As doctors, we bring our ideals, we bring our training, and
we bring ourselves.
The simplest is our ideals. “To do good,” that’s pretty much it. Hippocrates’ famous dictum “Do no
harm,” is cautionary. He was wise
to caution, because doctors have an inherent predilection to act, to do
something, which is why he says, “First, think, what’s the downside?” “Do no harm” is more quotable, however. But that’s translated from ancient
Greek. Before the translation, who
knows, it could have been, “WTF?”
Medical professional training is less simple than our
ideals, and with medical advances the technical training gets harder and harder
and longer and longer. I suspect,
but it may not be true, that all the technical training has crowded out
training in how to actually be a doctor.
Empathy, understanding, judgment – I’m pretty sure this has to be taught
by people actually experienced in being real doctors, not just medical educators. It has to be personal, in small groups
or individually, and it’s mostly look at the way I do it.
I admire the doctors who really tend to teaching the next
generation personally. I went to
one of the best foot orthopedists in the country yesterday, and he had a young
woman with him who must have been a resident – so young, oh so young! After he
saw me I saw him in the hallway explaining to her, one on one. This guy is more emeritus than I am,
and here he is, passing along his art, the way he does it, the way he
understands it, for no payment or recognition whatsoever. Who knows what he was telling her? About the foot? Or about how other doctors – and me, the
patient – got the diagnosis wrong.
If it had been my father there in the hallway, I know he would have
emphasized the latter. This guy is
old school, so maybe that was what he was doing, too.
And finally, besides ideals and training, we bring
ourselves. We have our own
experiences, our own understanding of life that is often hard won, and if we
are good doctors, we will pass this on.
Last Monday I used this last tool, myself, and I hope I
didn’t do any harm. Two brothers
ages 12 and 13 came to see me for their first visit, just for checkups. They were brought by their stepmother;
their divorced mother and father had both remarried and share custody. The older boy is at his Mom’s in San
Francisco Monday and Tuesday, then over to his Dad’s in Oakland. The younger one goes to another school and
so is at his Mom’s Monday through Friday, as I understood it. I had a shock of recognition when I
heard this, since I shared custody of my two eldest sons with my ex-wife for
years and years, splitting up the weeks and having the kids travel back and
forth. I told them I was familiar
with their situation and observed that it must be a hard for them. Or, as their stepmother put it, “The
Backpacks.”
In a checkup visit, I try to do some good. I can do it with prevention – I always
deal with exercise, usually with nutrition, etc. But I bring myself to the visit, and try to figure out how they
can leave the room better off than when they came in, rather than a simple
“everything’s fine.” So, since
there were no obvious health issues, I persisted in asking them if the schedule
was working for them, even though it’s hard. The stepmother, a nice lady who commented on their and her
Myers-Briggs typology, so she’s pretty aware, said “No, it doesn’t. It’s really a lot of driving, but we
make it work.” Hard on her,
clearly, as well as them. But she
was honest and clearly determined to overcome barriers. One barrier being that the younger one
is INT (introverted thinking) and J, so she finds it hard to make contact.
I don’t have a lot of time in these visits, so I tend to
shoot things out and hope they work.
I immediately told them that I was divorced also and had shared custody
of two boys, which led the stepmother to say, “Maybe you will be able to help
us some, then.” Maybe so. I had to save time, so I just
preemptively said, hoping it would help to frame the situation well, that it
might be difficult going back and forth, but it’s a lot better than having to
feel deserted by one or the other parent.
Maybe it helped, maybe it didn’t.
Maybe that will resonate.
Later when I was alone with the younger boy I asked him if
everyone got along OK, assuring him everything was confidential, as I always
do. He said that he felt that they
two boys were asked to clean up the house at his Dad and stepmother’s house,
and he didn’t think it was fair, since she was the one who messed it up the
most. I asked him if he could talk
about this to his Dad or stepmother and he said, not really. Do you have anyone to talk to about
it? “My mom,” he said.
The plot thickened – I know this pattern. So I asked him, “What does your Mom say
when you tell her about it?” I asked.
He said, “She says, ‘Well, I guess you should live here with
me.’”
I’m so proud that I didn’t comment directly on this. I was hoping I could bring my best self
to this visit. So, I asked if I
could try to help this situation a little. He said yes. I
told him that it would be best if he could bring up complaints about his Dad’s
house directly to them without fear of repercussions. I went through with him how he could first say something
good – maybe how he appreciates how his stepmother cooks for them – and then
tag on the complaint.
“She doesn’t cook,” he said.
Right. “Well,”
I said, ”maybe you could say how much you appreciate all the driving she does
back and forth?” Yes, he thought
that was valid; I don’t think he had really thought about that, about how hard
his stepmother tries.
Then I asked him if I could help by bringing up the issue in
a way that couldn’t be traced back to him. He trusted me and said OK.
So when I got the three of them back in the room, I traded
on our common experience to say to them that they might think about having some
meetings as a family together, where they could say what was working well, and
what was a problem. The stepmother
said, we just had a meeting on Friday, but that was over a problem; maybe it’s
a good idea to have one where we can say good things. I said I thought that was important. The younger boy kind of looked at his
stepmother sideways, warily, but I knew he knew that I was doing what I said I
would, and had carried it out OK.
Hard to know what will happen. Easy to conceptualize, hard to do, especially with the
subterranean undermining mother.
Although I understand her.
It’s so hard not to have your kids all the time. I was watching old videos of our family
as I copy them to disk. My kids
stayed at their Mom’s Christmas Eve and early on Christmas morning, but were
expected at our house at 10 AM, when their stepbrother, stepsister, and
half-brother would also be there for opening presents. How hard it had to be for their mother to
say goodbye to them on Christmas morning.
And how hard it would have been for me not to see them. I know, because as time went on I
didn’t see them anymore for Christmas.
Divorce just sucks.
I just hope that what I did with these two boys and their stepmother
helped in some little way. At
least they know they are not alone, and maybe something I said helped. Like I say, ideals are important,
training sometimes helps, experience certainly helps, but bringing yourself to
the visit might be the most important thing of all.
Budd Shenkin
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