What do you feel when you see a clinic or doctor’s office?

When I first became a physical therapist, I was excited to see the clinic, if a bit overwhelmed. Over the course of the first year, my emotions included a kind of preemptive tiredness, as if I knew that I would be pouring energy at the risk of feeling unreplenished. At an outpatient pain medicine clinic, I meet many people with low expectations for physical therapy or any other medical intervention, because they’ve seen it all before. I thought I could be different. I thought that my blend of knowledge, skills, and passion could offer new value. Maybe it does, but it’s just not enough for everyone — if anyone.

After hearing so many stories from patients, there’s a new feeling when I see the clinic. I think about how others feel when they come to a doctor’s office. They’re afraid of being judged, angry at jumping through hoops just to get help, ashamed that they can’t fix their problems themselves, sad that they don’t feel themselves, and worried for their future. I don’t think so much about what I can offer; I think about what other people offer. When we are patients, we bring our stories, our pain, and our entire lives.

The Dark

Now, when I see the clinic, I feel that I am walking into darkness. It’s like I’m stepping into their pain, if only for a few minutes so that we might find a way forward — a path to light. I don’t mean that I have the answers, but we can pool our knowledge, skills, and experience so that we can come closer to joy. This feeling is partially inspired by this tweet:

I still fall into a trap of thinking I could be a healer, but I’m more aware that the trap exists. This allows me to surrender any image of being like a mechanic, a salesperson, or a lecturer. I am not someone who possesses a thing to sell or a service to render. I’m just a person, with another person, trying to live. We meet in the darkness.

After realizing the beauty of sharing the experience of pain, I reflected on how I ended up feeling this way, so that other clinicians/patients/humans could do the same. Three fundamental ideas help me to make contact with others in the darkness:

  1. Find the “why.” One day when I was riding my bike to work, a sentence overwhelmed me: I want to liberate humanity from pain so that we can all find joy in life. I had just listened to Find Your Why and felt inspired to find my purpose. Although I used to see myself as a “wannabe liberator” — like a hero — I now see the foolishness of that idea. If there’s any protagonist, it’s the patient. Even so, we’re actually interdependent, so I’d rather emphasize the latter part of the sentence: “…so that we can all find joy in life.” I feel like myself when I can contribute to others’ happiness. My “why” is about meeting in darkness so that we can find light, or at least try to do so together instead of letting someone struggle alone. But to do that, we need to know where others are, where they have been in life, and why they feel what they feel. Therefore…
  2. Know the narrative. If there’s one tragedy of our current healthcare system, it’s that patients’ stories are not heard. Sharing an experience requires us to listen, but external forces like reimbursement, lack of appropriate insurance coverage, and so-called productivity are all assaulting the opportunity to connect with patients. People are reduced to numbers and their clinic visits are ending before they even begin. As much as I love evidence-based pain management, it’s no solution to this problem. Narrative-based practice, on the other hand, is more likely to honor the humanity of patients. We learn the narrative through embracing storytelling, through cultivating compassion and curiosity, and through noting the complexity and context of what led the patient to the clinic.
  3. Love yourself. I’m down on myself when people don’t improve. This ballooned to feeling a heavy shame about my ability as a physical therapist. Even though I had been trying so hard, reading articles all of the time, and going to conferences about pain, I just felt that the outcomes weren’t satisfying. I have since been trying to savor the good moments. I look to my fuel sources: my wife, kids, my friends, music, a candle, exercising, meditating, even writing this post. It’s not that compassion is fatiguing — “compassion fatigue” is kind of a myth — but I agree with whoever said that we keep the lamp burning by putting more oil in it. One of the most powerful and unexpected ways that I found more oil is through working with someone on her last clinical rotation. Though she might not have noticed it at the time, I reflected on my values and my career because of our conversations about the inner goodness of people and about how hard it is to help others as much as we want to help. She taught me that when we share a workplace with someone who is compassionate and has similar values, then it’s easier to love ourselves; we see that we’re not crazy — or at least we’re not too crazy.

Out of the Wilderness

As scary as it is sometimes to walk into the darkness, there is comfort in the clarity of purpose. There is an even deeper comfort in knowing that my own suffering amplifies the urgency of alleviating others’ suffering. I couldn’t have seen this though without feeling broken at some point.

Years ago I would have said that I want to be the best, most successful physical therapist with all of the coolest letters behind my name. Those aspirations vaporized when my mother died in her sleep in August, shocking my whole family. I lost a part of myself when my mom died, and cared less about conventional achievement. I lost interest in proving myself, maybe to a fault, but I walked through the motions of proving myself anyway. I felt no joy from metrics at work or from getting retweeted or published.
David Brooks might say that this was a transition from a climbing a mountain into feeling lost in a wilderness.

Brooks describes a “second mountain” that we climb when we make different commitments — to our relationships, to foregoing individualism, to transcend the self. Wandering in the wilderness allows us to reflect and to learn about ourselves so that we can change. Even though the pain from grief is not the same as the pain of patients, I see a part of me in them when they feel frustrated, angry, and afraid. I see my mother in patients because she was skeptical of physical therapy, too. (She walked out of a session because the PT said that the exercises were “supposed to hurt” after she said that they hurt too much. She never returned.) She always told me to remember to be kind to patients and to listen to them when they said they’re hurting. On Monday, I start my PhD in Health Sciences, and I dedicate the degree to my mother because it’s really largely because of her that I can make a positive impact on how providers treat people.
My second mountain is to fulfill her promise and to help other providers to do the same.

The only way that I could make it out of the wilderness is through others. My wife and family keep me from losing my head, and my coworkers went way out of their way to make sure I was okay. Patients found out what happened and spent so much time comforting me and helping me to move forward. Patients gave me cards. They hugged me. They shared my pain.

We weren’t provider and patient at that point; we were equals. They met me in my darkness.

All I can do is return to their darkness. It comforts me to know that you could meet there, too, so that we can climb our mountains together.