Friday, March 17, 2017
It was not so much the words as the overall tone of the interaction. The doctor-patient relationship had been generally affable. There was the usual exchange of pleasantries over the years. Questions about family, children and grandchildren. It was a good relationship. Until Harvey got sick, that is.
Originally there was weight loss and fatigue. The initial physical exam and slew of testing showed nothing but a frail, cachectic, middle aged man. A few cat scans later and he was in the oncologist's office discussing chemotherapy. A regimen was decided on, and therapy began the next day.
Therapy was hard. Nausea. Retching. More weight loss. Far from feeling better or cured, Harvey could feel the clothes slipping from his emaciated body. It was as if life itself was drip dripping away as the chemo bulldozed into his broken veins. And this pissed Harvey off.
He lashed his family. He cursed his friends. He spun into a whirlwind of the most resistant depression. A depression, his therapist would later tell me, whose only salve was anger. While the anger allowed him to carry on, often he left those around him scorched.
His doctors were no exception. We often spent half of each visit withstanding abuse before getting down to the business of the appointment. He blamed us for the cancer. He blamed us for the lousy response. He blamed us for the side effects of his abysmal treatment.
So when I walked into the hospital room to tell him the scans showed his latest chemotherapy had failed to stem the red tide of death, I have to admit that I had already somewhat detached. How could I not? Although he was fairly lathered by the results, it was the mentioning of hospice that finally led to my expulsion. His wife ran after me with tears in her eyes. I'm quite certain that she paid dearly for her kind act of decorum.
Harvey died shortly thereafter.
I am prone to remember the pleasantries Harvey and I enjoyed before his health deteriorated. I am neither disturbed nor saddened by the anger. I cannot even say that I would not have been the same way if I had been lying in his hospital bed.
What surprises me, in retrospect, is how little he affected me. How his anger didn't penetrate the hardened shell.
Over my career I have been yelled at, cursed, blamed, hugged, and even loved by my patients.
And like the poor life force oozing out of Harvey's beleaguered body, it drip drips down my back.
And into a forgotten puddle on the ground.
My new book: Five Moments, now available on Amazon.
Posted by Jordan Grumet at 8:32 AM
Sunday, March 12, 2017
“Dad . . . you can let go now.”
Thomas heard his daughter’s voice from a distance. It awakened him from his reverie. He relived those five moments of life and took their lessons seriously.
Rejoice in the ordinary as if you were a child seeing everything for the first time.
Unconditional love can lift you up.
Forgive yourself over and over again.
No matter how much we deny it, we are who we are.
Some of the most difficult battles are those in which we choose not to fight.
Thomas opened his eyes and smiled. He looked at the faces of his family before him. After all these years he finally got it. He understood the meaning of existence that eluded him till now.
Eternity . . . Immortality . . .
His family was now joined by numerous others. Thomas’s friends and colleagues, his patients and students, even the man he once gave a five-dollar bill to on the street. They were all there. He gave a part of himself to each of these people. And each of them had given a part of themselves to others. There were thousands, if not millions, of people in the room with Thomas.
His life had meaning. Like a rock falling into a pond, his goodness made a small splash with the people around him. But the waves from the rock rippled throughout the pond. Thomas would live forever. Parts of him were dispersed into the world. And those parts would live and thrive. Thomas’s body was dying but his soul was strong. He felt oneness with his fellow man.
For a moment Thomas thought if he just had enough strength he could share this beauty with his family. But then he realized this was not the sort of thing someone could teach. Each person had to experience it himself.
Isabella’s word’s came back to him as he drifted off.He remembered sitting on the kitchen floor with his daughter and granddaughter the day she almost choked to death.
“See, Dad? It wasn’t all in vain.”
Thomas experienced one last thing before he died.A cool sensation started at the back of his head and washed over his cheeks, shoulders, body, and into his toes. With pure joy, he recognized this as the first sensation he felt upon exiting the birth canal.
Beginning and End. Birth and Death. They were all intermingled in this beautiful dance called Life.
Thomas’s heart stopped.
Posted by Jordan Grumet at 5:54 PM
Monday, March 6, 2017
Be assured that this will pass. Life has changed incomprehensibly in a fraction of a moment. It will take a few more moments for your psyche to advance accordingly. This is not disconnection. This is not denial. It's shock.
Grief will not be far behind. Overwhelming, discoloring, disjointed grief. Some will try to ignore it. Others will wallow. How you manage this grief says more about who you are and less about the gravity of the loss. There is no correct way to map this journey. We each travel this road separately.
My gentle advice to you dear traveler, is remember that separate does not mean alone. Others will not feel what you are feeling, but that does not prohibit sharing parts of your journey. The most arduous, at least. Surround yourself with people and things. Even if they have lost your interest. Even if they have lost meaning.
Interest and meaning return. The sun rises and falls. You will not break.
By far, the greatest danger lies ahead. In the days and weeks and years. You may be plagued by a demon so fastidious it will devour your hours, conscious and otherwise. It will haunt long nights and merciless days. It will cause the ground to shake relentlessly under your feet, knocking you off balance.
I'm talking of guilt.
You will feel guilty for not spending enough time, or spending too much. For not calling the nurse right away, or calling too quickly. For pushing the morphine that last time, or withholding it. Even the quiet and peaceful deaths end here. It is loves last grappling with earth-shattering loss. We are not programmed to let go of that which we cannot control.
And we can't control death. So we feel guilt.
This guilt will plague you. It will turn grieving from a process to a permanent state.
Don't let it. Your loved one died because it was time. Nothing you did would have changed that.
Let this forgiveness be one last act to honor the dying.
If you like this post, please order my new book of short fiction, Five Moments.
Posted by Jordan Grumet at 9:10 AM
Wednesday, March 1, 2017
And so begins my new book of short fiction, Five Moments.
This collection of short stories approaches the foibles of the human condition, often as seen through a physicians view point. Crafted over years, each draws from my experiences as a caregiver, a parent, and human being.
During the marketing of my last book, I Am Your Doctor And This Is My Humble Opinion, I found that above all the interviews, reviews, and assorted media-It was you, the reader, who carried the greatest impact.
So if you like what you read here week to week, please...
Buy the book!
Share on Facebook!
Tweet on twitter!
Rate on Amazon!
Post to Linkedin!
You are the most effective marketing force. Your help is much appreciated.
Five Moments can be purchased here.
I Am Your Doctor And This Is My humble Opinion here.
Posted by Jordan Grumet at 5:25 PM
Sunday, February 26, 2017
And then there is unspeakable magic.
I live for the days when a patient comes to the office with a particularly vexing set of symptoms. Specialist after specialist bows their head in disagreement. Laboratory values whisper falsehoods with jeering tongues. Symptoms are transient, physical exam signs inconsistent, and in the midst of head scratching an answer mysteriously appears. Maybe a common presentation of a rare disease. Or a rare presentation of a common disease.
Explaining with words so fast that sentences jumble. Ideas merge. The patient shakes their head enthusiastically less because of deep understanding, and more because they know that my excitement means that finally the answer will unfold like a blossoming flower selflessly bearing its pollen. I will eventually slow down enough to present a cogent explanation. And things will get better.
It lifts me up when a patient sits down beside me after yet another round of chemo. When, at the end of the day, I have a sparing moment to settle in for intense conversation. I bite my tongue, become quiet, and listen. I hear of hopes and dreams. I hear of pain and suffering, joy and fear. We talk like doctor and patient. Like friends. Family members.
We get past the intangibles of life and death, and move on to the more palpable like dignity. Upon finishing, we leave the room in strength. We leave the room with resolve. We leave the room with tears in our eyes. All of us.
And I love when an unwitting pattern is recalled from the deepest depths of memory. The clock is ticking. Heart beats rise and fall rapidly. Knowledge accrued from past struggles presents itself at the most opportune time, and a life is saved.
On the triumphant drive home from the hospital, with the radio blaring, I remember the patient whose back such life saving knowledge was attained.
And I rejoice that all their suffering was not in vain, and neither was mine.
Posted by Jordan Grumet at 6:23 PM
Wednesday, February 22, 2017
Yet time and time again, humility quickly disappears when dealing with the difficult patient. In fact the label, difficult, assumes the problem lies within the patient and not the technique being utilized by the care provider. Already blame is turned outward and personal responsibility abandoned.
A few years ago, when I was in a group practice, one of the senior partners had a particularly needy patient that somehow showed up on all our schedules from time to time. Her aged joints carried her into the exam room to their own particular hobbled rhythm. She paused before each sentence, her voice barely above a whisper.
Her litany of issues was long and nonsensical. And this was always the precise moment when humility left the room. We all became convinced that her complaints were largely psychosomatic. And we were right. It still amazes me at how cavalier I can be when I think a solution is either simple or non physiologic.
It was only after several visits that the need for a thorough exam became apparent. I tapped my feet and waited outside the door for what seemed like an eternity as she undressed and climbed into the unflattering gown. My stethoscope stumbled over the heart as if its mighty muscle had not thumped hundreds of thousands of beats. Auscultated the lungs absentmindedly untouched by the unmeasurable volumes that glanced the porous surface.
My hands fumbled over the fibrosed joints that absorbed the shock of a child's prance, a young athlete's stride, and an ancient shuffle.
My conceit, however, unshakable as it was, was shattered by the faded serial number tattooed on her forearm.
And my humility, once again, was restored to a respectable level.
Posted by Jordan Grumet at 7:17 PM
Sunday, February 19, 2017
The phone is ringing.
THE PHONE IS RINGING!
I sometimes feel my heart race. In the middle of the night. When I get a phone call. Or during the day. While taking a leisurely walk with my family by the lake. The sun streaming through clouds on a brisk morning, interrupted by a fall in room 36. An abrasion. A cardiac arrest. One phone call on top of another, Occasionally so many that the calls on hold are dropped. Or not so occasionally.
During dinner. While in the shower. Sitting on the toilet. Day and night. A faint pain in the ear where the blue tooth rests. Even when it is charging on the bedside table. A hallucination. The feeling of something that is no longer there. Of something that is undeniably no longer there.
The vexing confusion on the other side of the line when I answer professionally, and the call is personal. An even greater confusion when I answer personally, and the call is professional. Straining to hear life altering results in a crowded restaurant. Above the raucous sounds of my frolicking children. In the car when the light is changing.
A bad connection. The basement where there is never reception. At the car wash when the blue tooth flips from my ear to the car, giving the employees an unexpected treat. Or the waiter who stammers through my conversation concerning constipation, or blood in the stool, or foul smelling urine. To return to ordering a hamburger, after telling a family member that their loved one has just died.
Upon realizing a few minutes after being woken unexpectedly in the middle of the night, that a pertinent detail was missed. Waiting several minutes to get the nurse back onto the phone. And languishing the next few hours restless. despite great fatigue, because now the mind has started spinning uncontrollably.
Distracted conversations with my wife. Consistently interrupted. By a patient's emergency.
The ire I feel receiving yet another text. To only discover. That it is just my precious daughter.
Telling me she loves me.
In the middle of a blog post...
Posted by Jordan Grumet at 2:31 PM