Medical schools train physicians to be on the outlook for the body’s signals of disease. Because missing these traces can be dangerous this responsibility is taken deadly seriously.
Medical students and residents present their patients to more senior physicians. These presentations are formal and structured consisting of chief complaint, subjective history of the illness, findings of the examination, review of laboratory findings, a discussion of the differential diagnosis and a plan. This format is varied rarely and at the learner’s peril.
Constantly in the mind of both the student and the senior physician is the possibility of a life threatening condition. If such a condition is only a distant possibility the patient is still likely to be examined, tested and often even treated for this rarity.
This attitude of constant vigilance for “bad” things can have an unintended influence on physician’s behavior. Acting always out of worry of bad things can lead to reliance on expensive testing and an emerging world view that the physician’s job is to be a sentinel for what “pathogen” lies around the next dark corner. Sometimes bravado emerges in an attempt to tame this beast. This may not be the best response for either the physician or the patient but balance in the middle of this muddle is not easy.
In this morning’s newspaper is a story about the efforts of different research teams looking for the sources of happiness in people’s lives and more importantly, having found them, what can be done to multiply them. One technique being explored is this: at the end of the day, look back on three things that brought you happiness. Explore the origins of those events. Take note and be grateful. Do this every evening. By concentrating on good things, by exploring their origins, they prosper.
Do you think that physicians’ constant vigilance of bad things, exploring their origins and concentrating on their possibilities encourages them? I think they need not. One of my favorite physicians, Dr. Campbell McMillan, was a pediatric oncologist before he retired and he has a marvelous, infectious joy of life. He was gentle and loving when he needed to be, especially when breaking bad news. He was funny and accepting almost all of the rest of the time. I don’t think he had any illusions that he was going to ever rid the world of childhood cancer but he took thousands of small steps to help many individual children rid themselves of their own.
We can’t go through each day looking for signals of illness. This kind of behavior must lead to illness. We might benefit from going through each day looking for signposts for happiness. What would happen if in concentrating on what brings us joy we miss the signs of something bad?
Recently I’ve had the fortunate opportunity to discover this. Within just the past few months I’ve had two unrelated patients come to me with undiagnosed advanced cancer. They were both older. They had both had lives of unusual but simple joy. Neither was rich or even well-off financially. They both had grandchildren who brought them deep satisfactions. Perhaps of relevance, they both practiced yoga. They both had come to suspect, over time and with a dawning awareness, that something was deeply wrong within their bodies. I think they both had chosen not to pay too much attention to these signs.
In both cases, arriving at the diagnosis did not require expensive testing. In both cases when I shared my understanding of what was going on, both of these individuals accepted the news with grace and appreciation! They were relieved to have their suspicions confirmed so that the uncertainty was no longer a factor. They did not have to fear the unknown now. In both instances we discussed at some length the possible advantages of getting more information from more testing. In both instances they did not care to spend their own time or resources exploring that path. They both felt they had better ways to spend their time. They both left my office by giving me a warm and lingering embrace. I’m quite sure they both left to find ways to be happy.
My own cancer came in a period of my life when I was profoundly unhappy. I often wonder if the worry caused my cancer or I simply discovered it earlier because I was sad, afraid and looking into dark corners. There is a chance my cancer still is in me. I get tested annually now since it has been 8 years. When it is near the time for my test I worry. I notice body pains everywhere. I slip into bravado when the nurse draws the blood. I wish I had more serenity at these times.
For Christmas I’ve decided to give myself these presents. I’m going to look for gifts in three moments of every day and hope that my joy expands and fills dark corners. And oh yes, if there is bad news, I hope to accept it as graciously as those two patients.