Tag Archives: physician

A Dawdler’s Triumph

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10

I am a master procrastinator! It’s starting to show on this blog, but oh well, now you know me better. In high school I always wrote my English papers at the last minute, up late in the basement office, typing furiously, feeling giddily anxious under the pressure. In the end I always knew it could probably be better had I started sooner, but it was always good enough.

This time, though, I surprised and alarmed even myself.

Two weekends ago, while hiking happily through golden aspen groves in Silver Plume, Colorado, I realized my presentation to the American College of Surgeons Annual Clinical Congress was only ten days away. Rather than work on my slides that weekend, though, I spent my waking hours trekking through beautiful trails of my home state, with dear friends and family. I returned to the routine of life in Chicago only to realize that my blog post deadline had snuck up on me, too. I had every intention of writing on the camaraderie of friends, sharing stories, questioning, and challenging, all in loving, mutual respect and curiosity. I spent that weekend steeped in tribal love! No presentation slides materialized.

The trail to Pavilion Point, Silver Plume, Colorado

The trail to Pavilion Point, Silver Plume, Colorado

Last weekend I was scheduled to present a poster on physician wellness at the Society of General Internal Medicine, Mountain West regional meeting in Denver. Darn, I had to go back!  But as if my Unicycling post had foreshadowed, I overslept, missing my 6:00am flight and the poster session. The presentation was flung from my lazy Susan, thudding gracelessly to the ground. I felt terrible, as my colleagues in New Mexico had toiled to get the poster done on time, and because of my mistake, their work could not be presented.

You’d think the guilt from Friday morning would motivate me to get working on the ACS slide deck, but no. I spent that evening and the next day with my parents, seeking yet more autumn aspens among which to commune. This took us to the blue skies, crisp air, and vibrant foliage of Vail, and then back to Silverthorne, where instead of working I then proceeded to make greeting cards and bookmarks with my brilliant new leaf collection. I had come prepared with cardstock and packing tape, and I basked in procrastination heaven.

It wasn’t until 9:30 Saturday night that I finally opened PowerPoint. I chose a design and color scheme. I scoured files and Pub Med for data and citations. I consulted my outline, framed weeks before, and sifted through photos to represent main ideas. As usual, I felt an exhilarating mixture of, “Why do I do this to myself,” and, “Man, this could be really good.” By 4:30am, with eyelids of lead and a fair bit of pride, I could finally go to bed, 35 hours before the scheduled presentation.

Along I-70, Eagle County, Colorado

Along I-70, Eagle County, Colorado

So holy cow, what happened? This was a very big deal, I was going to speak to an entire audience of surgeons, for Chris-sakes, and they are no easy crowd! How could I put off preparing for THIS long? For my last original talk, at the Chicago Medical Society Midwest Clinical Conference in March, I had prepared weeks in advance, even allowing time to practice in front of friends before the big day. That was pretty uncharacteristic, but it was also a very big deal. For the first time in my professional life, I was not only presenting data and evidence, but also my own personal thesis on physician resilience—practices that I myself assert as fundamental to our professional well-being. WHY did I not take the same solemn approach this time?

Here’s the answer: FEAR. While not paralyzed, I certainly felt stymied. In my experience, surgeons tend not to think very highly of internists, as a group. Our training is shorter (think, ‘easier’), our hours often more forgiving, and our acute impact on people’s lives less (concretely) measurable. We are deemed less worthy, or at least that is my perception of surgeons’ perception (based on personal experience). So the idea of talking to this group on the ‘soft stuff’ of self-care and overcoming personal adversity made me feel more than a little vulnerable. On top of that, I lack the credentials we all look for in academic speakers: research publications, professor status, institutional titles. Who was I to speak with any authority to people who literally hold our patients’ lives in their hands every day?

By the time the slides were first done, I had determined that everything would be fine if I could just be myself behind the podium. After all, they invited me for a reason—someone had seen my CMS presentation and thought I was a good speaker. I’d better be, after nearly 30 years of practice! I’m relaxed, passionate, and articulate. So hopefully, the audience would just forget about my thin credentials and simply be awestruck by my superior presentation structure and style. Oh and I thought the content was pretty good, too.

I finally discovered my core confidence, of course, through writing. On the plane back to Chicago, I took out my freshly crafted aspen leaf notecards to write to my friends. Having just spent such quality time with them, I wanted to stay connected. It’s what I do. They knew about my upcoming talk, and I wanted to thank them for their encouragement and love. I also needed to confess my apprehension—get it out where it was safe. And I found myself writing, “I may not be the one designing the studies, and I may not have the fancy titles. But I’ve dedicated my whole professional life to helping people find their own agency, no matter who they are or what their circumstances. I know this shit; I live it. I’m the perfect person to talk about this, to anybody!”

Aspen leaf notecards and bookmarks, Vail, Colorado, 2015

Aspen leaf notecards and bookmarks, Vail, Colorado, 2015

Thanks to my remarkable tribeswomen, who hold me up even when I’m 37,000 feet in the air, I no longer question my own worthiness among colleagues in the American College of Surgeons, or anywhere. As long as I am my authentic self, and I do my homework, I can speak to anyone. In the hours prior to the talk I did a fair bit of power posing, just to be sure, and everything went swimmingly. I should also mention that three other women spoke at our session. They told personal stories of adversity and how they overcame. It was truly a privilege to be among them.

I sincerely hope that the ACS will invite more speakers from the ‘cognitive’ fields. I encourage the leadership of the American College of Physicians, the internal medicine professional society, to reach out to our surgery colleagues and collaborate on physician wellness initiatives. I read recently, “The only way to survive is by taking care of one another,” attributed to Grace Lee Boggs, 1915-2015.  Just as nobody overcomes personal adversity alone, and no physician can care for patients without an entire team of dedicated staff, no one specialty will hold the patent on physician wellness. Surgeons’ needs differ from internists’, to be sure, but we can all learn from one another, and the sooner we recognize that, the better for us all.

So, I procrastinate. It’s who I am. And I trust myself to get the job done–well, even. I have a chance at redemption for the SGIM blunder. I will represent my UNM colleagues at the podium of another conference in Washington, DC, in 10 days. I have the outline… Planning to create another PowerPoint file in the next day or two…

Physician as Trainer

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15

“No way, are you kidding me?” I would have said, if asked to do uphill sprint intervals this time last year. I also would never have ridden a bike through traffic and then up a training hill (or ridden a bike at all, really—biking has always scared me), or tried walk/jog/running from the bottom to the top of Ryan Gulch Road in Silverthorne, Colorado, an 800 foot climb over 2.5 miles.

How is it then, that this summer, I did all of these things? I credit my relationship with my trainer, Melissa. I started seeing her in January, 2014. I had thought for a (long) while that I needed to start exercising again, but after 15 sedentary years and two pregnancies, I barely recognized my body or its capabilities. I thought I could train for a few months and be back in shape, doing all things I used to do.

Little did I know what lay ahead in the actual training. First I had to identify some dysfunctional movement patterns I had developed over the years (wait, what do you mean, ‘fire your glutes,’ I’m supposed to be able to do that?), and correct them before loading them with weights and speed. I had to accept how out of shape I actually was, and reconcile the long, uphill path to physical health. And I am not an unhealthy person! I have no chronic medical problems, sleep well, and take no medications. I experience minor aches and pains that are generally attributable and transient. But last year I was afraid to start an exercise program on my own—I knew I needed help.

The first few sessions were fantastic, full of learning and potential. Turns out you can learn to fire your butt muscles in a one hour session—gluteal amnesia can be cured! But as each meeting revealed yet another pattern to be corrected, I got discouraged. How can there be so many things wrong with me, and when can I work out for real, already? After our first interval training session I wound up on the floor, dizzy, nauseated, and disgusted with myself. Later, Melissa demonstrated 14kg kettle bell swings. She told me I would do them, too—yeah, right (smirk)!  And, over time: Turkish get-ups, first ‘naked’ and then with weights, TRX lifting, Rip Stick swinging, planking, running in Kangoo Jumps, jump roping, kettle bell swinging and snatching, hill training on a bike, and, finally, metabolic circuit training that really gets my heart rate up—without ending up on the floor—I have actually done it all.

Why is the relationship key? From the beginning, Melissa has made it safe for me to show up every week, however I’m feeling and whatever is happening. It’s okay to tell her that something we did last week caused me pain. If I feel apprehensive about something she wants me to try, I can say so. She does not judge me, look down on me, or belittle me for what I cannot (or will not) do. She also does not judge herself. That I have pain is not necessarily her fault. Neither is the fact that I push myself to the point of dizziness and nausea. She holds the space for me to bring my concerns, without blaming or getting defensive. She states her observations objectively, of both my movements and how my personality and attitude affect my training. I have a hard time pacing myself, and she helps me monitor for and manage my tendency toward overexertion.

She gives me permission to just bring what I got. We go from there, wherever it is, and see how far we get. I often surprise myself with what I can do! As a result, my confidence and motivation have dramatically increased. These days when she offers a new activity, I say, “Great, let’s try it out!” It’s okay to fail, if that’s what you want to call it, because I always learn something to apply next time. Through it all, I know she is there to coach and support me, without judgment, and always with love.

It takes time and practice to acquire new skills and habits—‘way more than I initially thought! But now I think differently—hills are challenges rather than enemies. I look forward to what I will be able to do next, including uphill sprint intervals at 9000 feet—maybe next time—this time I did them at 5700 feet.

Melissa helps me stay on course in training with knowledge, application, openness and compassion. I can do the same for my patients and their health. When I withhold judgment about patients’ physical and motivational limitations, I make it safe for them to bring their fears and aspirations to every visit. I can meet them where they are each time, and hold space for the inevitable roadblocks: medication side effects, obstacles to behavior change, complications of treatment. We can then find a way through together, because we both know we’re in it for the long haul. Physicians and trainers may have more in common than we think.

Anything else?

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11

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?”