It’s been almost a year since my last blog. Much has happened and in some ways its been a little overwhelming to absorb all the transitions that have unfolded. Although, I suppose that in itself is not special. We all live our own important lives with transitions and adventures in our own way. So in some sense that is no excuse for not finding the time and mental space to keep writing. This blog helps me make sense of the world, the brilliance, and idiocy that surrounds me. Ultimately writing helps me to figure out which one is which. Perhaps I’m shy to write more again as I’m pretty sure I’ll just wind up finding idiocy in my own self perceived brilliance.
In summary over the last twelve months:
-Liz and I studied yoga in India for a month long 200 hour instructor course
-Spent a week in Dubai
-Bummed on some islands in Greece.
-Returned to the states after being away for a year and moved to Klamath Falls Oregon to start my residency over in Family Medicine as an intern….again.
-I’m currently in the process of joining the Oregon National Guard as a flight surgeon for an F-15 fighter wing.
Easily the biggest transition, and source of identity tension is that I am an intern again. I’m back at the bottom of the food chain and I’m trying my best to wear the hat that is the embodiment of the newly minted naive young wide eyed physician. Which in itself isn’t that bad, I’ve done this before and I can do it again, but for me the challenge is not simply walking a path that I have walked before, it’s being forced to assume an identity that I’ve moved away from, and to embrace a culture that I don’t see the same as I did before. That has come as both a blessing and a curse. Being a flight surgeon alone in the middle of Africa for nearly 13 months in addition to wanderlusting the globe for a year while exploring other cultures and their version of healing has left me with a new perspective on the western “modern” medicine.
My new existence is working 80 hours a week pushing out pills to lower cholesterol and blood pressure based on the latest and greatest studies to reduce 10 year morbidity and mortality all the while feeding some electronic medical record all the overly redundant words and codes it needs in order to bill a system that generates a profit that I never know. This might sound jaded, because it is, the life of any resident is a life of indentured servitude to a mechanical version of medicine that slowly whittles away healers of Hippocrates to technicians of Medicare. But, this life is finite, this only lasts a few years, at least that is what I thought. I remembered this painful existence from before, but what I know see is different. It doesn’t end with residency. The hours just get shorter. 80 hours becomes 40, but the machine is no different. The treadmill of working for a corporate entity, or begging and scraping with insurance companies continues. Hospitalists are still bitter, clinicians are still overworked at 20 minute encounters for complex patients that deserve and require more. I get told it gets better after residency, but it’s hard to tell me tales of future glory when I can see the reality in front of me, some people are totally ok with it, complacent and happy to pay off student loans in a secure job, but In reality I still don’t think it’s adequate medicine. It’s better after residency because it’s the difference between a hot poker and a sharp stick. That is, as long as we stay on the treadmill and continue to feed the machine of bureaucratic medicine
I think what residency is teaching me most is to ask “what is medicine”? I met a woman once in a pain management clinic that was every embodiment of what we refer to as the “train wreck”. Her body was wrecked by years of self abuse, and her spirit was just as broken. She was an emotional and physical mess seeking relief for her chronic back pain. The fast talking pain physician jotted out a prescription for some pain meds and mumbled something about weight loss and exercise. I don’t even think she heard him. He clicked a couple of buttons on a screen documenting that he counseled her on lifestyle management and moved on to the next room.
If medicine is appropriate therapy for the appropriate ailment, this was not it. She didn’t need a pill, or an injection. She needed an overhaul, and she probably needed it 10 years ago. The problem here is two fold. Her problems, her real problems were not going to be addressed or even discovered in a 15 minute encounter. The second problem that she highlights is all too common. This is reactive medicine and right now this is what our medical culture is built and sustained on. We treat her because she is “sick”. In fact we focus most of our energy on the “sick” patients. In the scope of typical modern medicine it seems you are either sick, or healthy. There is no treatment for the “healthy”, just the sick. No money, or energy goes into keeping the healthy from getting sick, but that’s just the edge of the problem. The other side of that is to ask what is healthy? Am I healthy because I don’t have diabetes, chronic degenerative diseases, or hypertension? Healthiness is a spectrum of wellness that we completely ignore. Most people reading this are probably somewhere in that spectrum, a vast grey area between perfect olympian health, and the ICD-10 defined sick.
What I learned in India, and in the jungles of Ecuador is that we are doing it wrong. We devalue the simple free things in our life that can make us more well all the while we over value things that we see as either quick fixes or therapies that we can ignore, like taking a pill every day to make pain go away. The biggest lesson I learned from Yoga is that wellness is work. We are a lazy culture. We don’t want to get up at 5:30 every morning and work on our body or a mindful breathing practice. We rush and race through our days and years without really devoting anytime for ourselves. Mindfulness, meditation, yoga, exercise, journaling all take precious time. Why is it ok to get time off work for a doctors appointment, potentially days off for multiple doctors appointments if you are “sick”, but it’s not necessarily ok to take time off for working on your own wellness. A company that gave its employees a half hour break everyday to do yoga or mediate or whatever they needed for their own wellness would be seen as hippie radical, but why? I think it’s because we value sick, and not well. My personal journey in medical education has now evolved to not only trying to grasp the vast array of knowledge that is Family Medicine, but also, and maybe more importantly how to deliver it correctly.