This post is an amalgam. Not the kind that fits in your back molar, but the kind that exists in my head. I’m trusting you have this type of overlapping-quilt-like-consuming-idea-thread that resides in your head at times and ultimately becomes thematic. How one event in life opens a new window into others and then suddenly there is sense and commonality in different spaces and experiences. You know what I mean? Evolving wisdom or simply experience, I don’t know. But I mean how something persists in your every-moment and helps you define meaning  with each new space and time. I’ll explain…

On Monday, a blog post of mine from last summer was published on Dr Kevin Pho’s blog, KevinMD. The post detailed my mom finishing her chemo and 5 words that her oncologist spoke one sunny afternoon: “You’re the picture of health.” The post is about the power of a physician’s words and how words spoken in the exam room linger in our life. In this post, I spoke about words we hear as patients (and caregivers) and how it’s essential that doctors detail wellness when they see it (rather than always focusing on illness). But reading the post again brought me back to last summer. More than once this week (let’s be honest, maybe like 6 times) I’d think about the post and well-up with tears. Maybe it’s the reality that we all face mortality or that I’ve been ushered into a new moment with my mom in her current remission where I am not filled with worry every day. Or maybe it brought me back to the emotion that was in the exam room that day, too. The same emotion I’ve typically divorced myself from. But,

It got me thinking, how was it I was starting a blog, helping my mom through chemo, moving to a new home, and caring for two little boys while caring for a panel of patients during that time? Why wasn’t I in a puddle of tears? Well…see…we do this. Parents (and children) do this ALL THE TIME. They muster incredible courage. Parents face fears. They exceed expectations and bust through boundaries for their children. For example, in the exam room, I tell parents we’re admitting their child to the hospital and then they listen, they thank me, they discuss.  They rise up to what is asked of them without their heart falling out of their chest and landing on the floor. They endure. They “keep it together,” they advocate. They share. Yes, they break down sometimes, too. Yes, they tremble. But they always do what they need to. They endure.

Which got me thinking, we really can be the balogne in the generational sandwich. We really can and do help others that are both older and younger than we are, even when we’re overwhelmed. We play our part and provide space for those two pieces of bread. So many of us do this. So although the beginning of my week was framed with my experience of what doctors say, the end was also about the position where I’m thinking about what parents and patients say to me, too.

Yes, what doctors say in the exam room lingers. But what patients say to doctors, it lingers too.

Which got me thinking, as I completed multiple interviews/meetings this week about my decision to enter social media, I kept returning to the doctor-patient relationship as the main reason I deviated from a typical path in pediatrics and entered social media. I really want to re-align patients and doctors. There is an expansive divide and tactile pulse of distrust right now between those who seek care and those who provide it. Some days it feels like we have seemingly forgotten how much nurses and physicians care, how much they know about preventing and treating illness, and how much they can advocate for patients. We’ve forgotten how doctors and nurses collaborate, how much they ruminate and worry, how much they invest in patients’ outcomes. And how much they give up to go to work to help.

Which got me thinking, after Watson, a computer created to play on Jeopardy, beat two humans earlier this month in a trivia game, I was left entirely convinced that even as computers and robots will be a part of generating differentials (list of possible diagnoses) in health care, my job wasn’t obsolete. Witnessing the computer win left me more convinced that with increasing intelligence, people will still take care of people. Despite the fallibility of people, the dishonor and the malpractice we hear about on the news, we humans will still want empathetic care and connection in the exam room, too. Even as the New York Times published an article within minutes of the end of the Jeopardy game show stating that Watson-type robot medical assistants would emerge within 18 months, I doubt they’ll replace we nurses and doctors. I believe in the nurturing that still occurs in health care. We really need physicians and nurses, assistants and social workers, hospital and clinic staff and volunteers, to listen and heal us in addition to diagnosing us.

Which got me thinking, it’s crazy what people say to me. I’ve written about it before. It’s been a long week for me (read above) and it’s not over. It will be another week or more until I have a day off. So when I walked into exam room #4 this week, while greeting a patient and parent, I didn’t see this coming. I asked how they were, and they were gracious enough to ask the same. I said, “Busy! But good.” The response? “Busy? Working 2 days a week?”

There was sarcasm dripping from the right corner of the parent’s mouth. I was taken aback, my stomach dropped to the floor. Energy filled my ears. It was Thursday, a day where I left the house at 6:40am and didn’t return home until after 9pm. I was exhausted and heavy already with what was ahead (today). It seems I walk a constant tight rope between guilt and longing (missing my boys) and energy (making change and helping parents and children). I chew on the decisions to work this much every day. And a parent, simply out of naivete, challenged that I was working, or even committed. She of course has no idea how hard I work. I’m certain she’s tired, too. I reminded her I had 3 jobs and would also be in clinic over the weekend. And then let it lie. Ultimately she was in the exam room to help her child, as was I. So I moved on to do so, yet I was left a bit dumb-founded. Did this parent, who was in the room for advice and guidance, doubt my commitment to children, to the profession?

Which got me thinking about the mom, later in the day, who said she’d read the blog about Flu shots and various others. And how she just wished I would get a day off.

Which got me thinking again about my mom, her doctor, and the words in the exam room.

Which got me thinking about the comment in the post (on Kevin MD) where a smoker talks about how their physician put her hand on their shoulder and provided comfort and belief. And how that moment translated into a final cigarette.

Which got me thinking about the power of a passing comment and the relationships we forge when the exam room doors are closed. How tiny statements can feel like novels and then huge moments can be championed with steely courage.

Which got me thinking that it remains an utter privilege to care for children and to assist parents in preventing injury and illness. And I awai was in the exam room to help her child, as was I. So I moved on to do so, yet I was left a bit dumb-founded. Did this parent, who was in the room for advice and guidance, doubt my commitment to children, to the profession?

Which got me thinking about the mom, later in the day, who said she’d read the blog about Flu shots and various others. And how she just wished I would get a day off.

Which got me thinking again about my mom, her doctor, and the words in the exam room.

Which got me thinking about the comment in the post (on Kevin MD) where a smoker talks about how their physician put her hand on their shoulder and provided comfort and belief. And how that moment translated into a final cigarette.

Which got me thinking about the power of a passing comment and the relationships we forge when the exam room doors are closed. How tiny statements can feel like novels and then huge moments can be championed with steely courage.

Which got me thinking that it remains an utter privilege to care for children and to assist parents in preventing injury and illness. And I await the ongoing comments in the exam room. I’ll work hard, each and every day, to choose mine carefully.

And that there, that’s an amalgam.