Namaste . . . to Myself

So many of the phrases that I use when talking and writing about palliative care – meeting people where they are, starting low and going slow[ly] (when managing pain meds), following the signs that the body shows us – apply surprisingly well to yoga. Yogic wisdom encourages us to go at our own pace, focusing on where we are in our own practice and on our own mat on any given day.

Of course, I was always the person peeking at the forms on the mats around me, seeing how I stacked up in terms of flexibility, stamina, strength. Searching for ways to compete within this practice of meditation and self-discovery.

Until I hadn’t done yoga in over a year. Until I realized that I could no longer blame my extra pounds on having just had my second baby. . . because that baby is now walking, his chubby legs and gregarious smile propelling him toward – no, into – the adventures of toddlerhood.

Tonight I went back to yoga. To a beginner class. And I reached and I stretched and I lunged and it wasn’t pretty or graceful, but for once my mind stayed on my mat as if there were no one else in the room. It was time for a huge slice of humble pie. With a side of self-acceptance.

~~~~~

I truly did not plan this post as a way to work in another of my old poems, but somewhere on my walk to and from class I remembered that these are lessons I have worked on before:

 

                                                     Sunday Morning 

                                                     I salute the Easter sun

                                                     from my mat

                                                     air sweetened by incense

                                                     in place of lilies

                                                     When people spoke of yoga

                                                     saving their lives

                                                     I was a skeptic

                                                     But each time I rise

                                                     from savasana

                                                     I am reborn

 

Tonight, of course, we started in savasana.

 

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Orange for Good Luck

Seven years ago, my poem about an orange dress won Honorable Mention in the annual William Carlos Williams Poetry Contest for medical students organized by the Northeastern Ohio Universities Colleges of Medicine and Pharmacy. (It also closes out my poetry chapbook, Tools for Survival.) I distinctly remember writing it; it was one of those poems that just flowed out of me, already formed. I was studying for Step One of the US Medical Licensing Exam, and trying to make the best of that pressured month by bringing my books out on the patio to sit in the sun. Wearing a flowing orange sundress seemed like it would help, too.

I’m wearing it again as we’re about to board a plane, our first time flying with both boys, now ages 3 and 1. I still love it and its breezy comfort and cheerfulness seem like good ingredients to mix into this adventure. Here’s hoping it carries some good karma for a smooth (and well-behaved!) flight.

 

Ode to an Orange Dress

See how it flows

part goddess, part boho

chic

See what it makes me do – impromptu trip

out West,

spill my heart

to a stranger on

the subway

after she said

she liked the color

Skirt dances around

my legs even when

the wind dies

I’d take it to heaven

if I could

but no, better leave it

help someone else

do some living

 

 

Year One

It was not long into my first year of medical school that I realized that I needed to write. I needed a way to process all that I was learning and feeling, something to enjoy and something to anchor myself. By the time I graduated, I had composed a collection of essays related – some loosely, some with complete fidelity – to my experiences. Several have been published in their original forms and a few have evolved over multiple iterations before finding homes. I’m so pleased that the very first piece in the collection – titled Year One because I simply could not find another set of words to capture the thrill, the shock, the overpowering wave of responsibility, humility, and fear that arise and collide in that first stage of training – appears today on in-House, the online magazine for medical residents and fellows. Some elements of it come from true events, but overall it is a work of fiction. Click here to read: http://in-housestaff.org/year-one-688

Maybe Later We’ll See

I could go on and on about the ways that becoming a mother made me a better doctor. It’s much easier to build rapport with families when you can throw a genuine, understanding “yup, my kids do that, too!” into the conversation. It helps me to give much better, more realistic, advice, especially to parents of very young children. (How I wish I could apologize to every new mother whom I advised to just “sleep when the baby sleeps.”) Not to mention the fact that I didn’t need to study developmental milestones for my General Pediatrics boards.

But until recently, I felt hard-pressed to list any ways in which being a doctor has made me a better mother. It has made me a more tired mother, a more guilt-laden mother, a mother who excels at multi-tasking, though I’m not entirely certain that that’s a good thing. Because of my specialty, my kids are growing up with an exorbitant emphasis on safety (Safe sleep habits! Rear-facing car seats past age 2! No riding down slides on grown-ups’ laps!). This will likely make their lives slightly less exciting than they would be otherwise, and might even be a detriment to their social skills; at two and a half, Bean regularly points to people biking through our neighborhood and shouts, “Ridin’ bike not wearin’ helmet! Need get helmet!”

The other day, however, I witnessed an interaction that shook me and has already changed, in no small way, an aspect of my parenting. As a fellow in Hospice & Palliative Medicine, I frequently participate in family meetings and discussions surrounding goals of care. I’m there when people learn that their health or that of their loved one is declining, that the remaining time is likely measured in weeks to months; when they hear for the first time that their end-stage organ failure isn’t simply a chronic condition but one that will drastically shorten their life. When they learn that they are no longer a candidate for cure-directed treatment. Oftentimes I am the one to deliver these emotional blows. Regardless, whenever I am involved, my job is to help patients and families understand their clinical conditions and the options that remain – the pros and cons, best- and worst-case scenarios. Their decisions and goals don’t have to make sense to me or coincide with my own values and beliefs, but my job is to try to ensure that the choices they make are well-informed.

I recently met a man and his family who quickly became one of my favorites that I have worked with. The couple were in their seventies, with several grown children and young grandchildren living nearby. His diagnosis was one that most in the medical community would consider devastating, though he and his wife maintained an upbeat attitude and an intention to pursue any form of treatment offered, no matter how severe the side effects or how slim the likelihood of benefit.

The first steps in his treatment knocked him down hard. He suffered debilitating side effects. He began to recover bit by bit, but then, still miles away from his pre-treatment baseline, he landed in the hospital with another complication.

I began to explore with him and his wife the potential paths that lay ahead. There was always the possibility of declining aggressive treatment and focusing on comfort, though he insisted over and over again that he would keep fighting his disease. But after yet another complication, it became clear that he might not, in fact, even be a candidate for any further treatment.

They had many appropriate questions, and I tried for days to get the primary team to sit down with this couple and give them some answers about what might lay in the patient’s future. When they finally did, the meeting began before I could arrive, and I entered the room to hear them discussing a plan to wait one more week and then meet to assess whether or not he might be able to tolerate further treatment. The patient and his wife pressed the physician further. “How likely do you think it is that he will be strong enough to get more treatment?” the wife asked.

“Well, we’ll have to wait and see,” replied the physician.

And there it was. The line that I had been using as of late to side-step Bean’s requests, to put them off in the hopes that he would forget, to deny without officially saying no. As he rounds the bend from two and a half to three years old, he has become quite a skilled negotiator; a frequent refrain is, “Later, nappy time over, do good listening, watch Cars [his current favorite movie]?” He’ll ask even if he’s just seen it the day before. And because I feel bad denying his request – and also because I would prefer to avoid a meltdown – I use a variety of stock Mom-phrases that I hadn’t even realized I relied on until he began repeating them back to me in response to requests of my own: “We’ll see.” “Maybe later.” “Wait and see.”

When I heard it from a fellow physician in such a loaded setting, I grew angry. Of course nothing is certain in medicine and our prediction skills are often poor. But when I looked at the patient before me, knowing his course and his current condition, I knew that I would be utterly shocked if he recovered to the point of being able to press onward with treatment. And the other physician – as he admitted later when we spoke outside of the room – knew it, too.

It made me think hard about the responses that I present to my own child. Yes, it’s easier to give some hand-wavy answer in an attempt to move on, change the subject, dodge the thing staring you in the face. And yes, a toddler’s request for more screen time is exponentially less serious than a family’s request for a clinical prediction. But in both cases, I think that we as humans should show one another the respect that comes with an honest answer, no matter how uncertain, no matter how difficult to deliver and to hear.

So I have started explaining to Bean what we are waiting to see. “It depends on how much time we have after we shop for groceries and take baths,” I’ll say. Or, “Well, let’s see if it’s nice outside; if it’s sunny, we should go to the park instead.” He doesn’t always love my answer, but he knows where things stand and what it is that we are waiting to see.

*Cross-posted at Mothers in Medicine (www.mothersinmedicine.com)*

Turn the Mirror on Yourself

I’m at a conference – a very exciting conference – on palliative care, which is the field of medicine that focuses on the quality of life for patients with life-limiting or -threatening illnesses, as well as that of their caregivers. Sitting in a huge hall of huge people with huge ideas, I can barely keep still, can barely keep my eyes, ears, brain focused on the presentations before me because each one is so exciting, so inspirational, so thought-provoking, that a thousand other thoughts spin out from it: things I want to learn, to do, to teach. There is session upon session, lectures, discussions, questions, and an entire cavernous hall filled with posters, each jam-packed with its own inventory of results, conclusions, directions for future research. It’s so much that my brain begins to fog and stall, but there is so much still to see and explore and absorb that I try to push on, try to will the tendrils of curiosity to get back out there, pick up just a little bit more. Because I’ve only been to xx sessions, only been at this for xx hours, only experienced xx percent of what is here. When you look at the quantity of my experience, it’s just not enough.

Although the quality has been superb.

 

Oh.  

 

Right.

 

Still so much to learn.