I usually think of it as a positive the sign. A patient is depressed, mourning, or just doing poorly. Then they show up on my schedule for a physical. It's the small efforts that start to change the tide: being sure to remember to brush the teeth in the morning, having that piece of fruit after lunch, going for an evening jog. When one pushes the body to do healthy things, the mind often follows albeit unwillingly.
And this doctor thing can be quite tricky. We strive to both create and break barriers. We must ensure a level of trust to allow our patients to divulge the sensitive parts. But we also maintain a certain amount of coldness, it is sometimes the art of being aloof that coaxes the truth from reticent lips. We draw them in and push them away.
Draw them in and push them away.
It's an artificially crafted dance that for the most part serves the profession well. The trick is to know when it's time to let go and stop being a doctor.
*
Johnny had no one. Years before, his girlfriend had convinced him to move to Chicago after graduate school. He packed his belongings and left his family and friends without much thought. He was in love. Their relationship went swimmingly, and during our last visit we discussed his wedding plans. The deal was sealed and the date was secured.
So it was with great surprise, that I watched Johnny amble into my office for his annual with his head hanging low. According to my calculations, his wedding should have taken place a few weeks ago. But it didn't, she left him at the altar. The wedding was cancelled. The engagement was called off.
Johnny was alone. His former fiancee had packed her belongings and left the apartment. His family was hundreds of miles away. Most of his Chicago friends were actually hers. He contemplated leaving his job and moving, but it was his one source of pleasure. He didn't have the strength.
We talked briefly, and I examined him. His body was listless. His eyes focused on the floor and he spoke in a monotone. A single tear fell from each eye. Although Johnny was only a decade younger than I, I felt like a father looking upon his wounded son. As I finished my notes, I stared at the screen and tried to think of a way to comfort him. I was at a loss.
Johnny and I both stood at the end of the appointment. All the sudden I knew what I had to do, although I felt self conscious and awkward. I ignored those feelings.
Looking him in the eye, I took a step closer. I put my head down.
Then I embraced him.
His body became tense and then relaxed. He wept. I'm not sure how long we stood in place. Eventually I handed him Kleenex and he walked out the office.
I saw Johnny again yesterday. Years later, he still lives in Chicago. At the end of our visit he showed me a picture of his newborn. He is married and happy.
*
As physicians we learn to use all our senses. We rely on our eyes and ears in addition to our minds. But sometimes human beings require something more primal in times of great need.
Like a great defibrillating shock,
the power of touch can also bring us back to life.
Thursday, August 30, 2012
Tuesday, August 28, 2012
Are You Trying Hard Enough?
I have had many mentors over the years. I learned from countless teachers: family, friends, and colleagues. But there has been one influence that has trumped all others.
I remember high school. When my mother remarried, we moved to a new district. My first day of classes, I knew no one. Shy by nature, I spent weeks in the lunch room eating by myself. Everyday I went to the gym and played basketball. It was on the court that I began to make my first friends.
I always loved basketball. I tried out for the team in middle school, but was never good enough to make the cut. The summer before freshman year, I hit the court every single day. I practiced my shots, dribbling, and overall endurance. I vowed that I would make the team.
As the summer months passed and I actually started school, I realized that this could be the key to making friends. If only I was successful, I would have an instant group to belong to.
It seemed like hundreds of kids showed up on the first day. The coaches put us through drills and then we scrimmaged. By the end of the first tryout, I thought I was doing pretty well. But as the days passed, I became anxious about the consequences. In every sense of the word, I choked. My jump shot fell short, my passes were off, and my dribbling was awkward.
I wasn't surprised, on the final practice, when the coach sat a few of us down to talk. I was cut on the last day. I was devastated.
Strangely, it is moments like these that I now look on with the most pride. I was beaten that day. I failed. It was one of a series of failures that plagued my childhood: academically, physically, and emotionally. It seemed that success was a distant shore that I could never quite swim to.
The funny thing about failure, however, is that it can either sink you or lift you up. It wasn't that my lack of success created a raging fire in my belly, it was quite opposite. I was so used to falling short, that the possibility no longer hindered me from trying. I started to think:
Why not give it a try? The worst that can happen is that I can fail. I've been there before and it's no big deal!
I never did play on the high school basketball team. But it was those early failures that provided the greatest opportunity to learn about myself and my abilities. As an adult, I now find success to be the norm. And the skills I learned as a child, are enormously helpful as a physician.
While disease and illness do not neatly lend themselves to such terms as success and failure, it is in those times when outcomes are most poor that I dig in and investigate even more thoroughly. Every mistake, incorrect calculation, or unexpected turn becomes a data point to improve on. There is no time to bury ones head in the sand, quality improvement must be continuous and real time.
If you want to know what makes a great physician, it is someone who learns from each and every misstep.
Have you failed at anything recently?
If not, maybe you're not trying hard enough.
I remember high school. When my mother remarried, we moved to a new district. My first day of classes, I knew no one. Shy by nature, I spent weeks in the lunch room eating by myself. Everyday I went to the gym and played basketball. It was on the court that I began to make my first friends.
I always loved basketball. I tried out for the team in middle school, but was never good enough to make the cut. The summer before freshman year, I hit the court every single day. I practiced my shots, dribbling, and overall endurance. I vowed that I would make the team.
As the summer months passed and I actually started school, I realized that this could be the key to making friends. If only I was successful, I would have an instant group to belong to.
It seemed like hundreds of kids showed up on the first day. The coaches put us through drills and then we scrimmaged. By the end of the first tryout, I thought I was doing pretty well. But as the days passed, I became anxious about the consequences. In every sense of the word, I choked. My jump shot fell short, my passes were off, and my dribbling was awkward.
I wasn't surprised, on the final practice, when the coach sat a few of us down to talk. I was cut on the last day. I was devastated.
Strangely, it is moments like these that I now look on with the most pride. I was beaten that day. I failed. It was one of a series of failures that plagued my childhood: academically, physically, and emotionally. It seemed that success was a distant shore that I could never quite swim to.
The funny thing about failure, however, is that it can either sink you or lift you up. It wasn't that my lack of success created a raging fire in my belly, it was quite opposite. I was so used to falling short, that the possibility no longer hindered me from trying. I started to think:
Why not give it a try? The worst that can happen is that I can fail. I've been there before and it's no big deal!
I never did play on the high school basketball team. But it was those early failures that provided the greatest opportunity to learn about myself and my abilities. As an adult, I now find success to be the norm. And the skills I learned as a child, are enormously helpful as a physician.
While disease and illness do not neatly lend themselves to such terms as success and failure, it is in those times when outcomes are most poor that I dig in and investigate even more thoroughly. Every mistake, incorrect calculation, or unexpected turn becomes a data point to improve on. There is no time to bury ones head in the sand, quality improvement must be continuous and real time.
If you want to know what makes a great physician, it is someone who learns from each and every misstep.
Have you failed at anything recently?
If not, maybe you're not trying hard enough.
Sunday, August 26, 2012
The O.K. Corral
I had already decided that I wasn't going to be a pediatrician. So my third year rotation ended on a high note. I was working in the cardiac care unit. Most of the admissions were short stays, teenagers with a history of congenital heart disease coming in for their annual cardiac catheterizations. They were healthy. They stayed for a few days of intensive testing, and then were discharged back to their normal lives. Occasionally we would take care of a sick kid, but the majority was routine.
My days were filled with conferences. I enjoyed the banter between the pediatric cardiothoracic surgeons and the interventional cardiologists. The room was alight with spirit and bravado. Later in the morning we rounded on the new admissions. Lastly, I would see our only frequent flier
Jeremy was a twelve year old with end stage congestive heart failure. From the outside, he looked like your average pre-teen. But if you watched him walk down the hall, you would notice his face turn blue and his respirations increase. He basically lived in the hospital. Waiting for a heart transplant, he was confined to the cardiac unit and tethered to his IV pole with life saving infusions continuously dripping into his veins.
No one knew exactly how long he had been confined. He often stood at the nursing station and chatted with young nurses and the secretary. He sometimes followed behind the medical students as one of the attendings gave an interesting lecture on the pathophysiology of disease.
He was a funny kid who was beloved by all. More than one staff member said a prayer each night while kneeling in front of their beds hoping he would receive the heart he so badly needed.
My last weekend on call, I arrived to the floor Saturday morning to find that Jeremy was gone. A poor family's tragedy became his possible triumph. The report from the OR was that they were sewing up his chest with a perfectly viable, beating heart.
Later that night I accompanied fellow doctors, secretaries, and nurses to visit him in the ICU. His angelic face was swollen, and his mouth was distorted by a breathing tube. But his vitals were stable. We all felt sure that he would make it through just fine.
I beamed with pride upon leaving the room. I was beginning the journey into the profound profession of medicine. I, like the brave cardiothoracic surgeon, would deliver life saving care. I would make people whole again.
Years later, I realize that such pride is very common in medical students. It's a time before reality sets in. A time before we willingly jump into the meat grinder that is our modern day health care system. It's spits us out rough, haggard, and much less idealistic. Many will say that it is the training process that beats the spirit out of us.
I think this view is much too simplistic.
How often are we wounded when a loved one or family member dies? How deep does the dagger cut? How long before the wound heals?
The problem with being a physician is that we are sliced and diced every single day. We fight so many battles that from the outset can never be won. We watch helplessly as death stakes it's claim, and try haplessly to deal with the remnants of destroyed life.
Over and over again. Year after year. We are marked by the tragedy that we witness. We carry the extra burden of culpability and responsibility. And we ruthlessly try to wash the blood from our own hands. Victories are transient and far in between.
And patients wonder why their doctor is distant. They wonder why in desperation they reach out to the stone cold figure that stands distractedly in front of them. They become angry, suspicious, and sometimes downright accusatory. The net effect is that the wounded doctor crawls further into his shell of protection. Facing an angry public and afraid of litigation, the isolation becomes greater.
Once again we are stuck with a doctor-patient relationship that is dysfunctional.
It's like we're both gunslingers at the O.K. Corral. As we stand with our guns pointed at each others chests, we realize the silliness. We need deep, meaningful communication so badly, we just don't know how. But in order to avert grave misfortune, one of us has to be brave enough to re holster his weapon first.
Can you see what I'm trying to do here?
I'm trying to lay down my gun.
My days were filled with conferences. I enjoyed the banter between the pediatric cardiothoracic surgeons and the interventional cardiologists. The room was alight with spirit and bravado. Later in the morning we rounded on the new admissions. Lastly, I would see our only frequent flier
Jeremy was a twelve year old with end stage congestive heart failure. From the outside, he looked like your average pre-teen. But if you watched him walk down the hall, you would notice his face turn blue and his respirations increase. He basically lived in the hospital. Waiting for a heart transplant, he was confined to the cardiac unit and tethered to his IV pole with life saving infusions continuously dripping into his veins.
No one knew exactly how long he had been confined. He often stood at the nursing station and chatted with young nurses and the secretary. He sometimes followed behind the medical students as one of the attendings gave an interesting lecture on the pathophysiology of disease.
He was a funny kid who was beloved by all. More than one staff member said a prayer each night while kneeling in front of their beds hoping he would receive the heart he so badly needed.
My last weekend on call, I arrived to the floor Saturday morning to find that Jeremy was gone. A poor family's tragedy became his possible triumph. The report from the OR was that they were sewing up his chest with a perfectly viable, beating heart.
Later that night I accompanied fellow doctors, secretaries, and nurses to visit him in the ICU. His angelic face was swollen, and his mouth was distorted by a breathing tube. But his vitals were stable. We all felt sure that he would make it through just fine.
I beamed with pride upon leaving the room. I was beginning the journey into the profound profession of medicine. I, like the brave cardiothoracic surgeon, would deliver life saving care. I would make people whole again.
Years later, I realize that such pride is very common in medical students. It's a time before reality sets in. A time before we willingly jump into the meat grinder that is our modern day health care system. It's spits us out rough, haggard, and much less idealistic. Many will say that it is the training process that beats the spirit out of us.
I think this view is much too simplistic.
How often are we wounded when a loved one or family member dies? How deep does the dagger cut? How long before the wound heals?
The problem with being a physician is that we are sliced and diced every single day. We fight so many battles that from the outset can never be won. We watch helplessly as death stakes it's claim, and try haplessly to deal with the remnants of destroyed life.
Over and over again. Year after year. We are marked by the tragedy that we witness. We carry the extra burden of culpability and responsibility. And we ruthlessly try to wash the blood from our own hands. Victories are transient and far in between.
And patients wonder why their doctor is distant. They wonder why in desperation they reach out to the stone cold figure that stands distractedly in front of them. They become angry, suspicious, and sometimes downright accusatory. The net effect is that the wounded doctor crawls further into his shell of protection. Facing an angry public and afraid of litigation, the isolation becomes greater.
Once again we are stuck with a doctor-patient relationship that is dysfunctional.
It's like we're both gunslingers at the O.K. Corral. As we stand with our guns pointed at each others chests, we realize the silliness. We need deep, meaningful communication so badly, we just don't know how. But in order to avert grave misfortune, one of us has to be brave enough to re holster his weapon first.
Can you see what I'm trying to do here?
I'm trying to lay down my gun.
Saturday, August 25, 2012
A Slippery Slope
Dr. Sisk shifted uncomfortably in his chair. He stared at the computer screen in front of him as he once again tried to plead with the elderly woman and her husband sitting quietly in the exam room. The treatment being offered was futile. The cancer had spread to too many organs. It was time to consider hospice.
The couple listened patiently but again expressed their wish to continue forward. If the oncologist was offering, they were taking. They weren't quitters after all. Dr. Sisk took another deep exasperated breath. He wiped the sweat from his forehead before speaking.
Well then, I'm going to have to ask you to find another doctor.
He looked down as he said the words. He couldn't bare to peer into the eyes of the grandmotherly figure sitting in front of him. But, he felt he had no choice. The chemotherapy cycle called for new injections every two weeks. No doubt, debilitated as she was, she would land in the hospital shortly thereafter.That would mean two admissions in less than the allowed thirty day period. He couldn't take the risk that medicare would refuse to pay him. The new rules had burned him countless times already She was too high risk.
The couple left the office dejected. Faced with the fight of their lives, the abandonment of their long time physician was just another hurdle in a series of impossible challenges.
Dr. Sisk returned to his office and pulled up the schedule. The next appointment was a new patient with congestive heart failure. He grabbed the phone and dialed his secretary.
Marge, this new guy with CHF, did you do a hospital check before accepting him.
He typed furiously at the hospital EMR as he waited for an answer. Just as he suspected! Three admissions in the last two months. Someone was trying to sneak this guy past him. He spit into the receiver before his secretary could respond.
Marge! You want us to go bankrupt? Get that guy off my schedule.
Don't you dare check him in!
The couple listened patiently but again expressed their wish to continue forward. If the oncologist was offering, they were taking. They weren't quitters after all. Dr. Sisk took another deep exasperated breath. He wiped the sweat from his forehead before speaking.
Well then, I'm going to have to ask you to find another doctor.
He looked down as he said the words. He couldn't bare to peer into the eyes of the grandmotherly figure sitting in front of him. But, he felt he had no choice. The chemotherapy cycle called for new injections every two weeks. No doubt, debilitated as she was, she would land in the hospital shortly thereafter.That would mean two admissions in less than the allowed thirty day period. He couldn't take the risk that medicare would refuse to pay him. The new rules had burned him countless times already She was too high risk.
The couple left the office dejected. Faced with the fight of their lives, the abandonment of their long time physician was just another hurdle in a series of impossible challenges.
Dr. Sisk returned to his office and pulled up the schedule. The next appointment was a new patient with congestive heart failure. He grabbed the phone and dialed his secretary.
Marge, this new guy with CHF, did you do a hospital check before accepting him.
He typed furiously at the hospital EMR as he waited for an answer. Just as he suspected! Three admissions in the last two months. Someone was trying to sneak this guy past him. He spit into the receiver before his secretary could respond.
Marge! You want us to go bankrupt? Get that guy off my schedule.
Don't you dare check him in!
Friday, August 24, 2012
Trial By Fire
I could feel her holding her breath as I continued the phone conversation with the oncologist. She sat in the floral upholstered chair next to the desk in my office. Her short white coat was a touch to clean to belong to a student entrenched in hospital warfare. A second year medical student with little clinical experience, she asked to shadow me a few days earlier.
Half way through my morning, we had only encountered the simple bread and butter issues: upper respiratory infections, blood pressure follow ups, etc. She followed dutifully from room to to room, writing notes in a small pad that she slipped gently into her front pocket from time to time before retrieving again as need be.
She was young. Inexperienced. Her exuberance was evident in her overly self conscious nature and her precise preoccupation with detail. I tried to be patient and kind. Remembering my own student days, I knew that a young persons field of study was often determined by the quality of their experiences and not the day to day content.
As I hung up the phone, I paused for the comment that I sensed waiting to burst forth from her lips. She spoke with surprising conviction.
That's why I want to be an Internist. Oncologists have to deal with death all the time!
Almost falling off my chair, I bit my lip so hard, I drew blood. I stood like a statue trying to mentally compose myself. There were so many things I wanted to say.
My dear child. Today you will walk in my shoes. You will wake at 4:30 AM and drive to the nursing home and pronounce the old man dead right in front of his wife and daughter. You will express your condolences and sorrow before you excuse yourself to round at the hospital. Your first patient will be a seventy year old with widely metastatic lung cancer who has finally agreed to hospice. Her time is limited. But so is yours, so you will rush to see the other patients and then return to your office for a few minutes of paperwork. The message on your desk to greet you will be a notice that a middle aged man you once took care of collapsed unexpectedly on vacation. The funeral will be over the weekend. It's is 7:30 AM and your first office visit will be arriving soon.
In the few short hours you've been awake, death has already consumed you.
But instead, I leave the soliloquy in the realm of my thoughts where it belongs. I look down at the computer screen and search for the next patient: a thirty five year old who is losing his battle with leukemia. I beckon her to follow. I needn't say a word.
Experience will be a far better teacher than I.
Half way through my morning, we had only encountered the simple bread and butter issues: upper respiratory infections, blood pressure follow ups, etc. She followed dutifully from room to to room, writing notes in a small pad that she slipped gently into her front pocket from time to time before retrieving again as need be.
She was young. Inexperienced. Her exuberance was evident in her overly self conscious nature and her precise preoccupation with detail. I tried to be patient and kind. Remembering my own student days, I knew that a young persons field of study was often determined by the quality of their experiences and not the day to day content.
As I hung up the phone, I paused for the comment that I sensed waiting to burst forth from her lips. She spoke with surprising conviction.
That's why I want to be an Internist. Oncologists have to deal with death all the time!
Almost falling off my chair, I bit my lip so hard, I drew blood. I stood like a statue trying to mentally compose myself. There were so many things I wanted to say.
My dear child. Today you will walk in my shoes. You will wake at 4:30 AM and drive to the nursing home and pronounce the old man dead right in front of his wife and daughter. You will express your condolences and sorrow before you excuse yourself to round at the hospital. Your first patient will be a seventy year old with widely metastatic lung cancer who has finally agreed to hospice. Her time is limited. But so is yours, so you will rush to see the other patients and then return to your office for a few minutes of paperwork. The message on your desk to greet you will be a notice that a middle aged man you once took care of collapsed unexpectedly on vacation. The funeral will be over the weekend. It's is 7:30 AM and your first office visit will be arriving soon.
In the few short hours you've been awake, death has already consumed you.
But instead, I leave the soliloquy in the realm of my thoughts where it belongs. I look down at the computer screen and search for the next patient: a thirty five year old who is losing his battle with leukemia. I beckon her to follow. I needn't say a word.
Experience will be a far better teacher than I.
Wednesday, August 22, 2012
The Rise And Fall Of Consequence
She hobbled into my exam room, pausing half way to lean on the walker and take a deep breath. A year to the day, we had placed her husband in hospice. He died shortly there after. Seven decades of marriage over in the shuddering of a heart beat. She now roamed the empty halls of her home. She kept active with cooking and cleaning, chasing after her adult grandchildren, and other assorted hobbies. It wasn't that she was unhappy, she was grieving.
The exam room was thick with the memory of what had been. They always came to their appointments together. I made pleasant conversation as we released ourselves to the puppeteer of familiarity. She lifted the back of her shirt without being asked and took deep breaths without cue.
We talked about her kids. Her face lit up and choked back the tears of sorrow. She was in her nineties. At the end of the appointment I discussed having her return in a few months. Her eyes sparkled as she answered.
If I'm still here!
I almost laughed in answer.
You probably will be.
The irony of being young.
We spend every moment trying to prolong the minutes, wishing to turn back the calender. But for her, minutes were hours, hours days, and days like millenia. She was counting the moments till returning to her beloved. And although their time apart will pale in comparison to the seventy some odd years together, she can't wait for it to be over.
And it made me think how small my thoughts and fears are: whether my next patient will be on time, if I do a good job and make a successful living, or if anyone reads this blog. The brain busies itself with countless worries that raise the blood pressure.
Maybe none of it matters.
Maybe we are all just specks, mere flecks in the vast universe, waiting for the next indifferent gust of wind to blow us asunder.
The exam room was thick with the memory of what had been. They always came to their appointments together. I made pleasant conversation as we released ourselves to the puppeteer of familiarity. She lifted the back of her shirt without being asked and took deep breaths without cue.
We talked about her kids. Her face lit up and choked back the tears of sorrow. She was in her nineties. At the end of the appointment I discussed having her return in a few months. Her eyes sparkled as she answered.
If I'm still here!
I almost laughed in answer.
You probably will be.
The irony of being young.
We spend every moment trying to prolong the minutes, wishing to turn back the calender. But for her, minutes were hours, hours days, and days like millenia. She was counting the moments till returning to her beloved. And although their time apart will pale in comparison to the seventy some odd years together, she can't wait for it to be over.
And it made me think how small my thoughts and fears are: whether my next patient will be on time, if I do a good job and make a successful living, or if anyone reads this blog. The brain busies itself with countless worries that raise the blood pressure.
Maybe none of it matters.
Maybe we are all just specks, mere flecks in the vast universe, waiting for the next indifferent gust of wind to blow us asunder.
Tuesday, August 21, 2012
Skin In The Game
Ricky and I were the same age. We both were struggling with the ins and outs of new parenthood. I had a boy, he a girl. Yet my gray coat hid the mildly protuberant abdomen, while his belly bulged into his t-shirt and formed a barrier between us. He was at least a hundred pounds over weight. And I, as his physician, wasn't going to pas up the opportunity to counsel on healthy living.
Once a year, Ricky waltzed into my office for his annual. Over time, I had noticed how his height stayed the same, but his weight kept growing. He now fell into the category of morbidly obese. I breached the subject of diets. He preferred Atkins, I preferred Weight Watchers. We discussed different methods of keeping active. I suggested family walks with the little one in a stroller.
As the conversation progressed, I couldn't help but feel a dysphoric twinge in the pit of my stomach. I shifted my weight in the chair. My size thirty six pants were starting to get a little too tight. I absentmindedly wiped the edges of my mouth in order to make sure no remnants of the fast food I ate for lunch were left in plain view.
I was a hypocrite. My girth had ballooned since medical school. My eating habits were poor, and I lived a sedentary lifestyle. Why ever should Ricky listen to me? I decided to try a different angle. I cleared my throat before speaking.
You know what? I could do this better too. Why don't we work together?
We put our heads down, and a few minutes later had a plan that we could live by. Ricky would join Weight Watchers and swim three times a week, and I would cut out the fast food and walk every day. The office visit ended with a sense of camaraderie and shared mission.
*
My son will turn eight in October. I have no idea what came of Ricky. The last time I saw him, he had lost over seventy five pounds. His blood pressure was better, and he stopped all his diabetes medications. I lost track of him after he moved to another city.
And me? I dropped twenty pounds and now sport a comfortable size thirty two waist. I walk everyday.
Ricky taught me so much about the practice of medicine without even knowing it. I now know that to talk the talk, you have to walk the walk.
More importantly, over the years I've learned one essential truth. For this doctor-patient relationship thing to work,
we have to all be in it together.
Once a year, Ricky waltzed into my office for his annual. Over time, I had noticed how his height stayed the same, but his weight kept growing. He now fell into the category of morbidly obese. I breached the subject of diets. He preferred Atkins, I preferred Weight Watchers. We discussed different methods of keeping active. I suggested family walks with the little one in a stroller.
As the conversation progressed, I couldn't help but feel a dysphoric twinge in the pit of my stomach. I shifted my weight in the chair. My size thirty six pants were starting to get a little too tight. I absentmindedly wiped the edges of my mouth in order to make sure no remnants of the fast food I ate for lunch were left in plain view.
I was a hypocrite. My girth had ballooned since medical school. My eating habits were poor, and I lived a sedentary lifestyle. Why ever should Ricky listen to me? I decided to try a different angle. I cleared my throat before speaking.
You know what? I could do this better too. Why don't we work together?
We put our heads down, and a few minutes later had a plan that we could live by. Ricky would join Weight Watchers and swim three times a week, and I would cut out the fast food and walk every day. The office visit ended with a sense of camaraderie and shared mission.
*
My son will turn eight in October. I have no idea what came of Ricky. The last time I saw him, he had lost over seventy five pounds. His blood pressure was better, and he stopped all his diabetes medications. I lost track of him after he moved to another city.
And me? I dropped twenty pounds and now sport a comfortable size thirty two waist. I walk everyday.
Ricky taught me so much about the practice of medicine without even knowing it. I now know that to talk the talk, you have to walk the walk.
More importantly, over the years I've learned one essential truth. For this doctor-patient relationship thing to work,
we have to all be in it together.
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