acquiring a knack for discernment

The decision to depart from my chosen path in life and to start all over again as a wannabe writer both broke my heart and healed it.

It broke my heart because my life was dedicated to the practice of medicine. Leaving medicine felt like a desertion. A defection. My patients panicked. What would they do now, they wondered. My colleagues steeled themselves to take on the extra work load. 

 

It wasn’t as though I simply got fed up, turned in my stethoscope and tongue blades, and slammed the door on my way out of the office. I agonized over the decision for years...from the first rumblings of  discontent, to fierce vacillation, to growing conviction, to the ultimate proclamation...the day I cleared off my desk, said goodbye, and took the leap.

"To be fully alive, fully human,

and completely awake is to be continuously 

thrown out of the nest."

~Pema Chodron~

 

What finally got to me was the subversion of the American health care system by self-proclaimed intermediaries who had neither knowledge of nor concern for patient well being and care...and I would add, I'm afraid that under the current administration, things are only going to get worse. 

 

On a personal note, I struggled with an oppositional defiant EMR system. A baffling coding and reimbursement system. The ever present threat of litigation. A pharmaceutical industry that invested as heavily in marketing as it did in research. A health insurance industry whose number one priority was corporate profit…not compassionate care. Aggravations that followed health care providers through life like a swarm of angry bees.

Now, we're facing politically driven directives that contradict the ethics of medical practice...mandates that make it unlawful to care for our patients depending upon their needs, interventions that make health care inaccessible to people depending upon their identity, and corporate greed that makes it unaffordable for the poor, disabled, and elderly. Among others...

I can't imagine practicing medicine under the onus of these forces. My heart aches for patients who will suffer and may die because of them. Personally, I wasn't defeated by the perpetually long hours that seemed to get longer as I got older. I didn't retire because of exhaustion, or ill-health, or forgetfulness. I abandoned my life in medicine out of fear and frustration. I had to step away...

"Never underestimate the power you have

to take your life in a new direction."

~Germany Kent~ 

 

to decide which path to take. One was familiar but I didn't like where it was taking me. The other one--the healing path--led into the unknown.

 

But, I had a book in mind that insisted on coming out. Several, in fact. So, writing became my compass. Uphill or down, through sunlight or shadow, I chose my path.

 

It's a good thing we get plenty of practice with life changing decisions over the years because, over time, we acquire a knack for discernment. To marry or not. To have a child or not. To start chemo or not. Will we follow our head or our heart? Will the way lead us to love? To happiness? To fulfillment? Or will it bring us heartbreak? Disappointment? Defeat?

 

Are you facing a life-changing decision? How will it affect your future? Are you willing to take the risk? 

Can you put it into words on a page?

"Courage is taking those first steps 

to your dream

even if you can't see the path ahead."

~www.my-youth-basketball-player.com~

jan

 

 

the downside of doctoring

 

One of the perks of being a physician is the fact that you get to live in a state of perpetual awe. It starts with the first pass of the scalpel on your first day in the anatomy lab. It continues as you tease out every organ, blood vessel, and nerve in the body you've been assigned to dissect. A sense of wonder punches you in the gut the first time you hear a beating human heart and realize that your own heart has been beating steadily and predictably without any effort on your part since before the day you were born.

 

"There is nothing worse than

thinking you are well enough...

Don't turn your head.

Keep looking at the bandaged place.

That's where the light enters you.

And don't believe for a minute

that you are healing yourself."

~Jelaluddin Rumi~

 

You'd have to be a toadstool not to be mystified by the anatomy, physiology, and psychology of your very own body. You'd have to believe in miracles if you understood the way a broken body heals, what it takes for an open wound to close, how a lifeless heart can pick up the beat again.

 

Don't even ask what happens during sex.



I studied medicine for seven years and practiced it for over three decades, so I understand how the body works. I know what it takes to keep it up and running. Most of the time, I know how to fix it when something goes wrong. Most people don't. They get out of bed in the morning and expect their bodies to cooperate with their plans for the day. They have to get their children off to school. They have to get to their jobs. They don't have time to be sick.

 

But what if you woke up in the morning and you couldn't move the left side of your body, and you speech was garbled so you couldn't tell anyone what had happened? What if you woke up to find the infant you rocked to sleep the night before pale and lifeless in her crib? What if everything that was familiar and predictable to you changed in a heartbeat?

 

We expect our bodies to work, but sometimes they don't. We think our children are safe, but we can't guarantee it. We take health and happiness for granted until something goes wrong. The cancer comes back. The paralysis is permanent. The depression won't lift. Sometimes the afflictions of the body go beyond its own ability to heal, and beyond the physician's ability to help.

 

What then?

 

When a patient under his care gets worse and there is nothing he can do about it, a doctor feels helpless. When he has tried everything he knows and nothing has worked, he feels like a failure. So not-God as is sometimes still expected of physicians.

 

And that's the problem. The downside of doctoring is that sometimes the patient gets worse despite your noblest efforts. The cancer spreads. The heart fails. The wound won't close. There is nothing more you can do. You concede it would take a miracle for the patient to recover. All you have left is prayer.

 

"The greatest force in the human body

is the natural drive of the body to heal itself,

but that force is not independent of belief...

What we believe is the most powerful option of all."

~Norman Cousins~



But what if you don't believe in miracles and you've given up on prayer? Your sense of awe comes into question. Your sense of wonder falters. Hope fades away. Where do you turn?

 

You might try this. Study the night sky. Watch for the first signs of spring. Feel the pulse in your own wrist. And teach your patients to do it, too.

 

"The human body experiences

a powerful gravitational pull

in the direction of hope."

~Norman Cousins~

jan



 

what you can do when things get to be too much

"The greatness of a nation and its moral progress
can be judged by the way its animals are treated."~Mahatma Gandhi

This week was especially challenging for those of us who identify as empaths. 

According to Chivonna Childs, PhD of the Cleveland Clinic, an empath is a person who feels what others feel. They are known to take on the emotional responses of others and to process them on a deeper level. When others suffer, they suffer.

"Empathy is about finding

echoes of another person in yourself."

~Mohsin Hamid~

This week's news was hard on empaths. It featured the devastating loss of life and property in the California's wildfires. The continuing challenge of frigid temperatures, wind, and drifting snow that have had a paralyzing grip on the mid-Atlantic states and on New England for weeks. The fact that residents of North Carolina are still struggling to recover from Hurricane Helene. Not to mention the political chaos our country is facing. Not to mention the unavoidable static of illness, grief, and despair that blankets so many.

On the other hand, some things barely made the news at all this week. The wars in Ukraine and Gaza. A massive earthquake in Tibet. The all but forgotten refugee camps in Sudan.

On a more personal note, I have been fretting about the deer, the little squirrels and chipmunks, and the birds outdoors with nothing but a little fur or a few feathers to keep them warm. My heart aches for all the pets who snuck out the door and wandered off when no one was watching and are now lost out in the cold, without shelter or food...which is why I doubled the amount of birdseed I put out. Even the deer are eating it.

People suffering. Animals suffering. Empaths suffering.

"Be kind, for everyone you meet

is fighting a hard battle."

~multiple attributions~

How do you process it? Where do you begin? 

Well, you can try to ignore it. You can turn off the news. Distract yourself with mindless entertainment, go shopping for things you don't need (...be honest), or attend to some of those mundane chores you've been putting off. You can pretend it isn't your problem, even though, in a way, it is.

Here are a few things that helped get me through the week:

• I was finally able to get outside and walk, which is a contemplative practice for me. It may not have helped anyone else, but it gave me time to reflect on my place in the world with gratitude and compassion.
• I watched the squirrels scamper around and the deer bound out of the woods the minute I put the birdseed out...the good kind with whole seeds, real nuts, and dried fruit in it. Happy to oblige.
• Night after night I watched the sun set in brilliant shades of pink and orange and purple.
• I watched the "wolf" moon rise.
• I learned something new from Neil deGrasse Tyson about the tides. You can visit him here: https://www.youtube.com/watch?v=dBwNadry-TU
• I took note that snow still glitters in the sunshine.

In other words, when things get to be just too much:

"Enjoy the little things in life...

for one day you'll look back and realize

they were the big things."

~multiple attributions~

jan

 

a pathway to healing

 

I came up against this situation several times recently, and I wasn't exactly sure how I could help. In each case, the circumstances were different but the issue was the same. 

In one case, a gentleman had fallen and injured his hand, but he didn't seek care for it at the time. Weeks later, he was still complaining about the pain...and still refusing to have it evaluated and treated.

Another person had multiple medical problems including diabetes and a heart condition, but he neglected to see his doctor for follow-up. He constantly complained about disabling shortness of breath, fatigue, swelling in his legs, and back pain, but refused to have his symptoms evaluated and treated.

A third person had a persistent cough and wheezing that she blamed on the "flu", even though she was a smoker. She knew it could be something serious, but she refused to have it checked.

"Pain is inevitable.

Suffering is optional."

~Haruki Murakami~

Why do you think people avoid seeking medical care while they continue to complain about their symptoms? What is the story behind it?

Certainly, the prohibitive cost of health care is a major deterrent for many, especially the uninsured. They simply can't afford to see a health care provider, to pay for the diagnostic workup, or to cover the cost of treatment. 

Then there is fear...fear it might be something serious that they just can't face at the time. The shortness of breath that could signal heart failure. The cough that might indicate lung cancer. The injury that might end their career.

Which brings us to the issue of denial. Let's say the woman with the cough, above, lost her mother to lung cancer when she was just two years older than our reluctant patient. It isn't surprising she would pretend her cough was something simple, a cold or the flu, rather than confront the reality she holds in her heart. 

An injury that threatens one's job is more complicated. Taking time off to heal is a problem for a person who has a home and a family, and depends upon a steady income. If it isn't too bad, he can't be blamed for waiting a while to see if things get better on their own. On the other hand, the patient who neglects follow up or who doesn't comply with recommendations for treatment might be milking the system to secure or extend disability benefits. That's a whole different story...

"I told the doctor I broke my leg

in two places.

He told me to quit going to those places."

~Henny Youngman~

If you encounter someone who insists he is sick or in pain but refuses to seek care, it is important to understand his reasons. His story. His circumstances, fears, and expectations. If you are his health care provider, this will help both of you navigate the issue, and it may offer him a pathway to healing.

"There is more wisdom in your body

than in your deepest philosophy."

~Friedrich Nietzsche~

jan