Carving

She started the day by announcing that I should take violin lessons.

I was on an elective month, spending a lot of one-on-one time with an attending physician whom I greatly admired.  And she had had a terrific piano lesson the day before, which was why, upon learning that I had played the violin seriously from childhood through college, she insisted that I restart my practice.

Because it will feed your soul, she explained.  And when you feed your soul, you come to your patients whole.  You’re not missing anything, not holding onto anything, and they can sense that.  They can sense whether they can share everything with you or whether you’ve got your own stuff going on.  Nourish yourself and you’ll be completely there for them.  You’ll be a better doctor.

It was nothing I hadn’t told myself – or heard from my husband – before.  I have written about both my longing for more music in my life (“Music Memory”) and about the difficulties of finding time for life outside of medicine (“The Hardest Thing”) on my blog during medical school.  I love the phrase, the idea, of feeding one’s soul.  I first heard it during one of my medical school rotations when the course director encouraged us to make time for just that.  And in my subsequent training, I have known several attendings who take music lessons, and one who attends weekly Pilates classes religiously.

The problem lies not in embracing the concept – Do things I love that make me feel whole as a person?  I’m there! – but in executing it successfully.  The doctor who encouraged me to take violin lessons, and, in fact, began Googling local teachers for me, told me that I just needed to carve out the time.

It sounded easy enough.  After all, this was an elective month with hours far more forgiving than usual.  At home that evening, I scanned my calendar and pinpointed two opportunities for some soul nourishing: the next morning, which was scheduled for a later start, I would dust off my violin.  And two evenings later, I would take a class at the yoga studio I had been meaning to try.

I was proud of my progress.  With a little bit of effort, I could get myself back on track, moving toward that coveted work-life balance.

That night before bed I skimmed through my emails and saw two requests from coworkers for meetings regarding some work-related projects.  One wanted to meet the following morning – Great!  I didn’t have to be at the hospital until late anyway – and the other suggested an evening meeting a few nights later – Perfect!  We would be able to make some progress on our grant proposal.

Only after shooting off enthusiastic responses did I realize that I had just scheduled work time into the slots that only hours before had felt gapingly open, just waiting to accommodate any soul-nourishing activity I could fathom.

And that’s when several things grew clear.  In order to make any of this happen, in order to really – really – incorporate outside-of-medicine enrichments into my life, I would need to schedule them.  As in, write them on a calendar and honor the commitments just as I would an appointment at the dentist or to get my car serviced.  But doing so would require that each non-work activity occupy time that might otherwise have been dedicated to work; it is impossible to simply squeeze one more thing into a finite number of hours.  Wanting to, yearning to, believing with my whole heart that it is important, won’t make it just happen.

Which is why the phrase carving out time suddenly feels so apt.  It depicts the active process demanded by such a task; one does not just passively find or halfheartedly set aside the time to do something.  One must diligently and painstakingly labor, chiseling scratch by scratch into the rock face of each day, to carve out the space in which to nestle those things that nourish them and make them whole.

Nourish yourself, she said.  Feed your soul.  She could sense my Yes, but response, and she was ready.

If you won’t do it for yourself, do it for your patients.

Time to get out the chisel.

Basketball and Medicine

A few months ago, my husband and his brother took me to my first professional basketball game.  Prior to this, the last basketball game I had attended had been to watch from the corner of my eye as my middle school boyfriend and his teammates trekked up and down the court, facing the team from a neighboring district, as my girlfriends and I gossiped and giggled.  At this more recent game, my husband and brother-in-law laughed at my reactions to the barely-clothed dancers who gyrated during extended time-outs and at the way that my interest was only piqued by the Big Wheels race for children held on the court at half-time.  The rest of the time they spend in detailed analysis with one another while I gazed around the arena and daydreamed.

But one of the things that really struck me was the treatment and behavior of the players, the way that a man about to substitute for his teammate would rise from the bench, pull off the T-shirt layered over his jersey, drop it to the floor and step out onto the court without giving it a second glance.  The job of retrieving it fell to the ball boy or some similar team employee, who would scurry quickly to grab it before retreating back out of the limelight.

I grow irritated when people don’t pick up after themselves, and even more so when they expect others to do it for them.  I scold my husband for this repeatedly, when he leaves that day’s tie on the shelf in our entryway, having shed it the moment he walked through the door, or his shoes one in front of the other, in the exact position that he stepped out of them, along the hallway leading to our bedroom, as if they had begun to walk themselves back to their home in the closet but hadn’t quite made it to their destination.

The subtext that I read from such actions is that the perpetrator views himself, or his time, as more important that someone else’s, and that it is appropriate for that other person, who holds a lower position, to cater to the first.  And I began thinking about similar situations that occur in medicine, the way that doctors, and attending physicians in particular, have many tasks completed for them, tasks that wouldn’t necessarily cost them a lot of time, but that just make their lives a little bit easier.  For example, in hospitals that still utilize a paper medical record, each patient’s chart is often bookmarked, allowing the attending to open it to the next blank page rather than having to rifle through it before beginning the day’s progress note.  In other places, the page for the day’s note is removed from each patient’s chart, and once the notes are written, the pages are filed back in their proper places – by someone other than the attending.

These are small courtesies, to be sure.  They don’t occupy a large portion of the day for the person who performs them, nor would they occupy a large portion of the attending’s time.  Some would argue that physicians who have completed four years of college, four years of medical school, and at least three years of residency potentially followed by fellowship have earned exemption from certain more menial tasks.  Perhaps I am too early in my training to share this feeling of entitlement, but I am uncomfortable with any special accommodations that stem from status alone.  Certain divisions of labor are appropriate and necessary for the flow of an organization; ball boys, not the players, should retrieve balls that have traveled out of bounds in order not to delay the progress of the game.  Similarly, nurses administer vaccinations to children at the end of my clinic visits, which allows me to move on to the next waiting patient.  But I do feel that, when I am an attending physician, I will not be too slowed by the need to flip through the chart to find a blank page.

I recently came across a charming blog post entitled “Physicians: Learn to pick up the proverbial poop.”  The author describes his experience being a clown in the circus and seeing the elephant tamer, the man with the highest status in the show, helping to pick up the elephant droppings after the performance.  He draws from this a lesson that can be applied to physicians, managers, and any professional operating in a hierarchical setting: when leaders indicate through their actions that no task is beneath them, they set an example and promote a culture of teamwork from which everyone will reap benefits.

I haven’t been to any basketball games lately.  And I am certainly far from being offered any of the courtesies reserved for attending physicians.  But my irritation at these seemingly innocent yet powerfully charged distributions of tasks has made me determined to pay closer attention to my treatment of coworkers in different areas of patient care and of medical students – of anyone who could potentially feel compelled to show deference to even a junior physician.  I appreciate their respect, and hope that we all demonstrate mutual respect for one another, but I don’t deserve special treatment.  We may have different tasks, but we’re all in the business of caring for patients together.