Friday, August 31, 2012

The other side.


As doctors, we see patients, hear their stories and carry them inside of our hearts. We do. But the truth is that, no matter how much we care, we go home and carry on with our lives. And our patients take their realities home with them and live with them until the next time they see us again.

They sure do.

Like today, I laughed out loud with a patient very close to my age who was just diagnosed with insulin dependent diabetes. Recovered from life threatening diabetic ketoacidosis and was now doing his best to get used to this new diagnosis. He's a runner and a biker. Not a bicycle-biker but like the Harley Davidson hog kind of biker that rides cross country in a tasseled vest with all of his friends.

He asked me yesterday if I thought that being diabetic would put the kibosh on all of that and I simply said, "My guess is that there is a person on insulin who has successfully rolled out on a Harley onto open highways." He seemed to like that.

Today he was showing me this app that he'd downloaded to his smartphone. It's called "Diabetes Buddy." So when I came in, he said, "Hey! Have you seen my little buddy?" And I looked totally puzzled until he showed me how it all worked on his iPhone.  So I started clapping and so did he.

A few moments later he said, "I wonder how this will affect my long runs? I carb load usually when I do those. This is going to be kind of a buzz-kill. Damn."

And I looked at him and said, "You know what? Serious health stuff can be a buzz-kill." I sighed and went on. "I want to say something really encouraging right now but the truth is that you're going to have to make some major adjustments. But eventually it will be second nature."

He looked at me and smiled. "You know? I appreciate that, doc. That diabetes educator lady was in here earlier and when she left, I just sort of sat there by myself with all that information. Finally, I was just like, 'Damn. This is kind of f--ked up.'" Then he chuckled which made me chuckle, too.

I twisted my mouth and sat on the edge of his bed. "Yeah. But it kind of is messed up."

"Excuse me, I said f--ked up."

"That too." We laughed again.

"It's kind of funny. People waltz in and tell you all this stuff that's about to change your whole damn life like it ain't nothing. 'Here! Shoot yourself with needles! Hey! Track all your carbohydrates!' It's a trip."

"Yeah. It sounds like a trip."

"I like that you basically called it for what it is. This shit is a big deal. And some times it is gonna be a buzz-kill, for real. But I will be okay. I know I will."

"I know you will, too."

And after that we shook hands and I showed him two other cool apps that he might also like. A running one and a food log one. Then he asked me if I am a runner and I admitted that I am totally Alyson Felix but only in my warped imagination. Otherwise, no, I'm simply a wanna-be runner.

He seemed to like that, too.

So that visit was good because it made me think. And I pretty much like anything that makes me think.

My patient was showing me something that I rarely think about. The other side. The things that happen when the clinic wraps up and the discharge papers get signed. The hard knocks and realities that get forgotten. By me, too.

This morning I shared photos of a little girl named Ella who was diagnosed with acute lymphoblastic leukemia two years ago. I engaged in a little bit of that discussion that makes us all squeamish because seeing that and hearing that means it's no longer hypothetical. I call that the other side. The side we don't like to think of and that we fear that, when assigned to someone real, could somehow make it. . . .I don't know. . .  contagious?

Yes. I said it. Contagious. Like, if I say something or think something or ask something or do something with them, the universe might throw a bulls-eye onto my back just for doing it.

Crazy, I know.

Anyways. It's funny that this is on my mind today because just as I got home with the boys, I sat at my computer to read a few of my favorite blogs. One of those belongs to my amazing friend Elizabeth who writes such raw and beautiful words about her real-life walk on the other side that I go back to reread her posts just to make myself a better doctor. She's just that fantastic.

Interestingly, Elizabeth is an Atlanta native that now lives in the Los Angeles area--the direct opposite of me, the L.A. girl now living in her old stomping grounds. She is the mother to three amazing children--Sophie, Henry and Oliver. She writes about many things, but among those things she writes about their life with her daughter who has a severe seizure disorder. It is brave and eye-opening. Especially to read it as a doctor. Because even the most well-meaning of us struggle with truly seeing the other side--the side that talks about what to do when your child has seizures at the dinner table or when your other children are crying because someone used the word "retard" to describe any and everything.

And see, that? That is the other side. Elizabeth takes us there. Grips our hands and pulls us into the reality of it even if it makes us squirm. Ella's mother Katie does the same thing.


Today on Elizabeth's blog she shared a video project that she'd been working on that just knocked the wind from my chest. It is the other side in high definition . . . . and in their own words.

See it. Feel it. Share it.



Fellow health care providers and medical students, try this exercise:

Allow yourself to imagine what will happen in the twenty four hours after you discharge your patient from the hospital or clinic. Think of everything from the car ride home to how they will manage to get into the pharmacy to pick up the medicines you just prescribed to what they will tell the loved one whose birthday party they missed because of a minor setback.

Because all of that is the other side. It sure is.

Happy Friday. Again.


  1. Oh, my gosh. You know, making that video made me weep -- particularly when I gazed into the eyes of those who participated.

    But you, you. How can I thank you? Thank you, Dr. Thank you for taking the time to write about us, for being affected by us, for doing what you do every single day. Thank you for working with us. From the bottom of my very large heart, thank you.

    1. You make me a better doctor and a better writer, Elizabeth. 'Preciate you.

  2. Excellent post, and something that we too often forget as health care providers. We do this every day to the point where it's no big deal for us. But for our patients and their families, it is a really big deal.

    When I trained new paramedics, and now when I train new organ donation coordinators, I remind them of that. For their patients and their families, this is like 9/11/2001. The day we meet them will be a day forever seared into their brains. Our job (in addition to excellent patient care) is to recognize and respect that, and consider the impact that such an event has on their baseline cognition when we're explaining and re-explaining and re-re-explaining what's going on. Our role is to take something horrible, something terrifying, and help the patient/family transform it into something that they overcame.

    When we do that, that's a success.

    1. PJ, you always have the best insights. Sometimes you read something or get something that even I didn't see in my own writing and I love that about you. I love that someone so smart is reading my blog repeatedly and has been deterred.

      Thank you.

  3. Love this! It is such an important life lesson, I'm sure if I pour my feelings out, this comment with become a mini-blog post in itself :).

    Taking a walk down the other side is so important, whether it's as a doctor or as a patient or just as a human being. Thanks for putting it all down so beautifully as you always so Dr M.

    -- Tara

  4. So true, so true. I always think that in many ways, in many situations , the hardest part begins when patients leave the hospitals and clinics.

    Maria, fellow Meharrian

    1. It so very is. Thanks for always being her and always sharing your thoughtful comments.

      Kimberly, fellow Meharrian.

  5. This post sure hit home for the span of 48 hours my dad was diagnosed with lung cancer stage 4 and we were sent home and ON OUR OWN! We had no idea what we were doing...the language being spoken was foriegn to us...we were just hoping to make it through the first night...

    1. Wow. I have read your words and know that you will. But still. That sounds like a whole, whole lot. Cancer sucks. I'm sorry that this is what you are dealing with today. I truly, truly am.


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