Join the club.

San Francisco Coffee Roasting Company

I am changing, trying every way I can.
I am changing, I'll be better than I am.
I'm trying to find a way to understand.
But I need you, I need you, I need a hand.

I am changing, seeing everything so clear.
I am changing, I'm gonna start right now, right here.
I'm hoping to work it out and I know that I can.
But I need you, I need a hand

~ from Dreamgirls

________________________________________

Today I spent part of my afternoon hanging out at the San Francisco Coffee Company having java and conversation with Anna H., one of our medical students. Anna is starting up her final year of medical school so we were trying to situate her schedule which was pretty much already together. That allowed us to move on to other things.

We somehow got on the subject of suffering and how that affects us as caregivers.

"I think losing my sister changed me," I told her. "Like. . . I don't know. . . . I somehow feel more connected to people who have loss and less like I'm watching a sad movie."

So Anna, in her thoughtful Anna way, looked at me intently and let that resonate before she spoke. And, like always, her words were selected with care. "Do you think that we have to endure some kind of suffering to really be effective at what we do as physicians?"

That question was a heavy one. It was. It was also a fair one because I'd said to her before this that I thought, after going through all of that, that such unspeakable grief had changed me and made me a more empathic doctor. We discussed how having your own kids helps you as a pediatrician or how having your own baby makes you better understand labor and relate to your patients more.

But this? This idea that you need to suffer and feel like the skin was ripped off of you to really and truly "get it?"  I wasn't sure of the answer to that.

I'm still not.

"I guess if you live long enough, this is a club you'll be initiated into. That or you'll do the initiating for someone."

And despite this macabre notion, Anna nodded in agreement.

"You know?" I said, "Now I say a lot less. I don't feel the need to fill the space with words because I know what helped me and what didn't. I just sit and listen and touch people more. I do say things but I'm more careful. And even though my urge to cry in front of my patients has shifted, my heart feels much more aligned with their feelings. Does that make sense?"

"I think so."

I wasn't even sure if it all made sense to me. But that's how I feel. It really and truly is.

There is this club. This club that has been quietly existing around me that no one really talks to you about until you find yourself thrust into the first meeting. Something happens--like losing a sibling or a parent--and fellow initiates come quietly out of the shadows. They give you their testimonies on tiny handwritten cards or in hushed hallways. Their eyes look different. Their words peppered with things you'd never heard because you weren't privy to such discussions.

Not before you entered the club.

I specifically said a parent or a sibling because I think losing a child or a spouse is altogether a different animal. I am careful not to ever relate my experience with Deanna's passing to what a parent has to walk through after funeralizing a child. Losing your child is so unnatural and out of order that, even as a member of this club, just a few moments of quiet reflection tells you that nothing about it is the same.

Nothing.

Several of my colleagues wrote me heartfelt notes in those weeks after Deanna left us. People I'd worked with shoulder to shoulder for years who I know very well. But I didn't know they were in this club. At least three spoke of losing siblings suddenly. And prematurely, too. They knew of the longing to call and recount old stories that only a sibling could laugh over. They knew of the agony of watching parents with distant, glistening eyes and the helplessness that follows because that club--that parent-who-lost-a-child-before-them club-- is altogether different. They knew. And before that, I had never known that they did.

I don't know if suffering is a necessary component for truly empathic doctoring. (It certainly helps song writers, that's for sure.) But I do know that the more we see ourselves in our patients and people in general, the better we can relate to them. And sometimes that's when they are suffering, yes. But other times, it's something else.

And no--not in that purely hypothetical watching-a-sad-movie kind of way, either. But in that way where you feel somehow intertwined and like your humanity is a continuum.

This is what changed in me on November 15. At least, that's what I think.

Yeah.

I was just thinking about this and wondering about Anna's thought-provoking question. I'd love to hear your thoughts, too.  And if I haven't said it recently, I deeply, deeply appreciate every single person who comes to read here. This has also made me a better doctor and person. We, too, are intertwined; our humanity is a continuum.

It is.

***
Happy late night Friday almost Saturday.

Now playing on my mental iPod. . . . . "I Am Changing" from the Dreamgirls soundtrack. Interesting. In this moment, I just remembered that Deanna loved this song. That just made me love it more.