Dan GottliebQ: I don't have a question. I just wanted to let you know what a great hour I just enjoyed. Thanks for taking the trouble to put it out there. You've got a new internet fan (I already read your column regularly, and it's always time well spent).
Dear Dr. Dan Gottlieb,A few months ago I heard part of your show on the topic of caring and sympathetic doctors. The part of the show I heard was unanimous that doctors should feel the pain of their patients. I can agree with that. A few years ago I walked out of the office of a doctor who was not very caring. Doctors, funeral home directors, police officers, firemen, clergy, teachers, etc. and really all of us in helping professions can be more sympathetic. At the same time anyone who has a career in helping people, especially in their crisis times, has to be able to put away from the pain of others or that professional will not be able to survive emotionally for very long. I am a pastor, and in one day I presided at the wedding of two very special people and two hours later I presided at the funeral of a beloved person. In the morning I felt joy with one family and in the afternoon I felt grief with another family. In the evening I had to disengage from both of those families and focus on my own family. To carry home the emotions, especially the grief, of earlier in the day would not be fair to my family. Now speaking as an individual, I do have my special, unique pains that I feel and live through and I can’t expect every person to feel the pain to the same intensity that I do. I don’t want others to pretend.
thank you for writing this letter as I am going to deal with this subject in my column next week. Many caregivers suffer with what is called compassion fatigue because those of us who care deeply often have difficulty establishing appropriate boundaries.I will later which will be the subject of my column
Dear Dr. Gottlieb:
What is wrong with me? I really and truly understand that Mr. Vick had a horrible childhood. A cruel childhood that led to unimaginable violence, dog fighting and G-d know what else. I also understand the concept of paying ones debt to society and having a second chance. But, after reading and trying to understand your column today-I still do not understand how he could kill a dog that did not win a fight in such a cruel and terrible way. Couldn't he shoot the dog? No! He had to wet the dog and electrocute him. Doesn't that say more about his heart than about his childhood? What is wrong with me that I find his behavior more than just violent? To me the man is innately evil.
One of my least favorite sports clichés, and there are many, is "there is no I in team." As I think about it, there is also no U in team. So if there is no I and there is no U, maybe the whole team thing is an illusion.
So that got me thinking about identity. Not only is there an I in identity, there is no U. now of course identity is only about the self, but maybe that's an illusion also. I was thinking about that on a recent meditation retreat when I was supposed to be thinking about other things, but that's the way minds work, they never do what you want them to do, the little rascals.
But maybe all our identities really are an illusion. Or, at the very least, not completely true. We tell ourselves who we are : the good girl, the workaholic, the martyr, the caregiver, or even the blogger. One woman told me when we first met socially that she is and anxious person. Well, she might have more anxiety and she wants, and it might be so uncomfortable that it is sometimes disabling, but is she and anxious person? No more so than I am a quadriplegic or a blogger or even a nice guy. All of the labels we give ourselves still don't add up to who we are. And all of those labels are connected only to the way we see experience ourselves intermittently. And then to make matters more complicated, those minds of ours create stories about why we are the people we think we are: neglectful parents, childhood trauma, illness of a loved one, recent breakup, spiritual calling or just plain unlucky. So we have our identity, our explanations and we are ready for life. Maybe.
Is it coincidence that Easter Sunday, Passover, and springtime all come at the same time of the year? I'm guessing no. For the same reason it's no coincidence that all of them represent the same thing -- birth, rebirth, freedom from what has enslaved us. And speaking of freedom from whatever has enslaved us, I once read that only a small percentage of Jews followed Moses out of Egypt. In a way I can understand that. After all, here's a guy with a speech impediment saying that he is talking to God and not to worry, everybody would be okay. That will cause you to pause for a minute before making a decision. But the end result was a majority stayed back. And that is really not a surprise. The majority chose to settle for the enslavement of their lives knowing that it was at least predictable and that tomorrow would look pretty much the same as today. Those who talk the leap of faith, had no vision of their future just faith that it would be better one day.
I see exactly the same thing in my office every day. People suffer today based on what has happened in their childhoods, their marriages, the work place or their children's behavior. And the causes range from life-threatening illness to a rejected college application. But all of these sufferings have something in common and that is the stories we tell ourselves about what these things mean. And generally the stories are global and hopeless. More often than not, we suffer because of our stories. Mark Twain once said that he lived through a thousand tragedies in his life "and some of them actually happened"!
I received a letter from a woman I'll call Jane who was an avid sky diver prior to a disabling illness. She said she sometimes cannot stand how much she misses it.
I went to see a new cardiologist the other day as I have been having ongoing blood-pressure difficulties that have been difficult, well, impossible to diagnose. After a brief wait, a nice-looking 50-year-old man walked in with his young intern trailing behind. They both took their respective chairs (hers near the corner) and he began the interview. The first thing that thing that struck me about this man was that he actually listened. He paused after my answers just for a second or two before he asked another question. The second thing I noticed was how exhausted this poor intern looked, and how hard she was trying to hold on to all the information that was coming her way. As the doctor moved closer to me in order to listen to my heart and take my blood pressure, he asked me another question about my symptoms. My answer seemed to take him by surprise as I don't think it fit in his diagnostic formulation. He sat quietly for several long seconds with his eyes closed and then continued our discussion. Towards the end, he made some recommendations and an interim plan and said goodbye. On his way out the door, I said to the intern that what she witnessed was an example of doctoring at its best. I told her how this man sat next to me with his eyes closed not afraid of not knowing what was happening. Not afraid to be confused, and caring enough to do all of that in my presence.
There wasn't time to tell her everything I wanted to tell her about caring in medicine and eye contact and the power of touch. I couldn't tell her how alone people feel in that examining room and whenever they see a cardiologist that it is about matters of the metaphorical heart also. I wanted to tell her that it takes courage, strength and self confidence for a doctor to be open to their own ignorance.
I had dinner with a friend of mine the other night and she was telling me a story about a woman she works with whose husband suddenly left her. "Out of the nowhere", the friend said. And of course these things are very rarely out of nowhere, but they often feel that way. But while my friend was going on with the story, half of my brain was musing over that phrase. Out of nowhere was what happened to me 30 years ago when a tire crushed my car. Out of nowhere is what happens when we find a lump or hear any tragic news. So in the middle of her story, I blurt out "I hate that place". Of course she is well into the story and has no idea what I'm talking about. So when she asks what place I am referring to I said "that nowhere place where things just seem to happen."
Okay so now she's giving me a strange look that I often get when I blurt things like that out, but she is a nice person so she invited me to develop my thought.
And then I realized that "out of nowhere" is where all things happen, good and bad. It's not just about tumors and divorces. Out of nowhere is where we fall in love. But the truth is we all live right there where none of us have any idea about what's coming around the corner. We tell ourselves we do and that tomorrow will look pretty much like yesterday and we find some comfort in that. But that's an illusion.
I know Dr. Dan is supposed to be compassionate and understanding. And he is not supposed to be reactive without feeling empathy for both sides of the conflict. But today Dr. Dan is taking the day off and his angry, reactive alter ego will be making today's entry.
A friend of mine told me that he and his 10-year-old son were taking a walk in the woods the other day when they found a hunting arrow in a tree. The boy thought this was pretty cool (as most any boy would) and brought it to school the next day to show his friends. And then this little boy with a very cool arrow became a big problem. He and his very cool arrow trigger all sorts of events about deadly weapons and regulations and questions about suspensions or other major consequences. I've heard stories of some schools filing charges against small children. But this boy came home crying and was afraid to face his parents feeling he had done something horrible.
That reaction is not unusual. Children who live in abusive families usually think that their family is normal and there is something wrong with them.