The spasms of pain were gentle at first. The large muscles of the right side of my neck and shoulder would tense and then ease up. The pain radiated up my spine and ended in my right temple. I sat at the nursing station hunched over a desk with twenty charts sitting by my side. The chair was stuck on a low setting and I had to arch my back and shoulder to reach the desk. Apparently the environmental controls for the building had just two settings: hot and cold. Today it was hot.
I rushed to finish charting so I could drive home, feed the kids dinner, and get my son to his violin class. The pain in my head ebbed and flowed. Some moments severe, like when I turned my shoulders the wrong way, others bearable.
As I cleared the dinner plates, I could feel the nausea building. We hurried to the car and arrived just in time for the violin lesson. The squeaking of bow on string compounded the stress as my cell phone was abuzz with new admissions. As I walked outside to take a call, I perched the phone between my right shoulder and head. The jolt of pain lanced through my scalp and landed above my eye. I stepped into the cold air and took a few deep breaths.
By the time I arrived home, I was fidgeting with discomfort. My stomach was raw and bilious. I fumbled with the ibuprofen container and crawled into bed. I could hear my son and daughter screeching a floor below. My wife was vacuuming the floor.
As I laid in bed prostrate, I knew there was only one way to make the pain abate.
*
Without thinking, my mind began the process autonomously. I started with slow deep breaths as I tried to disassociate myself from the searing enemy. I mentally took stock of each muscle group and localized the pain. I concentrated first on neck and shoulders, then the intricate muscles of the face. I imagined the flexed, agitated, spindles as flaming red orbs.
As I had done so many times in the past, I completed the inventory and then started the process of relaxation. I isolated each inflamed muscle group. I systemically tightened and relaxed. All the while, I visualized the muscle fibers. I commanded them to let go of the tension.
My body swayed up and down rhythmically. My torso sunk into the bed below me. I finished the muscle work and moved on to my breathing. I felt as if a tight band had been released from my cranium. The nausea was gone.
As I tried to fight sleep, my mind drifted off to childhood.
*
I could hear my mom yelling frustratedly at my father behind the closed door.
But your the doctor, what is wrong with him.
We had been to some of the best clinics in the city. I had taken test after test. Xrays, cat scans, and blood work all came up negative. The pediatric neurologist was at a loss on how to cure my headaches.
My mom and dad were struggling. I complained daily of head pain. Some days were mild, others were severe. I was missing school on a regular basis. After months of failed attempts, my mother made an appointment for me to see a new type of doctor.
As the years pass, I can no longer remember his face, but his words stick with me. He wouldn't take any more tests or draw more blood. He simply wanted me to relax in his chair and listen.
We met weekly. He called his technique "self hypnosis". He explained that we have great power over our bodies if we know how to access it. This access is granted when we bring ourselves to a state of relaxation and visualize the changes we want to take place.
He gave me homework. Each day I sat in my room alone and practiced. At first I would lie flat in bed. But as I got better, I was able to do my relaxation exercises sitting up and with my eyes open.
Over the next few months my headaches disappeared. But more importantly, I learned a life skill. Although I no longer practice anymore, I return to biofeedback often. It has helped me with both physical and emotional pain. It has improved my performance academically as well as physically.
Biofeedback has centered me as a human being.
*
My voyage into medicine has been littered with positive role models and teachers. I have many people to thank for becoming the physician that I am today.
But the truth is, this amorphous man whose face I can no longer remember, taught me more about the human body then any gross anatomy professor.
Wednesday, November 9, 2011
Monday, November 7, 2011
On Cell Phones And Primary Care
For a brief interlude, the world moved in slow motion. I saw the cell phone leaving my hand and twist and turn wantonly in the air. It fell onto the pavement with a loud thud. I stared at the lifeless object. It's face hugged the ground. I cautiously bent down and turned it over in my palm.
With great horror, I looked at the distorted face. A large fissure splayed from the corner like children's fingers striving to frantically grasp the unreachable.
I felt a vague sense of discomfort vibrate through my body. What could I do now? The phone calls from the nursing homes would not stop for a broken phone. I pressed the power button. The display lit up, but half of the view was shrouded in black. The dial pad worked but the smart functions were unusable.
For the next few hours there would be no email, no twitter, no blue tooth, and no Internet access. I was in the middle of nowhere. In, of all places, Wisconsin.
And so the odyssey began.
*
I cut my trip short and drove to the Sprint store close to my house. I browsed for nearly an hour while I waited for the customer service agent. I impatiently explained that, as a doctor, I needed cell phone access restored as soon as possible. The calls were already piling up.
The room suddenly started to spin. I lifted my arm to wipe the sweat off my forehead and tapped my feet. Apparently, I had few options. I could buy a new phone for $500 or I could take it to their service center.
I stomped out of the store and drove twenty minutes to the Mecca of phone repair. By the time I walked into the building, my levels of agitation were rising. It had been hours already, and still no resolution.
The clerk at the front desk was courteous but unhelpful. He explained that although they had the capability, the service center wasn't authorized to fix trauma induced phone damage. As I turned to leave, he slipped me a piece of paper with the name of an independent repair company.
Shh. You didn't get that from me!
I slammed the door on my car and frantically dialed the number. After multiple rings the line went dead. I called back again. The same response.
It was Sunday afternoon. Come Monday morning, I would be faced with an onslaught of phone calls without blue tooth or hands free dialer. I only had use of half of the dialing pad. And I couldn't use twitter!
Needless to say, it was a sleepless night
*
As I explained to my office manager my predicament the next morning, my medical assistant chimed in on our conversation.
I know exactly what you need!
She made me an appointment to a repair shop close to my home. I struggled all day to use my nonfunctional phone. I pulled over three times on the highway to return pages.
By the time I walked into the shop, I was at the end of my rope. I was hungry and tired. I was grumpy. And I wanted my cell phone fixed.
The gentlemen who owned the store greeted me at the front door.
You've come to the right place. We'll have it fixed in no time.
They were kind and courteous. When they didn't have the right parts, they came up with a creative solution. At one point, they called Sprint themselves to fix my settings.
They were not only professional but empathetic. How many stressed out customers had walked through their doors with similar needs? One of the owners pulled out a bucket of broken cell phone parts.
This is just from today!
An hour later, I was on my way home. My phone was fixed for a third of the price I expected. My blue tooth was perched on my ear and my hands free dialer was reinstalled.
I felt the knots in my chest relaxing.
And then it dawned on me. I wonder how often patients walk out of my office feeling this cared for?
How did we PCP's lose our way?
With great horror, I looked at the distorted face. A large fissure splayed from the corner like children's fingers striving to frantically grasp the unreachable.
I felt a vague sense of discomfort vibrate through my body. What could I do now? The phone calls from the nursing homes would not stop for a broken phone. I pressed the power button. The display lit up, but half of the view was shrouded in black. The dial pad worked but the smart functions were unusable.
For the next few hours there would be no email, no twitter, no blue tooth, and no Internet access. I was in the middle of nowhere. In, of all places, Wisconsin.
And so the odyssey began.
*
I cut my trip short and drove to the Sprint store close to my house. I browsed for nearly an hour while I waited for the customer service agent. I impatiently explained that, as a doctor, I needed cell phone access restored as soon as possible. The calls were already piling up.
The room suddenly started to spin. I lifted my arm to wipe the sweat off my forehead and tapped my feet. Apparently, I had few options. I could buy a new phone for $500 or I could take it to their service center.
I stomped out of the store and drove twenty minutes to the Mecca of phone repair. By the time I walked into the building, my levels of agitation were rising. It had been hours already, and still no resolution.
The clerk at the front desk was courteous but unhelpful. He explained that although they had the capability, the service center wasn't authorized to fix trauma induced phone damage. As I turned to leave, he slipped me a piece of paper with the name of an independent repair company.
Shh. You didn't get that from me!
I slammed the door on my car and frantically dialed the number. After multiple rings the line went dead. I called back again. The same response.
It was Sunday afternoon. Come Monday morning, I would be faced with an onslaught of phone calls without blue tooth or hands free dialer. I only had use of half of the dialing pad. And I couldn't use twitter!
Needless to say, it was a sleepless night
*
As I explained to my office manager my predicament the next morning, my medical assistant chimed in on our conversation.
I know exactly what you need!
She made me an appointment to a repair shop close to my home. I struggled all day to use my nonfunctional phone. I pulled over three times on the highway to return pages.
By the time I walked into the shop, I was at the end of my rope. I was hungry and tired. I was grumpy. And I wanted my cell phone fixed.
The gentlemen who owned the store greeted me at the front door.
You've come to the right place. We'll have it fixed in no time.
They were kind and courteous. When they didn't have the right parts, they came up with a creative solution. At one point, they called Sprint themselves to fix my settings.
They were not only professional but empathetic. How many stressed out customers had walked through their doors with similar needs? One of the owners pulled out a bucket of broken cell phone parts.
This is just from today!
An hour later, I was on my way home. My phone was fixed for a third of the price I expected. My blue tooth was perched on my ear and my hands free dialer was reinstalled.
I felt the knots in my chest relaxing.
And then it dawned on me. I wonder how often patients walk out of my office feeling this cared for?
How did we PCP's lose our way?
Sunday, November 6, 2011
Medicare For All. Be Careful What You Wish For.
John's facial tick reminds me of a shark. His upper lip curls behind his teeth and he makes a hissing sound. He does this every time we talk about health care reform. He smiles and teases, but he's only half joking.
You doctors have it coming! Boy do you have it coming!
We banter back and forth as I examine him. John's muscular limbs are surprising for a ninety year old. His opinions offend, but only slightly. He belongs to the far left. He is most comfortable discussing universal health care and the public option. To him, medicare is the final answer.
Medicare for all!
He looks at me with both sincerity and pity. He realizes that my colleagues and I think this will be the death knell of modern medicine. But he doesn't care. He's fairly certain that we are wrong.
*
Although John's emphysema is much improved, his ankle is now swollen and painful. It's bruised and barely able to support his weight. He hobbles through the door with a cane. He is finished with the prednisone and levaquin, but now is suffering the consequences. His tendon has ruptured.
A week later his orthopaedist performs a short surgical procedure. He is discharged home hours later with detailed instructions. His only support is his eighty five year old spouse.
The next morning John's wife calls. Her voice trembles with panic.
John's too weak. He can't even get out of bed. We're bringing him to the nursing home.
I pause a moment. While I definitely think a skilled facility is a good idea, I'm doubtful that medicare will pay or it. I begin to verbalize my concerns, but John, who has now joined the line, interrupts.
Oh don't you worry. Medicare will take care of me.
*
Weeks later John is recovering at home. His physical therapy is going well. As he stoops to lower himself down on the chair in my office, he slams a stack of papers on the desk. I look up quizzically.
Five thousand dollars! Can you believe five thousand dollars of nursing home bills? And medicare won't pay a cent.
It is now I who looks at him with pity.
Medicare for all.
Be careful what you wish for!
You doctors have it coming! Boy do you have it coming!
We banter back and forth as I examine him. John's muscular limbs are surprising for a ninety year old. His opinions offend, but only slightly. He belongs to the far left. He is most comfortable discussing universal health care and the public option. To him, medicare is the final answer.
Medicare for all!
He looks at me with both sincerity and pity. He realizes that my colleagues and I think this will be the death knell of modern medicine. But he doesn't care. He's fairly certain that we are wrong.
*
Although John's emphysema is much improved, his ankle is now swollen and painful. It's bruised and barely able to support his weight. He hobbles through the door with a cane. He is finished with the prednisone and levaquin, but now is suffering the consequences. His tendon has ruptured.
A week later his orthopaedist performs a short surgical procedure. He is discharged home hours later with detailed instructions. His only support is his eighty five year old spouse.
The next morning John's wife calls. Her voice trembles with panic.
John's too weak. He can't even get out of bed. We're bringing him to the nursing home.
I pause a moment. While I definitely think a skilled facility is a good idea, I'm doubtful that medicare will pay or it. I begin to verbalize my concerns, but John, who has now joined the line, interrupts.
Oh don't you worry. Medicare will take care of me.
*
Weeks later John is recovering at home. His physical therapy is going well. As he stoops to lower himself down on the chair in my office, he slams a stack of papers on the desk. I look up quizzically.
Five thousand dollars! Can you believe five thousand dollars of nursing home bills? And medicare won't pay a cent.
It is now I who looks at him with pity.
Medicare for all.
Be careful what you wish for!
Saturday, November 5, 2011
I Could
Adapted from the poem "I Could"
Cook County hospital 1998
Breast center
Who's next?
He calls to the residents, as if he is a bank teller waiting to accept his next deposit. He walks from room to room with the medical students trailing behind. He enters the cubicle without taking the time to introduce himself. He touches breast tissue with precision and tenderness. Yet to put his arm around the shoulder of a suffering patient would be considered to intimate.
How could you?
He stops momentarily to scan a mammogram. He is decisive and arrogant.
You will need a biopsy!
The crying woman looks up and her trembling finger points to the adjacent light box where last years mammogram sits uninspected.
Oh. Those calcifications were present before. I guess we can wait on the biopsy.
Her head is now in her hands. She doesn't look up.
How could you?
I wince as he shoves the needle into her breast. Her face contorts and a tear roles down her cheek. As he smirks, I find myself more worried about the amount of local anesthetic than the accuracy of his technique. He high fives the resident.
We got it
How could you?
A young woman sits on a chair with her two children playing on the floor with a set of checkers. He buries his head in her chart as he delivers bad news.
Your lymph nodes are positive.You will need chemotherapy.
He hands her a referral and leaves the room without waiting for questions.
How could you want to be a doctor?
He asks me in my dreams.
Because you will hurt for each and every patient who walks through your doors.
And in my dreams, I scream the answer, ablating his image from the depths of my being.
How could I not?
Cook County hospital 1998
Breast center
Who's next?
He calls to the residents, as if he is a bank teller waiting to accept his next deposit. He walks from room to room with the medical students trailing behind. He enters the cubicle without taking the time to introduce himself. He touches breast tissue with precision and tenderness. Yet to put his arm around the shoulder of a suffering patient would be considered to intimate.
How could you?
He stops momentarily to scan a mammogram. He is decisive and arrogant.
You will need a biopsy!
The crying woman looks up and her trembling finger points to the adjacent light box where last years mammogram sits uninspected.
Oh. Those calcifications were present before. I guess we can wait on the biopsy.
Her head is now in her hands. She doesn't look up.
How could you?
I wince as he shoves the needle into her breast. Her face contorts and a tear roles down her cheek. As he smirks, I find myself more worried about the amount of local anesthetic than the accuracy of his technique. He high fives the resident.
We got it
How could you?
A young woman sits on a chair with her two children playing on the floor with a set of checkers. He buries his head in her chart as he delivers bad news.
Your lymph nodes are positive.You will need chemotherapy.
He hands her a referral and leaves the room without waiting for questions.
How could you want to be a doctor?
He asks me in my dreams.
Because you will hurt for each and every patient who walks through your doors.
And in my dreams, I scream the answer, ablating his image from the depths of my being.
How could I not?
Thursday, November 3, 2011
A Calling
Would it surprise you to know that I often contemplate leaving medicine? That I awake some mornings with eyes drooping and jaw clenching. And I begin the day with the promise that it will be my last.
I have sworn off this profession more times than a bad habit. I have stormed out of the office with belly churning and head swimming in a migrainous ocean.
Each time, I feel more resolute then the last. Yet somehow I remain. I sit in my little office typing away on my lap top. The phone is ringing, my pager is buzzing, and the paperwork is piling up.
Yet, I'm still here.
*
Howie was like a tank. His thick muscular arms were covered in tattoos. His belly usually protruded proudly over his Harley as he drove into our parking lot. Needless to say, he wasn't the kind of guy who complained.
So it was with great surprise, that I watched him hobble into my office. His cherubic face was flaming red. Sweat soaked the front of his t-shirt. His left arm wrapped around his son, and they walked in unison as if they were participants in a three legged race.
I paused for a moment as Howie got settled on the examining table.
Doc. I think I'm dying
I was amazed at how this giant of a man had been transformed into a cowering mouse. I waited patiently as he explained the agony of the last few weeks. His knees were aching. His feet were swollen. He couldn't bare to walk or move. His pain was only tolerable if he remained perfectly still.
His trip to the ER had been fruitless. He was told that he didn't have blood clots in his legs, but was otherwise given no explanations. I surveyed the situation. His knees were warm and swollen with small circles of color radiating downward. He jumped with any attempt at manipulation. His ankles were also sensitive and edematous.
I diagnosed him with gout. I faxed a prescription for prednisone to his pharmacy and requested he come back the next day. He limped out of the office unconvinced.
Twenty four hours later, he strode through the hallway towards me a changed man. He walked confidently into the room. He smiled broadly showing his stained front teeth.
Doc. You saved my life!
I was about to disagree when he unexpectedly grabbed me around the shoulders and gave me a bear hug.
I didn't say a word. I was speechless.
*
Sometimes I feel that being a doctor is like fighting a pit bull. You scratch and claw against the vicious opponent in an attempt to survive. And when you finally pick yourself up off the ground in victory, the dogs owner walks over and kicks you in the groin.
Yet there are few professions that give back so much. Physicians are allowed a unique window into the lives of their fellow men. We help people live; we help them die. We bear witness to all that is laid at our doorstep.
We are treated as both kings and peasants. Our rewards are fleeting but much appreciated: a handshake, a pat on the back, a hug.
Years ago my parents asked me what I want to be when I grow up. I didn't know then what I know now. This profession is a calling. A loud, disruptive, unswerving calling.
And with every breath, of every moment, of every day,
I humbly answer it.
I have sworn off this profession more times than a bad habit. I have stormed out of the office with belly churning and head swimming in a migrainous ocean.
Each time, I feel more resolute then the last. Yet somehow I remain. I sit in my little office typing away on my lap top. The phone is ringing, my pager is buzzing, and the paperwork is piling up.
Yet, I'm still here.
*
Howie was like a tank. His thick muscular arms were covered in tattoos. His belly usually protruded proudly over his Harley as he drove into our parking lot. Needless to say, he wasn't the kind of guy who complained.
So it was with great surprise, that I watched him hobble into my office. His cherubic face was flaming red. Sweat soaked the front of his t-shirt. His left arm wrapped around his son, and they walked in unison as if they were participants in a three legged race.
I paused for a moment as Howie got settled on the examining table.
Doc. I think I'm dying
I was amazed at how this giant of a man had been transformed into a cowering mouse. I waited patiently as he explained the agony of the last few weeks. His knees were aching. His feet were swollen. He couldn't bare to walk or move. His pain was only tolerable if he remained perfectly still.
His trip to the ER had been fruitless. He was told that he didn't have blood clots in his legs, but was otherwise given no explanations. I surveyed the situation. His knees were warm and swollen with small circles of color radiating downward. He jumped with any attempt at manipulation. His ankles were also sensitive and edematous.
I diagnosed him with gout. I faxed a prescription for prednisone to his pharmacy and requested he come back the next day. He limped out of the office unconvinced.
Twenty four hours later, he strode through the hallway towards me a changed man. He walked confidently into the room. He smiled broadly showing his stained front teeth.
Doc. You saved my life!
I was about to disagree when he unexpectedly grabbed me around the shoulders and gave me a bear hug.
I didn't say a word. I was speechless.
*
Sometimes I feel that being a doctor is like fighting a pit bull. You scratch and claw against the vicious opponent in an attempt to survive. And when you finally pick yourself up off the ground in victory, the dogs owner walks over and kicks you in the groin.
Yet there are few professions that give back so much. Physicians are allowed a unique window into the lives of their fellow men. We help people live; we help them die. We bear witness to all that is laid at our doorstep.
We are treated as both kings and peasants. Our rewards are fleeting but much appreciated: a handshake, a pat on the back, a hug.
Years ago my parents asked me what I want to be when I grow up. I didn't know then what I know now. This profession is a calling. A loud, disruptive, unswerving calling.
And with every breath, of every moment, of every day,
I humbly answer it.
Wednesday, November 2, 2011
The Hand Holder
When the residents referred to Dr. Foster as a "hand holder" it wasn't meant as a term of endearment. In fact, we universally dreaded taking care of his patients. It wasn't just his wishy washy decision making, but also his syrupy bedside manner. Although the patients loved him, we often wanted to run out of the room and vomit.
I remember my last interaction with Dr. Foster. I was a third year resident and we were rounding together on a patient in the ICU. We examined the unfortunate gentleman. He was on a ventilator and his kidneys and heart were failing.
After methodically writing his note, Dr. Foster and I walked over to the waiting room to talk to the wife. Her eyes were stained with tears as she broke the news. The family had decided to withdraw life support.
Dr. Foster held her hand tightly as he looked deeply into her eyes. He begged her.
Don't give up yet. I feel like I could have done so much more!
The wife placed her hand on Dr. Foster's cheek and then embraced him.
Doctor. Don't blame yourself. You did all you could. It's time for him to go now.
I was disgusted. How had Dr. Foster become the center of attention. He should have been comforting the wife and not vice versa.
I would never see Dr. Foster again. But years later his memory would come clearly into focus at a most unexpected time.
*
Walter and Sarah were my favorite patients. Although their bodies had withered seventy years of abuse, their spirits were far younger. They bounced into my office with energy and kindness. They greeted the staff and physicians with equal measures of respect.
A year ago, Walter developed a persistent cough. After various remedies failed, a chest xray revealed a nodule in the lung. A cat scan was highly suspicious for cancer, and Walter's diagnosis was confirmed by lung resection.
He tolerated surgery well and was plugging along when a surveillance cat scan showed multiple new nodules. Months of chemotherapy and radiation followed. We met in the office frequently to discuss each new development. Sarah worried that her husband was dying. She agreed to the various treatments, but wondered if they were doing more harm then good.
Walter, for his part, put on a brave face and took his "medicine" as directed. He also knew that he was dying, but didn't want to leave Sarah behind.
As time passed, Walter's disease progressed. He was so weak that the oncologist cancelled all remaining appointments for chemotherapy. When he woke up one morning and couldn't get out of bed, Sarah took him to the hospital.
It was with great heaviness that I walked into Walter's room. Sarah was seated at his side. She held his hand as they talked. Sarah stood when she noticed me. I leaned over the bed. A faint smile came over Walter's face.
Doc. I think it's time to call it quits.
I felt the air leaving my lungs. I doubled over. As I opened my mouth to speak, I couldn't believe what I found myself saying.
I'm not ready for you to go!
Sarah was now standing next to me, her arm around my shoulder. The iconic image of Dr. Foster in the ICU waiting room came rushing back to me. Maybe I had been to harsh.
Sometimes when the cards are on the table, it's okay to let your guard down and allow this gentle act of submission. There is a time to transcend the doctor-patient relationship and to no longer be physician, patient, and family member.
We were just three human beings with deep emotional attachments.
And we were grieving.
Together.
I remember my last interaction with Dr. Foster. I was a third year resident and we were rounding together on a patient in the ICU. We examined the unfortunate gentleman. He was on a ventilator and his kidneys and heart were failing.
After methodically writing his note, Dr. Foster and I walked over to the waiting room to talk to the wife. Her eyes were stained with tears as she broke the news. The family had decided to withdraw life support.
Dr. Foster held her hand tightly as he looked deeply into her eyes. He begged her.
Don't give up yet. I feel like I could have done so much more!
The wife placed her hand on Dr. Foster's cheek and then embraced him.
Doctor. Don't blame yourself. You did all you could. It's time for him to go now.
I was disgusted. How had Dr. Foster become the center of attention. He should have been comforting the wife and not vice versa.
I would never see Dr. Foster again. But years later his memory would come clearly into focus at a most unexpected time.
*
Walter and Sarah were my favorite patients. Although their bodies had withered seventy years of abuse, their spirits were far younger. They bounced into my office with energy and kindness. They greeted the staff and physicians with equal measures of respect.
A year ago, Walter developed a persistent cough. After various remedies failed, a chest xray revealed a nodule in the lung. A cat scan was highly suspicious for cancer, and Walter's diagnosis was confirmed by lung resection.
He tolerated surgery well and was plugging along when a surveillance cat scan showed multiple new nodules. Months of chemotherapy and radiation followed. We met in the office frequently to discuss each new development. Sarah worried that her husband was dying. She agreed to the various treatments, but wondered if they were doing more harm then good.
Walter, for his part, put on a brave face and took his "medicine" as directed. He also knew that he was dying, but didn't want to leave Sarah behind.
As time passed, Walter's disease progressed. He was so weak that the oncologist cancelled all remaining appointments for chemotherapy. When he woke up one morning and couldn't get out of bed, Sarah took him to the hospital.
It was with great heaviness that I walked into Walter's room. Sarah was seated at his side. She held his hand as they talked. Sarah stood when she noticed me. I leaned over the bed. A faint smile came over Walter's face.
Doc. I think it's time to call it quits.
I felt the air leaving my lungs. I doubled over. As I opened my mouth to speak, I couldn't believe what I found myself saying.
I'm not ready for you to go!
Sarah was now standing next to me, her arm around my shoulder. The iconic image of Dr. Foster in the ICU waiting room came rushing back to me. Maybe I had been to harsh.
Sometimes when the cards are on the table, it's okay to let your guard down and allow this gentle act of submission. There is a time to transcend the doctor-patient relationship and to no longer be physician, patient, and family member.
We were just three human beings with deep emotional attachments.
And we were grieving.
Together.
Tuesday, November 1, 2011
Why I Blog Part 2
There's an ongoing struggle for the hearts and minds of the American people. The battle rages on quietly, but occasionally bubbles over into the public consciousness. One side is loud, veracious, and spits its tyrannical philosophy far and wide. The other is sheepish, and docile.
We all know that I'm talking about health care. There are those who feel that our system is undeniably broken. They think that we have journeyed so far off course that our moral fiber has eroded. They say our values languish under a system driven more by personal profit than public good. The detractors are a motley crew of journalists, politicians, policy wonks, and health care consultants.
They point their criticism at health care providers and coin new terms to describe the so called depravity. They talk about "accountability" as if they are the ones in the ICU having the family meetings. They pray at the alter of "quality" yet fail to define the specifics of such a term. They resent "over treatment" but never have suffered the consequences of not doing enough.
The veracity of one group of combatants is only equaled by the meekness of the other. Practicioners, actually providing the care in America, find themselves too busy to respond. They watch as the public's confidence erodes but feel overwhelmed by the complexity of patient care. Wasteful exercises in futility steel away their time: billing, coding, preauthorizations, meaningful use, electronic medical records.
It is a learned helplessness. The quiet rebellion continues. Doctors become businessman. Nurses become managers. We cling to new models like concierge and cash practices.
The public, inundated by the power and volume of our detractors message, has noticed our silence. Without a dissenting voice they are left to believe that what they are hearing is true. They are losing faith.
We as physicians and nurses, therapists and social workers, have but one choice left. We must recast the characters and rewrite the plot. We must repaint the fresco to be more airy and accurate.
We must tell our stories.
We all know that I'm talking about health care. There are those who feel that our system is undeniably broken. They think that we have journeyed so far off course that our moral fiber has eroded. They say our values languish under a system driven more by personal profit than public good. The detractors are a motley crew of journalists, politicians, policy wonks, and health care consultants.
They point their criticism at health care providers and coin new terms to describe the so called depravity. They talk about "accountability" as if they are the ones in the ICU having the family meetings. They pray at the alter of "quality" yet fail to define the specifics of such a term. They resent "over treatment" but never have suffered the consequences of not doing enough.
The veracity of one group of combatants is only equaled by the meekness of the other. Practicioners, actually providing the care in America, find themselves too busy to respond. They watch as the public's confidence erodes but feel overwhelmed by the complexity of patient care. Wasteful exercises in futility steel away their time: billing, coding, preauthorizations, meaningful use, electronic medical records.
It is a learned helplessness. The quiet rebellion continues. Doctors become businessman. Nurses become managers. We cling to new models like concierge and cash practices.
The public, inundated by the power and volume of our detractors message, has noticed our silence. Without a dissenting voice they are left to believe that what they are hearing is true. They are losing faith.
We as physicians and nurses, therapists and social workers, have but one choice left. We must recast the characters and rewrite the plot. We must repaint the fresco to be more airy and accurate.
We must tell our stories.
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