At the Still Point of the Turning World
Residency is over, NOW what? (While I'm waiting for the answer, I'll get some spinning done....)

Tuesday, June 10, 2003


This is Rachel Naomi Remen, pediatrician and author of the books Kitchen Table Wisdom and My Grandfather's Blessings. Rachel lives near San Francisco and is on the faculty of Family and Community Medicine at UCSF. I was lucky enough to take her elective course entitled "The Healer's Art" (twice), and to hear her address to the brand-new third-year medical students, on the eve of their first clinical rotation (three times). In person, she is the most beautiful human being you've ever seen, full of light and humor and kindness. I remember how the medical students drew as close to her as they could, like puppies to a warm fireplace.

Rachel was diagnosed with Crohn's Disease in her mid-teens and survived over a dozen surgeries attempting to control her symptoms. She developed osteoporosis and blindness at an early age as a consequence of the high-dose steroids she had to take when the surgeries didn't work. One day during her pediatric residency, she fractured her leg while rounding on her service, because her bones had become so fragile from her longstanding disease. She just kept rounding. Some days, when her steroid dose was especially heavy, she had to shave off the beard that developed from the masculinizing side effects. Despite all this, she was driven to succeed in academic pediatrics, and became head of the pediatric clinics at Stanford before professional burn-out steered her to a different path.

Today, Rachel co-directs the Commonweal center, which holds workshops for people living with life-threatening illnesses. In addition, she leads workshops for burnt-out physicians all over the country. Having experienced medicine from both the patient's and the doctor's point of view, she is in a unique position to understand the great emotional and spiritual costs of contemporary medical training. Her books encourage doctors to remember the true meaning of medicine: Service. She says that we all serve the life force in each of us, and I believe her.

In medical school, I was full of self-righteous certainty that I was so enlightened that no degree of burn-out could ever make me never lose sight of my commitment to service. It hasn't. Yet, two years deep into residency, I know that mere determination can't make a doctor good. It takes faith, good humor, better luck, and close attention--among other things--to make a good doctor. And it's a lifetime's worth of work.

During this weekend's conference, I was reminded of one of Rachel's exercises for seeing the extraordinary in everyday life. She invited our class to ask ourselves three questions at the end of each day, and to keep track of the answers in a journal. The three questions are:

--What surprised me today?
--What moved or touched me today?
--What inspired me today?

I'm going to start keeping track of my answers again, and will post them here from time to time. I've also listed the Three Questions on the sidebar, below the Tagboard, as a reminder to myself and as an invitation to all of you to use them for your own self-awareness. We are all caregivers, in one way or another.

Today's Answers

1. What surprised me? How annoyed I became with the mother of a child I saw in the clinic this afternoon. The mother was worried about her daughter because she had eaten a crayon one month ago. Clearly the child was fine, but the mother kept challenging my reasurrances. It took me what seemed like forever (it was probably 10 minutes), to convince her that you cannot see crayons on an X-ray. It was a frustrating interaction, and I found myself avoiding her eye after we'd left the exam room.

2. What moved me? The response of this evening's clinic attending to my confession of anger in #1. She is one of my least favorite attendings, usually cold and--let's face it--mean-spirited. I've never thought that she cared very much for how she made patients feel. And yet, she suggested to me that I ask the mother of the child in #1 why she was so worried, to see what I'd discover. This was such an expansive and tender suggestion that I simply stared in wonder.

3. What inspired me? That I can still, after having been at HUNDREDS of deliveries in the past two years, feel thrilled at a baby's first cry. (This does not mean, however, that I want to go to as many deliveries in the next two years as I have in the past two.)