Monday, August 5, 2013

And the (heart)beat goes on.

How do you sit on the edge of a bed, look into eyes and hold a hand without getting pulled into someone's world? How can you meet the parents and the fiancee and even the folks from the "church home" without somehow folding a piece of yourself into the story they all tell? How do you do all of these things and then, when the calendar turns over into a new month, just walk away?

This is what it kind of feels like to be an inpatient hospital physician sometimes during the time we are scheduled to be on the wards. We arrive all bright-eyed and bushy-tailed. We work shoulder to shoulder with our residents and nurses or, if it isn't a resident teaching service, with the countless other people who aren't residents and students but who are integral to hospital care. We high five in hallways, chuckle on rounds, and break bread together. We dissect clinical conundrums and process adverse outcomes over the course of two to four weeks. The time we are slated to be "on service."


That all leads to some bonding. And much like a boot camp or a pledge period of sorts, you gel, yes. But simultaneously some part of you is cheering when you reach the finish line. A piece of your time handed back to you, life finally back in your grasp.


As bittersweet as that might be, it doesn't compare to how it feels to leave the patients. You get so invested in them. For some, you feel like the loved one who rustles them awake on the first day of school and the next door neighbor who stops by after school. You are the one often ushering them into a new normal--this life after a diagnosis has been rendered. Your words and the cadence with which you speak them play like a broken record in their heads and you search to make sure they are more melody than cacophony.

And . . .  you worry about them. On your drive home. In the cafeteria. During journal club sessions. And whatever else you are doing. You pull up papers from the New England Journal of Medicine on your smartphone and read them while waiting for elevators in an attempt to find answers. The answers to, first, what the new normal even is and second, what to do about it. You see your consultant friends in the hallways and exchange both pleasantries and cutting edge thoughts gleaned from those articles that required your reading glasses to see.

You do all of this. For a finite period of time, you do.

And then it ends.

The clock strikes six P.M. on a weekday afternoon. The calendar tells it in big block letters. It is a new month, a new block, a new group of doctors. Your time is up. You are free to leave.

Woo hoo?

So invested, you type up some list of your patients with probably more detail than is even desired, but you do. And this person who doesn't know and love them like you do listens to you droning on and on and they politely nod and say, "Uh huh. Uh huh. Got it." And partly they say that because they are getting it. But also because they know that you need to honor your patients through this exchange.

I go to their bedsides and tell them. "You will see some new faces tomorrow," I say. And their eyes always widen when I do. Some because they are confused by the process. Other more seasoned patients because, though familiar with how the hospital teams turn over, they are simply sorry to see you go.

And a lot of the times, I feel the exact same way. Like I've somehow betrayed them.

I said good bye to a man last week who'd received some very bad news. And I saw him right before that bad news was final and then the page turned and it was August 1. Life started happening and I got busy with all of the things that had been on my back burner while on service so, despite my intention to do so, I didn't get upstairs to see him the following day. Yes, I was technically "off service" but still. I wanted to see him and look into his eyes and hold his hand. I did.

He left the hospital before I could. Yeah.

There is this thing we talk about called "transition of care." Where we hand our patients over to one another at the close of a scheduled time caring for them. The key is that we don't want any balls to get dropped or wheels to be reinvented so it is critical that this happens. And that part, I have figured out. But what I still struggle with is how how to transition the caring. Is there a way to communicate to someone the things that don't make it into the chart? How special this woman is to her grandson or how cherished this man is to his little boy? Should I assume that the next doctor will find this out on their own or should that, too, be typed into my little sign out sheet?

"Loves oranges but peak season peaches are his favorite."
"Has seen every single episode of Seinfeld and can quote them all."
"Says that the Maury Povich show is her guilty pleasure."
"Played center field for the Atlanta Black Crackers in the Negro League."
"Was a back up dancer for M.C. Hammer."

Some part of me doesn't want the ball to get dropped on all of that either.

So my point? I don't know what it is. I guess I'm just thinking about all of this over my coffee this morning. And even though I'm no longer the attending of record, my heart is still rounding every single day.


Happy Monday.


  1. I agree with you on every sentence. It feels like betrayal to leave behind patients to another doctor with a perfunctory transfer note and especially to give the patients the news. After getting to know them bit by bit, and making them comfortable enough to confide in you, just like that, at the turn of the month, you have to give up abruptly the 'relationship' that you had built and 'move on' to new patients. You mostly wouldn't be able to follow up the old patients and they remain yet another set of memories that had to be left unfinished.

  2. Wow, that this happens with a doctor who has seen a patient for a month? in a hospital, and doesn't seem to happen in office settings where they have been seeing the patient for 15 years is amazing.

  3. Oh, how I love how you put the human back into Doctor.

  4. you are such a fine doctor and human being. i wish i lived where you do. i would be knocking on your door. wait. i'm doing that anyway. from here. and you're answering. i cannot tell you how many times i have quoted your "you lose weight in the kitchen. you get fit in the gym." Yeah. i heard you.


  5. Yes! I know how you feel except I feel that way with some of my students. Especially the ones who have a struggle, or have been tagged as "difficult" and I have somehow made some progress with them. When they move on to their next teacher, I worry. Not that I don't trust the new teacher, but for a little while they were "mine" and I saw that beneath their tough facade is someone vulnerable and special. I wonder will the new teacher figure out my student is angry because her dad died leaving her mom with a lot of children to raise alone and that she is absent a lot to take care of her siblings? Or what about him, his dad committed suicide and he really struggled two years ago but now? He is on the class council!! That is a victory! I just want them to continue to feel special...even if it is only inside the walls of the school. Because life can be tough for teenagers too, you never know what struggles they carry in their backpacks weighing them down like bricks. I want them to fly. School starts in one day, I pray God shows me which student needs to someone to believe in them.

  6. Wow Lisa! Well said!

    Just wow!

  7. It's not hard to believe that healing is your calling. Thank you for the work you do and for the compassionate way you write about it.


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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