Recently I had a patient encounter go differently than the way I wanted. The patient is fine now, and it was not the fault of myself or the patient or her parents. Rather the problem was with the physicians, and more specifically, the protocols of the health systems they work for. In short, the patient had an abnormal exam, abnormal vitals, and diagnostic studies that I had done in the office that all supported the suspected (and later confirmed) serious diagnosis and just how sick she was. It was clear to me that she needed admission to the hospital quickly. It was even clear to the physicians at the two health systems that I called to try to get her admitted that that was the level of care she needed based on the labs alone. But because they couldn’t see this information in their EMR system, they declined to admit her directly and instead directed that she should go to the local ER even though they would immediately transfer her once she was stabilized, which I had already ensured she was. The reasoning: that’s how we do things. And so, the patient sat in the local ER waiting room for nearly three hours before being seen and then quickly being transferred to a higher level of care facility. A direct admission by either of these facilities would have had her receiving care within an hour.

With the month of November halfway gone, it’s easy to begin to stress about the holiday season. Where am I going to get my Thanksgiving turkey? How long do they need to defrost again? Do I have enough time and money for Christmas gifts? How will I balance seeing my family and my in-laws? All these questions need answering. It’s overwhelming and anxiety-provoking just thinking about it.

In the middle of my yard stands a majestic American chestnut tree. Virtually extinct for decades (1), this mature treasure is now a rare find, considered one of the most perfect of trees, with every part having great utility and beauty. I have learned a lot from that tree. The tree has been there for the nearly three decades I have called this place “home” and most likely a century prior.

I love the commercials that end with “what’s in your wallet?”.  How about “what is your passion?”. In retirement, mine is simple. Music. Not performance, but brass instruments. Specifically, trumpets, cornets, and flugelhorns. Last year, I had a trumpet made that I designed.

I could describe it to you in excruciating detail and tell you all that went into its creation. Hours of work spanning 4 to 5 years. Hundreds of hours determining its specifications. Countless hours spent emailing and phoning strangers who guided me educated me and provided their insight, all without compensation. I was able to form bonds with complete strangers over a shared love of brass instruments. In many ways, the community of brass instrument repairers and developers is more close-knit than the community of musical performers. Performers need design and repair people, the reverse is not true.

Recently, I reconnected with a woodwind man I hadn’t seen in decades. He has been a guest conductor in the UK, Europe, the Netherlands, and behind the old Iron Curtain. Oh, I forgot, Carnegie Hall and the Kennedy Center also. I guess you could say he’s been successful.

After we caught up and relived the past we spoke of the present. After a life on the road, he taught Jazz Musicology at two different universities. We’re both retired. He still performs in Pennsylvania and North Carolina just because he wants to.

Two different individuals, two different career paths, each with a shared passion in retirement that we shared in our youth. Music. When I told him about my trumpet design, he almost fell over. He demanded details, photos, etc. I gladly complied.

Why share this with you? Simple. Find or rediscover your passion. Don’t wait for the future. Do it now. Had I continued my passion for music while I still practiced psychiatry, I would have more fully benefited from the combined experience. Fortunately, I didn’t miss out entirely. I nurture my soul now. As is often said, “better late than never”.

A few days ago, my wife and I attended a concert by the Baroque Orchestra. Between selections, I whispered to her about the orchestra’s use of Eb and piccolo trumpets during various selections and why they were used. It wasn’t difficult. I had a teaching assistantship in the music department at my undergraduate school. I was a math major who taught “Intro to Music” to freshmen. Music has always been a part of me.

Walking home from the concert I said that I wished I had studied musicology in depth. She asked if I meant instead of practicing psychiatry. Heavens no. I should have done both.

“What is your passion?”

I have always been fascinated with growing things, mostly vegetables, occasionally flowers and houseplants. I have had varied success with the flowers and the houseplants, but, for the most part, I have had some spectacular yields from my home garden.

Head, Shoulders, Knees and Toes, Knees and Toes...

I have to admit, when I was young, I did not like to color. We all had to do it in elementary school. Coloring was a skill that taught us how to follow instructions, express creativity and stay in the lines. As a child, I followed instructions well, was more creative with words rather than drawing, and honestly, I had trouble staying in the lines, (though, my difficulty staying in the lines helped discover a vision problem).

Have you ever found yourself faced with a task so daunting and seemingly insurmountable that you procrastinate to the point where the task keeps mounting? Maybe it's a garage that needs cleaned out, a checkbook that needs reconciled, a mountain of incomplete medical records waiting for your finishing touch, a stack of CME articles that need to be read, a case review that needs written for submission for publication, a shelf exam requiring dedicated study? Me too.

Usually to restore wellness, one seeks activities that are peaceful and tranquil. Such activities might include yoga, meditation, exercise, or reading.

Have you ever wondered how you accumulate so much stuff and why you keep certain things? Recently, I have had the distinct privilege and responsibility to sort through the belongings of people who are close to me that have died. In the past five years, I have peered into the intimate life details of my mother, father and most impacting, my husband of 26 years.

How are you doing?  This is usually the first question I ask my patients when I see them in the office.  I suspect like many of you, the typical answers I get now (terrified, I don’t know, bad) are different than what I would have gotten six months ago (good, ok, not bad).  What hasn’t changed is the thing that patients most need from us – information.

As physicians, we tend to offer solutions and process thinking to our patients to solve their problems and stumbling blocks. Yet, as a group, physicians are facing burnout at unprecedented rates and are having trouble solving our collective problem. Single physician centered solutions, like practicing mindfulness, can be helpful but doesn’t not impact the overall systems of practice.

Postdoctoral training is rigorous and time-consuming. The emotional and physical implications of residency and fellowship call for trainees to take what little time they do have to participate in enjoyable activities that keep them going. As co-residents at Albert Einstein Medical Center in Philadelphia, we found the popular indoor cycling class, SoulCycle, to be our go-to wellness activity. Since our intern year, we have been arranging meet-ups at the music-blaring, sweat-dripping, lights-flashing dark room that is SoulCycle. Now, carrying on into our separate fellowships, we still find time to enjoy a 45-minute jam and cycle “sesh.”

I’m fortunate to sit on our residency leadership committee at Lehigh Valley Health Network and attend conferences where we discuss a wide range of physician leadership topics. A common topic is physician burnout and what healthcare leaders can do to mitigate it. At a recent meeting, we discussed an article from the Mayo Clinic Proceedings titled “Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout.” The authors, Tait D. Shanafelt, MD and John H. Noseworthy, MD, cite evidence suggesting that physicians who spend just 20% of their professional activities focused on the work they find most meaningful are at a dramatically lower risk for burnout. There was also a ceiling effect to this benefit at 20%, meaning that physicians who spend 50% of their time in the area most meaningful to them had no further decrease in burnout rate.

Throughout my 20-something year career in outpatient medicine, I’ve had the opportunity to enjoy a wonderful connection with many patients behind the closed doors of my offices.  There, patients can freely smile, cry, and share concerns without a fear of judgement.  This emotional sharing allows for a powerful connection between patient and physician.  Sometimes I know more about their inner thoughts and fears than their family does.  I’ve laughed with my patients as well as shed many a tear in solidarity with them.  Both encounters are equally powerful to me as well as to me patients.  Don’t be afraid to express your humanity in the moment.

“Art is the queen of all sciences communicating knowledge to all the generations of the world.” If this statement hadn’t already been so eloquently articulated by Leonardo Da Vinci, it would have been my own. These words perfectly illustrate my view of the relationship between art and science, and how this relationship has fueled my unique path towards a career in medicine.

Attend a Funeral

It doesn’t matter if you are new to medicine or more experienced, we will all be faced with a situation where a patient we are caring for dies.  Regaining your strength when this occurs is a challenge.  Depending on the situation there may be sadness, inadequacy, fear and loss of self-confidence.  Allowing yourself to feel these emotions and move on is critical.

Scream...

As residents, working 12 hours a day, we often wonder, “How do we do it all?”. It feels easy to be overwhelmed at the idea of achieving wellness. While we strive to have the perfect professional and personal life balance, it sometimes feels impossible to read, exercise, do household chores, and fulfill the role of a loving partner/parent/child/friend when we return back home. 

When I was first approached by a good friend to write this article for “how are you DOing”, I laughed.  But I wasn’t asked to write a “How are you DOing” I was asked to write “Who DO you walk?”