Jul 26, 2020
I have spent half of my life as a physician, beginning as an intern just before my 26th birthday.
It began in an inauspicious start on July 1st as an intern at the VA hospital. On our first day we spent most of the day in orientation, but at the end of the day I reported to my assigned general surgery team, currently on rotation at the VA hospital and doing afternoon rounds. When I arrived, I was informed I would be taking call that night, was shown to my call room at the end of rounds, and was given a few basic orientation tips.
I will never forget being handed the “code” pager for the first time. The chief resident explained to me that carrying the code pager as a surgery resident wasn’t a big deal. Be professional; be prompt; stay relaxed; work with the team; do your job. Basically, he said, you have to run to the code blue, announce that “surgery” was there. Surgery’s responsibility was to make sure tube and lines, things like IV access were present and functioning well and, if needed, to perform whatever bedside procedures needed to be done.
I nodded my head and said goodbye for the night to my fellow residents and medical students.
No sooner had I sat on the bed in the call room than the pager went off for a code blue.
Code Blue. Intensive Care Unit. Room 9.
Up I jumped, and made my way quickly to the intensive care room 9.
There I found a number of doctors and nurses already gathered around a patient and performing CPR and delivering medication. This ICU patient had plenty of tubes and IVs but I was there and I thought I should let people know just in case.
“Surgery is here!” I said as I entered the room.
“What?!” said the nurse standing at the bedside, “Who are you kidding? Get out of here!”
I took a look around the room, decided that surgery was not needed during this particular code blue, and slowly backed out of room 9 in the ICU and back to my call room.
Such began my life as a physician.
I learned two things that night
And there are many days where I feel about as relevant as I did that night. But, like Sysiphus, I keep pushing my rock up the hill. And I have been doing so over the last 26 years.
Enter 2020 and the abrupt halt to what I have come to know over the last half of my life. Clinics and surgeries cancelled, telehealth and video visits replacing in person interaction, time spent at home in isolation, wearing a mask not only the OR but many other places as well.
Our practice faced the challenge head on, adopting telemedicine quickly, shutting down clinics and cancelling unnecessary surgery in preparation for the COVID-19 surge. Our changes felt and still feel like the right answer. We were ahead of the curve, if only slightly, still we were ahead.
At first it was a break. An unwelcome break, but a break nonetheless. I vowed to take the time for personal development, hoped to make a few podcasts and videos, and, to be honest, did not expect our hiatus to last too terribly long.
My positivity waned a bit after a few weeks as I personally began to feel more and more distanced from my family, my friends, and actually more concerning for me, my work.
Without patient interaction, without the ability to touch people, either with a handshake or a scalpel, the practice of urology just isn’t as fun…at least for me.
But it’s summer, which has always allowed me one of my life’s simplest pleasures. I live on and grew up on body of water called the St. Croix River, on section of the river called the Lake St Croix because it widens into an area that is the size of a very large lake. The river is designated as a National Scenic Riverway, and it is fantastic in the summer.
A near nightly ritual for me in the summer is to put on a bathing suit at the end of the day and wash away the cares of the day with a dip in the water. This is not a workout. I usually have a beer in hand. Think of this almost as a nightly baptism, and I emerge refreshed.
I often think about a quote from an ancient philosopher as I go on my nightly swims.
"A man cannot jump into the same river twice. It is not the same river, and he is not the same man."
I am old enough now to know, and feel, that as I approach the river each night both the river and I have changed, if ever so slightly.
The quote comes from Heraclitus who lived around 500 B.C. in the city of Ephesus, in modern-day Turkey and then part of the Persian Empire.
His philosophy was characterized by Panta rhei or impermanence. He was most famous for his insistence on ever-present change, or flux or becoming.
He wrote a single work, On Nature, which remains only in fragments. He was called “The Obscure” because he spoke, wrote, and taught in ways difficult to understand. He was also called "The Weeping Philosopher” because he was prone to depression.
As we look on the tragedies of men we have a choice if we want to turn away from anger. We can laugh, or we can cry. Heraclitus apparently chose to cry.
Our current state of affairs has been a tragedy on so many levels. Over the last few months I have been angry; I have laughed; and I have cried.
Fortunately, we have flattened the curve in Minnesota and we are beginning slowly, at least for the moment, to open back up. Even one of my favorite places, my local public library, is allowing a limited amount of traffic. I went there the other night to pick up some books. The library was eerily quiet as I walked through the stacks of books. Where once would be families with kids, high school and college students studying, middle aged and elderly people reading magazines or looking for a novel now there was empty chairs and echoes.
We are ever so slowly dipping our toe back into the water.
But the river has changed; the world has changed; and, of course, we have changed.
But what strikes me about it all is that life still feels familiar.
As I begin to see patients in the office again, and operate again we know that medicine has changed and will continue to change, but it still feels much the same. People still need their medical care because, well, life is short, and it keeps moving on.
Life is short; the art is long is attributed to Hippocrates, who lived 400 BC and is considered the father of Western medicine. Hippocratic medicine was notable for its strict professionalism, discipline, and rigorous practice. Hippocrates recommended that physicians always be clean, honest, calm, understanding, and serious.
I suspect he would tell us this whether we were in an operating room, the clinic, or at home on our computers trying to tell patients how to unmute their microphones or maybe they could move the computer a little bit so the camera would show all of their face.
Here is my point. I am a bit reflective as I face my 52nd birthday. Half of my life has been spent as a physician. Which feels appropriate since I only half define who I am as a physician. The other half has been the guy in the swimsuit with the beer in his hand.
This Great Reset has come at an interesting time in my life as I ponder the next 26 years, the third half of my life. What will I bring forward? How have I changed? How has the world changed? What is the best response to avoid anger, should I laugh or should I cry?
I do not have the answers, by the way, but I continue to explore for the answers.
Which brings me to a line I remember reading back in high school, it’s from a poem by T.S. Eliot.
“We shall not cease from exploration, and the end of all our exploring will be to arrive where we started and know the place for the first time.”
Each day, whether I return to the clinic, or the river that I have been jumping into since I was a kid I arrive at the place and I know it for the first time.