When Grief Hits Home

The medical profession is all about giving – serving those who are hurting and helping find medical solutions.

We’re not so good at receiving.

Yesterday morning I got a text message from my sister. My big sister is a doc herself and has been part of my ‘cheering section’ as I’ve pursued my own medical career. But this message hit me hard.

“I’m writing to tell you that Al passed away this morning.”

There’s nothing that can prepare you for such news. And while I feel like my sister holds half of my heart, I know that the sadness I feel is minuscule compared to hers. She found her true soul-mate late in life, and Al was one of those priceless men who treated my sister like a queen. Their life together was a beautiful testament to how wonderful a marriage is supposed to be. And my only thought was, I need to get to her. I need to help get our mother to her. We need to be together and wrap her up in our love and support.

As messages of condolences roll in, I’m watching how different folks deal with grief in another’s life. Some don’t say much but their “I’m with you” message is clear. Some offer prayers, some share a similar situation in their own lives. And some ask what they can do to help. With the help of friends, we set up a gofundme account to help us siblings and our mother travel so we can just be with. 

The most priceless messages we’ve received are those who say something like this:

Its okay to be sad. Its okay to cry. You don’t need to pretend you’re alright. I understand.

I hope I always remember this, as I continue to reach out to suffering patients. While there is a limit to medicine’s ability to ‘fix’ things, there is no limit to the power of compassion.

And often, just saying, “we’re with you” is enough.

Your contributions will be used to help us travel to be with my sis, and anything beyond travel costs will go to help with all those ‘little’ things for my sister. May blessings continue to flow into your life as you give, and receive, compassion.

The Others

I’m convinced that its never too early to begin establishing habits of acknowledging those “others” – the ones who so heavily contribute to student doctors and physicians being able to effectively do their jobs.

Last night, I spent late hours at my local hospital Emergency Department. It wasn’t exactly a busy night, but there was a steady stream of patients. The little boy with a croupy cough – not bad enough for admission, but I spent quite awhile reassuring his exhausted parents. The dad in the middle of a custody fight concerned about possible abuse to his 2 year old daughter. The confused young man high on ‘something’ and his mom who tried to cope…

As I watched the night play out, I paid attention to those “others”. Here’s a few of the lessons I learned.

  • Take time. In a busy setting like an emergency room, everyone is focused on doing their job. But I’m finding it so important to create time to interact with those “others”, even if just for a moment. The nurse who seemed relieved to share how her own son is doing with his medical challenges. The front desk folks who’s faces light up when I stop to ask them how their night is going. Don’t be so busy “doing your job” that you forget to take time.
  • Make eye contact. Its not enough to throw out a fast “how the heck are ya?” as you dash past the tech, or housekeeper, or student nurse. Stop walking for just a moment and make eye contact. Its important.
  • Say thank you. Last night I watched as patients were collected by Radiology for a fast CT scan, blood draws and X-rays quietly just “happened” after the doc checked that box in the EMR… Saying Thank You is huge. It doesn’t happen often enough. Its important.
  • Intentionally acknowledge people. Sure, often those “others” are just doing their jobs. And they’ll most often brush off your acknowledgement. Do it anyway.

It was after midnight when I finally said good bye to a mostly empty ER and walked out the door. I said good night to security and walked out into the drizzle – after all, I was parked close, under a light, and I didn’t feel any need of an escort. As I started up my car I looked out my rear view mirror and saw the security guy standing on the sidewalk. I hadn’t asked him to, but he had followed me out and was watching. Just to be sure.

I jumped out of my car and jogged back to where he was standing.

“Thank you,” I said, reaching out to shake his hand. “I didn’t think to ask you to watch, but I feel safer having you here.”

He acted a bit embarrassed actually as he dropped his eyes. “Just doing my job ma’am”. But I saw the smile lifting the corners of his mouth as I turned around to leave again.

Acknowledge people. Everyone. ALL are important.

The Pendulum Swings

I’m daily reminded of the gaping chasm between academic medicine and actual medical practice. I don’t have a solution (yet), but I notice it. Mostly on days when I’m in clinic or making housecalls or working in the ER with my clinical mentor.

I went into this grand adventure hearing for at least the last decade how more than half the information I learn in medical school would be obsolete by the time I graduated. That’s a theoretical and interesting fact until one is experiencing the whiplash going back and forth between clinical experience and memorizing seemingly endless facts.

Things like: if the evidence is incontrovertible that antibiotics simply don’t benefit patients with acute bronchitis, why are we taught to prescribe it?

If evidence indicates no net benefit for Tamiflu, why are we taught to use it?

Why are we taught to use thrombolytics for acute ischemic stroke when evidence shows they don’t help a single patient?

If there’s no advantage to using PSA to screen for prostate cancer

Well, you get the picture.

I spend hours every day learning, memorizing, absorbing all the details of development, anatomy and physiology of different body systems, what can go wrong, and how to treat it when that ‘wrong’ becomes reality. I enjoy (truly) every moment of this learning experience. But then there’s the whiplash of seeing patients with bronchitis, grossly enlarged prostate, or pharyngitis and watching docs cite the latest research and say something like, “The evidence shows that we could actually cause more harm than good by treating this with antibiotics …. With very few exceptions, your body really will take care of the infection.”

What’s even worse is watching docs prescribe treatments that they know have no benefit, because their employer has published the protocol, or because they’re afraid of litigation.

Holding both treat, or don’t treat, in my head at the same time sometimes makes me a little twitchy. I’ll admit, as a baby-boomer I’m thoroughly immersed in the belief that there’s a pill for just about everything, and its been tough to let that go. So in some ways, I’m much more comfortable memorizing lists of medications to treat various disease states. Yet I keep coming back to what I experience out there in the real world of patient care, learning from docs who are providing the very best care possible to their patients.

Perhaps by the time I’m a practicing physician, the pendulum will have swung back the other way. But I find myself hoping not. I dream of being part of a medical profession that intervenes rarely, that prescribes only when the evidence is incontrovertible that the benefits outweigh the risks, and that truly has the overall best interests of the patient in mind at every moment. I’m idealistic enough to believe I can help make that happen.

 

 

 

 

Pessimism

I consider myself pretty dang tough. Over the last couple of decades, I’ve honed skills of determination, introspection, and time management. I’ve learned which goals are super important to me and what I’m willing to do to achieve them. And I’ve told myself for years that I’m not swayed much by circumstance especially when it comes to issues that are important to me.

Then last night happened.

Working at the hospital as a medical student gives me the almost indescribably wonderful advantage of learning all about emergency medical care, with few of the stresses I’ll experience as a 3rd or 4th year during rotations. Since I’m a first year student, I get teased often when my typical answer is “I don’t know”, and my mentor and other docs seem to enjoy the prospect of having me as their captive audience to teach. I’ve been exposed to several different styles of practicing emergency medicine, and many different doctor personalities.

Last night was an eye-opening experience. As the typical non-emergent patients began their journey through our Emergency Department, I found myself surrounded by frustrated physicians. Maybe it was just an ‘off-day’ for them. Maybe last night was the end of a long week of shifts. Maybe this patient was the 47th who had come in with nebulous pain complaints and no definable injury or illness. Maybe frustrations over endless bureaucratic paperwork and pointless busywork were spilling over onto the patients who didn’t know where else to go.

I don’t know why. And bottom line it doesn’t matter. All I know is that as the evening wore on, I found myself joining in with eye-rolls and jokes about the intelligence levels of those allowed to procreate. I felt a growing internal battle over my drive to always deliver compassionate care, and a sarcastic almost jaded attitude toward those asking for that care. And I watched as I laughed at the jokes, added a few of my own, and mentally excused times when caregivers ignored requests or talked over a patient trying to find a way to express themselves.

And today, thinking about last night makes me uncomfortable. Not that there were jokes and sarcasm – lord knows there needs to be an element of humor in medical care to help balance out all the seriousness. But what bothers me in hindsight is how quickly I allowed myself to be drawn in to an attitude of jaded pessimism.

That’s not me.

Not only am I not a “follower”, but I have some bottom-line standards that I hold myself to. Always before I’ve been able to simply observe when I saw behavior that nudged close to the invisible line, reminding myself that I could learn from each encounter even if the person I was observing was practicing medicine differently than I would choose to.

So now… now, I get to raise the bar. For myself. I get to remind myself that I can be swayed by those around me, even against my own internal standards, if I’m not careful.

From my life experience I know that only so long as I remain conscious of potential pitfalls can I guard against waking up one day only to discover that I’ve become one of “those” docs who seems to genuinely dislike their job.

I’m grateful for the lesson this early in my medical school journey.