Below is a picture taken during the Santa Rosa Fires and an original daily dose of spoken word reflecting on the photo and fires.
As the aquamarine skies turn to a heartwarming tangerine and the little dot of gold bids adieu… it assures that it would see me again at dawn… the light would be brighter and the thrill to follow merrier, a new day would come with good prospects… after all we have realized so much… we have set eyes on the beauty… the simplicity and have learnt to appreciate its onset… the sunrise once again, every day is a blessing and this creation ,” sheer magnificence!”
Kathleen Ellis, a Lodi Kindergarten teacher, created two music videos for her students amidst the COVID-19 pandemic. The goal was to promote distance learning since school has been closed for the time being. The first song is called “log on and count with me” (from ‘Shut up and Dance” by WALK THE MOON) and the second song is called “Isolation” (from “Celebration” by Kool and the Gang) My sister is awesome!
Back in a 2009 interview this is what Journalist Susan Cohen wrote about Abraham Verghese, MD, MACP :
“Verghese believes in the curative power of literature for physicians. Writing is a way to explore what they see every day and can’t share. Reading is a way for students to revive the empathy that gets lost in the process of medical training”.
We at daily dose of humanities fully agree with this view.
Abraham Verghese, MD. MACP is the Linda R. Meier and Joan F. Lane Provostial Professor in the Department of Medicine at Stanford.
Here are some relevant quotes from his published works and interviews.
1) I still find the best way to understand a hospitalized patient is not by staring at the computer screen but by going to see the patient; it’s only at the bedside that I can figure out what is important.
2) I think we learn from medicine everywhere that it is, at its heart, a human endeavor, requiring good science but also a limitless curiosity and interest in your fellow human being, and that the physician-patient relationship is key; all else follows from it.
3) What we need in medical schools is not to teach empathy, as much as to preserve it. The process of learning huge volumes of information about disease, of learning a specialized language, can ironically make one lose sight of the patient one came to serve; empathy can be replaced by cynicism.
4) Tell us please, what treatment in an emergency is administered by ear?”
….I met his gaze and I did not blink.
“Words of comfort,” I said to my father
5) Patients know in a heartbeat if they’re getting a clumsy exam.
6) When I use the word ‘healing’, by that I mean that every disease has a physical element that we’re very good at handling, but there’s always a sense of the violation. ‘Why me?’ ‘Why is my leg broken on the ski trip and not anyone else’s?’ And I think that medicine has done a terrible job of addressing that spiritual violation.
7) Literature is a beautiful way of keeping the imagination alive, of visiting worlds you would never have time to in your day-to-day life. It keeps you abreast of a wider spectrum of human activities.
Sometimes the simplest poetry can create the most lasting impact.
In this strange and uncertain times let these following words ease and humbly resonate with your humanity today.
The Dash Poem
by Linda Ellis
I read of a man who stood to speak at a funeral of a friend. He referred to the dates on the tombstone from the beginning…to the end.
He noted that first came the date of birth and spoke of the following date with tears but said what mattered most of all was the dash between those years.
For that dash represents all the time they spent alive on earth and now only those who loved them know what that little line is worth.
For it matters not, how much we own, the cars…the house…the cash. What matters is how we lived and loved and how we spend our dash.
So, think about this long and hard; are there things you’d like to change? For you never know how much time is left that still can be rearranged.
To be less quick to anger and show appreciation more and love the people in our lives like we’ve never loved before.
If we treat each other with respect and more often wear a smile…remembering that this special dash might only last a little while.
So, when your eulogy is being read, with your life’s actions to rehash, would you be proud of the things they say about how you lived your dash?
Dr. Paul Kalanithi’s book “When Breath Becomes Air” provides a sobering view of living life in the face of impending death. Dr. Kalanithi was a brilliant physician finishing his neurosurgery residency when he was suddenly diagnosed with metastatic lung cancer. During his battle with cancer, he wrote this book detailing his experiences from the perspective of both a physician and as a patient. His writing contained many pearls to learn from, but two quotes stood out to me.
1) “In that moment, all my occasions of failed empathy came rushing back to me: the times I had pushed discharge over patient worries, ignored patients’ pain when other demands pressed. The people whose suffering I saw, noted, and neatly packaged into various diagnoses, the significance of which I failed to recognize… I feared I was on the way to becoming Tolstoy’s stereotype of a doctor, preoccupied with empty formalism, focussed on the rote treatment of disease and utterly missing the larger human significance.”
In this quote, we see the perspective of Dr. Kalanithi in the role of the physician. He is inundated with tasks focussed solely on getting his work done. Patients became problems on his list of things to be taken care of. I chose this quote because this is a common problem among many physicians and significant contributor to physician burn out. Burnt out physicians have often lost sight of the bigger picture and forget why they originally chose to pursue medicine.
In order to remedy this we must take time to reflect on our interactions. We must live life with gratitude for the opportunity to be serving as physicians. We cannot lose the empathy that we all had when we entered medical school.
2) “I could see that in Brad’s eyes I was not a patient, I was a problem: a box to be checked off.”
In this second quote, we see the perspective of Dr. Kalanithi in the role of the patient. He was requesting for his chemotherapy medication to treat his bone pain from Brad the resident physician, but this medication required special authorization. Being that it was in the middle of the night, Brad did not want to wake and trouble the attending physician.
This quote stands out to me in contrast to the first quote where Dr. Kalanithi was in the physician role similar to Brad viewing the patient as a problem rather than a person.
Now as the patient, Dr. Kalanithi realizes how it feels when a physician sees you as a problem.
Tell us how you feel after reading about Dr. Kalanithi’s change in perspective. Have you seen this happening in your care? How can we help change this “problem” perspective?
When I’m at the library talking to my female peers, the conversation frequently comes up that we are not recognized in medicine. When someone asks what I’m pursing and I reply “medicine”, the next question is,
“No, like a doctor. I’m in medical school.”
“Oh, like for nurses right?”
At this point, I tend to give up and just say okay. But this conversation has happened more than a couple times, and for many of my female peers, it’s a similar story. Even on rotations, I can see how sometimes I am treated more like the student whose job it is to go fetch things and console crying children while the male students get taught medicine. What’s sad is when female residents and attendings acknowledge this is happening and say they have had to face it as well.
Here’s a quote from Marianne Williamson’s book, A Woman’s Worth to further illustrate how I and many women in the field of medicine feel on a daily basis:
“…the more of us who understand the game and see through the lie and forge ahead in support of every other woman’s right to a passionate response to life, the more we will hasten the end of our jail term. Women have been imprisoned for ages, and in our cells, our hearts, we have carried our true feelings like sleeping children, our spiritual issuance, our love. The prison walls are melting. We’re almost out. And when we fly free, we will carry with us such gifts to the outside world. Our gifts haven’t atrophied; they have grown in power. They have been waiting for centuries, and so have we.
Let’s keep our eyes on the sky. They’ll throw tomatoes; they’ll lie about us and try to discredit us. When we rise, they’ll try to undermine us. But when they do, we’ll remember the truth and bless our enemies and find strength in God. The regime of oppression is almost over; its life force is waning, and only its ghost remains. Don’t tarry too long to mourn its effects; celebrate and rejoice in the new. The past is over. Wipe the dirt off your feet.” ― Marianne Williamson, A Woman’s Worth
Marianne Williamson’s poem really emphasizes standing together, embracing your qualities, and moving forward to prove your worth.
So yes, I am a woman in medicine, studying to be a doctor. I am compassionate, caring, take the time to listen, can console many crying children (which parents and other patients sure appreciate during the visit), anticipate what my patients need and have that ready, sense my patients’ insecurities and fears and address these in a nonjudgmental and caring way, ALL while being their doctor and working with them to provide the best care possible.
The term imposter syndrome has come to seem like the perfect definition of me. Rotations, as amazing and rewarding as they have been, bring forth feelings of insecurity and self-doubt more than I had ever imagined. Sometimes I don’t even know if I am capable of being a doctor. Getting the pimp questions wrong, pronouncing procedure names incorrectly, and just plain making a fool of myself in front of the residents and attendings makes it seem like I learned nothing in the past three years correctly.
While deep down I know these feelings do not define me or my ability to practice medicine, it can be hard to overcome them and move forward. I first read this poem in high school, and it has stuck with me since. This poem helps me overcome the fear associated with imposter syndrome. I’ve been told by countless peers, friends, and family, that I sell myself short. Most of this is out of fear, as the poem below illustrates. If we do not address imposter syndrome, we start to limit ourselves in applying to residences, promotions, and most of all, providing the best care for out patients. If I am not confident in myself, how will I provide the best care and empathy for my patients, why would they listen to someone who seems frightened all the time? Our fears are as Marianne Williamson says below:
“Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won’t feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It’s not just in some of us; it’s in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.”
Reciting this poem during rotations, and sharing it with other students, residents, and attendings has helped more than just me. It has taught us all to acknowledge the fear and self-doubt, and create strategies to make ourselves stronger from that. Here’s some strategies I’ve used throughout the year to help:
Collect all your positive memories and experiences in some way, shape, or form. For me, this has been through pictures, notes from patients and colleagues, and writings. When I feel down, I look back at all the people’s lives I’ve had some sort of impact in. It really helps lift your mood and strive to provide better care and impact more patients positively.
Have a support system ready. For me, this has been my friends. We studied for 4 years together. We know each other’s strengths and weaknesses very well. When a stressful or doubtful situation arises, you can rest assured that I will call my best friend ASAP and talk about how I’m feeling. And it doesn’t take but 5-10 minutes for him to remind me why I’m here and reinforce all the positive aspects I bring to medicine.
Tell yourself, many many times, QUESTIONS aren’t BAD! This is a big one for me. I feel that if I ask a question, I’ll just sound dumb because everyone probably knows the answer already. Don’t every feel like that! When you truly don’t understand something, just ask. You will learn a lot more overall and you would be surprised how much it helps when you later go in to speak to your patients. You develop a better understanding and can engage your patients on a much deeper level.
Sit and talk to your patients. It can sometimes be annoying, okay really annoying, when your attending only assigns you 1-2 patients THE WHOLE DAY. You think, seriously, what I am going to learn from 1-2 patients. I want to see more, learn more. While we cannot always change this, we can make the most out of the opportunity. What I learned is, when I have free time after rounds and when I just don’t feel like studying, I go check up on my patients. I sit with them and just listen to them talk. Sometimes it’s about their illness, sometimes their grandkids, sometimes its how bad hospital food is and how good mom’s cooking really is, sometimes its keeping them company during hemodialysis. It seems like nothing to us, but for our patients, it means the WORLD. Seriously. They light up when you sit and talk to them. And you learn about their lives, which can help understand their condition more too.
We have worked hard to get here. We are in a demanding and difficult profession. But do not forget, we are healers. It may seem like we have little impact now, but we are on the road to making a place in the hearts of many. Keep going strong, take off that imposter mask and be your true compassionate self!
IT COMES FROM the Latin vocare, to call, and means the work a man is called to by God.
There are all different kinds of voices calling you to all different kinds of work, and the problem is to find out which is the voice of God rather than of Society, say, or the Super-ego, or Self-Interest.
By and large a good rule for finding out is this. The kind of work God usually calls you to is the kind of work (a) that you need most to do and (b) that the world most needs to have done. If you really get a kick out of your work, you’ve presumably met requirement (a), but if your work is writing TV deodorant commercials, the chances are you’ve missed requirement (b). On the other hand, if your work is being a doctor in a leper colony, you have probably met requirement (b), but if most of the time you’re bored and depressed by it, the chances are you have not only bypassed (a) but probably aren’t helping your patients much either.
Neither the hair shirt nor the soft berth will do.
The place God calls you to is the place where your deep gladness and the world’s deep hunger meet.
Originally published in Wishful Thinking BY FREDERICK BUECHNER
Daily Dose of Humanities 