Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

Sunday musings…1/19/20

Sunday musings…

1) Hiatus. Been a couple of weeks. Miss me? Lots to catch up on.

2) Spotify. I love Spotify.

That is all.

3) Dragon. At the moment I am awaiting the delivery of a new laptop that will allow me to “talk” my writing. I have long known that I am much more creative when I speak than when I type (my fingers can’t keep up with my brain, especially with this gawd awful new Mac keyboard).

With the likely exception of travel this may be the last “musings…” I type.

4) Wax. To increase or grow. To thrive

Wane. To decline or shrink. To wither.

Admit it, you always have to pause for just a moment to remember which is which. You’re welcome.

5) Narrative. Pretty much just means story. Like “my story” instead of “my narrative” except that narrative has been adopted by the precious consulting/media class to upgrade the seriousness of whatever they may be discussing. It’s all so very pretentious if you ask me. “Narrative correction” is simply changing the story, usually to one that makes the changer look better or gives them some sort of edge. For some reason it just seems more acceptable, rational, and proper if you are changing the “narrative” rather than your “story”.

Remember, the folks who insist on using “narrative” are the same folks who have so brutally abused the word “so” through such massively unthinking overuse that it makes “Um” look like a comparative slacker in public speaking. I still wonder why every declarative sentence uttered when changing the narrative ends in an uptick, a verbal question mark.

If you have questions about every sentence in your narrative why should I believe your story?

6) Judy. For the life of me I don’t know why I suggested that Beth and I watch the new Renee Zellwinger movie about the late singer Judy Garland. Man, it was 2 hours of relentless beat down of both Ms. Garland and anyone watching. What a sad story. Judy was psychologically abused from her earliest teen years, emotionally abandoned by her parents and apparently physically abused by power figures (read: men) in the studio system that made her a star. Dead at 47 but by the looks of it without living for many, many years prior to that.

Ms. Zellwinger is a revelation in the title role. If you are a movie buff (and I admit, I am starting to enjoy the exploration of movies as I enter my last 3 innings) her performance is riveting. If not this is probably one to steer clear of.

The end was a relief.

7) Trifle. My day job is one that has one of the highest suicide rates of any jobs in the U.S. Physician, that is. Don’t worry, this is not any kind of plea for help as I do not suffer from what is commonly known as “physician burnout”, the umbrella term for the myriad psychological stresses felt by practicing doctors that leads to the kind of beat down felt above by Ms. Garland. (As an aside a recurring theme around Judy Garland was a kind of incredulity by people with whom she worked that anyone like Ms. Garland could have any reason to be unhappy, let alone depressed). In fact I recently gave a speech about the quest for happiness in doctors in which I state early and often that I am actually quite happy.

But as I look around at my colleagues I see so many of them succumbing to the continual micro-assaults they suffer in silence until eventually the cumulative wounds add up to a hemorrhage of the spirit that is as unstoppable as a single slash to their emotional carotid artery. As is my wont I have been searching for some vocabulary help, some phrasing, a metaphor to use that would help me to both understand and explain what I see. Reading “The Ethicist” in this morning’s Sunday Times I came across this gem:

“De minimus non curat lex.” The Law does not care about trifles.

Eureka. Every doctor is taught that nothing is a trifle when it comes to the health of their patients. Especially the patient sitting in front of them. And yet 90+% of the changes in the provision of medicine over the last 2 decades have been precisely that, the introduction and proliferation of trifles into the sacred space between doctor and patient. “Non-combatant” narrative correctors have piled trifle upon trifle into the life of your doctors. Things that have no meaningful positive impact on your health. These, in turn, have bled much of the joy from the exam room for those same doctors. Making matters worse is the fact that more and more power has been vested in those OUTSIDE the exam room, OUTSIDE the operating room. Think administrators, government functionaries, insurance and pharma executives.Those who brought you the abuse of “so”, the question mark at the end of declarative sentences, and “narrative” want your doctor to be accountable to them, not to you and your individual health.

Fidelity to HIPPA rather than the Hippocratic Oath.

Despair over the injuries of a thousand pin pricks can be hidden until the psychological blood loss is the equivalent of a head on car crash. Judy Garland was “Judy Garland” on opening night in London. No one in that audience could see the scars from her years of abuse. No one knew how much “blood” had been lost until her injuries added up to a stumbling, bumbling and mumbling catastrophe on stage. Doctors, like Judy Garland, are looked upon as pampered creatures of privilege. Generally well-paid and with at least the veneer of social prominence and deference, it is inconceivable that they could be suffering from the very thing that has given them their station. To complain, nay even to offer the observation that such a thing could be, is met with at best incredulity, at least as often with scorn and ridicule. It’s just a trifle; what’s your problem?

Each trifle is in itself trivial. Yet trifle upon trifle leads to discouragement. It is discouragement that leads to despair, despair that can lead to death. To be damaged by being buried under a ton of pebbles is no different than the damage that occurs from the strike of a a single, massive boulder.

Just this morning the solution came to me thanks to The Ethicist and my new vocabulary word, “trifle”. We physicians are more important to our audience than Judy Garland was to hers because we possess the ability to prolong life, to cure, to make well. And like Ms. Garland who could not resist the stage, we desperately want to to this, to prolong life, to cure, to make well. During a brief conversation with my colleague Barry this morning it became apparent to me that our “narrative” has been stolen, or at least our right to own and tell our narrative, and with it I fear our ability to save ourselves is gone as well.

Think about this a little bit, won’t you? My epiphany this morning was equal parts simple, straight forward, and stunning. That part of our healthcare system that that most deserves saving is the part where a doctor sits with a patient with the sole responsibility and goal of making them healthy; call it the Hippocratic Space. Saving that sacred space won’t ┬ácome from us, your doctors. This morning it became clear to me that saving that space, and along with it saving doctors, will be done by patients. All of us are patients, and it is as patients that we have the most to lose if the avalanche of trifles drives doctors as we’ve known them off the mountain.

8) Dragon 2. If I had dictated “Sunday musings…” today I would not only have been done long ago, but at the time I type these last words I would also be done with my workout, taken a shower, and finished the laundry.

I’ll see you next week…

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