February 2021

When flight attendants deliver safety instructions, they remind us of the need to put on our own oxygen masks first before we try to assist others.

As health-care professionals, our natural tendency is to focus on the well-being of others; that’s what we’ve been trained to do. We give our patients good advice regarding their physical and mental health, yet the environments we work in are not always conducive to our own well-being. The result can be burnout, which is associated with depression, which increases the risk for suicide. In fact, physicians have a higher suicide rate than the general population.

“You’ll feel better after the surgery,” my psychiatrist said, “and the cancer is cut out.” I scoffed. He knew me too well to think it would be that easy to quell my escalating anxiety. Cognitive behavioral therapy has never been my thing, and there weren’t enough pills in my prescription bottles to make my fears fly out the window as neatly as that 6 mm tumor would be excised from my breast.

The surgery was easy, as was the recovery. The wound healed quickly. Just five weeks later, my scar is a smooth, scarlet sliver that looks more like a careless scratch than evidence of the purposeful cutting that it was. If I were an optimist, I’d say this is a good sign. Things are going well. I’ve also gotten through my first round of chemo with relatively mild complaints. My body is responding, and healing.

Her voice trembled as she fumbled with the scrap of paper in her hands. What did I do wrong? Is this the right prescription? Am I going to die? The questions gushed from her all at once.

As a medical student on my first clinical rotation, I was still getting used to how to run these clinic visits. It seemed like no one was ever there for the reason originally listed, and somehow I always ended up with the long-winded patients that kept me in the room so long I was lucky if I made it to the physical exam before my attending ran into the room to take over. Any plan I had made to make this visit any different was quickly derailed when I heard the words: deep vein thrombosis.

I was transported back five months prior when my mother received the same diagnosis. She had a long personal and family history with varicose veins, but the new, painful swelling in one of her legs was new. I recalled the darkness of the ultrasound room, the feeling of holding my breath each time the technician paused to ask my mother a question, the unbearable waiting

I’ve been thinking a lot about how the practice of medicine is not always the practice of wellness. How optimistically I applied to join this profession out of a sense that I intuitively took better care of myself than did many of my peers. I knew that happiness and health intertwined, though my naiveté about how to rescue one if the other faltered was sorely lacking. 

Ahh, youth. Unencumbered by the kind of financial and emotional obligations I would eventually crave, back then I could restore balance with a day trip to wine country, or a chance to ski instead of study. I took up swing dancing during my surgery rotation in medical school, if only to prove to myself that my life was my own. 

Years later I chose yoga, biking, traveling. Now, in the pandemic, yoga happens in my living room. I write about little moments. I hike. I daydream about the places I once went and hope to take my children someday.

But my pastimes are not my patients’ pastimes. Often, dropping one activity suggestion after another, like feeding quarters into a slot, I hear them fall into the coin return instantly, never registering. Too many teens are

One of the hardest parts of being a physician is dealing with the death of a patient. In the course of my career, I’ve learned that the physician-patient relationship can be an effective tool for healing, for the doctor as well as the patient’s family.

An example follows: My patient with advanced COPD died in association with emergency surgery. Despite appropriate care, his condition overwhelmed him. His wife, also my patient, was an assertive, take-charge individual. In addition to blaming herself, she angrily insisted that some error in care led to her husband’s death.

I realized that we had to allow time with active listening to help the widow to heal. I decided to increase her visits, at first using the cover of following her blood pressure and atrial fibrillation more closely.

It was not pleasant, and it required restraint. One day, after listening to the litany for over eighteen months, I became frustrated, and said: “Mrs. Smith, let me help you find a good malpractice lawyer! Otherwise, if you continue down this path, there will be another death. Yours!”

Slowly, her anger dissipated, and she remained my patient twenty more years.

Perhaps one can call this extreme grief counseling.