and learning, I was now positively beside myself with zeal.  It was everything I had hoped and more.  I was surrounded by colleagues from three continents, all gathered to share and unite around making our professional world more humane.  We explored ideas like awe, joy, mindfulness, empathy, presence, and vulnerability.  I had lived two glorious days in a cocoon of safety, love, and resonance.  I was among my people.

This day’s workshop focused on compassion, and aimed to tap its deepest reaches within each attendee.  The presenter prepared us for the exercise by describing his work with previous groups—CEOs breaking open in anger, shame, forgiveness, and finally compassion.  He asked that we hold the gravity of vulnerability with reverence and respect.  We understood the solemnness asked of us, and responded in kind.  This was the exercise:

On a blank 5×7 index card, write a personal story.  You will have five minutes.  The cards will be collected at your table, redistributed, and shared anonymously at another table.  Be aware that your writing may be shared aloud with the whole group, later in the exercise.  Instruction:  Write the story of a time in the past year that was really hard for you, when you suffered.  It could be personal or professional.

For a split second I felt a catching in my chest—‘Yikes!’  And in the next breath, ‘Bring it.’  I knew this tribe.  They would hold it for me, with me, no question.  And because I was also a tribe member, I would do it for them.  I looked forward to it, actually.  I wrote with surprisingly little effort, concisely yet in detail, about a particularly challenging relationship and my struggles with perfectionism.  How could my other relationships shine so brightly, feel so easy, and flow so freely, while this one so regularly caused me angst and turmoil?

At the end of five minutes my tablemates and I placed our cards in an envelope provided.  I felt oddly relieved, as though a great weight I carried all this year had been lifted.  The envelope was marked, then passed three or four times between tables, so we didn’t know where our cards ended up.  They were as letters in a corked bottle, cast into the ocean, released to an uncertain, but hopeful, fate.

Our presenter explained that at this time, the envelopes would normally be opened, and each of us would take one card and read it.  We were to hold it and its anonymous author in the space of compassion, then share with our tablemates.  We would help one another hold one another.  Then, if so moved, each table would choose one card to share with the larger group.  Our task was to connect, with ourselves and one another, to feel deeply now, to remind us how to do it out in the world.  This was where it would get real, we all knew.   And though he had warned us earlier about an unforeseen shortening of the workshop schedule, we did not see the abrupt end of the exercise coming.  He told us we would not have enough time to do the exercise justice, and so the envelopes would remain unopened this day.  He acknowledged the conflict we all felt, the urge to look.  But he stood firm that experiences like this cannot be rushed, and he respected the time constraints of the meeting.

The tension in the room was palpable, even as we all sat in silence.  It felt jarring, painful, anxious.  What would happen to the cards?  What about all that suffering contained in them, people’s hearts and lives scribed with intention to be seen, known, understood, and held?  Surely they would not just be thrown in the trash?  One colleague voiced so poignantly our core conflict:  We all wanted closure for this vulnerable exercise, and that need competed with honor for the time required to complete it.  Our leader gracefully acknowledged this truth, and solemnly held the space for us all to be present to its discomfort.

For a moment we felt stuck, we connection seekers.  I looked at our leader.  His expression conveyed nothing but humility and empathy.  His posture conveyed resolution.  Despite our deep longing, he refused to lead us into treacherously thorny fields, because he knew he did not have the time to bring us safely through to the other side.  But he also allowed us to process, invited us to consider how else we could collectively resolve our unease.

I wondered what would physically become of the cards.  Would he take them home with him?  Would he burn them in a reverent ceremony of sorts?  I knew he felt responsible for us and our predicament.  Would he read each one, hold each of us and all of our suffering, all by himself?  I felt immediate compassion for him, and hoped that he would not take that route; none of us would want that for him.

I wanted to suggest that we be given the option of each pulling one card, to hold in compassion privately, as we left the workshop.   But we were spread out in a big room, feeling separated from one another rather than connected, and I felt sheepish.

Within a minute or so we had decided to collect the envelopes together, stand surrounding them as if around an altar, and offer a benediction of sorts.  I could not shake the urge to reach out, to take one person’s suffering and hold it for them, love them, send energy of compassion and solidarity to them, whoever they may be.  I realized also that this was exactly what I wanted for my card, for my suffering.  And now that we stood shoulder to shoulder, at least physically if not emotionally proximal, I felt more comfortable to speak.  “I really want for someone to take my card and hold it for me, and I really want to do that for someone.”  Another attendee immediately looked me in the eye and said, “I’ll do it.”  The group consented; each of us would take a card at random, if we wanted.  I pulled one from the third envelope from the top of the pile.  I held it to my chest and returned to my seat.  I forgot all about my own card, and my anxiety evaporated.  I no longer cared if anyone saw mine; I had released it.  My task was to hold my colleague’s sorrow with my own heart, and wish with my whole being for their peace and healing.

I’m so proud of all of us.  We attended to so many needs that morning, all with respect and kindness.  The presenter set the tone for the workshop from the beginning and we all understood the learning objectives: Practice opening up to let the healing in and practice the inner work of holding another’s suffering with your own.  Connect with our shared humanity.  We all learned an important lesson in flexibility, creativity, collaboration, and acceptance.  We held space like champions.

I’m proud of myself for finally speaking up, for asking for what I needed.  That I was met with such generosity and tenderness speaks to the remarkable power of mutual understanding and compassion.  I took a deep breath and read the card in my hands.  My colleague’s story was short, about the 5 year anniversary of his/her father’s death, and memories of loss and helplessness.  Tears came when I read it.  I hugged the card and said a prayer for its writer.  I’ll keep the card someplace safe, and eventually release it in some respectful, peaceful way.

I don’t know if anyone pulled my card.  It’s okay.  Just the hope that someone might have seen it and given it some consideration is enough.  I learned the lesson I needed: Offering my pain for someone else to hold a while, and accepting another’s sorrow to hold for them, constitutes the cycle of healing.  We are not here to go it alone.  We need one another in the best ways.