Lessons from the heart

This week has been, as one of my daughters would put it, a whole lot of no fun. My accountant is clamoring for my tax stuff, my health insurance needs to be renegotiated (can you believe how expensive it is these days?), my office staff is in turmoil because none of the ladies really like each other, I forgot to pay a couple of (household) bills because I've been so busy at the office, my feet hurt from standing around so much, an attorney called and asked if I might be an expert witness (I guess because I'm so experienced with the legal system), I have a couple of patients with Crohns that perplex me, my BP was 150/99 earlier today, and it's been drop-dead gorgeous outside and all I can do is sigh and think of the days of my youth when such a day would motivate me to ride my motorcycle or go gliding or to do something other than sit around and complain to a bunch of total strangers.

It's good of you to listen. Sometimes the only thing you can do is be there for me.

In the Christian tradition followers often withdraw to a quiet place for solitude and meditation. In the American medical tradition the best place for solitude and meditation is the bathroom. They never find me there, and if I turn off the pager for ten minutes I can be guaranteed peace and relief from whatever burdens I might be carrying, if only for a fleeting moment.

I can read a lot on the move, so to speak, because I download a ton of stuff to my handheld. During times of stress when I feel like hiding in the basement until my creditors drag me out, I'll turn to something uplifting so I'll remember why I went into medicine in the first place.

The article that helped me today is an article from JAMA entitled Twenty lessons from the heart of medicine (see the link above). Dr. Alan Guttmacher is a medical geneticist who suffered a heart attack in the late 90's and went through an arrest, cardiac electrical shock, and lengthy rehabilitation. The article is both amusing and thought-provoking, and I've extracted the lessons for your enjoyment. Enjoy.

1. Never sleep with anyone who doesn't know CPR (his wife, a nurse, saved his life).
   
2. Although neither may know it, patients are actually more motivated than their caregivers.
   
3. Patients feel guilty if they don't meet caregivers' expectations.
   
4. Both unconsciousness and amnesia can be good (why do they have such bad reputations?)
   
5. While not as bad as I imagined, 250 joules (of electric shock) is better to give than to receive.
   
6. The sicker you are, the more helpful a sense of humor, in you and in loved ones.
   
7. Patients do not fully share physicians' excitement in "interesting" cases.
   
8. Always wonder, "Why does this person have this disease?"
   
9. Illness may not be the patient's fault.
   
10. All physicians become patients.
    
11. Always ask about family history, particularly if the patient is a geneticist.
    
12. Even for a physician, it is easy to be passive as a patient, especially when scared.
    
13. To prepare for Olympic swimming or a heart attack, shave your entire body.
    
14. Too seldom inquired about, the patient's view of therapy often differs from the physician's, and is valid.
    
15. In medicine, one size does not fit all. Treat the patient, not the disease.
    
16. You can't overvalue family and friends.
    
17. Illness is an intense part of the human experience. While always unwanted, it is often literally invigorating.
    
18. Every day is a gift. Be well. Do well for our patients.