It's 10PM on a Friday night. I'm alone in an old house up a dirt road across from the clinic of my dreams. I have to carry a flashlight to get from the kitchen to my bedroom. I feel my way along the walls, fumbling for doorways and light bulb chains.
This somehow became my life.
Tonight, my preceptor showed me where to buy gluten-free food and a chill, cheap restaurant. There's kale, feta, egg whites, and lactose-free milk in the fridge. Surprisingly, I have a better Internet connection than at home. Triumph's in the shed (I drove him at 80 mph on the interstate on a bike rack for the first time -- he handled it better than I did). Across the street, a symbolic and practical representation of what I want to be and do with my life. Right here in this moment, all of my needs are met.
Except, I'm not particularly thrilled right now. I'm distracted by two unsettling events of today that I'm going to need to process before I can immerse myself in my new opportunity.
I assisted one of my favorite people today removing skin tags from a diabetic patient. I did the post-snip cauterization. What that entailed was taking a scalding hot wire and inserting it into the patient's open wound, singeing the skin and replacing blood with charcoal-esque ash. No joke.
I'd seen cauterization during a few GI surgeries I've observed -- but it NEVER occurred to me that this would be done to an awake person on the surface of their skin. Insane. But very cool.
The patient didn't have a particularly thorough sense of what was going on with this procedure, with her disease, with much of anything. But suddenly, before we began, a coherent thought rang out: "Has she ever done this before?"
Holy shit. That "she" is me. Shit. What do I say? I can't lie. I can't lie. I won't lie. Shit. Wait. She's not talking to me. I don't have to answer. Look straight ahead. Avoid eye contact. Avoid eye movement. Let the professional handle this. Breathe.
"Sure, she has."
Oh gosh. That wasn't supposed to go that way.
I felt guilty -- guilty about in any way being party to a misrepresentation, guilty about having been relieved to get a "break" from accepting responsibility for reality. I promised myself I would USE this. I had to. Otherwise I couldn't justify it. I would use this as a prompt to process how I would respond if I were asked the question myself. I'm going to be asked, repeatedly even, by multiple people. Just as I coach people on their bikes, anticipating a challenge and rehearsing a response to it is absolutely the way to go. But no responses came to mind. I made a mental 'note to self' to ask my preceptor how he handled this in medical school.
The day progresses. I saw some familiar patterns and story lines, found myself readily recognizing things that had been brand new even a few weeks ago. Made a few useful observations, asked a few useful questions. Took blood pressure and not only didn't fumble and embarrass myself, but actually obtained the same measurement as my preceptor. My confidence, my calmness, drastically changed. I felt legitimately competent.
A few hours later, I was at dinner with my preceptor to discuss our project, which now has a significantly larger health literacy assessment component (as this is my priority in life, for better or for worse). Got onto the subject of "non-compliance" -- but instead of the inspiring experience I had discussing this life approach paradigm shift that I'd had with this particular character in DC, I walked away feeling demoralized and discouraged. Maybe I really AM naive to believe most fervently that patient's understanding of what they're taking, why they're taking it, how they're taking it, etc. is the rate-limiting mediator of all other outcomes. Educating people at the onset, empowering them to play an active role in their own lives, MUST affect how regularly they take their meds. Misunderstandings are qualitatively different than "yeah, I know, I just don't take 'em all the time," for sure. But either way, it boils down to a miscommunication, a mismatch between the goals/values of the provider and the patient. "Non-compliance" is a cop-out.
I was disappointed by this conversation, in that I had built up this fantastic image of my preceptor as a champion of this cause. Again, expectations are everything. He's inspiring and amazing for other reasons, and I need to compartmentalize my frustration and discouragement and get back to learning and experiencing. This is how I see the world and, while I don't need to apologize for it, I also don't need to talk about it so much. It means something, but not everything.
And I need to be ok with that.
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4 comments:
Well, we certainly have triggered an interesting thought process.
When I first started spinning I was very compliant. One instructor has her students in four different positions in three seconds (repeat six times). Psycho crazy. When I started getting injured a lot I knew part of the cause was due to my spinning activities. The day after I nearly collapsed after a long bike ride was the day I decided I needed to get educated, so I signed up for my spinning certification. The day I became educated in spinning was the same day I was empowered, had self-efficacy, and could be non-compliant. I no longer go to four different positions in less than three seconds. I am non-compliant because I am empowered through education.
This is a constant dilemma for me as a father of a teenage girl. I want her to have self-efficacy, I want her to be empowered, yet when she is non-compliant (as she often is) it tends to irritate me.
So I guess what it really comes down to is self-efficacy and empowerment can only be achieved through education.
Thanks for the neural activity.
I would argue that what you're describing as "non-compliance" isn't that at all. "Non-compliance" has negative connotations - and you're doing the complete polar opposite of negative things. You are PROACTIVE, you are independent, you are empowered... there's no non-compliance; you're just doin' your thing. You're describing your choices made within the context of there being no "rules." There are no rules in Spinning class; there are no rules in medicine.
On the contrary, there are probably rules in your house that you set. Your daughter's actions contrary to those rules aren't the same thing as your proactive choices to abandon a set of instructions from a Spinning instructor or a doctor. I think it's a subtle but significant difference. You're encouraging her to tap into self-efficacy and empowerment, and that's great. But disregarding your rules isn't THAT. There really ARE rules out there in the world, and by and large we try to be responsible to them. In contexts where there are no external circumstances to be responsible, THEN it's a wide and open field. No?
In contexts where there are no external circumstances to be responsible, THEN it's a wide and open field. No?
I would agree with that, the hard part is determining when there are no external circumstances, or what qualifies as an external circumstance.
There are no external responsibilities when deciding to sit during a standing climb in a Spinning class, clear enough.
How about wearing headphones in a Spinning class? Any external responsibilities there?
Are there external responsibilities if you don't wear a helmet when you ride a bike, or a motorcycle? I would argue yes, others vehemently argue no.
Perhaps its knowing the difference between rules and suggestions, or knowing when its OK to not follow the rules. For me, this is often difficult to figure out.
BTW - In my club there are "Spinning Class Rules" posted on the door. The "No headphone" rule is on that list.
VERY fair points. I agree, that it's a matter of knowing when there are rules and, if there are rules, whether it's ok to break them. I suppose it's a function of understanding the purpose of the rules.
The purpose of helmet rules or no-headphones rules (both of which I support) is safety. As a coach, I would be extremely anxious if someone couldn't hear me. That's not a suggestion; that's a policy.
But it's the role of policy-setters to provide education as to why those policies exist, for the interest of those affected by the policy. Such can be said for Spin class and, I reckon, for parenting ;-)
My parents would laugh their asses off if they ever read me saying that.
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