Reflecting Back…

The Pacific Medical Center (2012) Photo by Joe Mabel
http://www.pactower.org

Some years ago, while sitting with my husband and young family high in the upper reaches of Seattle’s (then) Safeco Field watching the Mariners lose to the Cleveland (then) Indians, my attention diverted from the baseball game to the expansive view of the surrounding city.

In particular, I couldn’t help but place myself back inside the old Art Deco building that sits up on Beacon Hill (now known as the Pac Tower.) I had spent a hundreds of hours of my life in that building in the late 1970s; it was easy imagine my younger self in those hallways and rooms.

The 90 year old building had a number of different purposes since originally being constructed to provide hospital care for the region’s Merchant seamen. By 1999, it had become the home of a five year old business that had outgrown Jeff Bezos’ garage — Amazon.com. 

I trained inside the walls of that Public Health Hospital, back in the days when it was the hospital in the region for not only Merchant Marines, but many of the indigenous people of the Pacific northwest and Alaska, in addition to local folks who needed affordable (as in free) health care. I had opportunity to work several clinical rotations in this building as a University of Washington medical student, and to think of it being Amazon’s first (but not last) major headquarters for Amazon made my brain do twists. 

I remembered so much life and death happening inside those walls over the years. 

I first walked into this building as a very green 24 year old med student beginning a surgical rotation in fall 1976, knowing only which end of the stethoscope to put in my ears and which end rests on the patient. On the first day I was shown how to put on a surgical gown, masks and sterile gloves without contaminating myself and the people around me. I never have forgotten that sequence of moves, even though my opportunity to go into an operating room (other than as a patient) became rare after my training days. My chief surgical resident was an exceptionally talented young man who worked himself and everyone working with him around the clock caring for his patients. This brilliant surgeon could only operate on patients while listening and singing to the music of Elvis Presley. I can’t hear any Elvis Presley songs to this day without smelling the odors of surgery–cauterized blood vessels and pus. 

He was soon to become a leading trauma surgeon in a city known for its fine surgeons. The pressure was too much for him. He experienced a personal crisis for which he sought treatment. When he returned to medicine, he abandoned his incredible surgical skills to train as a psychiatrist and still remains an authority on helping impaired physicians, assisting other care providers to acknowledge and deal with addiction and mental health burnout before they harm a patient. 

Those endless clinical rotation days and nights meant witnessing the misery of the most vulnerable of humanity in desperate need of healing, and sometimes we succeeded, but often we did not.  I still have a recurring dream of running up and down the staircases of the Public Health Hospital, bringing pint after pint of blood to the OR from the lab as our team operated on an Alaskan indigenous patient bleeding from dilated esophageal varices, developed as a result of a damaged liver from chronic alcohol dependency. We did not save her, nor have I saved her even once in my dreams over the decades, though I keep trying to run faster. My response to her death was to spend 20 years of my clinical career working with patients in an alcohol and drug treatment program, hoping to prevent her fate in others.

Nor did we save a classmate of mine, on a rotation on a different service, the daughter of a beloved radiologist in this very hospital, who for reasons unknown, had a cardiac arrest while napping briefly during her 32 hour shift.  Another medical student sleeping in the same room heard her odd breathing, found her unresponsive and all medical interventions were employed, to no avail. Even when all the right people, and the right equipment, and the right medicine is seconds away, death can still come, even to healthy people in their 20s.  This was a shock to us all, and an extraordinarily humbling lesson to the pompous and overconfident among us. We might die, in our sleep, whenever it is our time. Years later, I still remember that in my evening prayers.

There was also the young surgical resident who was hospitalized there with jaundice and subsequently died of Hepatitis B, contracted from a blood exposure during his training. No vaccination was available in those days, but was in development. And it was in this and other hospitals in the city, we began to see unusual cases of gay men with severe wasting, rare skin cancers and difficult to treat pneumonias. Initially called GRID (gay-related immune deficiency), it was renamed AIDS as it began appearing in the general population as well, and for too long was a death sentence for anyone infected.

One on-call night in particular is memorable. It was Christmas Eve, and a heavy snowstorm had brought the city to a standstill.  We had very little to do that night in the hospital as the elective surgeries were all postponed until after the holiday and no ambulance could easily make it up the steep drive to the ER, so they were being diverted to other hospitals. As a result, our patient load was light. I was in my tiny sleeping room, on the 14th floor of the tower, facing out north to the city of Seattle, able to enjoy the view of the city, everything blanketed under snow, so peaceful and very quiet.  The freeway, ordinarily so busy day and night, was practically abandoned, and the lights of the city were brighter from the snowfall. It was an enchanting vision of a city forced to slow itself and be still, so anticipatory on a sacred and holy night.

I remember thinking about how young and inexperienced I was, and how very little I knew. My chief resident thought I’d make a good surgeon – I was a diligent worker and technically very good with my hands. My heart told me that I’d be better as a generalist/family doctor. The city held many attractions and excitement, but I longed to return to a farm and a someday family. It was a wistful bittersweet night and I slept very little, perched on that little bed overlooking the sleeping snowy city. I wondered where life might take me, as I reflected on who I was becoming and where I was meant to be.

Forty five years later, I still am reminded every day at how little I know,  but I do realize this:
for however long we’re on this earth, each day we have a distinct purpose and reason for being.

That day, my purpose was to be snowbound on that Christmas day at the old Public Health Hospital, unable to go home from my shift because my car was stuck in the parking lot. Instead, I covered for others who couldn’t make it in to work, singing Christmas carols for all the patients who had to stay put in their hospital beds.

Soon, my purpose was to meet the man I was to marry, eventually living with three beloved children on a little farm 100 miles to the north while practicing medicine in a variety of primary care roles for over forty years. 

And perhaps, my purpose now in retirement is to share a few stories while reflecting on a life still in progress.

Only the Lord knows why He places us where He does.

view from the “sleeping room” at the top of the tower
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The Fly in the Currant Cake

Nothing seems to please a fly so much as to be taken for a currant;
and if it can be baked in a cake and palmed off on the unwary, it dies happy.
~Mark Twain

Today I will wrap up 45 years of uninterrupted training and doctoring. Most of that time, I have worried I’m like a fly hiding among the black currants hoping to eventually become part of the currant cake. 

Maybe no one has noticed. These days we call it the “impostor” syndrome. Mark Twain knew all about currant cake and how easy it was for a fly to blend into its batter.

Even while bearing three children and going through a few surgeries myself, I’ve not been away from patients for more than twenty consecutive days at any one time.  This is primarily out of my concern that, even after a few weeks, I would forget all that I’ve ever known. In fact, half of what I learned in medical school and residency over forty years ago has evolved, thanks to new discoveries and clarifying research. I worried if I were to actually to step away from doctoring for an extended time, then return to see patients again, I would be masquerading as a physician rather than be the real thing. A mere fly among the currants palmed off on the unwary.

If being truly honest, those who spend their professional lives providing medical care to others always share this concern: if a patient only knew how much we don’t know and will never know, despite everything we DO know, there would really be no trust left for us at all.

Of course, some say, didn’t the COVID pandemic prove our ignorance? Physicians started at Ground Zero with a novel virus with unclear transmissibility and immense potential to wreak havoc on the human body … or cause no symptoms whatsoever. We had no collected data to base prevention or treatment decisions: would masks just protect others or would they only protect ourselves, or maybe they protect both? Could a common inexpensive anti-inflammatory/antimalarial drug be beneficial or would a parasitic wormer medication be somehow effective to fight the devastation of the virus?

Effective treatments are still being sought all these months later; others have been debated, studied and discarded as worthless.

Or would this pandemic finally resolve thanks to effective yet controversial public health mandates while rapidly distributing highly effective vaccines developed from many prior years of carefully performed research?

During the past 16 months, your next door neighbor, or the loudest tweet on Twitter proclaimed more expertise than the average medical professional and definitely had a stronger opinion. At least we doctors knew how much we didn’t know and how much was simply guess work based on experience, good intentions and hopeful prayer. Gradually, while lives were lost, including too many of our own, real data began to trickle in so decisions could be made with some evidence backing them. But even that data continues to evolve, day by day, as authentic medical evidence always does.

That doesn’t stop all the “quack” flies out there from climbing into the batter pretending to be currants. With so much rapidly changing medical information at everyone’s fingertips, who needs a trained physician when there are so many other resources – sketchy and opportunistic though they may be – for seeking health care advice?

Even so, I am convinced most patients really do care that doctors share the best information they have available at any point in time. None of us who are doctoring wants to be the “fly” in the batter of health care.

As I meet with my last patient today, I know over forty years of clinical experience has given me an eye and an ear for the subtle signs and symptoms that no googled website or internet doc-in-the-box can discern.  The avoidance of eye contact, the tremble of the lip as they speak, the barely palpable rash, the hardly discernible extra heart sound, the fullness over an ovary, the slight squeak in a lung base.  These are things I am privileged to see and hear and about which I make decisions together with my patients.  What I’ve done over four decades has been no masquerade; out of my natural caution, I am not appearing to be someone I am not.  This is what I was trained to do and have done for thousands of days and many more thousands of patients during my professional life, while passing a comprehensive certification examination every few years to prove my continued study and changing fund of knowledge.

The hidden fly in the currant bush of health care may be disguised enough that an unwary patient might gobble it down to their ultimate detriment. I know I’ve not been that doctor. I’ve been the real thing all these years for my patients, even if I’ve seemed a bit on the tart side at times, yet offering up just enough tang to be exactly what was needed in the moment and in the long term.

And someday, hopefully not too soon, I will die happy having done this with my life.

My ID photo from my first year of medical school 1976
45 years later…

A new book from Barnstorming is available to order here:

Giving Life or Draining It

In every encounter we either give life or drain it. There is no neutral exchange. We enhance human dignity or we diminish it. The success or failure of a given day is measured by the quality of our interest and compassion toward those around us.
~Brennan Manning
from Abba’s Child: The Cry of the Heart for Intimate Belonging

Forty years ago this week I graduated with an M.D. degree from the University of Washington and began a lifetime of trying to be life-giving rather than life-draining to others.

There have been times when I’ve failed miserably, my interest waning and my compassion fatigued.

But like tracing the path of a spiral from inside to outside, I continue to try to reach farther and encompass more with each step I take in the time I have left, remembering the dignity of each person I meet and being worthy of their time and trust.

May this young woman who embarked so enthusiastically on the physician journey so many decades ago never forget, after so much seasoning, what it took to get there and what it means to continue to be worthy.

The Best Education Of All

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Every child should have mud pies, grasshoppers, water bugs, tadpoles, frogs, mud turtles, elderberries, wild strawberries, acorns, chestnuts, trees to climb.  Brooks to wade, water lilies, woodchucks, bats, bees, butterflies, various animals to pet, hayfields, pine-cones, rocks to roll, sand, snakes, huckleberries and hornets;  and any child who has been deprived of these has been deprived of the best part of education.  By being well acquainted with all these they come into most intimate harmony with nature, whose lessons are, of course, natural and wholesome.
~Luther Burbank from “Training of the Human Plant”

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