This has been a summer of constant work. No other distractions or crises-- just work, seven days a week. Long days, often beginning at seven and then phone calls, emails and chart reviews until 8 p.m.
The weekends have been filled with chart reviews that I have done periodically but have now chosen to do with each annual visit. After all, after 25 years of time with a patient, it is helpful to review anew the past and the story of our time together. This kind of work requires quiet time and often becomes diagnostic as the patient's memory in the present may no longer be in sync with the story told at that first visit years ago. Initial patient interviews and evaluations lasting two or three hours cannot be integrated in the space of that first consultation. It's customary that I spend an hour on the weekend for two separate weekends with each chart of a new patient, putting the pieces together of a one thousand piece puzzle that has only a blurred picture on the puzzle box to guide me.
I have clues from each woman's life stage, clues from the narrative of her life, clues from her symptoms, clues from her physical exam and clues from her goals and choices. But the strange work I do diagnostically begins in the quiet hour when I am alone with her story, and work to understand how she became who she is at this time.
I write the story in narrative form in each patient's chart and it is the writing that distills my thoughts. The next weekend I have the chart with me again, with additional clues from diagnostic tests. For each woman, the original narrative and this new information generally give me the insight I need to create a plan that will work uniquely for her -- to allow her to obtain better health and understand the importance of self care.
Medical team building requires that each patient must be the equal partner in her goals for good health care. I have known patients who prefer to just fax their body parts in to the office and have a bit looked over and a blessing made or a treatment prescribed. But, sadly, this does not fit in the work that is done in a medical relationship with me.
But this doctor lost her way this summer. I forgot balance. Before I knew it, this summer of intense work was almost over and I had been the worst of role models for my patients. Healing after all, does not come just from listening to the patient, examining the body, performing the diagnostic tests and putting the puzzle together. Healing in its best form, involves being a decent role model for the patient. Since I preach moderation in eating and drinking and prescribe fitness in body and mind, and promote mindfulness and living fully in the moment and finding balance in work and life, then I have not been the role model I could have been this summer. I had run out of fuel and did not know that I was running on fumes until this morning.
I was invited to stay on Nantucket with my dear friend who has known me the longest and has been the most important mentor in my life. Caught up in the need to catch up more and more, I felt initially that I could not take time away. The husband, however, was sick-sick-sick of our taking no time off. Although he has always respected my need to do my work in the way that I have always needed to do it, he insisted that we take time to recover--to reconnect and reconsider how the current way of working and living might not be working as well as it could. Chooses his words very carefully, the husband does.
He avoids the judgmental, but is a force for moral choices like common sense and having a life outside the world of medicine. "Do your work the way you must since only you know what must be done, but it is important to clear your mind and refresh your body and spirit so that you can continue to be the kind of doctor you are, but also find time for friends and joy." I often tease the husband that over the years of our marriage he fancies that he is a doctor. Well, he was my doctor and guide as I trusted him enough to stop and take time for a holiday.
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