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Meandering Musing

Thoughts on Medicine, Life, Technology

Moving On

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I woke up this morning vividly remembering my dream. I’m sure I dream often, but they are generally lost to the subconscious – never to be known. Today was different, and I’m still teary-bleary eyed as I type this.

In my dream, I was visiting with a young doctor who was contemplating going to work at the same place I had started my career. She was seeking advice on whether or not she was making the right decision. I paused and reflected before I answered her, and then passionately laid out how my dissatisfaction began to arise from having too many conflicting tasks. More importantly, I had conflicting tasks that took me away from what should have been the most immediate priority of caring for my patients. And at the time, most of my patients were hospitalized children – an especially vulnerable population.

Ultimately, the inner conflict of knowing what I personally and professionally needed to be doing versus the work I was mandated to perform led to an irreconcilable internal crisis. I would either compromise my values to maintain the status quo or I would have to move on. Being no one’s water boy, it was time to move on. My advice to the young doctor was to stand up for herself, and for what she knew to be right if that conflict ever visited her. And then I woke up.  I grabbed my coffee and stared into the mirror at the lines in my face and the gray in my beard.  I wish someone had told me the words I shared with that young, imaginary doctor.  I might have been less tolerant of the conflicts I faced and been more decisive in my actions.  As it is, I’m doing the right things, just further down the road than I had hoped.

And as I stare at middle-aged me in the mirror, I am once again at the precipice of a new beginning.  Once again, the conflicts arose, pitting idealistic me against the realities of modern healthcare.  I am not alone, as talk of burn out is all the rage in medicine these days.  Many of my immediate colleagues move on to other patient care venues, while across the country, hundreds, and ultimately thousands, of physicians will be leaving medicine entirely.  I’m somewhere in the middle, as my new career remains in healthcare, but I will no longer be at the bedside caring directly for patients.  It turns out one of the biggest casualties of burn out is one’s own sense of remorse, as I cannot help but find myself eager and excited to move on and start healing my soul.  I could either keep sacrificing my dignity and purpose to the gods of medical administration, or I could take a chance on myself and begin anew.  In the end, is this a choice at all?

Many of you reading have probably never thought about the business of medicine. Well, the dirty little secret is that most doctors also aren’t well-educated in the business of medicine either. In fact, we bristle at the notion of calling it a business. We simply finish residency and then go to work, trusting in the end that we somehow made a good investment in ourselves to take on crazy debt in pursuit of a calling. And for the vast majority of physicians, it is a calling. I know I never sat down to determine if it was a good investment – it was just what I had to do – no matter what the personal cost. And the personal costs – emotional, spiritual, and financial – were very high.

So here I am, now 19 years out of medical school, and I’m starting over.  Not because I am any less passionate about caring for the sick, but precisely because of how passionate I am.  You see, the other dirty little secret is that nearly all our education is in the treatment of disease.  We spend countless hours learning about infectious diseases and cancer and heart disease and strokes and dementia and on and on and on.  We piece together the symptoms of our patient with their physical exam and labs and x-rays and give them a diagnosis.  Then we deploy our other greatest expertise to treat them – drugs.  If I had to put a number on it, about 95% of our education centered on Diseases and Drugs.

The overwhelming focus of my career (and those of my peers as well) has been the diagnosis and treatment of disease.  I performed these services in the confines of systems that need sick people to stay in business.  Without disease, the doors could never stay open.  And this is the ultimate paradox in healthcare.  Early in our careers, we young doctors would often say to ourselves that we are the only profession that altruistically wants to put itself out of business.  Middle-aged me now admits this is far from the truth.  Medicine is big business, and sick patients keep healthcare dollars flowing.  Sad, but oh so true.

It is in this context  that my wife and I started a journey this year born out of our own medical nightmares.  We are both doing well, but have been awakened to how ignorant we were of what it actually means to have and maintain HEALTH.  I’ve often said the most dangerous doctor is the one who has no idea what he doesn’t know, and here I was realizing I had a blind spot in what it takes be healthy and to actually compel patients to take non-pharmacologic actions to improve or even eliminate their own disease.  The insights we continue gaining to improve the health of ourselves and others is far more motivating than the diagnosis and treatment disease.  And while we can never prevent and fully stamp out all disease, it certainly seems like a better goal than just putting up with disease to keep the doors of our clinics and hospitals open.  More on all of this later!

This is the start of what I’m calling The 46 Project.  I like projects, as defining methods and goals is far more practical than the nebulous notion of just wanting to be a better, more loving, healthier person.  I haven’t really started a project I was intimately passionate about since college.  In fact, the last real project I completed was accomplishing everything it took to get in to medical school.  Huh.  Weird.  I’ll also be revealing some other tangential projects as I go along.  I have suppressed and suppressed long enough, and some ideas just won’t die in my mind and need a chance to be born.

Most people would look at the family, career and possessions I have at age 46 and think, “That guy has it all!”  And they’d largely be right.  I have a wonderful family and I’ve done a lot of good in caring for patients, but I have also spent too much time on the acquisition of things (and the resultant time and cost of maintaining these things) and have been too willing to go with the flow to avoid conflict.  If I’m brutally honest, I’m also pretty damn frustrated at how I physically feel at this inflection point.  The lack of time I’ve dedicated to self-care is a reflection of my own misplaced priorities.  I have built little in terms of lasting legacy, and I know quite well I’m capable of doing a great deal more than just treating one diseased patient at a time.  So, The 46 Project begins.

 

Left Brain. Right Brain.

pexels-photo-963056.jpegI checked my right brain at the door when I started medical school in 1995.  Writing, performing music, and acting didn’t make it in.  How could they?  I had very little free time and why would I want to cling to touchy feely distractions?  I was prepared to sacrifice personal interests and passions to clear my mental decks.  I wanted to dedicate all my brain power to the promise of learning critical information that would empower me to care for the ill.  It was a left brain dominant exercise for sure.   And walking the hill at my graduation from KU, I remember thinking I had given up my love for art and beauty in the world to fill my mind with far too much clinically irrelevant minutiae.

I had screwed up very, very badly.  No doubt, many of my peers made the same mistake I did when we started med school.  Until recent life events smacked me upside the head (much, much more on that later), I had given up on my right brain enthusiasms.  On an EEG, it would have been a virtual flat-line.  The creative, inventive, passionate side of me was in squalor and disrepair.  What I thought had been an informed decision to become a brilliant doctor (and I only use that adjective as a hypothetical description, not necessarily my reality!) left me as a doctor who only used half his brain.  That, dear reader, was one of the stupidest things I’ve ever done.

Certainly, there were limited benefits to this decision.  If I spent my career as a right brain dominant person, then I would have been crushed by the emotional nature of the work and flamed out long ago.  I even managed to find the love of my life, and I take great joy in being with my children.  Being with my family is the primary motivation that gets me through my week.

Keeping some distance and being slightly dispassionate on the job is how most of us survive.  We also find individual tools to keep us going.  My primary coping skill is sarcastic humor.  Without the ability to laugh at myself and the impossible situations I sometimes find myself in professionally, I’d have been carted to the loony bin long ago!  And in the hospital, where I’ve spent almost my entire career, it hits every single one of us in the face at times.  And some days, just when we manage to pull it all together after being sucker punched emotionally, we find ourselves knocked to the ground again.  Medicine can be the most rewarding, as well as the most cruel, profession in the world.

Nobody who works in a hospital gets by unscathed – from the highly trained and professional code blue team desperately working to resuscitate the 23-year-old expectant mother who won’t live see her baby – to the housekeeping crew who cleans up the blood soaked floor and walls from the family of 5 killed in a car accident – it can be terrible.  Personally, I’ve seen bad things TNTC.  That means “too numerous to count” for all of you normal, non-medical people of whom I have been increasingly jealous over the past decade.  If I let my right brain run amok, I’d never get out of bed.  I’d never go to work again.  None of us would.  It would simply be too much.

Compartmentalization is a key to survival, but the expectation and demand for compartmentalization is also destructive to us personally and professionally.  The internet is littered with hundreds, if not thousands, of vignettes from physicians, nurses and support staff who have given their all at work, only to find themselves inadequately cared for with respect to their own mental health.  And with the nearly universal philosophy of “doing more with less,” the pressure cooker is only going to increase in intensity.  More on this later, after some additional research.

As for now, in reading this, you are an unwitting victim of my need to practice writing again.  It’s akin to watching a 46 year-old former minor league baseball player at batting practice after not playing for 23 years.  Sure, he can swing the bat, but it’s a helluva lot slower and sometimes ugly to watch.  And like the ball player who dreams of getting just one chance to play in the Bigs, I’m dreaming of making a larger difference than settling for just one-patient-at-a-time.

What I can only now call some “healthcare-related concepts” have fired up my right brain.  Maybe too much.  The din of exploding ideas inside my head is deafening at times.  But other than asking my lovely wife to marry me, the conscious decision to bring my right brain back from the brink of death might be the smartest thing I’ve ever done.

 

PS – for any of you neurologists or neurobiologists out there, I am well aware that the left brain, right brain concept is not very accurate clinically.  Get over it.  I’m emoting.

33 Years.

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It has been a struggle to get out of my own way.  I’m sure many of you have the same feeling.  My health and well-being have suffered mightily from the stress of taking care of others in my work as a physician.  I have not taken care of myself.  Period.  My career does not make me unique in this situation, as the patients I treat every day suffer from similar emotions of frustration and despair.  Many of them are trapped in far more serious situations, with truly life-threatening diseases, and they see no visible way out.  They are losing, or have lost, hope.

I went for a walk today to clear my mind and ponder my path forward.  I glanced at my watch and realized to my dismay that today it had been 33 years – almost to the minute – since my life was changed forever.  The moment the school secretary took 12-year-old me from Mr. Rhodes’ classroom, down seemingly endless hallways to the principal’s office.  Sitting there was my father and our dear family friend, Nancy.  The only words I remember from that day are, “Your mother has gone to be with God.”  After that—void.

When I was younger, I would dread May 7 starting weeks in advance.  It represented the wrecking ball that tore down the walls of my childhood.  It represented the sudden, inescapable knowledge that mortality is real and my innocence was lost.  It tormented me and tortured my mind.

And then the healing measure of time passed over me.  Little by little, the gaping wound of loss began to heal and scar covered the hole in my heart.  Twenty years down the road, I would sometimes remember my loss a day late.  And then the wound would rupture open and bleed from the guilt of having forgotten.  However, I’m certain Mom would have been thrilled I was finally almost whole, and that May 7 was no longer a day filled with emptiness.  Sometimes, May 7 could be just another day.  She would want me to remember how much she loved me, and that she never wanted to go.  But she would want me to move past despair and focus on hope.

And so, 33 years later, I will despair no more.  I chose to be a physician because of what happened that warm spring day.  My fate was cemented in that moment, and I know she is proud.  And so, 33 years later, I dedicate my future work to her and the patients who see no way forward.  The patients who measure their life in days and breaths.  The patients who are about to give life to another in birth.  The patients who grip my hand to calm their fears, and the patients who hug me in joy.  The patients who just need to talk, and the patients who would certainly die without my help.

33 years to fully realize what my life’s work is about and to know how I must shape my future.

33 years…

Meandering Musing

Welcome to my blog.  In all honesty, I write this much more for me than for you.  In fact, there is a 98.9% chance no one else will ever read a syllable.  My wife will undoubtedly groan when I tell her I’m going to start putting myself out on the internet.  I can’t blame her.  She is recalcitrant in embracing Facebook and a lot of the other tech I enjoy.  I’m glad – she’s a true and honest person in a fleeting digital world.  She is an analog LP to my binary iPhone and a guiding light in a world in which I would have otherwise become lost long ago.

That said, it’s time to write again.  I was a bit of an essayist and poet in college but the rigors of med school beat the passion to write out of me.  In an effort to re-energize my life and career, I’m ready to pickup up my pen (ok, keyboard) once more.  I’d like to share some of the great things I love, call out things that are simply not right, and if I can touch just a handful of lives, then maybe I can leave this world a little better place than I found it.

And so, here goes….

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