I got myself up this morning and dragged myself to church. I didn’t want to after the ridiculous call night on Friday topped off by the three am call last night from the lady who just wanted to talk because she has a high level of anxiety about her husband’s health. When those calls come in, I have to remember to put myself in his or her shoes, remind myself that it’s part of the job I signed myself up for, and reach down into my well of patience and compassion and give him or her what he or she needs to hear. Reassurance, a little wisdom, and most of all, someone in authority who will take the time to listen to his or her story for a while. I have found that by doing this, my patients almost always feel better after a few minutes even though I really haven’t done much.
Anyway, I did manage to get in some sleep last night and the choir was due to sing this morning, so up I got for choir rehearsal and service and it’s a good thing I did as it was a service I needed to hear. Our minister is out on maternity leave (safe delivery of a son last week) so we have some pulpit guests for the next six or eight weeks until she returns. Today, it was John Archibald. Anyone who considers themselves an informed Birminghamian will be familiar with him and his writings as a columnist for the Birmingham News and its various on line permutations. His topic was Finding Reason in an Unreasonable World. I was expecting some sort of dissection of the political status of Birmingham, Alabam, and the United States but, instead, he began by reflecting on the difficulties he had in creating a coherent message to go with his topic. (I’m glad I’m not the only one who thinks of a bang up title for a lecture and is then stymied by the task of coming up with material worthy of that title).
His ultimate message was that the only way to find reason in the crazy political moment in which we find ourselves is to draw back. None of us can fix the US political system. What we can do is find meaning, order and reason in small moments and kindnesses in our everyday lives and that’s what we have to hang on to. It was a sermon that resonated as it made me think about my life and its changes over the last six months. I am now a different person and in a different place than I was in March. What has made that bearable have been hundreds of small acts of kindness from hundreds of people over the interim. The words of sympathy, the funny texts, the invitations to dinner, the offers of help, positive comments on my writings. Each and every one keeps me going from one day to the next. They make me recognize that I am a thread in a grand tapestry of life, touching other threads and making a complex pattern. We sometimes spend our time fighting and worrying over threads far removed from our own and while it’s good to see how they contribute to the overall picture, our courage, resilience and fortitude comes from our immediate surroundings, not capitol buildings in distant cities.
Storytime – This one involves me and my medical school experiences. I entered medical school immediately after completing my undergraduate degree. Stanford handed me a diploma in June and I was behind a desk for my first medical school class in late August. I was at the University of Washington for a combination of in state tuition and because it was the only med school I got into. My first year, spent in what was known as the WAMI program (Washington/Alaska/Montana/Idaho) went well. The three smaller states do not have state medical schools so students from those states can attend U of W as in state students. They spend their first year and many of their clinical rotations in their home state. Washington participates in the same way but it’s rare for them to get a lot of volunteers to head off to WSU in Pullman so they draft to fill up the complement and I was one of the draftees. We were a small group and that sort of seminar learning worked well for me and I had a good time and did quite well grade wise. It probably also set the stage for my interest in rural health.
Second year, everyone was back in Seattle in large lecture classes and I hated it. My grades remained OK, but not stellar and I became one of those indifferent middle of the pack med students that aren’t destined for a particularly illustrious career. I found that I could learn as much on my own as from lectures so by the spring quarter, I was barely going to class. When I hit clinical rotations in my third year, being in the WAMI program I rotated out to places such as Boise, Nome and Whitefish. As one of only a few students at a time, I did well. When in the huge complex of U of W, I did not do so well as I did not like playing the subservience games medical students are supposed to play.
I did graduate on time and, as I wasn’t certain what I wanted to do with a medical degree decided to match in Internal Medicine as I figured it was probably the most flexible thing I could do. I had no idea what I wanted to do. The match system put me at University of California Davis Medical Center in Sacramento so in June of 1988, I packed up the U-Haul and headed to California. Most of my first year of residency is a blur due to the combination of overwork and sleep deprivation and I was not happy with my life or my choices. However, in my second year, I started to really get to know Faith Fitzgerald, our residency program director. She was a tall, angular woman with a brillo pad of iron gray hair who I at first had found quite intimidating. She, through luck of the draw, became my outpatient clinic preceptor my second year. One day in clinic, she made a remark about the bed of Procrustes. This brought blank stares from the other residents; I on the other hand knew the reference and lobbed something back about Jason and the Argonauts. I think I was the first resident she had had in some years who had a deep interest in the humanities as well as the sciences and she took me under her wing and helped me find a balance in my life between medicine and my other interests and she, more than anyone else, showed me how to love medicine as an art, unusual in this time of science. She didn’t favor me over other residents, she just took the time to understand who I was, something that hadn’t happened ever in med school, and gave me a little nudge or two over the years that eventually led me to develop the career I have today. It’s the little kindnesses and the listening that can have enormous ripple effects years later.