Category: Reflections on Life, Being Human, and Medicine

Reflections on a variety of topics. My hope is to stir your thinking and perhaps even give you things to talk about in regards to what it means to be human, about life in general, and often times on the practice of medicine.

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Being human Medicine Reflections on Life, Being Human, and Medicine Reflections on the Christian Life

Dependency

He has a terminal diagnosis. It is taking him slowly. No one can know how long he will last. It is weakening him and that is hard for him.

It was a routine clinic day for me. I was bopping from room to room working through my day trying to keep on time. I hate being behind in clinic. I keep pushing to get my notes done between patients. I rapidly scan the chart for the next patient. I see that he was recently hospitalized. In the hospital he didn’t respond very well to the treatment. He is home now but it doesn’t look very good for him.

When I enter the exam room seeing his face “clicks” something in my mind. I am a visual learner. Seeing him and his wife helps me remember a lot about him. He is a big and muscular man. He is the type that has always been strong in both body but also spirit. He is the type of person that you could rely on to always be there and to always get everything done.

He looks different now. He is clearly being weakened by his disease. His color is not good. It is still him, but it is as though the battery has been partly drained. The strong muscles are not getting the energy they need. This is going in the wrong direction. As his doctor, I do not have a thing that I can do to alter that.

I tried to engage him in a goals of care discussion. I don’t think that the hospital will ever be a good place for him. It won’t help him. It will likely just weaken him even more. If we are smart, we would keep him in his home. I honestly think he will live longer if we don’t ever put him in the hospital again. 

If we don’t talk about this proactively the hospital is where he is going to end up. That is the default and easy pathway in the U.S. It amazes me how it is always so much hard work to fight against that. Every time it is heavy lifting. I think – for him – this may be the most important thing that I can do today.

What does he want? What are his goals? What are his fears? What would be an unacceptable outcome for him?

He doesn’t want to be a burden on his family. He will want to be hospitalized purely so that they don’t have to take care of him. His wife was shaking her head firmly. She has no problem taking care of him. I know that we can get hospice or other home care resources to him. Even so he doesn’t like the dependent role that he was been forced into.

It has become clear that this is about so much more than just whether or not he wants to be hospitalized again. It is about how to accept and handle dependency on others. He is not wanting to talk about it, but he needs to. His wife knows it. I know it. And deep down he knows it.

I cross the line and start talking about my cancer journey. They knew I was off on a medical leave. They didn’t know why. I explain it to them. I then take it further and talk about some of the lessons. I talk about what it meant to me to be a man. I had strength. I had stamina. I could push myself. And then I could push myself more. I could work late. If I couldn’t get things done at night, I would secretly set my alarm earlier. It could even be extreme if need be to get the job done. I could and I would shoulder the responsibility for whatever I needed to get done. Sleep was good but I could sacrifice it at will to meet the needs of my work, my family, and my life. Sleep was the margin that I could and would sacrifice.

I told him that this was who I was. He nodded and tears formed in the corner of his eyes as I could tell that we were connecting. This was who he had been. 

But no longer.

Shortly before my surgery I lost my stamina. Perhaps it was the tumor. Perhaps it was the stress. I couldn’t keep up the pace anymore. The surgery was staggering to me.  It was enough to roll over in bed, let alone do anything physical. Radiation continued the story. Chemo turned it from a short story to a novel. 

I told him how my wife insisted on driving me to my radiation appointments. I thought I could go alone. She insisted that I not.

He and his wife started nodding. I had struck another point of agreement and understanding.

I told them how we are in this life together. As much as I wish I could be the man that I was before it was not intended to be. I told them that I believed my Lord had forced me into dependency. Sarah and my family and friends and colleagues needed to take care of me. I needed to accept having others do things. I had to accept the role of dependency.

I told him it was ok. His years of strength and serving and supporting his family were wonderful. In this chapter if he needed to have the roles reversed it was ok. He didn’t have to like it. But his wife and his children needed to take on supporting him. 

JJ and Sarah trying to cut the Christmas tree for me while I was recovering from surgery. So maybe they were not very good at it!

I told him that his wife and children too were being traumatized by his illness. They have been forced into a feeling of helplessness as they watched him fading. They were desperate to do something to help. In their grief they needed something physical that they could do. The energy that they exerted helping him was the only tangible means that they would have to fight. His willingness to let them come and help him was a gift. He needed to understand that as the leader of his family he needed to help them to be able to grieve. His illness was calling him to do something hard.  

He had to let others serve him. He had to accept dependency.

It was ok.

By now, the tears were evident in his eyes. He understood. I understood. We didn’t have to like it. But as strong men, we can and would do whatever was best for our family.

The doors were now open. We talked about home care services. We talked about hospice. We talked about continuing to endure – to work to stay alive – for now – if that is what was best. We talked about the inevitability of death for every one of us. “A recent study has shown that human mortality is close to 100%” We laughed. Then we talked more.  In his case now, we talked about the important questions of “how” and “where” rather than “if” or “when”.

I didn’t really change much in terms of his medicines. But I like to think I was a good doctor. I provided the treatment that he desperately needed. 

Thank you, Lord, for letting me be your servant in the exam room this last week. Thank you for letting my cancer journey be used for good. It makes it just a little bit better if it could do some good. It is not that I wanted the cancer. But at least, in that moment, it was good.

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Being human Reflections on Life, Being Human, and Medicine

The Old Heavy Flannel Shirt

I was on the elevator running between meetings. I do not recall what it was or where I was going at the time. Whatever was “so important” suddenly was out-shadowed by an old heavy flannel shirt. That I can remember in detail.

As I stood on the elevator there was a woman coming from visiting a family member in the heart center. She had on multiple layers of clothing. The outermost one was an old heavy insulated flannel shirt. It was worn and faded and looked a bit thin in areas. She was “squishy”. She was older, somewhat weathered, and did not have on any makeup. She was not dirty. She was clean. Her hair was not fancy but not unkempt either. She was just herself.

I wore a business suit and dress shoes. My hospital ID badge was prominently displayed on my chest. My dress shirt was crisp. We stood in contrast of each other.

In an instant I envied her. 

My mind was suddenly pulled to imagining her life. I was back on the farm. I was in my grandparent’s house. There was clutter on the kitchen counter. Not unkempt but just the things of life. There was a cast iron frying pan on the stove with fried potatoes in it. There was a jar of Folger’s instant coffee on the dining room table. There was a stack of newspapers in the living room. Covers protected the sofas. A small television was on the one wall. It would get two or maybe three channels. My mind filled with the images and smells and sounds of the place. I longed to be back there.

It was winter. There was some work to do but it was not high pressure. After coffee and breakfast, they would be out in the garage grading apples. Their dog would come with them. Depending on the day they might take a mid-morning coffee break. They would certainly break and come inside for lunch. When the day ended so did the work. They would be in the house and would have dinner and watch Jeopardy and read the newspaper. They might have worries about the farm. But there also would be seasons when there was not as much to think or worry about. There would be times when life would be simpler.

They would be together in the warm house in the evening. They did not have to be dressed up. They could just be.

I remembered the hours working on the farm. My mind would drift off in a thousand directions as I worked. I would have adventures in my mind or solve great things in my mind as I worked. There was plenty of time to think as I went about my work. I can remember the times working on the tractor and getting into a groove. Sometimes I would just be. Other times I would think through stories or daydreams as I drove along in a repetitive pattern in the field.

The elevator doors opened, and the woman in the flannel shirt got off the elevator. I wanted to speak to her, but I had no idea what I would say. I wanted to tell her to celebrate the wonder of her life. I wanted to tell her that I envied her. I wanted to tell her of the wisdom of her manner of life. I somehow wanted to escape. That perhaps I could put on such a flannel shirt. That I could recapture the wisdom of simple things. That I could escape the complexities of a sophisticated life. That I could just be at home with my family, in a warm house, with nothing to do but watch what was on the 2 or 3 channels of television that would be available and accept that that would be enough.

When my grandfather died my family found several unworn dress shirts in his bedroom, many still in the boxes. It seems that each year when a birthday or Christmas would come around the family members would give him a new shirt. He would be appreciative of the gifts. But he had shirts that still had a lot of wear left in them. He didn’t need new shirts yet. He would wear them when they were needed. He didn’t need to wear a new shirt to be happy. 

Should we flee to the farm? For some that may be the answer. Escape to a place that is simpler. Wear old and worn but clean clothes. Eat breakfast in your own dining room every day. Go about your work with your dog by your side. Work with your hands. Let your mind have time to dream and be free. Be in your house for lunch and supper. Have a little too much clutter around. Have furniture that is not perfect but comfortable. Settle in for the evening at the end of the day.

Do we all need to flee to the farm? Is it just the farm that we seek? Is the farm really nirvana? Certainly, it carries with it its own worries and concerns.  Then what are we seeking? 

Perspective. Simplification. Margin. Family. Contentment.

It is not just one thing. It is more like a picture. You look at it and you like it. But trying to describe the feeling or the appeal in words can’t quite capture it. Perhaps you shouldn’t try to put it into words. I don’t know that I can get quite enough words to repaint the image or feeling that is in my mind.

There is a painting in the hospital by Mathias Alten called “Man with Wheelbarrow.” It is by one of the elevators. I really like it. I stand and look at it as I am forced to pause to wait for the elevator. It captures my mind and takes me to a place that I like to go.  In it is an older man with a wheelbarrow walking alone through a field. It captures what I am talking about. Nature. Quiet. Physical work. Not hurried. Doing the work of the moment. His mind is clear to think but not pressured.

I went into my next meeting. My mind followed the woman from the elevator. I actively participated in the meeting, but somehow, little things didn’t seem quite so important. Perspective. Simplify. Margin. Family. Contentment. 

The woman wore a heavy flannel shirt. It was old and worn but clean. It was still a perfectly good shirt. She was on her way home. I could smell and feel and imagine the home that she was returning to. It was not fancy. It likely had a bit too much clutter. The sofa and chairs had softened and were a bit broken down with age. But it was her home and her life. And it could be a happy place. In my mind I wished her well.

Your home, your family, your life, your world are all great gifts. Enjoy!