Tuesday, June 30, 2009


Over time, I've come to accept that I have more genuinely life-altering "moments" than most people. There was a point that I attributed this to the mere fact that I make a big federal ordeal about experiences that others brush off; I'm over that. No. I really do lead a life of a continuous string of movie-esque moments. The characters, the screenplay, the soundtrack -- all of it perfectly scripted, the way it's "supposed" to be. The way it needs to be.

The clinic director -- the character I uprooted my life to move to Vermont to meet and see how he did what he did, in whose presence I had a panic relapse upon introducing him to give a presentation at my school -- returned from vacation. My brain was excited that he was around; my sympathetic nervous system threw a shitfit. I started stuttering, stammering, sweating, acting like a complete idiot.

Stop it
, I told myself. You need to NOT do this. WTF is wrong with you?

I shared my physiological responses with two people at the clinic, who observed that other people legitimately have the same responses to this character. I found this encouraging. One of them suggested I actually medicate -- block my sympathetic nervous system with a beta blocker. Fascinating. Imagine what it would be like to go through life perfectly calm and at ease. 12 hours later, I was driving in a horrifically scary storm. It was truly petrifying -- people were pulling over on the side of the interstate left and right; nobody could see anything. But I kept going -- crawling, but fighting through it. I was hyperalert, hypervigilant, hyperfocused. My sympathetic nervous system saved the day, and I appreciated that this experience existed only to demonstrate to me why I should never block it. Check. I get it.

So this week, I've attempted to work through various strategies that are "supposed" to work for this kind of ridiculum. I breathed. I self-coached. I pulled my "adopt a character" improv trick. I instituted a reward system: "If you can get out two sentences without tripping over yourself, you get a Reese's Peanut Butter cup." No joke; this is what my life has become. Turns out, I'm motivated more by chocolate than by professional pride. Who knew?

Tonight, I targeted the ultimate reward. I told myself that if I could survive without embarassing myself until 6PM (i.e., 10 hours of work), I would reward myself by giving myself permission to take the ultimate plunge: asking this man if I could accompany him to see a patient. People do NOT tag along with him, let alone people who are relatively useless. Everyone talks about his clinical presence as being magical -- that, literally, magic happens. Patients say it; doctors say it. I wanted this experience so badly that it hurt.

But indeed, I had to earn it -- psychologically -- in order justify taking the requisite risks to structure that opportunity for myself. Today was a good day. I did 90% of a physical exam without supervision (and my findings accepted as truth... that might be a topic for another post; it was my first time experiencing that level of pressure, of confidence). Turns out, I was much better at basic exam skills with no preceptor in the room. I saw both optic discs, took blood pressure fluidly, and actually palpated a liver edge -- other exam skills are fine, but those three things thwart me ALL the time. Just like that, nailed them all. Alleviating performance pressure by replacing it with pressure to actually be correct? I spent a lot of time reading today, too. I taught myself about a ton of stuff I've been meaning to look up. I understood stuff. I integrated it into the existing framework in my brain. I was proud of my thought process, very specifically.

All of this set the context for my plunge. One more interaction, then I'd ask. Interaction: go. "The patient didn't know if he was taking X." (1 of 17 meds)
"He's taking Y."(another of 17 meds).
"Ok. But X...?"
"X is Y." (brand vs. generic)
Idiot. 9 hours and 58 minutes down without self-sabotaging. Game over.

I inhaled deeply, diaphragmatically, and exhaled loudly. I didn't even care if he heard me. I just needed to not have a panic attack. I didn't. I walkied away, dejected, appreciating that my moment had passed me.

I turned around. Stop it. Avoidance = bad. Just ask.
"Do you think that it might be possible to... go in with you?"
Oh shit. What did I do?

I spent the next 3 hours with him, seeing patients and asking him questions. It was nothing short of magical.

The man listens. Time stops when you hold his attention. He is so "present." Nothing else matters but the words that come out of your mouth. Everything slows down.

He speaks with greater precision than I've ever heard. Everything is deliberate. Everything means something.

We saw a man who had a post-bypass pulmonary embolism last week-- crazy hospital crisis, crazy scare. The whole clinic staff got involved, it was pretty crazy. We listened to him talk about how fears about his body falling apart, and the compulsive monitoring and adjusting he was doing. It was magic as I watched the director listen with such purpose. It was magic as the layers of anxiety peeled away. Softened features. Softened will. Something happened in that room. It was nothing short of magical.

Afterwards, I told him so.

Sometimes when I wear my cycling coach hat, I shift into a pseudo-uncomfortable tone: of knowing what I'm talking about, and almost feeling apologetic and guilty for knowing what I'm talking about. For adopting almost a "wisdom" of whatever stylistic something-or-other I'm describing for another's benefit. I remind myself that there's no need for apology; that I actually DO this particular thing well, and that it's ok to appreciate my own niche of stylistic expertise. This guy visibly goes through this same process when he is complimented. But the more I compliment him, the less apologetic he gets -- and the more he elaborates, the more he shares and teaches. It's a really wonderful cycle, actually.

So when I acknowledged the power of his influence, he acknowledged it and shared some stories about how that sort of power can be advanced and abused. Again, every word carved deliberately with extreme precision. I locked his eyes, captivated. I knew that he knew that I was soaking every word up.

"We touch people's lives in ways we may not realize."

My eyes glowed, connecting with this thought that so deeply resonated with me. As I smiled with my eyes, I felt my breathing slow. Rhythmic, fluid. I was clear. I was present.

"Thank you. Today was one of my favorite days EVER."

I was finally myself. And that alone was magic.

No comments: