Primary care: I love The Variety And The Intimacy Of The Problems That Are Placed Before Me

An excerpt from Becoming Doctors 25 Years Later: Twenty five physicians sharing the journey from medical student to retirement.

If I get out of bed now, I can squeeze in that ten-minute morning yoga routine on YouTube. But it feels so nice lying here, sunlight streaming in, sips of coffee warming my body and boosting my heart rate up a notch. If I did anything right in life, it was marrying a man who brings a tumbler of fresh coffee to my bedside every morning. I sip and enjoy the stillness.

The boys must be busy on their devices. Another twenty minutes or so before I have to start rushing them through breakfast, tooth brushing, and out the door to the school bus.

My oldest son is almost eleven, closer to the age I started medical school than I am now. (It seems like three hundred years ago that I was working in cadaver lab.) My younger son is in first grade … which is having its big Valentine’s party tomorrow! Didn’t I sign up to send in napkins? When the oldest was in first grade, I did the “doctor mom” thing, coming to his class to teach a lesson about the real heart. I let the kids listen through my stethoscope, and I showed them pictures of the atria, ventricles, and valves in my old anatomy atlas. The kids loved it and, I’ll admit, I felt proud to teach them something “cool” and “gross” when the other parents showed up with glitter and glue sticks. Small twinge of guilt that I only volunteered the napkins this year, but this year it’s all I feel able to manage. Why are these school events always scheduled at a ridiculous time like 10:45 a.m. on a Tuesday? Don’t schools know that parents have to work?

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I do what I can.

To do today: Maybe yoga. Shower. Get the kids on the school bus. A load of laundry on my way out the door. Then start my real day. Six hours of patients in the primary care clinic.

Fifteen minutes for a checkup or urgent problem, thirty minutes for a physical. In the tiny gasps of time in between: Refilling scripts, checking labs, and signing medical supply orders and insurance authorization requests. Maybe lunch. Maybe a chance to get to the restroom if I am lucky. Clicking, always clicking away on my EMR, hoping to finish my notes. Maybe typing notes while holding on a phone call (why do patients call with a question about a medicine, but they leave the vial upstairs and have to retrieve it while you wait?), while trying to cram a few bites of lunch, while wondering if I will get out of there in time to get the blasted Valentine’s napkins before picking up the kids from their after-school program.

I take a deep breath.

A “stress management” tip that I read a while back is to take deep breaths along with the patients’ inspirations when you auscultate their lungs. The tip is ridiculous and somewhat patronizing. (That is the only time a physician gets to breathe?) Yet, somehow, it helps me to slow down and focus. There is so much to do in a day, but I try to be fully present with each patient. I try to stay mindful that while each visit is just a short blip in my day, it may be an “event” for my patients. They shave their legs or select a pair of socks without holes. (Or apologize if they have not, as if I care.) They prepare lists of questions or consult “Dr. Google” to try to guess what I will say. Maybe they rehearse their stories ahead of time, how they will gently lead into the reason for the appointment.

“Doc, I know you’ll be mad at me. I never got the colonoscopy we talked about last year, and now the blood is in my stool again.”

Or “It’s so silly, probably just stress, but I’m having sweats at night, and sometimes I get dizzy.”

They sit before me on the cold table, their expressions so often betraying shame or fear, dismay at their body’s failings, longing for reassurance or a cure. I understand the weight of this strange job that deals in sickness and health, life, and death. Mostly in fifteen-minute intervals.

I remember a mentor in med school trying to dissuade me from a career in primary care.

“Won’t you get bored of treating colds all day?” she said. The truth is, after twenty years, I am not bored. Primary care is so much more than “colds.” And even a cold is not a cold. It could be a patient who secretly fears that she has lung cancer, or an elderly man with an exacerbation of heart failure, or a new mother who, now that you mention it, has been having crying jags every afternoon while the baby naps and could use someone to talk to.

I love the variety and the intimacy of the problems that are placed before me. I feel privileged to peer so deeply into the essence of humanity … the lumps and boils and sore throats, the fears, and anxieties; all the mental and physical imperfections that make us human.

Maybe we doctors enter this profession, in large part, to try to defend ourselves and our loved ones against illness and pain. The longer we practice, the more we understand that many ailments cannot be prevented or cured. We become more comfortable with limitations and uncertainties. Hopefully, we sharpen our ability to at least soothe, or to serve as a witness. So often, a patient will thank me just for listening. I hope that whatever I do, it helps.

I just wish I had more help with the rest of it, not the doctoring, but the unrelenting scut parts of the job that threaten to drain me dry. So much paperwork. Red tape and logistics. ICD and CPT codes. The work absence letters and FMLA forms. Not to mention finishing up the day’s office notes late at night in the backroom of my house, when I should be reading a novel, or joining my husband for a glass of wine, or preparing Valentine’s snacks for the next day. (Will the boys notice if I don’t? Will their friends’ moms have artsy little muffins ready for them at tomorrow’s breakfast? If I hug them extra tight, will my sons of a doctor know that a healthy, beating heart means so much more than a sugary emoji?)

I do what I can … for my patients, my family … and if there is a tiny bit left, for myself.

The bedroom door creaks open. “Mommy, will you make me oatmeal?”

Simultaneously, a text from the on-call service. “Patient’s fingerstick is 426 this morning, wants to know how much insulin to take.” I look at the clock. I guess YouTube yoga is not going to happen. I put down my coffee and lie back in bed, for one last moment. I take a deep breath in, expanding my lungs, filling my belly, and stretching my toes. I guess this counts as savasana, the yoga position known as corpse pose. It will have to do. I arise again to start my day.

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