Thanks l you for sharing the ups and downs of this week with us. I am glad you felt celebrated before your leave and hope that buoys you in the next few days/weeks. And so distressing (although not so surprising) about the demands of medicine on people who care enough to connect with people.
Thanks Christine. I wondered for a long time why it was harder for me than others (I'm not sure it actually is, I think we are all struggling, some show it more) But I also think some are too wounded to invest themselves anymore too. Also, I have an idea of a guest post I'd love to have you write if you're up for it. If so, I'll DM you to chat about it.
I think you're on to something - that it's probably hard for everyone, but not everyone expresses it. Also I've seen my fair share of people delivering that news poorly - so not everyone is even aware enough in the moment about how it impacts them. I'm intrigued by your guest post idea, happy to talk more!
“If we cannot react with the fullest of our feelings when our lives have been torn asunder, when can we? “. Are you wanting him to not go gently into that good night?
Thanks for this. FWIW, I sing and dance in stores, and I don't care what people think.
My father recently died three weeks before his 91st birthday (we turned his birthday party into a celebration of life) after he, his woman friend, my sister, and I tried in vain to impress upon the doctor the severity of how ill my father was, as he, the cardiologist who didn't know him, repeatedly postponed an aortic valve replacement and stents in his blocked arteries. In a doctor visit my sister and I attended via speakerphone, I told the doctor, "You're putting this off, but I feel like time is not something we have in great abundance." He reassured me this was not an emergency situation. My father died two days later.
Even so, I want to challenge your point about delivering news that "ruins people's lives." Neither you, nor the news you deliver, nor the illness itself is ruining anything. We are mortal beings. Mortality is the human condition. The how and when of our death remains unknown to us until we are either at or near the end, but the fact of it is something we've known all our lives. It's what makes us human.
I'm a believer in karma, in reincarnation, and in incarnation as a school for the soul. In my world view, no challenge is without purpose, even when we can't see it. Every miserable, difficult, downright shitty experience contains gifts. As a friend once said, "When it's raining shit I thank God for the manure." Cancer, brain bleeds, horrible accidents, the death of loved ones--all are fertilizer. The question is how we use the experience, the ways in which we allow it to change us.
I do agree that a compassionate approach to delivering bad news is warranted, and a lot of our medical professionals appear not to have been taught the people skills their patients need, some very desperately. I appreciate the care you have brought to your profession. I'm a teacher and have been in a similar boat, loving work that, the way it's done in this country, burns people out, so that those who do it well are often inclined to leave for their own wellbeing.
Lastly, I think you'd relate to this book, whether you read it or listen to it, though I think the audiobook is very well done. I loved it so much I booked a session with the author as soon as I finished it.
Thanks for sharing your story Gillian. I'm very sorry for your loss. Discerning sick from not sick is actually one of the hardest things we do in medicine. I think it might be our most important area of expertise in emergency medicine. Trying to do that without the humility to take the concerns of patient and family into account would be very difficult.
The phrase "ruins people's lives" was a bit intentionally dramatic. I just mean it's the sort of news that there's a clear before and after and you can never go back. That your life is ruined because the life you knew before was thrown into turmoil and you have to figure out how to put it back together again.
Delivering bad news was definitely part of my training in Emergency Medicine. It was one of the few psychosocial things that I feel like I was taught well and actually felt prepared for. Some of my supervising doctors paid close attention and even noticed things like the pitch of my voice going really high when I was delivering bad news (which doesn't really soften the blow, but can make you sound like you don't know what the hell you're talking about if you're accidentally talking in baby voice).
And yes, I think teaching may be one profession where the burnout is worse. Two factors that look to me like they would make it worse are that you aren't compensated appropriately so you have added financial stress and that I think lay people think they can do your job in a way that they don't with doctors (though they still try sometimes).
Thank you for the book recommendation. I will definitely check it out.
Thanks Katharine, Martin Buber was the person who wrote about this originally if you are interested in the deep dive. If you are writing about pronouns and nature, I suspect you may have already encountered this, but if not I think you would be interested in the essay Robin Wall Kimmerer writes about ki and kin in Braiding Sweetgrass.
I mention your Substack at the end of my about-to-be-published issue. Just knowing that "it" has been a thing, historically, is helpful. in kinship, katharine
I'm so proud of you, Amy. You've been much stronger than I wish you had to be during this chapter, and your thoughtfulness as you take a breath has been so beautiful to witness. (PS: I sometimes sing and hum at the grocery store and quietly in the airport too. ;) )
I suspect that I didn't actually have to be. I think that of the culture of medicine had a healthier attitude toward rest and that emotional needs are real that we would have learned to set healthy boundaries, though then the powers that be wouldn't be able to continue to ask us to do more and more with less and less, so the incentives won't change until a critical mass of doctors leave.
Yeah, it doesn't seem like it would need to be too many before the system can't work in it's current form. My unvarnished opinion is that some sort of cataclysm will have to happen and rebuild from scratch. I sort of thought COVID would be it, but that didn't pan out. Instead, they are just trying to get people to do more with less with AI. And you're right wait times for most specialists are dangerous and there's not really a system to support getting people more urgent evaluation short of going to the ER in many locations. I had a patient who had brand new liver failure and was schedule to follow up in like 8 weeks, unfortunately she died of sepsis two weeks before her appointment. Her doctor should have advocated for more emergent follow up, but if they say no, the options are manage it yourself or send the patient to the ER. I don't know, it's just a total mess in every direction.
Thanks l you for sharing the ups and downs of this week with us. I am glad you felt celebrated before your leave and hope that buoys you in the next few days/weeks. And so distressing (although not so surprising) about the demands of medicine on people who care enough to connect with people.
Thanks Christine. I wondered for a long time why it was harder for me than others (I'm not sure it actually is, I think we are all struggling, some show it more) But I also think some are too wounded to invest themselves anymore too. Also, I have an idea of a guest post I'd love to have you write if you're up for it. If so, I'll DM you to chat about it.
I think you're on to something - that it's probably hard for everyone, but not everyone expresses it. Also I've seen my fair share of people delivering that news poorly - so not everyone is even aware enough in the moment about how it impacts them. I'm intrigued by your guest post idea, happy to talk more!
“If we cannot react with the fullest of our feelings when our lives have been torn asunder, when can we? “. Are you wanting him to not go gently into that good night?
I'm not sure I know who you mean by him in your question. I wanted to convey that grief is bodily and communal, not solitary and composed.
Thanks for this. FWIW, I sing and dance in stores, and I don't care what people think.
My father recently died three weeks before his 91st birthday (we turned his birthday party into a celebration of life) after he, his woman friend, my sister, and I tried in vain to impress upon the doctor the severity of how ill my father was, as he, the cardiologist who didn't know him, repeatedly postponed an aortic valve replacement and stents in his blocked arteries. In a doctor visit my sister and I attended via speakerphone, I told the doctor, "You're putting this off, but I feel like time is not something we have in great abundance." He reassured me this was not an emergency situation. My father died two days later.
Even so, I want to challenge your point about delivering news that "ruins people's lives." Neither you, nor the news you deliver, nor the illness itself is ruining anything. We are mortal beings. Mortality is the human condition. The how and when of our death remains unknown to us until we are either at or near the end, but the fact of it is something we've known all our lives. It's what makes us human.
I'm a believer in karma, in reincarnation, and in incarnation as a school for the soul. In my world view, no challenge is without purpose, even when we can't see it. Every miserable, difficult, downright shitty experience contains gifts. As a friend once said, "When it's raining shit I thank God for the manure." Cancer, brain bleeds, horrible accidents, the death of loved ones--all are fertilizer. The question is how we use the experience, the ways in which we allow it to change us.
I do agree that a compassionate approach to delivering bad news is warranted, and a lot of our medical professionals appear not to have been taught the people skills their patients need, some very desperately. I appreciate the care you have brought to your profession. I'm a teacher and have been in a similar boat, loving work that, the way it's done in this country, burns people out, so that those who do it well are often inclined to leave for their own wellbeing.
Lastly, I think you'd relate to this book, whether you read it or listen to it, though I think the audiobook is very well done. I loved it so much I booked a session with the author as soon as I finished it.
https://www.audible.com/pd/Swimming-with-Elephants-Audiobook/B079TFSJMV?ref_pageloadid=not_applicable&ref=a_library_t_c5_libItem_B079TFSJMV_0&pf_rd_p=80765e81-b10a-4f33-b1d3-ffb87793d047&pf_rd_r=W1WNBRQ1Z42D4WV5FCPH&pageLoadId=SroCl7eAMpDvgJmm&creativeId=4ee810cf-ac8e-4eeb-8b79-40e176d0a225
Thanks for sharing your story Gillian. I'm very sorry for your loss. Discerning sick from not sick is actually one of the hardest things we do in medicine. I think it might be our most important area of expertise in emergency medicine. Trying to do that without the humility to take the concerns of patient and family into account would be very difficult.
The phrase "ruins people's lives" was a bit intentionally dramatic. I just mean it's the sort of news that there's a clear before and after and you can never go back. That your life is ruined because the life you knew before was thrown into turmoil and you have to figure out how to put it back together again.
Delivering bad news was definitely part of my training in Emergency Medicine. It was one of the few psychosocial things that I feel like I was taught well and actually felt prepared for. Some of my supervising doctors paid close attention and even noticed things like the pitch of my voice going really high when I was delivering bad news (which doesn't really soften the blow, but can make you sound like you don't know what the hell you're talking about if you're accidentally talking in baby voice).
And yes, I think teaching may be one profession where the burnout is worse. Two factors that look to me like they would make it worse are that you aren't compensated appropriately so you have added financial stress and that I think lay people think they can do your job in a way that they don't with doctors (though they still try sometimes).
Thank you for the book recommendation. I will definitely check it out.
Amy, thank you for addressing I-it!
I’ve been working my way through a draft about pronoun usage in regard to nature. I had not considered the “it-ness” between humans.🌱
Thanks Katharine, Martin Buber was the person who wrote about this originally if you are interested in the deep dive. If you are writing about pronouns and nature, I suspect you may have already encountered this, but if not I think you would be interested in the essay Robin Wall Kimmerer writes about ki and kin in Braiding Sweetgrass.
Amy, thanks for the Martin Buber reference.
I mention your Substack at the end of my about-to-be-published issue. Just knowing that "it" has been a thing, historically, is helpful. in kinship, katharine
Honored, thanks! I'll keep an eye out for it, but if you have a chance to share it here, I'd appreciate that too.
oops.
dm your email if you'd like to see it.
I will.
In the meantime I’m sending you a test draft to your email. Any comments before I publish are welcome. It’s also with my editor for a final review 🌱
I'm happy to check it out when you publish. I trust you :)
I'm so proud of you, Amy. You've been much stronger than I wish you had to be during this chapter, and your thoughtfulness as you take a breath has been so beautiful to witness. (PS: I sometimes sing and hum at the grocery store and quietly in the airport too. ;) )
I suspect that I didn't actually have to be. I think that of the culture of medicine had a healthier attitude toward rest and that emotional needs are real that we would have learned to set healthy boundaries, though then the powers that be wouldn't be able to continue to ask us to do more and more with less and less, so the incentives won't change until a critical mass of doctors leave.
Given how hard it is now to get an appointment for ANYTHING, I'm wondering what will define "critical mass."
Yeah, it doesn't seem like it would need to be too many before the system can't work in it's current form. My unvarnished opinion is that some sort of cataclysm will have to happen and rebuild from scratch. I sort of thought COVID would be it, but that didn't pan out. Instead, they are just trying to get people to do more with less with AI. And you're right wait times for most specialists are dangerous and there's not really a system to support getting people more urgent evaluation short of going to the ER in many locations. I had a patient who had brand new liver failure and was schedule to follow up in like 8 weeks, unfortunately she died of sepsis two weeks before her appointment. Her doctor should have advocated for more emergent follow up, but if they say no, the options are manage it yourself or send the patient to the ER. I don't know, it's just a total mess in every direction.