In the process of becoming a physician, I've seen unspeakable horrors. I watched as the ER trauma bays filled with mangled bodies fresh from a multiple car pile up on the expressway. I felt the splatter of blood on my surgical gown as an abdomen was opened to expose a bleeder. I have been vomited on, urinated on, and spit on. We in the medical profession expect such things.
The physical trauma can only be matched by mental anguish. After countless hours of uninterrupted work, I have looked into the eyes of a family member and delivered bad news. Each evening of my career has been punctuated with a series of "what ifs". Sleep becomes a temporary respite, a relief from the repetitive stressful moments of every day.
So it is safe to say that after a decade in the business, there really is very little that shakes me. I find it laughable when a patient apologizes for unshaven legs or bad breath. Most of the time I don't even notice. Certainly it doesn't have a lasting effect.
But I will never forget the day that almost broke me. I shudder, shudder as I put these words on the page.
Her name was Alice and she was a slightly spacey, if not a harmless middle aged woman. She worked as a secretary in a business a mile away from my building. Although she had a car, she often liked to walk to my office as a form of exercise. A somewhat harmless, if not healthy life choice, it was almost the cause of my very real demise.
It was a scorching hot day in the middle of July. Alice, who had gotten delayed in her office, slipped off her high heals and quickly laced up a pair of gym shoes for the trip to our appointment. She paused briefly when she realized that she forgot a pair of socks, she would have to do without them.
It only took a few minutes of walking briskly under the unfaltering sun for the sweat to pour from her slightly rotund body. It wended its way down her legs and settled into the cheap canvas that held in her bulging feet. She reflexively wiped at her forehead with a tissue as she made her way into my building.
A few minutes later, my medical assistant knocked on the door and let me know that Alice was ready. She chuckled and her mouth twisted into a smirk.
Good luck.
Upon entering the room, I felt my nostrils start to twitch. I inhaled briefly and then the air caught in my nose. I began to choke. The fetid smell of sweaty feet wrapped in musty cloth hit me and knocked me over. I grabbed at my face and stepped quickly out of the room. By this time, my medical assistant was standing down the hall. She giggled and pointed at me with the secretary. I took two deep breaths and then walked back into the room. I sat at the desk and spoke carefully trying not to inhale.
Hello Alice, what can I do for you today?
My mind raced as I waited for her response. Please be a sore throat! Please be a runny nose! She looked at me coyly.
I have an itch. Down there!
I almost fell off the chair. Any physician out there will know that doing a pelvic exam is one thing, but putting her on the exam table and placing her bare feet in stirrups right on the level of my nose...
Let's just say I can't talk about what happened next. It's locked and buried deeply in that place in my psyche that I don't allow myself to go. I tried to escape to my happy place, but now I can't go there ever again.
She had a yeast infection.
The moral of my story is a simple one. Your doctor doesn't care what you look like, whether you are groomed, or what kind of clothes you are wearing.
But if your feet evoke more fear than your privates,
please wash them before coming into the office!
Sunday, July 8, 2012
Saturday, July 7, 2012
Dying Of The Light
I read the letter incredulously. The writer was a medical school administrator and had seen my poem published in The Annals Of Internal Medicine. He was hoping I would send a few dozen signed reprints for him to share with the medical ethics class he taught at the local university. I carefully fingered the paper and then threw it onto a pile of unsorted mail. I felt a mixture of excitement and shame pulse through my body. Somehow I knew that I would never send the reprints. I would make up some lame excuse like I didn't have the time, or didn't want to spend the money on the prints. But in reality, I knew the truth. I felt a strange sense of awkwardness about acknowledging such naked praise. I hate making a spectacle of myself.
As a child, I remember trying to avoid the limelight. Nothing made me more uncomfortable than my own birthday or graduation party. Growing up in a large gregarious household, I felt best when I was observing from the corner, away from the spotlight. With the passage of time, I learned to raise my voice and assert myself. Yet, I still felt shame discussing my own accomplishments.
Years later, I realize, that for a person with such qualities, becoming a physician was a perfect fit. In what other field does one so naturally sublimate their own identity? We seek not the praise of our accomplishments but the health of our patients. At the beginning of our careers we take an oath not to forward our own personal needs but rather to do no harm.
Even in training, we learn the art of self abrogation. We abandon our families to spend countless hours in the hospital for minimal wages in the service of humanity and the learning of tradition. We donate our time and energies to staff free clinics and provide for those who are less fortunate.
And when we hang out our shingle and become engrossed in the business as well as the practice of medicine, the majority of us still feel a certain sense of humility. We take a loss on various procedures because it is the right thing to do. We write off our patients debt when they are too poor to pay their bills. And it is a rare day that a truly needy patient is turned away at the door, despite the inconvenience it causes.
We imagine ourselves as servants regardless of society's point of view.
So it comes with little surprise that the heads of physicians are on the chopping block in today's health care reform climate. Indeed, physician advocacy groups applauded the supreme court's recent decision to uphold the ACA even though it may well sound the death knell for the modern practitioner. How indeed could the AMA or the ACP deny a plan that would bring health insurance to countless millions of uncovered lives. It would be down right unphysician like.
Yet strangely, we require such a greater burden of proof for our own medical treatments in contrast to the sweeping changes that reform promises. We accept accountable care organizations and patient centered medical homes without a shred of evidence that they are beneficial. We defile the doctor-patient relationship and bastardize the residency training process because it's easier to accept than to stand up and advocate for ourselves.
It is easier to let the nobility of our profession melt away than to call attention to our own needs.
The politicians and insurance companies don't have such qualms. The pharmaceutical companies and leagues of government administrators don't face such psychic doubts.
We are witnessing the dying of the light.
And we have no one but ourselves to blame for it.
As a child, I remember trying to avoid the limelight. Nothing made me more uncomfortable than my own birthday or graduation party. Growing up in a large gregarious household, I felt best when I was observing from the corner, away from the spotlight. With the passage of time, I learned to raise my voice and assert myself. Yet, I still felt shame discussing my own accomplishments.
Years later, I realize, that for a person with such qualities, becoming a physician was a perfect fit. In what other field does one so naturally sublimate their own identity? We seek not the praise of our accomplishments but the health of our patients. At the beginning of our careers we take an oath not to forward our own personal needs but rather to do no harm.
Even in training, we learn the art of self abrogation. We abandon our families to spend countless hours in the hospital for minimal wages in the service of humanity and the learning of tradition. We donate our time and energies to staff free clinics and provide for those who are less fortunate.
And when we hang out our shingle and become engrossed in the business as well as the practice of medicine, the majority of us still feel a certain sense of humility. We take a loss on various procedures because it is the right thing to do. We write off our patients debt when they are too poor to pay their bills. And it is a rare day that a truly needy patient is turned away at the door, despite the inconvenience it causes.
We imagine ourselves as servants regardless of society's point of view.
So it comes with little surprise that the heads of physicians are on the chopping block in today's health care reform climate. Indeed, physician advocacy groups applauded the supreme court's recent decision to uphold the ACA even though it may well sound the death knell for the modern practitioner. How indeed could the AMA or the ACP deny a plan that would bring health insurance to countless millions of uncovered lives. It would be down right unphysician like.
Yet strangely, we require such a greater burden of proof for our own medical treatments in contrast to the sweeping changes that reform promises. We accept accountable care organizations and patient centered medical homes without a shred of evidence that they are beneficial. We defile the doctor-patient relationship and bastardize the residency training process because it's easier to accept than to stand up and advocate for ourselves.
It is easier to let the nobility of our profession melt away than to call attention to our own needs.
The politicians and insurance companies don't have such qualms. The pharmaceutical companies and leagues of government administrators don't face such psychic doubts.
We are witnessing the dying of the light.
And we have no one but ourselves to blame for it.
Friday, July 6, 2012
Lawrence Spann Review Of My Chapbook "Primary Care"
I was honored to have Lawrence Spann review my chapbook, "Primary Care". Because of technical issues, his words were not included on the publisher's website or on the cover. His time and commitment are much appreciated. Without further ado:
There is no one else writing like Jordan Grumet today. And how desperately we need a physician who humanely approaches doctoring through his eyes with moral sensitivity and the surgical language of a poet. My question is how does he do it? I know many doctors and work with them everyday. I felt the same way some years back when I came upon Jordan Grumet's poem "Fake" in the Journal of the American Medical Association. I published it in an anthology because I though it spoke so clearly to my own experienced working with physicians. How delighted I was to read his new book and find indeed that this theme is central to his work. Dr. Grumet exposes the heart of the American Physician. He allows us to hear the inner workings and strain. He allows us to enter into what it takes to keep a doctor going to work each day. Dr. Grumet is a rare find, like Celine or like Camus' s Dr. Bernard Rieux who endeavors to relieve human suffering in spite of the odds.
To order a copy, please email me at grumetjordan(at)yahoo(dot)com.
There is no one else writing like Jordan Grumet today. And how desperately we need a physician who humanely approaches doctoring through his eyes with moral sensitivity and the surgical language of a poet. My question is how does he do it? I know many doctors and work with them everyday. I felt the same way some years back when I came upon Jordan Grumet's poem "Fake" in the Journal of the American Medical Association. I published it in an anthology because I though it spoke so clearly to my own experienced working with physicians. How delighted I was to read his new book and find indeed that this theme is central to his work. Dr. Grumet exposes the heart of the American Physician. He allows us to hear the inner workings and strain. He allows us to enter into what it takes to keep a doctor going to work each day. Dr. Grumet is a rare find, like Celine or like Camus' s Dr. Bernard Rieux who endeavors to relieve human suffering in spite of the odds.
To order a copy, please email me at grumetjordan(at)yahoo(dot)com.
Thursday, July 5, 2012
A Blink Of The Eye
What does a young doctor know?
You scowl at me across the examining table suspiciously. And indeed, the occasional spasms of pain that jolt my back are nothing in comparison to the strangling vines that form a vice grip around your lumbar spine. I have diagnosed stenosis thousands of times, but never tasted the bitterness of singed nerves roasted on burning coals.
You hold your chest in agony, and I can only compare to the fleeting fire of bronchitis. I have studied the inflections of countless electrocardiograms, but coronary artery disease for me is still just a conception. I can't really tell you how it feels.
Yet there are things that you don't know. I have endured loss in all it's various manifestations. I stood by while death snuck up and smite it's foe with little warning. I paused for what seemed like years as the grim reaper danced a slow and elegant waltz in my direction. I have been acquainted with almost every form of pain and suffering. And unlike you who lived all those years in sweet oblivion, I know exactly what awaits me.
We all walk down the same narrow precipice. Although the paths may vary, missteps are common and many vines are dressed with thorns. You may be a blink of the eye ahead and I a foot fall behind, but none of us escapes unscathed. None of us.
Maybe it would lessen your burden to know that we are all in this together. Maybe you will see the situation as I do.
The difference in years need not form an insurmountable divide.
You and I are much the same.
You scowl at me across the examining table suspiciously. And indeed, the occasional spasms of pain that jolt my back are nothing in comparison to the strangling vines that form a vice grip around your lumbar spine. I have diagnosed stenosis thousands of times, but never tasted the bitterness of singed nerves roasted on burning coals.
You hold your chest in agony, and I can only compare to the fleeting fire of bronchitis. I have studied the inflections of countless electrocardiograms, but coronary artery disease for me is still just a conception. I can't really tell you how it feels.
Yet there are things that you don't know. I have endured loss in all it's various manifestations. I stood by while death snuck up and smite it's foe with little warning. I paused for what seemed like years as the grim reaper danced a slow and elegant waltz in my direction. I have been acquainted with almost every form of pain and suffering. And unlike you who lived all those years in sweet oblivion, I know exactly what awaits me.
We all walk down the same narrow precipice. Although the paths may vary, missteps are common and many vines are dressed with thorns. You may be a blink of the eye ahead and I a foot fall behind, but none of us escapes unscathed. None of us.
Maybe it would lessen your burden to know that we are all in this together. Maybe you will see the situation as I do.
The difference in years need not form an insurmountable divide.
You and I are much the same.
Wednesday, July 4, 2012
Some Thoughts On The 4Th Of July
I don't remember my father's birthday. I don't remember the date of his death. These are secrets that are locked away in the heart of a little boy. But there is one day, each year, that I wake up thinking of my dad. Every July 4th I spend the day lost in a cloud of nostalgia. It is not only the recollection of parades and cookouts, but also connected to some of the few memories I have left of my short time with him.
Every year in Evanston, Central Street is roped off for a mile and a half stretch between Bent Park and the Northwestern football stadium for the annual parade. I remember as a five year old driving from lamp post to lamp post down the street with my dad. On each block, he would get out of the car and stand a ladder against the post. I would hand him the two large flags, and he would climb up and perch them above the street.
Later that year, after the parade, the kids gathered in the back yard for fireworks smuggled in from Wisconsin. After a few small ones, my dad lit what looked like a small bomb, and ran to the corner of the yard. The blast was so loud and the power so great that it blew the glasses right off his face.
***
Year after year, I make the pilgrimage to the Central Street Parade with my family for at least a few minutes. I won't lie, I have occasionally missed here and there. But every morning, I wake up with a clear plan in my mind.
This year will be different. My son is now old enough to be busy with various after school and summer activities, and for one of these, we both have been asked to walk in the parade. Although I have promised him I would, I can't say I'm excited about it. The ninety degree heat and soaking humidity notwithstanding, I feel a certain sense of betrayal towards my father. This is not how we celebrated!
The indignity of death is that memories fade. Now as a father myself, I will create new traditions with my son and daughter. I fear that as I grow older, when I think of July 4th, I'll remember the day I walked in the parade with my son and not the fleeting moments I have left of my dad.
When you become a parent you learn to sublimate your own needs. You let go of a bit of your dreams to help your hapless offspring fulfill theirs. As I walk the parade with my son this afternoon, maybe I will have more in common with my father than before..
Maybe, I will be even closer to him.
Every year in Evanston, Central Street is roped off for a mile and a half stretch between Bent Park and the Northwestern football stadium for the annual parade. I remember as a five year old driving from lamp post to lamp post down the street with my dad. On each block, he would get out of the car and stand a ladder against the post. I would hand him the two large flags, and he would climb up and perch them above the street.
Later that year, after the parade, the kids gathered in the back yard for fireworks smuggled in from Wisconsin. After a few small ones, my dad lit what looked like a small bomb, and ran to the corner of the yard. The blast was so loud and the power so great that it blew the glasses right off his face.
***
Year after year, I make the pilgrimage to the Central Street Parade with my family for at least a few minutes. I won't lie, I have occasionally missed here and there. But every morning, I wake up with a clear plan in my mind.
This year will be different. My son is now old enough to be busy with various after school and summer activities, and for one of these, we both have been asked to walk in the parade. Although I have promised him I would, I can't say I'm excited about it. The ninety degree heat and soaking humidity notwithstanding, I feel a certain sense of betrayal towards my father. This is not how we celebrated!
The indignity of death is that memories fade. Now as a father myself, I will create new traditions with my son and daughter. I fear that as I grow older, when I think of July 4th, I'll remember the day I walked in the parade with my son and not the fleeting moments I have left of my dad.
When you become a parent you learn to sublimate your own needs. You let go of a bit of your dreams to help your hapless offspring fulfill theirs. As I walk the parade with my son this afternoon, maybe I will have more in common with my father than before..
Maybe, I will be even closer to him.
Tuesday, July 3, 2012
The Depths Of The Ocean
I could taste the frustration and anger. I walked out of the room instead of saying something I would regret. My patient was dying. She had cancer riddled throughout her body. Her kidneys and liver were failing. Every ounce of medical knowledge told me that she would be gone in days. But she refused to hear it. She didn't care if it was futile, she wanted to go to the hospital. She wanted IV's and cat scans, chemotherapy, and radiation. It mattered little the physical and emotional toll it would take on her.
My anger quickly transformed into shame and guilt. Could I blame her for hoping to prolong the inevitable? Just as I couldn't see the world through her eyes, she couldn't step into my shoes. She had no idea the horrors that awaited her. She had not watched helplessly by the bedside as torture upon torture was practiced on a beloved patient. But I had, and it scarred me.
***
We talk of burnout as if it is a single event. One day the doctor was happily rounding at the hospital and the next day boom...he turned bitter. But those of us who have trudged through medical education know the fallacy of such arguments. Our profession struggles not with the ebb and flow of the current but rather with the depths of the ocean.
The process of becoming a physician is marked by the diminution of the stress response. We become so overwhelmed by intense, prolonged stimulation that the signals our patients send are no longer recognized as abnormal. We are habituated to pain, dulled to suffering, and downright unsympathetic at times. We have lost the ability to walk a moment in someonelse's shoes.
And in some ways, I truly believe that this is the pound of flesh that is extracted for the privilege of wearing the stethoscope. But this loss comes at a price. Physicians become depressed, leave the profession, or continue to practice on auto pilot.
***
One day, I woke up and realized that my brains are full of knowledge, my hands full of skill, and yet a small part of my soul is gone.
And sadly, it was that part that drove me to medicine,
that part that used to make me feel so special in the first place.
My anger quickly transformed into shame and guilt. Could I blame her for hoping to prolong the inevitable? Just as I couldn't see the world through her eyes, she couldn't step into my shoes. She had no idea the horrors that awaited her. She had not watched helplessly by the bedside as torture upon torture was practiced on a beloved patient. But I had, and it scarred me.
***
We talk of burnout as if it is a single event. One day the doctor was happily rounding at the hospital and the next day boom...he turned bitter. But those of us who have trudged through medical education know the fallacy of such arguments. Our profession struggles not with the ebb and flow of the current but rather with the depths of the ocean.
The process of becoming a physician is marked by the diminution of the stress response. We become so overwhelmed by intense, prolonged stimulation that the signals our patients send are no longer recognized as abnormal. We are habituated to pain, dulled to suffering, and downright unsympathetic at times. We have lost the ability to walk a moment in someonelse's shoes.
And in some ways, I truly believe that this is the pound of flesh that is extracted for the privilege of wearing the stethoscope. But this loss comes at a price. Physicians become depressed, leave the profession, or continue to practice on auto pilot.
***
One day, I woke up and realized that my brains are full of knowledge, my hands full of skill, and yet a small part of my soul is gone.
And sadly, it was that part that drove me to medicine,
that part that used to make me feel so special in the first place.
Sunday, July 1, 2012
A Post #TheWalkingGallery, @ReginaHolliday
We walk.
Sometimes we crawl.
Through surgery, chemotherapy, innattention, mistakes,
and the moans of our loved ones.
Bent over, we carry the load on our backs,
hunched, we cover the scars with cloth.
We walk.
Somwetimes we run.
Through hospital corridors and exam rooms.
We carry our patient's pain in our shoulders,
hidden underneath the lanky arms of lab coats.
We walk.
Sometimes we jump. Our heads held
high in advocacy. We blog, we tweet,
we shout. Until others cover their ears.
We walk.
Our bodies as poetry in motion.
We no longer carry our hearts on our sleeves.
We carry them on our backs.
We Are The Walking Gallery
Sometimes we crawl.
Through surgery, chemotherapy, innattention, mistakes,
and the moans of our loved ones.
Bent over, we carry the load on our backs,
hunched, we cover the scars with cloth.
We walk.
Somwetimes we run.
Through hospital corridors and exam rooms.
We carry our patient's pain in our shoulders,
hidden underneath the lanky arms of lab coats.
We walk.
Sometimes we jump. Our heads held
high in advocacy. We blog, we tweet,
we shout. Until others cover their ears.
We walk.
Our bodies as poetry in motion.
We no longer carry our hearts on our sleeves.
We carry them on our backs.
We Are The Walking Gallery
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