Reflection of a Clinican-educator on a Tuesday: Reasons, Seasons, and Lifetimes

with my "small goup" advisees at the AIDS Walk 2008. . .
. . then as second year students. . .soon to be 4th years. . .

With my former fourth year student, Bianca S. at Commencement 2010

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Nothing is here to stay

Everything has to begin and end

A ship in a bottle won't sail

All we can do is dream that the wind

will blow us across the water . . . .

A ship in a bottle set sail.

from "Baby" by Dave Matthews

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May and June mark the end of our academic year in medical education. The medical students either advance to the next level or become sho' nuff and bona fide doctors--albeit uncertified and untrained--but doctors nonetheless. The interns exit the novice stage and become residents; one week asking someone senior what to do, the next telling someone junior what to do. And of course, the senior residents and fellows finally get the stamp of approval that officially releases them from the nest. It's kind of bittersweet for folks like me--the surrogate mommies and daddies that helped guide them along this path to becoming full-fledged physicians. (Though I'm sure it comes as no surprise to you) I must admit that this time of year, I get just a wee-bit choked up. (Don't worry--it's usually not the ugly cry.)

with my former fourth year student, Olivier D., at Commencement 2010

Right now we are doing the whole "graduation" thing. Farewells to so many. . . our chief residents, our senior residents, and even the interns that spent this first year training in Internal Medicine as Transitional Year interns--all of whom will now flutter away to their chosen career paths. At risk of sounding cliche, I'll say it anyway: "Seems like only yesterday that y'all were deer in headlights asking me your cute little questions in orientation." Sigh.

with Shannon H. and Annie G., transitional interns 2009 - 2010
. . .Radiologists 2010 and beyond

What used to make these transitions so hard for me is the nature of time. With time, some of the most seemingly memorable people can fade into fuzzy blurs. . . .reduced completely to, snap your finger! snap your finger! "What was that guy's name? Uggghh! It's going to bother me all day! You know who I'm talking about! That guy with the sandy brown hair and freckles that went into Cardiology!" That guy took call with you every third night in the ICU and ordered Chinese and Mediterranean and Italian takeout with you. That guy told you that your inconsiderate boyfriend who made you cry between admissions was missing out and that it was his loss. That girl wrote you the nicest card at the end of the year, and even invited you to her wedding. Oh, and that student you worked with? She was the one you vowed to stay in contact with forever. What happened?

with my former advisees Shveta R. and Dorothy W. on Match Day 2007

A few months ago, I was at the ACP meeting in Toronto and saw this gentleman standing in the conference hall from a distance. I knew I knew him from residency training, or was it an away rotation during my 4th year of medical school? Hmmm. Maybe he trained at Emory? I know he was on a team with me at some point. But his name? No where near the tip of my tongue. I squinted my eyes and remembered that he was very nice. . . Lebanese, maybe. . . . .a great doctor. . . .and exceptionally smart. But despite my best efforts, I could not, for the life of me, place his name or his place in the time line of my medical life. It bothered me because I knew that we'd worked closely at some point, and that, whenever or wherever it was, I'd spent a lot of time with him. How could I not remember exactly who he was? Does it mean that I am a loser? Gosh, I sure hope not.

So here's the thing: Life happens. People move and people move on. Those every day surroundings fade into remote memories right along with some of the most every day people. What does that mean? Does it mean that those things were somehow less important? Does it mean that we have allowed ourselves to become so busy with our business, and fussy with our fussiness that we've neglected to preserve the flowers that we used to smell every single day? Naaah. It's not that simple. The older you get, the more you realize that there's more to it than that.

with former Grady doctors, Ben A. and Cherry L. (and their ninos) 2009

"People come into your life for a reason, a season, or a lifetime.

When you figure out which it is,
you know exactly what to do for each person."

~ Aleksandra Lachut

My mother shared this quote with me the day before I got married. She elaborated on the importance of all three, and how fortunate those who can discern such a thing are when meeting people along life's path. I've decided that this applies to the relationships fostered in medicine, too. There are some students and residents that I can close my eyes and see, hear, and bring to life with virtually no effort. Then there are classmates from medical school that I could not name if my life depended upon it.

As I pondered this more, I also thought about the people that I've had only fleeting contact with professionally--who somehow clicked with me and became "keepers." Like my friend Kris R. who worked with me at Grady for, like five seconds, but who, upon first meeting, was an automatic keeper. The instant friend that was only passing through but whose friendship felt exactly like worn-in slippers from the start, and who made me laugh so hard over dinner last week that I thought I would be sick. Or like my friend and fellow Grady doctor, Lesley M. who almost never shares the same clinic schedule or ward schedule or schedule period with me, but who seamlessly maintains "lifetime" status as one of the people I most look forward to seeing at work. Now I understand that some people have an impact on you for a reason. . . or only for a season . . .or, if you're lucky, a lifetime. And that the quantity of time they spend with you, or even the quality alone for that matter, is not quite what determines where they will fall in this line up. It seems to just sort of happen on some higher plane that can't be forced or explained.

I won't take it personally if a student, a resident, or a colleague doesn't remember me in high definition. It's okay because I know that some will. And despite their best efforts, I know that the others will eventually recall me only as, snap your finger! snap your finger! "You know! That black female attending that wore the short haircut that wrote the touchy-feely blog! You know who I'm talking about!" Yep. It's hard to imagine. . .but it's a reality that just is. And you know what? I'm okay with that.

After 'while. . . . . crocodile?

So yeah. . . . .I'm waving goodbye to some, saying "see you later" to others, and preparing to usher in a whole new complement of students, interns and colleagues. Through it all, I'll be silently sorting each of these special people into reason, season, or lifetime. Who knows? Some may fall into all of the above. In doing this,especially during these periods of transition, I think the "thank you for everythings" will feel more authentic, and the "you've been wonderful to work withs" will mean just a little bit more. No matter what, there is one thing I now know for sure: Despite how important I feel today, I know that for many, as of June 2010, my season in their lives has come to an end. . . . .and again. . . .I'm okay with that, too.

"To every thing there is a season, and a time to every purpose under the heaven."

~ Ecclesiastes 3:1 KJV

With our current and former chief residents, Julie J-M, Gabriel W., Roy A., and Rosette C.