What Would You Do For Love?

What Would You Do For Love?

jtopin

What would you do for love?

That question is often posed during the dizzying intoxication of a new relationship. Answered in romantic comedies by driving cross country or hopping on some transcontinental flight, chasing down one’s true soulmate. It might mean moving to another state, postponing your career or donating an organ. These are dramatic and bold actions that do something in a positive way, consistent and affirming the depth of connection and magnitude of one’s love.

But what about your children? Like most parents, I would jump in front of bullets for mine. I have declared it out loud for all to hear and whispered in silence to myself; I would be that person they could always trust and count on to protect from harm and shield from pain. Without fail. End of story. Full stop.

But what if you need to cause their suffering?

What if you need to be the source of their pain?

What if you need to disrupt and alter their lives in traumatic and dramatic fashion? And in doing so, instead of protecting them from pain and suffering, you become the origin and cause; breaking all those promises once made.

Would you risk losing your child’s trust and faith in you?

Would you risk losing their love?

I am writing this in the present. But my mind is filled with the memories and emotions of the past…

***

A nightlight interrupts the darkness as I wake up in the big chair in your room having fallen asleep again reading to you before bed. Madison, the blond hair on your seven-year-old head is so short, poking out from underneath the covers. Your breathing is soft and your body calm. In stark contrast, Maya’s tangled curls cover her eyes as she sprawls on top of her bed, without any of the covers she kicked off long ago. I stay in the chair and just watch and listen. These moments made perfect by their silence. Love. Awe. Responsibility. They are overwhelming in a comforting way. I make quiet promises to you both, vowing to protect. To shelter. To be present. Always.

***

I am on a flight back from a brief 36-hour trip to Hawaii. In order to see first-hand where you are about to go, I actually spend more time on the plane than off. I am fighting back tears, knowing what’s looming ahead. The dissonance I feel is overwhelming. In the weight of my breath, the ache in my bones, the hesitancy in my voice. The impending betrayal of promises whispered over and over in your ear, while awake or sound asleep, is tearing me up from the inside out. My logical and clinical brain knows a change needs to be made. It knows the status quo is not sustainable. But logic and pragmatism are no match for my tortured, emotional brain, which is all too aware of the pain lying ahead for my son. I wish I could take it. Swallow it. Eat it whole. Let my core absorb and dampen it. But I understand the paradox. This intense and almost primal need to protect is no longer healthy. It is, in part, why we have arrived here.

***

There are still several weeks to go. Sitting on this secret. This emotional and traumatic time bomb will soon detonate. It has been looming for weeks. I wear an invisible shroud that barely constrains my emotions. Like water just before a boil, I appear calm. But it does not take much for a bubble full of fear to erupt, throwing me into a panic, before settling down. Then another, this time a burst of sadness, with tears flowing from my heart through my eyes before regaining control. My sleep disjointed. Work disrupted. I cannot compartmentalize. I look at you, knowing you don’t know. I’m desperate for another option but I have none.  I look at you, knowing that despite all we have been through, you love me as I love you. That you trust me, despite the fights and frustrations. We always end up back in a safe zone. But it’s a mirage of sorts, a false hope. De-escalation should not be mistaken for conflict resolution nor is it a path to healthy growth and change. So I have committed us to a different path. One of separation. And by doing so, I am betraying what I have promised.

I don’t know what will happen next, when the fear and pain I anticipate becomes your reality? How will you handle the additional injury, when you call for help, and I by choice, will fail to be there?

***

It is morning. My brain is heavy from lack of sleep and the weight of knowing this day has come. Two strangers are standing at our front door. My stomach is twisting, my heart hurting.  I let them in. Our exchange is brief, talking in muted voices. They are calm. My wife and I, despite attempts to project otherwise, are not. They walk into your room. Madison, you are asleep. The brown hair on your nineteen-year-old head is so short, poking out from underneath the covers. Your breathing is soft, your body calm. You still are, and always will be, that sweet boy I fell asleep next to, while reading in the big chair.

When we wake you, you quickly realize there are two strangers in the room. There is a flash of confusion in your eyes, not yet understanding what is happening. But I know. I am breaking my promise.

***

What would I do for love?

I was willing to risk my child’s trust and faith in me. I hoped, at best, that it would only cause a “fracture”. Something painful, but able to heal and repair and, dare I hope, even stronger than before? But I could not escape my fear for the worst; would this trigger an insult so damaging that it would be beyond repair?

What did I do for love?

I took a leap of faith. I made us jump, without knowing where we would land. My head told me it was the right choice. My heart just ached, unable to reconcile this emotionally incongruent action.

I am not sure how to frame it for others to understand. I am not sure that, after more than a year and half, my son understands. A change was needed. Not small. Not incremental. But transformational. My love, although well intentioned, had become constrictive and stunting. In order for growth and adaptation to occur, I needed to be out of the equation. But in order for that to happen, my son was flown around the globe. He had to have everything that he knew taken away. His room, his house, his dog. His sister. His mom and dad. He had to wake up far away and start over. By sending him away, I put his faith, trust and love in me at risk. I risked all that so ultimately, hopefully, he could put that faith and love and trust in himself.

My family has been on quite a journey since July of 2017, both together and individually. All of us have our own unique view of how we experienced and navigated that time. I can only speak cautiously for myself. My son is finally back home, and the internal dissonance, I once woke up to daily, is starting to dissipate.

I remember a fight, a few years back, when I yelled at him, explaining it was because I loved him so much. He screamed back in response, “Maybe you care too much!” At the time, I thought it was an immature and flip retort. Now I think it quite prescient. I don’t believe you can actually love or care for someone too much. But I do believe there are unhealthy ways to express that love. 

My journey has been, in part, to recognize that my son can endure both mental and physical challenges and tolerate suffering. Not surprisingly, by doing so, he has gained the confidence and pride that comes with that ability. He is able to cope with the consequences of bad choices and reap the benefits of good decisions. I learned to recognize that while a fierce unrelenting and unwavering love for child can be comforting, it can be constricting as well.

My son has been home for several weeks now. Our family was able to celebrate his twenty-first birthday together. His hair is a bit longer and he has a thick bushy beard that I have taken quite a liking to. We are still figuring out the feel and dimensions of our current relationship. Most of our interactions are working around the “edges” as we learn the contours of these boundaries. But there have also been some deeper dives into amazing conversations, with a depth and honesty that is new to us. We are still a little tentative and hesitant on some topics. I have not pointedly asked him how that decision, made eighteen months ago, has impacted his ability to trust and love our family. It still feels too direct and blunt. Asking him to articulate in words, what is probably a complex set of emotions, in the hopes of relieving some of my lingering guilt, would be selfish.

Right now, it feels more like we are healing a fracture than coping with unrepairable damage. After our leap of faith, my family’s feet are finally on the ground. And with each tentative step we take forward, a bit more hope replaces the ache in my heart.

The Big Chair

The Big Chair

jtopin

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

jtopin

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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

A Chasm too Wide to Bridge

jtopin

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.