The Big Chair

I miss when you both were little. The three of us with room to spare in the big chair.  That precious time before you would sleep, wearing soft PJ’s dotted in animal shapes. I preferred the ones without “footsies”, so I could feel those small, cold feet brush against my legs as you both wiggled and wriggled. We all stretched out in that oversized chair; your bodies lay against mine in the evening hours. Your skin smelled so sweet, like innocence. You were so small, I guess in the same way I must have been so tall. Giggles and laughs. I wanted to sleep. You wanted to play. You both insisted on reading again and again. Silly words, silly times. I needed to rest my eyes. Eventually words became mumbled, vision became blurred. Finally, we all succumbed to sleep.

I watched you play and practice. On baseball and softball fields. In the swimming pool or dance studio. Racing through to the end of my work day with an invisible clock in the back of my head, always present. Always ticking. Counting down the time left to get a glimpse. A chance to see you swing or pitch. Flying starts off the block and into the pool, or an aerial that tooky our feet off the ground and upside down.

We ate pancake breakfasts at home. Hands and mouths sticky from syrup with bits of melted chocolate chip on your lips. Or Saturday morning trips into town to Georgie V’s or Egg Harbor, with the promise of an endless cup of black coffee for me and a soon-to-be spilled hot chocolate for you.  We laughed and giggled. Drew pictures on paper placemats with blunt tipped crayons. Played with words. Spelling them, putting them in haikus or rearranging their letters. There were no iPhones to distract.

When I write these words now, I stop and pause. I lose track of time. I leave the present and go back to the past. The time between then and now keeps getting longer, marching on in unrelenting fashion. Just like the two of you. You grow. In age. In height. In independence. In defining yourselves.

That oversized chair is gone. One of your rooms empty for over a year. The other soon to be. Those too infrequent times when you both are home, sleep usually lasts through breakfast and well beyond. My time outside the hospital is no longer spent racing to watch you participate in life, but waiting for you both to share with me what it has become. I check my IPhone, hoping to catch a static glimpse of dynamic moments in your life. Through Instagram, snapchat or a text.

My perception of self is that I am still youthful and young.In body and soul. Until I wake up in the morning with pain in my back and knee. Or I see the gray in my hair and the lines on the face that looks back at me in the mirror. But most of all, I feel an ache in my core, over the passage of time when I think back to those days. The big chair. Chocolate chip pancakes.Running out a grounder on a dry, dusty field.

The ache turns to loss. And when loss turns to angst, I want to cling to you both. Grab you. Weave my world even more with yours. But that is selfish, thinking I can slow the pace of change by not letting you freely move forward in this world. I know that it is now time for both of you to begin creating your own. That chair has become too small for us all.

A Thanksgiving 2000 Miles Apart

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For me, holidays such as Thanksgiving, evoke memories more than emotions. Reflection on traditions more than generating a visceral response. The ritual of a 4am wake up alarm followed by a moonlit drive on barren roads to an empty hospital parking lot has been repeated multiple times over the last few years. Racing through the workday, fueled by bitter black hospital coffee, in order to get home in time for dinner with extended family. Binging on turkey and stuffing before passing out on the couch. These are my core Thanksgiving memories. The demands of the hospital and a plateful of side dishes have overshadowed emotion and family connection.

2017 turned many things on their head. My family’s trajectory, as a whole and as individuals, abruptly changed. Among many things I have taken for granted over the years was my family’s ability to be under a single roof for Thanksgiving and other big holidays. Last year challenged that presumption. Through somewhat Herculean efforts, Becky, Maya and I were able to travel to Oregon so we could share the day with Madison. And it was there that emotions became front and center while the traditional meal faded into background noise.  The four of us dealt with emotions of a family separated but temporarily reunited, appreciating a little more the connection we share with each other.

Pages on the calendar have turned and this year’s turkey day appeared on the horizon. We assumed another reunion, this time home in Illinois. But neither Madison’s nor my schedule allowed us to travel. And with that came a growing realization that for the first time, our family was not going to celebrate together.

Families, both as a collective group and as individuals, handle stress in different ways. A few weeks ago, each of us as individuals struggled with our own unique uncertain futures. We are all at the moment working on creating and finding new paths. Each of us hope soon to be able to stride confidently down the road of our own making and choosing. But as a connected family, our struggles affect each other. Our individual orbits are not without their gravitational pulls. They may be invisible, but they are impactful on each other nonetheless. But we continue forward coping in the best way possible.

We settled upon a least worst option. Becky would fly to Oregon and share the day with Madison. Maya, with a friend visiting from out of town, would stay home. I would navigate a turkey day squeezed between two busy shifts at the hospital. Not a solution, but a response to a problem that stretched, twisted and turned all our emotions, straining our invisible bands of connection.

Separate and in silence we absorbed this.  There was no specific conversation or group discussion on our family text chain. But internally I felt isolated. Disconnected. The emotional equilibrium I struggle to maintain felt off. Our orbits disparate. Our family separated by more than the geography of 2000 miles. With no other options and out of necessity, I put one in front of the other. Outwardly moving forward. Inside, my heart ached.

Change can be triggered by events big and small. Transformation can come from within or due to outside forces. And sometimes the most trivial of events can reveal what is already present.

My daughter’s friend from out of town was no longer able to travel and visit.

Almost immediately, simultaneous texts occur. One sibling offering to pay the airfare for the other. One sibling laments that they are now not able to visit.

And the emotional disequilibrium shifts.

From separate to shared. From fractured to connected.

Again, despite the gravitational pulls that affect each individual member of my family, there is more that binds us together than pulls us apart. The power of family continues to trump individual struggles and crisis. Strain and stress may hurt our family, but like fractured bone, we remodel and mold our connection into something even stronger than before.

Our family of four will not physically be in the same place this Thanksgiving.  But for the moment, we are together in this shared space of emotional connection.

So, turkey will be eaten. Gluten free stuffing will be enjoyed. Crumbs will be the only evidence left of  pumpkin pie. But the meal, no longer center stage, will be relegated to its appropriate minor supporting role as my family moves forward on our collective and individual journeys. And despite being the one left here in the Midwest, when I look back and remember this thanksgiving, it won’t be about us being apart. But it will be of the invisible emotional threads, that despite the tension and distance of 2000 miles, continue to bind and hold this family together.  And for that, my heart aches, but now full of thanks.

Happy Thanksgiving to my family, friends and to those whose journey at least briefly brought you here to Balance.

Jeremy

A Chasm too Wide to Bridge

chasm

This piece recently was published at Doximity’s Op-(m)ed.  I worked on this essay for quite a while for publication elsewhere. It does touch on many of the same themes I have already written about on this blog.  In that sense, it is not particularly revealing of novel, but it is put together in an original way.  I will continue to try and bring to BALANCE original thoughts, meandering and stories to you all. 

Best,

JT

In high school, I was more comfortable in the pool playing water polo than studying in a classroom. I struggled in math and science, so it was no surprise that medical school was nowhere on my radar. But near the end of my liberal arts education and collegiate water polo playing days, I decided to challenge myself as a student. I took first semester chemistry during the second semester of my senior year, and a spark was lit. Objective questions, with demonstratively right or wrong answers, were a better fit for me than the subjective political science essays I had been writing. After graduation, I enrolled in a post-bac program to complete the premed science requirements. By day, I tackled three-dimensional carbon models. By night, I waited tables at Chili’s. Once I was accepted into medical school, any doubts about my path were silenced by my wide-eyed fascination with the physiology of the human body. What makes the heart contract in a rhythmic and synchronized fashion? How do the lungs extract oxygen from air and transport it into the bloodstream? What consequences arise when these organs are injured or fail? That spark had turned into a flame.

I trained to become board certified in both internal medicine and pediatrics, eventually finding my true calling in the sub-specialty of pulmonary and critical care. I was intrigued by the skill set of the intensivist, filtering hundreds of data points to make quick, high-stake decisions, while needing a steady, proficient hand to perform procedures on the critically ill. The technical aspects of critical care drew me in. And when I widened my focus beyond the treatment of diseased organs and abnormal lab values, I was able to connect and communicate more meaningfully with patients and their families. I had found my calling.

Physicians can dispense difficult information in an accurate, efficient and sterile manner. Or they can engage with grieving families by sharing time, space and vulnerability in an anxiety-filled room. Even when discussing a brutal diagnosis or grave prognosis, there are opportunities for intimate and authentic connections full of compassion, humility and grace. My most meaningful memories are not white-knuckled life and death decisions. They are the quiet moments spent with patients and families, sharing their hopes, grief and fear.

After thirteen years in practice, I should be in the sweet spot of medicine; not too far from training to be out of step with the best practices in my specialty, but with plenty of experience and wisdom to offer in the care of my patients. I should be moving into leadership positions left open by retiring senior physicians and mentoring the next generation of wide-eyed future medical doctors. Instead, a year ago I cut back to part-time. Like many others in my profession, I am struggling to find the fuel to keep my flame bright.

Social media is packed with essays listing the “top ten reasons for burnout” or “five traits of happy doctors.” Position papers from medical societies and leading journals detail ideas for its prevention and academic centers are forming committees to promote physician wellness. Throughout this cacophony, if you listen closely, there is a common chord formed by the many disparate notes.

Physicians dedicate and sacrifice their twenties and early thirties developing a unique vision of how they will bring their experience, knowledge and compassion to their patients. Although that rarely translates perfectly in the real world, for many doctors the gap between the vision of what could be and what is has become a chasm so wide that it feels impossible to bridge. The doctors we aspire to be become the exception, rather than the rule.

After twelve years of practicing medicine, the divide between my ideal day and my reality was measurably fractured. Shifting gears between critically ill patients in the ICU, with impromptu and emergent family meetings, was emotionally exhausting. Ongoing trends to staff leaner ICUs stretched care teams too thin to care for the higher volume and acuity of the ICU population. Today’s shorter hospital stays generate outpatients with active medical problems and unresolved social issues for which my office is ill equipped. My thirty-minute lunch break morphed into an hour of phone calls and paperwork, with time spent battling insurance companies to authorize treatments and prescriptions. Electronic medical records (EMRs) that can be accessed from my laptop destroyed the barriers that once kept me from bringing work home. Four years of a frivolous lawsuit consumed my free time. I spent hours reading depositions and reviewing old charts, only to be dropped the day before taking the stand. Through it all, I struggled to prioritize the growing complexity of my family.

My ability to maintain the status quo crumbled. Multiple rounds of snoozing replaced early morning exercise. Interactions with my partners felt less collegial. Evaluations from medical students were no longer filled with high marks and positive comments, and eventually nurses and new residents stopped looking forward to my time on service. Worst of all, morning rounds in the ICU became technical and checklist oriented, instead of patient centered, as my capacity to recognize opportunities for deeper connections with patients and families deteriorated.

Naively, I clung to the idea that simple, transient problems were to blame. Maybe it was fatigue, the terrible stress of the lawsuit, a crazy flu season or being short staffed. If I could just push through to my vacation week, I could recharge. I wanted there to be a reason. A fixable external problem. But ultimately, I had to look at myself. I needed to make a change.

I am lucky that the other physicians in my practice are friends as well as business partners. They were genuinely concerned about the changes in my behavior. But they were also frustrated, because my situation negatively impacted their work environment. Ultimately, after twelve years, I gave up my partnership and cut back to twenty-three weeks a year. I take the same amount of call and weekend coverage as the rest of my group, but now have twenty-nine weeks away from the hospital instead of six.  Although we are still friends, my choices caused some challenges within the practice. I upset the balance of our group dynamic that had been based on an equally shared workload. In decreasing my own burden, I obligatorily increased theirs.

Initially, my patients were confused, worried I was abandoning them. A few transitioned to other doctors in my group. But most have been surprisingly enthusiastic and supportive of my decision. During visits, they ask what I have been doing with my time, if I have written anything new and how my family is doing.

My children, ages seventeen and twenty, enjoy their dad being more physically and emotionally present. As a forty-seven-year-old, I now have the unique opportunity to connect with them in new ways. I am a fellow student, heading back to school to earn a master’s degree at Johns Hopkins Bloomberg School of Public Health. My son and I play on the same master’s water polo team and I am coaching at my daughter’s high school. She likes having me there, but would prefer her friends not know what her dad looks like wearing a speedo.

My wife had a front row seat with a clear view as the intensity, passion and joy I once brought to work slowly eroded away. She encouraged me to make big changes, despite the impact they would have on our family’s financial security and the uncertainty they would inject into our lives. Paradoxically, she feels enormous guilt about not earning a paycheck since she stopped teaching twenty years ago, but is unwavering in her support of my choices to coach the high school water polo team, write for my blog, train for triathlons and go back to school. She has allowed me to pursue other sparks in my life.

As for myself, when I look back on this past year, it is obvious how much a change was needed. At the hospital, I am no longer disappointed in my rounds and am again connecting with patients, families, residents and students. I have regained the sense of satisfaction and purpose that I had lost. My weeks away from the ICU allow me to pursue my interests in writing and coaching, as well as being more present for my family. What started as a leap of faith onto an unfamiliar and undefined path has evolved. I am no longer simply taking a tentative step away from medicine to create much needed physical and emotional space. I am now striding towards a future that gains clarity with each new day. I know I am getting closer to that ideal day of mine. And I am comfortable knowing that many of them will not involve having a stethoscope around my neck.

Guest Post by Monisha Vasa: Red Lipstick and the Quest for Perfection

I am excited to bring another guest post to Balance, written by Doctor Monisha Vasa! Monisha is a psychiatrist, mother and writer, currently living in Orange County, California, but has strong ties to Chicago growing up in the southwest suburbs. I have had the opportunity to read through much of her writings and poetry on her website and appreciate the emotional honesty of her voice as she shares her own journey.

There were a quite a few posts that I could relate with. When I shared with Monisha the three or four I was thinking about using, she told me one of them was a favorite.  I find her words captures my thoughts as well…

“Taking small and big detours and not knowing and figuring it out as we go isn’t necessarily the life plan…But that is the truth of how we all unfold.  That is how we all grow towards whatever light we are each uniquely designed to find.  Whether we like it or not, and whether we share it or not, that is the reality of how most of us navigate our days”

RED LIPSTICK AND THE QUEST FOR PERFECTION

by Monisha Vasa

 

“You awake? :)))”

“Yes!”

“Do you have the energy for me to unload some of my crazy on you? :)))”

“Yes!”

And so our text exchange began, the type of long drawn out texting that unfolds late at night, when there is so much to release, and kids’ perky ears still awake and within earshot.  The types of text conversations that you can only have with dear friends who will respond to the 11 pm pings and whistles, happily and without hesitation.

On this particular night, my neurosis was indeed just that–neurosis.  I went on to share a certain pressure that I had been feeling.  A few blog posts ago, I had received some wonderful feedback about how my words had been especially meaningful to one of my readers.  I was so touched that they had found some wisdom in what I had written, and that, in a sense, my words had helped them.

After all, that is why I write.

But since then, I found myself chasing the high, if you will.  Trying to “knock it out of the ballpark” with another sage post.  Trying to say something important and unique and memorable.

To make matters worse, what wanted to be written lately was poetry, an art form that was entirely new to me.  I don’t know how to write poems.  In fact I know nothing at all about poetry.  But I love the chance to play and stretch and yes, suck at it too.  I love the vulnerability of expressing myself in an unfamiliar way.

What I didn’t love was the feeling of somehow falling short of my readers’ expectations.  What if my poems were not as meaningful as my other blog posts?  Where was the wisdom?  Was I disappointing my supporters?  In my poetry-playing, was I somehow depriving my readers of something they had come to look forward to, a post to learn from every week?

If you want to kill your creative spirit (and over-inflate your ego), try engaging in an entirely self imposed pressure to write a perfect, life altering, mind blowing blog post every week.

My phone lit up:  “Why are you doubting yourself and your work?  Your readers don’t want perfect. If anything, your readers want more of YOU.”

And yet another ding:  “You are putting too much pressure on yourself.  Remember why you started your blog.  For your children to read one day.  Remember them.  Remember your intention.”

Yes.  Thank you dear friend.

My intention from the beginning was to be real, true, and most of all myself, as I show up on the page.  I don’t want to be perfect.  I don’t want to save anybody.  My readers don’t need my “help.”

My readers need my honesty and transparency and my humanity most of all.  They need to feel my love, one shaky, uncertain word at a time.  The last thing they need is shiny wisdom, which inadvertently has left us all feeling inadequate and needy at one time or another.

We were texting about my blog, but as always, it was a reminder that writing mirrors life and vice versa.  My desire to get it “just right” has often paralyzed me from taking risks big and small.  I didn’t go for the English major because it wasn’t part of the pre-med plan.  I struggle with letting my kids be free to have a do-nothing summer because I fear a blank college application.  I wanted to take a couple of years off to travel but never found the right time or opportunity.

I don’t wear the red lipstick because I simply don’t trust that I can pull it off.

Letting it all hang out while we seek and screw up and struggle for answers in the dark isn’t how it’s supposed to go.  Taking small and big detours and not knowing and figuring it out as we go isn’t necessarily the life plan.  The unfortunate lipstick choices and dead ends aren’t the parts we are comfortable showing to the world.

But that is the truth of how we all unfold.  That is how we all grow towards whatever light we are each uniquely designed to find.  Whether we like it or not, and whether we share it or not, that is the reality of how most of us navigate our days.

I am grateful for the mid-night soothing of my (entirely unrealistic) anxiety to change the world one blog post at a time.  Because in some ways, we actually all need to be a little less perfect.  What if we could simply show up as we are, and share our stories as a way to let ourselves out and let others in? What if these words represented what we most long for–a relationship between you and me?

So today and in the week ahead, I invite you to join me in noticing where you might be imposing perfection upon yourself.  How does perfection paralyze you?  Are there small ways for you to show up just as you are?

With gratitude, Monisha