Wednesday, January 25, 2017

It's Geting Dark in Here

So for Christmas Duncan bought be some great books. Maybe true love is someone who knows what books to buy you.

I am currently reading The Antidote: Happiness for people who can't stand positive thinking by Oliver Burkeman and Awake at the Bedside by Koshin Paley Ellison. They are both SO intriguing and thought provoking. I am trying to be monogamous, but it's not working. These books have many overlapping themes and central ideas despite being about very different subjects. I love how they randomly came into my life at the same time.

I never really had any proper training in palliative medicine, which I feel was a major gap in my medical education. Yes, I did 18 weeks of general practice, 15 weeks of internal medicine, 15 weeks of surgery, etc etc. but zero weeks in palliative care during medical school and zero weeks in residency. Weird because, uh...we ALL die. We might dodge the nephrotic syndrome, the massive stroke, the carcinoid metastasis, the glioblastoma, the neck fracture, but we all...die. So why is this universal outcome so ignored and unexplored in medical training? It's absurd really.

I'm left trying to sort out how to manage the physical manifestations of this fact while learning how to listen, problem solve, know when it is not time to problem solve but just listen, juggle oncology telehealth appointments with finding out how to get a ramp made so my patient can get into his house with a wheelchair. It's a clash of the ultimate in existentialism, spirituality, and bowel care. The logistics of continence and difficult discussions and denial and heartbreak weave in and out of daily interactions, most of which I feel woefully inept at.

So I make mistakes. Say things I shouldn't. Extend myself in ways I won't again and retreat in times I should have been present. But I am trying to learn, LISTEN, read, think, reflect, improve.

I've learned that the Ellison book is not for bedtime reading. Unless you want to go attempt sleep with questions like "who do you want with you when you die?" or "what are the fundamentals of a good death and how would you like your death to unfold?" rolling around in your head.

I started this post before going on post-Christmas holidays. I brought so many books with me in the hopes of enlightenment and insight. I read about 2 paragraphs over the 2 weeks. So I am still here, at the same place. But now the pressing paperwork, charting, forms, follow-ups, tasks, notes and labs are pouring in and as usual I find myself mostly living in the "urgent unimportant" world.

So I will leave this for now. A poem that hit the nail on the head for me at a time when I needed it.

The Last Time
Marie Howe

The last time we had dinner together in a restaurant
with white tablecloths, he leaned forward

and took my two hands in his hands and said,
I'm going to die soon. I want you to know that.

And I said, I think you do know.
And he said. What surprises me is that you don't.

And I said, I do. And he said, What?
And I said,  Know that you're going to die.

And he said, No, I mean know that you are.

6 comments:

Unknown said...

As a reader of your blog, I thought you might appreciate this article by Atul Gawande http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care

Albinoblackbear said...

Thank you! I will certainly read it as IMHO everything he writes is gold dust. Appreciate the link and the sentiment.

Solitary Diner said...

Some of the attendings in my program gave all the residents a copy of the Antidote when we graduated, and I think it contains a lot of wisdom. We don't get a lot of time in our training to think about happiness (or to go to the bathroom, for that matter), but now that I'm an attending I'm trying to devote a bit of time and thought to it. Best to start out with a practice/life that will promote happiness than to wait decades to try to be happy.

Albinoblackbear said...

@SD - Wow those are pretty forward thinking attendings! Nice ! I agree, happiness can't be a long term goal/destination which is hard to implement when you've been working in a "delayed gratification" mode for a decade or more! ;)

tracy said...



Perhaps you might enjoy Atul Gawande's "Being Mortal". It is excellent.

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