January 30, 2021

by drplasticpicker

Yoga continues to provide me with moments of bodily and emotional discovery. Last night I went to sleep just listening to the Ocean Waves Dark Screen YouTube Video, and it did help deepen my sleep. But the previous night I also did 10 minutes of Yoga by Adrienne and also the Ocean Waves Dark Screen YouTube Video – and I slept much more deeply. Good sleep is very important to have a clear spirit and mind.

Something Adrienne at Yoga by Adrienne said really struck me during one of the meditation YouTube videos. It was a series of simple stretches and meditation exercises toward the end of the day, and she said something along the lines of “embrace the close. The close of the day. And with the close, tomorrow you can accept the morning and a new beginning.” Maybe I made that up, but I could swear she was saying that directly to me. For no particular reason my thoughts started turning toward shifts in my professional life and other big life decisions. My thoughts turned to the two little toddler patients that had cancer that are intertwined in what had been a period of deep personal saddness for me, and whose story I have alluded to others several times and has been each time painful. And I realized that on multiple different fronts, I was ready to emotionally embrace the close.

Dr. Plastic Picker has been me blogging at my kitchen table at 4-6am, and then going to the beach. Dr. Plastic Picker has been initially about me declaring to the blogsphere I was going to save the earth! One piece of ocean plastic picking at a time. But a lot of Dr. Plastic Picker I realized a few months into the blog, was my being irreverent and silly and laughing at the world and at life and what a mess it had become. Working through the past stories and issues has been enough, and this blog has always been about a true journey and never been about followers or others reading – so sometimes a part of ones life just becomes sensationalistic and no longer helpful. I’ve decided that after the UCSD Family Practice Grand Rounds, that I won’t talk about physician burnout anyway. I will tell the painful story about my saddness two years ago one last time to a wonderful group of colleagues, and then I will embrace the close. Certainly if anyone asks me, I will explain the origins and I’ve mentioned it in several interviews. But I never set out to be a physician burnout advocate. But more importantly I want to embrace the close of the story in my heart about those two little girls who meant so much to me. The pain can never go away. I see her father and mother often at work, and we remember her that she died just after learning to walk. I will never forget the call from the PICU attending at Rady’s who called me to let me know that the baby had died. So quick, and just one visit I saw her between her diagnosis and her death. I wish I had hugged her while she was in her wheelchair, but it’s hard to hug a child that is vented and trached and in a wheelchair.

I have to embrace the close of that story, because medicine continues to be very emotionally painful. I don’t know how people have done it all their lives, people like Dr. Dear Friend who in their hearts are so much more emotionally open than I ever was. When I started going to the beach, it opened this beautiful new world of healing for me and I’m much more present for my patients. But last night, I came home very late and did not get home until 7pm when it was supposed to be done at 5pm. I don’t mind staying late as I am finally practicing medicine the way it needs to be done to truly listen and to guide my families.

But usually on Friday afternoons, and usually one of the later patients – I will see those teens. And this was a typical story, the COVID pandemic has fracture a family and a marriage and unintended one hurt is one of the sweetest teenagers I have ever known in my practice. And as I was ordering her eating disorder labs and EKG, and getting ready the referrals to the eating disorder team – I saw something I had never seen before. I have done this set of tasks hundreds of times. This is a bread and butter diagnosis and I have set hundreds of teens on the the same pathway of treatment.

But I have that moment and that image forever locked in my memory. Beautiful thin freckled face, looking up at her mother. Eyes red=rimmed and tears pooling in her wide eyes and head turned to her mother. Posture straight. Neck stiff and looking so intently. And I saw the little girl that I’ve taken care for over a decade serially superimposed on that face, wide eyed looking at her mother with so much trust and love, and now with still love but just lost. She looked so lost and wanted to be found by the person sitting right next to her that was just talking, and whose words I didn’t hear at all. And this little girl’s life is fractured and as I told her mother gently, “I’m not going to show you the weight because it’s not about the weight. It’s about relationships and family and control. “

Chef Nephi from the Western Apache Nationa and the movie Gather said “Empathy without boundaries equals destruction.” Yesterday I realize that I need to start putting up some emotional boundaries, because I cannot go on like this. Medicine is too painful and the stories are too painful, and sometimes just one pediatrician is not enough.