Behind the closed door of the exam room, patients always hesitate in a predictable manner before asking uncomfortable questions. As the visit winds down, they finally summon their courage and inquire. We providers recognize this scenario, having witnessed it countless times before. Perhaps the patients sense us relaxing into the familiar and feel briefly encouraged to proceed.
Joe is deaf when he isn’t wearing his hearing aids. So he didn’t hear my crutches behind him on the floor at 2:00 a.m. when I got out of bed for a drink of water. We’d just returned from a beautiful Mediterranean cruise. The day before our flight back to the U.S., I’d slipped on a wet staircase and torn the anterior cruciate ligament in my left knee. Surgery was successful and my rehab was going well.
But apparently my relationship wasn’t going so well. As I walked up behind Joe, I saw that he was on my laptop, corresponding with a woman on a dating site.
The tables have turned. I am now taking advice from my children.
At my daughter’s urging, I signed up with a personal trainer at the local YMCA. He is a lovely young man. And since he was raised by his grandparents in the Philippines, he has a special regard for old people.
Twice a week, he takes me through a series of exercises designed to strengthen and flex various muscle groups. My goal is both modest and huge: to be able to get up off the floor unassisted.
Had Dad not passed this month fifteen years ago, we would be celebrating his birthday today. He was born–and died–in October.
This was the time when India was still a British colony. Vaccinations, antibiotics and potable water were not yet available, and infant mortality from infectious disease was high. When dad was two years old, his mother noticed that her active baby went from running to limping, and his left leg looked strange. Terrified, she took him to a country doctor who diagnosed paralytic polio and stated that his leg would be paralyzed forever.
In the mid-seventies, when learning to be a labor and delivery nurse, one of the first people I met at my new job was Nurse A, a wizened veteran of the department. She stood four feet, eleven inches tall, weighed ninety pounds, had short dyed brown hair and was ten years past retirement age. She sprinted up and down the halls, rushed in and out of rooms, talked nonstop and ordered everyone around like a drill sergeant. Her trademark was the “3 H” enema – high, hot, and hell of a lot – to stimulate contractions.
It seems as if I’m always asking my patients what they’d like to work on. And whether it’s their sleep patterns, their career goals, their symptoms of anxiety or depression, or something else, my role as a behavioral health clinician is to help motivate them and create behavioral activation.
Having had breast cancer and vitreous macular traction myself for the past few years, I am also keenly aware of my own goals for health and mind-body wellness. This fall, I want to encourage others to focus on cancer prevention (mammogram screenings and early detection save lives!), as well as on self-care strategies: health-care providers need to continue to nurture themselves so they can continue saving others.
The older I get, the less motivated I become. I imagine the dust gathering on my carpet, and I see it covering my walnut-colored end tables with a light gray film. Yet, I cannot push myself to vacuum or clean. The laundry gets done, but not as often as it did when I was younger than springtime. My listless days consist of reading, watching dismal news on CNN, and taking adult education classes via zoom—while often still dressed in my pajamas.
Dear readers,
A good part of my career as a doctor was spent trying to motivate patients to do what was good for them, like eating more fruits and vegetables, getting exercise or remembering to take their pills.
Most patients wanted to do the right thing–go to the gym, stop smoking and get their diabetes under control. They felt bad about themselves for not doing better.
With that in mind, I didn’t think it was productive to lecture them and make them feel even worse. I thought they’d be more likely to get motivated if they felt hopeful and positive–so I did my best to offer some understanding and encouragement rather than criticism.
Medical school was, at times, traumatic for me. Although I now love practicing medicine, I am honestly not sure I could endure the training again. In fact, many of the lessons I learned in the process of becoming a physician were about what type of physician I did not want to be.
I still remember the moment—midway through my third-year clerkship, following a tumultuous internal medicine block—when I realized that palliative care was where I belonged. By carrying forward lessons learned from the imperfect practice of medicine, I have developed a set of values that now ground my current practice.
To my former neuro-oncologist (separated by insurance):
Greetings, again.
What you said when I first became your patient, about the consequences in adult survivors of childhood cancer with secondary tumors, was spot on, and I’m now in palliative care.
A dentist friend once mused that people should be born with a third set of teeth that would erupt late in life, since our permanent teeth evolved at a time when humans’ life expectancy was shorter and thus they wear in midlife. Imagine the Tooth Fairy visiting us in our sixties!
Since that conversation, I’ve pondered how long our bodies are meant to last. As a family physician, I wonder whether medical advances have set up some body parts to fail prematurely. I’m deeply saddened that societal structures have evolved minimally to keep pace with the way we now age.
I cradle my ninety-nine-year-old mother’s head in one hand while I massage shampoo through her sparse hair. She floats in the water; her feet do not touch the end of the tub. Always a small woman, now she is barely there. I offer spoons of coffee ice cream. Of all the pleasures she still manages to eke out of her vastly diminished life, eating ice cream in a warm tub ranks high. Should one of the cats sit on the rim of the tub . . . . Well, that is perfection.
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