“I know that name. Let’s grab that one.”
Scanning the list of patients waiting to be admitted, I watched as my scribe added this particular patient to our list. As much as I had wanted to emotionally divorce myself from my panel of patients when I was still in primary care, I couldn’t stop yearning for the continuity of care I once had.
What happened to S after I discharged them from the hospital? Did B follow up with cardiology? What did P’s follow up colonoscopy show? But, in order to keep up with the revolving door that is the hospital, I forced myself to wipe the slate clean after each patient encounter.
The process of purging each person’s story was proving to be more difficult than I had anticipated – was this better? Sure, this hospitalist gig gave me more time off to replenish the well, but these patient encounters were drawing more deeply from it than ever before.
D was no exception.
Echoes of his son’s pleas came to me from 3 months ago as my scribe and I walked down the long, artificially lit basement hallway to the emergency department.
“I can’t send him back to that place. This is my father. Please, help me take care of him.”
The rollercoaster of emotions of that moment threatened to run me over again even now: struggling to stuff down the frustration of having to adjust course after I was THISCLOSE to discharging him back to his skilled nursing facility, to the remorse washing over me as I spotted tears in this herculean man’s eyes while he squeezed the limp hand of D’s half paralyzed body.
How could I not be moved by the determination in his melodic Arabic voice as he made the decision to take on caring for his father who was suffering from a recent stroke?
“He will not build his strength there. They do not speak his language and they become impatient with him. And he hates the food. I’m taking him home with me. We will take care of him.”
I recalled the heated debate between the nursing care manager and I, the exasperation in her voice as I essentially undid all the work she’d done the last several days.
“D’s just going to bounce back. His son has NO IDEA what he’s getting himself into. I can’t believe you’re even signing off on this.”
I couldn’t believe it either. If anyone was going to be the queen of cynicism, it should’ve been me.
Yet I vouched for them.
Spent so much time reviewing the 15 meds we were discharging him on, daytime versus evening doses, insulin and blood sugar checks, figuring out the best way to apply the abdominal binder so he wouldn’t pull out his G tube – answering every question again and again until his son could repeat back everything he had written down in his notepad.
Maybe that was a mistake, M. He is back, after all.
Walking through the door with my trusty scribe trailing behind me, I watched as D’s son’s face transformed from boredom to grateful relief.
“It’s you! I hoped it would be you!”
Jumping out of his seat to grasp my outstretched hand with both of his massive bear paws, he excitedly pumped our arms.
“Baba, do you remember her? This was the doctor who took care of you last time you were here. The one who helped us bring you home.”
“Yes. How are you?”
D smiled and replied in halting English, taking me aback. 3 months ago, his scrambled Arabic had left even his son at a loss. Beaming, D’s son excitedly updated me of his progress.
“You should see him walk with a walker now! And he’s able to eat everything by mouth, so they pulled out his G tube. We no longer have to do insulin shots – you should have seen how happy he was when the doctor told him we were done with all those pokes!”
As I broke out into a smile, I registered how unfamiliar the crinkling of my newly forming crows feet felt. When was the last time I had anything to smile about at work?
“That’s wonderful! I’m so glad to see you doing so much better! Now let’s talk about what needs to happen so we can get you out of here and back home.”
“Do you miss it? The clinic, I mean?”
Turning to face my scribe, I shot her a questioning look as we made the long walk back down the hallway to the hospitalist office. Sheepishly she rushed to explain her probing question.
“I was just curious… I mean, D’s son did ask you if you could see them in the office…”
As her voice trailed off, I could still hear his voice repeat the same parting words he left me with at our last meeting,
“Will we see you again tomorrow? No? Well please find us if you go back to clinic. We would come and bring everyone to you, believe me!”
Do you really want to allow another scribe to invade your brain right now, M? You don’t have enough margin in your life for yourself, much less another person who clearly sees you as a possible mentor.
Cursing myself for not shutting down the small talk at the beginning of the shift, I glanced over at my scribe and wondered what she thought she’d just seen.
Did she think she had witnessed something all prospective med students’ dreams are made of? A doting doctor with her adoring patient and family? Did she envision her own future ripe with all the ways she could impact her patients’ lives?
Would she ever realize she was actually watching me unsuccessfully avoid a black hole of regret in real time?
As my inner monologue battled it out, I flashed one of my blank smiles to cover up the unexpected flash of anger making me see red.
Do you miss it?
With one simple question, she was forcing me to face the thing I was trying to avoid.
And like a coward I was displacing my frustration and anger on her.
Because I do miss walking into a room and seeing my patients’ faces light up with hope and relief.
I miss celebrating their hard fought wins and holding the space they need to cry it out during their lows.
I miss seeing people thrive instead of fading away in a sterile hospital room, measuring their existence by counting down the hours til their next salt restricted mush we call food.
Most of all, I miss the trust – the kind of trust that can only be built over time.
But admitting all this would be admitting I made a mistake.
Was I finally ready to do that?
Truth hurts…
“Yes…
I miss it.”
***
Photo of family hiking shenanigans at Bryce Canyon.
***
Thank you for 4 years.
You’ve been along for the ride through my first primary care job, the angst that lead me to and out of the hospital, then straight into a pandemic with a healthcare startup.
Beginning tomorrow, the adventure leads me back to a typical primary care clinic.
There’s much to catch up on, but I thought I’d finish the year by returning to my why.
Why, despite all the complaining about the state of medicine and primary care, I still show up.
Why I haven’t yet explored non-clinical work to tide me over til I get to FIRE.
Whenever I ask myself if it’s all worth it, I will always return to this:
I am my best self when I’m helping others.
I’m still trying to figure out how to do this without losing myself while nurturing my personal relationships, but that’s what 2022 is for!
Hope you had a restorative, COVID-negative, drama-free holiday and I’ll see you next year!
M