New Links

I am going to add some links under “My Link List” to literary journals that I like, in case you (my readers) are interested.  I will start with some that have been kind enough to publish my poetry, not because I am shamelessly promoting myself but because you may be curious about that side of my life. 

For me, writing is inextricably connected to the practice of medicine.  We participate in a great deal of story-telling.  We are receivers and interpreters of our patients’ stories.  We add to them with our own explanations, predictions, and meanings.

The sterile and impersonal language of medical records is never quite satisfying to me as a way to express someone’s experience of illness.  A more creative method is called for.

I have added a link to the Yale Journal for Humanities in Medicine, which I particularly enjoy.  I invite you to peruse its deep and fascinating exploration of not only “the humanities” but “humanity” itself, through the lens of illness and medical care.

On October 25, 2011, you will find Mr. H Tells His Doctor about Himself.  This poem is about a patient I encountered in the ER.  After only a few minutes of strictly biomedical history-taking, he offered up an illuminating tale of spiritual healing that he had experienced. 

I must admit that I was not fully prepared to receive it.  I wanted him to supply the answers to the questions on my admission documents (a list of past diagnoses and surgical procedures, allergies, medications, etc) as efficiently as possible.  After all, it was 3 am and I had a lot of work to do. 

Instead, he gave me unexpected insight into what his renal failure meant to him.  I would have liked the chance to talk more about it but had to focus on the immediate problem of the shortness of breath that brought him to the ER.  My unresolved desire to reflect more on his personal experience grew into this poem.

Pre-op

I recently had my post-dental surgery check-up, which prompted me to go back in my notebook and see what I had written prior to the procedure.  Though this is only a minor contribution to the doctor-as-patient trope, it was my first experience of this type.  Some of you may identify with it, so I have decided to share.

I am about to have dental surgery for the first time.  Really, my first time for any surgery.  My first time for sedation.  It’s a very common procedure, which I probably should have done a long time ago.  I am still reluctant, but I can think of this in the context of my relationship with my own patients.  Maybe it will be good for me to be in pain.  I have been blessed with good health, for the most part.  This will be a new experience.  I know that it will not be the same in duration, magnitude, or implication as what many of my patients suffer, but I can still approach it as a chance for learning and empathy.

I rarely deal with the healthcare system from the patient’s side.  I have a major advantage with my level of health literacy, able to navigate this territory and advocate for myself in ways that many patients find inaccessible.  I can only imagine how hard it would be to do all these steps of scheduling, parking, registration, following instructions, asking and answering questions, dealing with insurance and co-pay, completing forms, knowing what problems to look out for during recovery and what to do about them etc, if I did not speak English well, could not read, or had any number of other barriers that routinely burden people seeking care.

I also rarely do informed consent from the patient’s point of view.  I am usually the one explaining procedures and listing the possible complications.  Yes, complications are unlikely, but even something that goes wrong less than one percent of the time happens to somebody.  When I am the one receiving sedation, medications, cutting, and extracting, the risks feel closer to home.  Even in accepting necessary risk, people never imagine that it will actually happen to them. 

I like to be in control.  I would rather be doing than receiving procedures.  It’s hard for me to submit myself to sedation or to the clouded mind of pain medications.  However, just as I need to identify with other people’s pain, I also need to be sensitive to my patients’ vulnerability.  It’s an opportunity to give up control. 

Part of my desire to be in control manifests as a compulsion to be constantly accomplishing something.  I want to be making the most of every moment, moving forward, meeting goals.  Overall, this is good.  I work hard and devote myself to a vocation that helps others.  But sometimes, I have to give myself permission to slow down.  I had to argue with myself that it was okay to take a day off after surgery. 

Ironically, turning this whole experience into a lesson is, in a way, a means to control it.

Guest Post

Check out my guest post on KevinMD!

Reunion

This past weekend, I attended my 5-year medical school reunion.  My class made an impressive showing, considering the complexity of our lives and work.  It was delightful to see everyone who could make it.  We have gone on to a variety of successes: finishing residencies, some pursuing fellowships and some finding jobs.  What made the strongest impact on me, however, was seeing how many of us have children now.  Though I have not yet contributed, the rest of my class has been surprisingly productive.  I don’t have hard statistics on this, just an impression of an unexpected quantity of babies at this event.

It is not easy to be a parent in medicine, especially a mother.  Our prime childbearing years coincide with 80-hour work weeks and very little flexibility or control over our lives.  It is hard for anyone to spend long days and nights with constant mental and physical strain, skipped meals, lack of sleep.  It is even worse to attempt this while pregnant or nursing.  Maternity leave is only 6 weeks, and any desire to take longer is discouraged by the guilt of colleagues covering for you.

We devote so much time and energy taking care of others that we often neglect to take good care of ourselves.  We come to work even when feeling sick or exhausted because the work has to get done, and we are part of a macho culture that does not admit “weakness”. 

With so many factors arguing against children, it is heartening to me that so many women (and men) are overcoming these challenges and having families anyway.  Perhaps the culture of medical training is changing over time, as more women enter medicine.  We bring with us the revolutionary concept that there is more to life than work. 

Our work is vitally important and will always require dedication and sacrifice.  However, part of humanizing medical care for patients entails treating ourselves as people too.