Taking a Step Back to Move Forward

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This was first written and posted on Doximity’s Op-(M)ed and can be seen by clicking here... I will be writing monthly for them and hope to have a year-long discussion about the trials and travails of being part-time. Whether its enjoying more time with the kids, suffering through a bad Locums placement or learning to be a student all over again, I plan to share it all with all of you. For those that have been keeping up with a lot of my writing, a lot will be familiar. But I hope you enjoy the slightly different perspective.

Taking a Step Back to Move Forward…

“The simplest questions are the most profound.
Where were you born? Where is your home? Where are you going? What are you doing?
Think about these once in a while, and watch your answers change.”
— Richard Bach, Illusions

To an outsider, a hospital often feels like a chaotic place. Varied people flutter in and out of rooms, the color of their scrubs identifying nurse vs. patient care tech vs therapist. Bulky portable X-ray machines compete for hallway space against more streamlined transport carts, shuttling patients to procedures and tests and back again. All this against a soundtrack of monitor alarms in-between intermittent overhead announcements.

For those who work inside the hospital walls, there is a structure and pattern beneath this apparently random Brownian motion. Environmental services with their Zamboni-like machines clean the floors at 4 AM. Phlebotomist follow soon after to draw 5 AM labs. Portable X-rays make their way into the rooms about 5:30 AM. Resident handoffs start at six before the nurses have their shift change at seven. Multidisciplinary rounds tentatively start at eight. Notes finished by twelve so I can get to my first office patient by one in the afternoon.

Patients add improvisation, going off-script to inject their own episodes of distress, instability and crisis. But every day, in each hospital, there is a unique structure and rhythm to the day to anchor and build off of, to manage and cope with the unpredictable nature of the ICU. Almost every day for the last twenty years, I have relied on and used these routines and patterns to navigate and manage my day.

A year ago, everything changed.

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How Do You Know When Someone Is Broken?

How do you know when someone is broken? When their spirit is fractured? When their sense of self no longer aligns with what once was. When you feel as if you have woken up in a foreign land, but that sense of displacement is coming from you, not your surroundings.

In television shows and movies, that moment for a doctor is obvious. The scene in which a physician cries in the stairwell, knees bent, head hanging dejectedly. A downward spiral into drugs and alcohol that leads to a near-miss in surgery. Or a final, explosive ranting monologue, that alienates the doctor in front of patients and peers. They have snapped. They have broken. At least until the next scene or episode.

Real life rarely follows a Hollywood script.

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Crater Lake and the Weight of Snow

Minutes into my early morning run, the howl of a lone coyote broke the silence in the basin. A second one responded, and then two quickly became three. Other coyotes joined in, their howling echoing all around. On previous trips to Oregon, I’d found comfort and hope while running on this path. I had also walked here with my family, under a brilliant rainbow that offered a well-timed distraction from the tension building between us. This weekend, I had travelled here to celebrate my son’s birthday. Although excited to see him, I was still nervous about how the next few days would go. I was not inherently superstitious, but I could not help but wonder what type of omen howling coyotes on a brisk March morning might portend.

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Seventeen-years-old and into the Great Wide Open..

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Into the great wide open..
 Under a sky of blue”
                  -Tom Petty

In the absence of moonlight, the summer lake house had been pitch dark when we arrived. The five of us had made a spontaneous late-night decision to drive from the northern suburbs of Chicago to Michigan City, Indiana. Now, as dust particles dance in the glow of the morning sun streaming through the windows, I wake up in the large room known as the “dorm.” In other far too small single beds, three of my friends are refusing to acknowledge the start of the day.

The bed squeaks as I swing my feet onto the floor and walk outside to the concrete patio. The house sits on top of a bluff overlooking Lake Michigan. The cool morning air has not yet given way to the sun’s warmth. Peter is already up, coffee in hand. Slowly, the rest of the crew makes their way outside to sit on the stone steps that wind down to the street; Lake Michigan and the beach just on the other side. Hungry, we dig into a box of day old Dunkin Donuts brought from home.

It is the summer after our high-school graduation and we are at Peter’s summer house for a few days. A weekday or weekend? It doesn’t matter. Every day now feels the same. High school is behind us, yet college still feels far ahead in the distance. For the moment, there are no homework assignments, or grades to worry about. The ninety-minute drive to the beach house is as much a declaration of our growing independence as it is a fun forty-eight-hour getaway to squeaky white sand and mid-summer sun.

Still in our shorts and sweatshirts from yesterday, we eat the donuts and drink bad coffee. We talk about the Cubs and summer jobs. We retell inside jokes and repeat favorite movie lines. The afternoon will be filled playing catch on the beach, with the Cubs game on the radio, and cooling swims out to the sandbar. Our personal journeys lie ahead, but for the moment, we are carefree and at ease.

The memory of drinking coffee on the patio before spending the day on the beach is still vivid thirty years later. The cool rock on the back of my legs. The bitterness of that flavored coffee. The hot sand squeaking under my feet. My shoulder, sore from throwing the baseball all day long. The sun’s heat burning my back while lying on a sandy blanket. Swimming to the sandbar. Nowhere to be, nowhere to go. My future completely unwritten.

I didn’t recognize the significance of that day, or that summer, in real-time. I guess that’s the nature of being young and feeling immortal. Maybe it’s the slow and gradual accumulation of responsibilities that come with a job or marriage or children, that enable us to appreciate the days when we could just lie in the sand and bake in the sun. That summer, listening to the Cubs game on the radio with friends, the weight of future responsibilities had not yet entered our world.

Thirty years later, I am, once again, at a place in my life where things are yet unwritten. After 13 years as a pulmonary critical care physician, I chose to start working part-time in July. I have already encountered a few hiccups and speedbumps along the way, but this time I am able to appreciate the freedom and opportunities that lie ahead.

I am attending a TEDMED conference this week. Within the overarching theme “Limitless,” the talks highlight issues of medicine, both directly and tangentially. I am eager to see which talks will directly apply to me and what I can bring to the table. What mix of critical care medicine, parenting, water polo, and writing brief narratives stories related to those topics might spark a conversation with my colleagues? I am no longer a seventeen-year old kid lying in the sun, with no real responsibilities, but my future does require a similar shift in my mindset. And as I hear Tom Petty’s voice singing in my ear, I am focusing, not on what limits me, but on how limitless the possibilities are.