Be The Protagonist

I have said many times that we tell the stories about our own lives that make it bearable, or better yet magical, mystical.  I often use the death of my father as an example.  I was eight years old when he passed away.  Instead of embracing his premature demise as the greatest tragedy of my life, I credit this misfortune with my decision to pursue a career in medicine, and hopefully touch countless lives.  Reframing of my childhood has allowed me to feel like I grew up privileged.  Even lucky.

It has occurred to me recently that such story telling does not only have to be reserved for interpreting the past.  In fact, it is the present, and even the future that could also use a certain recalibration of lens.

I think that we, as human beings, struggle with happiness from day to day.  We bounce from stress to joy to tragedy.  We slog through our jobs, relationships, and financial issues and think little about how  our own thoughts lead to even greater distress.

I have decided to try to take a different path, and become the protagonist.

When facing the hardships of life, I am going to reframe my vantage point.  Like any good book or movie, most conflict can be distilled down (or blown up) into a battle between good and evil, right and wrong.

When you envision yourself the protagonist of this epic battle, you automatically view yourself in a different light.  For instance, the protagonist, from the outset, is innately good and virtuous.  It is the nature of the role even before any action takes place.

Furthermore, when you take on this persona, you hold yourself and your actions to a higher ethical standard.

No matter the outcome, win or lose, there is a certain glory in being the protagonist.  Success, against the odds, is expected.  And failure, even at it's worst, is filled with honor and humility.    

The role of protagonist could embody our best and most virtuous intentions.

 

Building

I have been thinking a lot lately about a dream I had as a first year medical student.

My father is standing besides my brothers.  We’re all building.  Putting the pieces together.  But I’m stuck and no longer making progress.  My mom stands besides me oblivious to my turmoil.


Does she know what I’m thinking?  This must be a dream because we are grown up now, and dad died when I was eight years old.


Although everyone’s building, I can’t.  I watch the way my father moves.  Somehow, I know this will be my last chance to see him again.  I’m afraid because over the decades his memory has faded so much.


But here he is in front of me.  I try to distill his essence, but it hurts.  I start to shake and bend over in pain.  I weep.


Mom turns to me and glares.  She’s the only one that notices.

”Tell him, tell him!” she urges and then turns away.

I crouch besides my dad while he continues to build.  I whisper softly in his ear.


”I will miss you dearly when you are gone”

These are words an eight year old never knew how to say.  But now, now I know


He turns around and smiles  He then holds me.


”I love you” he says

But I am too overwhelmed to speak.  Which really doesn’t matter.  He understands.


I hear voices, spirits, coming to take him away.  He holds my mom’s hand and she walks him to the door.  My brothers and I continue building.  But now we are joined by my wife and kids.

We continue building our lives.

As we work, I tell them we have to stick together .  We have to talk to each other.  My son and daughter look up inquisitively and ask me if I am okay.  I'm not a twenty two year old medical student anymore more but a forty two year old husband and father.  Yet with complete certainty, I answer the same way.

No.  No.  I am not okay.

I take a deep breath.  Put my head down.  Start all over.

And begin to build again.

For The Most Part, We Get It Right.

I have two refrigerators.

The full size, expensive version, sits in the usual location in the kitchen.  The small black one rests idly in the basement.  Excluding this morning, of course, when I dragged it up the steps and begrudgingly coaxed it back into action.  Let me explain.

Six months ago my old refrigerator started acting up.  Somewhere around year five, it’s motors groaned, its coolers moaned, and all the sudden the food started to smell.  So I called the repairman and hundreds of dollars later, it worked like a dream.

Until it didn’t.

The repairs held for all of a week.  I called the repairman back.  And we danced this dance a few more times.  In the meantime, I ran out to the local appliance store and bought a mini fridge to store my food.

I lived out of that little black fridge for weeks while workmen came and went.  Every time one problem was fixed, another popped up.  Eventually I bit the bullet, returned to the appliance store and brought a brand new, state of the art, full sized refrigerator to replace the old.

I happily returned the black fridge to the basement and thought little about it again.  For six months my new appliance worked exactly the way it should.  The ice bucket was always full.  Each zone maintained the correct temperature.  I had separate drawers for the fruits, vegetables, and dairy.

I thought I was truly on the pathway to appliance nirvana when the unexpected happened.  I awoke one morning to fine a horrible sound coming from my brand new refrigerator.  Hours later it was dead.  My ice cream melted and my vegetables wilted.

I called a different repairmen who showed up promptly, and fixed the problem in short order.  Money well spent, or so I thought, until the same exact scenario played itself out forty-eight hours later.  

Another trip to the basement, and the little black refrigerator has once again taken up residence in my kitchen.

This experience is nothing new.  I can’t count how many times a television has broken, an Ipad has malfunctioned, or a dishwasher latch has busted.  Each time I dutifully call an expert who sometimes gets the job done.  But often the repair  unravels or the machine is deemed DOA and unable to be fixed. 

This often makes me wonder why we expect so much out of our doctors.  The human body is far more complex than any electronic.  The number of moving parts measures in the millions.  And god knows how personal psychology plays into the range of pathology.

And for the most part, us doctors, get it right.  Eighty to ninety percent of the time.  Day after day, year after year.

I wish I could get this kind of service with my appliances.

Empathy: Are We Asking For Too Much?

As my daughter approached the stage toting her miniature violin, I could feel a flutter in my chest.  My palms were sweaty and my feet started to tremble.  I hesitated while she played the first note.  My heart soared with each rhythmic movement of her bow.  I caught my breath when she reached the most difficult portion, and exhaled calmly as she nailed it.  At the end, I elatedly stood and clapped with the rest of the crowd.

I have learned just about everything I know about empathy by being a husband and father.  In no other relationship have I so acutely felt the joys and pains of another person.  Triumph, despair, guilt, surprise.  Each emotion transcending the flesh and glomming on to those in closest proximity.

But empathy, like parenting, is hard.  You have little say over what befalls your children from day to day, yet feel each painful barb.  The loss of control can be maddening for those practiced in manipulating their surroundings.  You wear your heart on your sleeve unprotected.  I suspect this is one of the main reasons many decide not to procreate.

So I find it rather ironic that we stress empathy as a character trait to idealize in our physicians.  Few among us have the emotional fortitude to process such tumultuous emotions on a grand scale.  I dare say the majority of human beings would be paralyzed by the difficult and frequently overwhelming nature of illness.  Everyday.  With every patient.  All the time.

Empathy is an act of selflessness given as a gift to those we love most.

I think it is time to ask our doctors for what they are capable of.

Kindness, patience, humility.

And occasionally.  Very occasionally.

Empathy.

Gotcha

It was a little game we played.

My shoes squeaked quietly down the hallway of the nursing home as I approached her room.  I knocked gently trying to avoid any particular rhythm or dissonance.

Go away!

Her voice was at once stern, and then followed by peels of laughter.  She only saved such greetings for me.  And I tried to trip her up.  I varied my visits by time and pattern.  Sometimes I knocked, and others I would call out in a distorted voice.  She always knew.

She was recovering quickly and would be discharged soon.

The rest of my visits that day were not as positive.  The gentleman next door was concerned with service issues.  He decried the quality of the food, and demanded a faster response to his call light.  I didn't have the heart to explain that as the physician, I had little control over these issues.

The woman on the floor above was dying a slow, uncivilized death due to Alzheimer's.  I huddled with her family, and discussed the gruesome details.  Her body was fading away much in the same way as her mind.  She lost every ounce of extra weight.  Her voice had diminished to a nonsensical whisper.  She was no longer capable of making the difficult decisions that were left to her befuddled family.  They signed the necessary paperwork with both hope and sadness.  Hope that the end would ultimately be dignified, and sadness that her time was indeed near.

Cancer is an ugly term.  But it was chemotherapy that sickened the young man at the end of the hall.  He spent a week in the nursing home between hospitalizations.  His family couldn't manage the vomiting and intravenous fluids.  He peered through the window at the first ray of sunlight on a cold winter's day.  He didn't feel much like talking.

I left the facility two hours after stepping foot into the front atrium.  I felt as if I had already been working a full day.  But there was a certain lightness nonetheless.

Because just before leaving, I crept up to her door, knocked yet one more time, and waited gleefully.

Come in.

I paused for a moment and then joyously replied.

Gotcha.

I could hear her laughter echo past me and through the hallway as I exited the building.  

Just Be

It all started with the tip of my tongue.  Really.  I was chewing on dark chocolate chocolate chips with a vigor that was maybe a touch inappropriate for such a snack.  I bit down firmly and felt immediate pain sear through my mouth where the tooth overzealously punctured the soft tissue.

I bit my tongue.

Which wouldn't have seemed so calamitous if it had not been one of many bodily malfunctions that had recently befallen me.  A growth the size of a marble called a chalazion has grown under my eye lid.  My hairline continues to recede.  All of the sudden, out of nowhere, I have acne far surpassing that which befuddled me as a teenager.

My joints hurt every time I exercise.  My ankle now makes a clicking noise while jogging.  The connective tissue holding my abdomen in place has started to falter.

Time is passing.  I am getting older.  Yet my mind has thankfully lagged behind my body.  I wake up each morning feeling like a much younger man.  There are a thousand tasks to be performed, a thousand opportunities, and I chase after each one of them.  Enthralled by the possibilities, I rarely stop running until the day is over and I collapse into bed.  Six hours later the alarm sounds, and it starts again.

This makes me happy.

For the most part.  The problem that comes with an awareness of the possibilities is the realization that time is finite.  There are projects that I will never finish.  Relationships that will never be rekindled.  The past is gone and the future diminishes even as these precious moments pass.

And just when I seem to have gotten myself into lather, I feel a soft tugging on my shirtsleeve.  I peer down into my daughter's soulful brown eyes.

Dad, dad, you're spacing out again.

My son is dancing a silent jig on the other side of me, listening to music that only he can hear.

They both need me so much right now.

Maybe it's time to give up on all this thinking.

And just be.

Insults

It hit me today while on hold with an insurance company to get a preauthorization.  The call took thirty minutes.  The medication was denied.  And I knew that I was going to get an earful from the patient when I delivered the bad news.  As I dialed the phone number, a disturbing and yet all to familiar feeling overtook me.

Helplessness, powerlessness, impotence.

I struggle with these feelings daily.  In the beginning of my career, they were spurred by the complexity of disease, the willfulness of bad luck.  Battling the human condition was a long, difficult slog fraught with trap doors and missteps.  Many patients improved, but others suffered.  And I often suffered with them.

Years of practice brought a hard earned humility, the wisdom of acceptance.  I learned to rejoice when interventions were beneficial, and comfort when a kind heart was all I had to offer.  I felt great peace in this middle ground.

These were the battle scars that I carried proudly.  My wariness was never a sign of failure, it was the toughness and patience developed by the skilled art of warfare.   I wore my badge proudly.

Yet these feelings have returned, even more powerful than before.

My enemy, however, is no longer the thoughtful, wily adversary of the past.  Instead of the foibles of humanity, I am hereangued with a litany of administrative tasks with no trace of nobility.  Preauthorizations, face to face, peer to peer, meaningful use, ICD, CPT.  The list goes on.

A long line of administrators, insurance employees, and government workers await my attention.  They tell me that my care plans are incorrect.  Improbable.  Not covered.  Out of the question.

And as my blood pressure rises and my temperature boils, I see no silver lining.  No lesson learned.  

I always expected that I would be bludgeoned by the awe-inspiring task of practicing medicine.

Not broken by a thousand, tiny, thoughtless insults.