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May 15, 2018

People : Family


Lately, as I've adjusted to a life in a cast and on crutches, I've been alternately angry, annoyed and resigned at the fact of losing my independence.  Every so often (every ten minutes) I want to throw the crutches out the window, and then I internally rage at the thought of how hard it would be to go down the stairs to retrieve them.   

All my life I've considered independence as something to constantly cultivate, something I was always at risk of losing.  Growing up as the youngest sibling and only girl with four brothers, then living most of my adulthood in long-term relationships, I was worried that being positioned against men meant that I had to actively fight for my own space.  Luckily, my thoughtful, generous brothers raised me with the sense that my gender was a gift and that I could be the same and different; that the limitations can be overcome and that there are advantages to be found.  Still, it can be easy to lose the volume of your voice when so many have spoken before you.  And in relationships, when you are continually weighing someone else's needs, your own can become hazy. So I've made it a conscious point to do as much as I can for myself, and while I have my own reasons for it I know that the desire itself isn't unique to me.  It's what we all clamor for in our adolescence, what we struggle to sustain in adulthood, and what we mourn in old age.  

Recently, as I've had no choice but to rely on others for both basic needs and overall purpose, I see how dependent I've actually always been.  And more crucially, that this is actually something to celebrate.  If I envision connection as a foremost goal in life, why would I not want to be connected to other people deeply enough to need them?  As I've let my mom stack the pillows under my leg (thanks for that third one), my boyfriend arrange everything by my bedside (thanks for thinking of items I didn't realize I'd need), and my friends feed me one dessert after another (thanks for the best gelato in the city which I can't believe I didn't know about)--I realize: this need for others is really what lets me be everything else outside of them.  Including, hopefully, needed by others.  

Coincidentally, I read this today: "The self without sympathetic attachments is either a fiction or a lunatic.  Yet dependence is scorned even in intimate relationships, as though dependence were incompatible with self-reliance rather than the only thing that makes it possible." (From On Kindness by Adam Philips and Barbara Taylor, as quoted in Maggie Nelson's The Argonauts, which I loved a lot).

As we often do when we're considering how best to evaluate something for ourselves, we think about patients.  Almost more than I like getting to know our patients as individuals, I like seeing their relationships to the people in their lives.  Coming from a large family where each of us interacts with every other of us differently, I can relate to the strong bonds created from dysfunction.  It's interesting, and important, to see what this is like for others.  It's tempting to perceive a person just as she sits in front of you, and forget that she exists within a web of relationships that can support or loosen her.  

We see so many incredible sources of care from family members, that remind me that for all our man-made medicine, it's often best to capitalize on what's naturally there.  There are the elderly brothers, one taking care of the other ever since a traumatic brain injury in his senior year of college.  The homeless grandmother who fights daily to secure nourishment and shelter for her grandson.  The couple in their eighties who still hold hands.  The 19 year old, newly transitioned teenager-to-adult, who answers every question with hesitant flatness, except when asked about the baby on his phone, then come a drawn out smile and three fast happy words: "That's my niece."  Their natures are quiet, their love full of force.

Then there are a lot of people who don't have anyone, whose primary sources of stability (case managers, social workers, health care providers) try hard but can never be as present as family.  The woman whose time is marked by the hours between drinks, who stops by our clinic every few days to ask for a medicine or a place to stay.  We don't have anything to relieve her pain, and the waiting room eventually closes.  The man who needs an important procedure, but can't get it done because he has no one to drive him home.  It took several visits to realize this, because he was embarrassed to admit he didn't have any friends.  We have so little to offer these people who don't have a foundation of dependence.

And for others, who we might be able to offer something small, they're often (reasonably) skeptical and mistrustful.  They're not used to having people to (reliably) rely on, and sometimes would rather withdraw than to displace hopes.

Seeing people who have been neglected and disappointed, who are now wired to expect little from others, I can understand the appeal of caring for children.  There's more malleability and room to restructure, more chance to instill each action with a sense of trust in the world.  To create family, that which will be your crutch, of the physical and of the emotional kind.  

But after my injury temporarily reverted me to a childlike state (thanks again to everyone for feeding me, transporting me, consoling me), I think it's possible and important to re-enter this mindstate in adulthood.  Especially for people who grew up without the support every child should be able to depend on.  Adults generally don't want to re-enter this state of dependence (I didn't); it's scary to be vulnerable and it sucks to be let down.  Maybe it's part of our job to break down this resistance.  It's really difficult but I think possible over time, and at the very least worth trying (over and over).  We talk a lot about empowering our patients to care for themselves, to see their own strength and capacity.  But maybe first they need to know that there's still space for them to be someone's child: to voice their needs, to be on the receiving end of a relationship.  To know that dependence makes self-reliance possible.

So on this Mother's Day I'm grateful to my family for giving me so much to depend on, for making my needs so easy that I can make the choice to care about other things, other people. And on this Mother's Day, I'm mindful of the many people who don't have the gift of this family, this dependence.  It's for you that we show up, hoping maybe once or twice that we are there in the right moment and space.

So thanks to my crutches for revealing all the places I stumble and how much support I'm lucky to have; for reminding me what we all want to be for other people.  I guess you have a purpose in my life.  (But I will still happily throw you out the window when this cast is off).


* This is one of the few photographs of my mom with all her kids.  She's 7 months pregnant with me so I count my presence, and that is also probably why my youngest brother looks so unhappy.

April 23, 2018

Health: Breaking Bones



So I broke my right ankle (the fibula portion) in a couple places after I took a fall rock climbing in Yosemite.  I am totally fine, safe, and lucky.  After some more distance from that event I'd like to write more about it and what it means about climbing.  The short story is that despite a sucky outcome, it really was a positive experience in which I gained a lot of perspective about myself, the environment, and how we interact (as in, it's a relationship and there are moments to engage and there are moments to let things be).  Also my most prominent feeling is immense gratitude for having so many people in my life who are so supportive.  Thank you, I really love you and appreciate you!

Which is really what I was thinking about as I hopped my way through the well-oiled machine of the Kaiser system this morning.  That I'm really lucky to have the resources to navigate a sudden change in my life, and how much these things affect every level of daily life, which can then spiral.  And how different it is for our patients.

In medical school, I once attended a lecture on palliative care that started with: "Sudden illness and death are inconvenient."  We talked about how all the ways in which these things mess up our lives, the simple and basic daily things.  In medicine, we focus on how to treat the acute sickness and injury, but who is there to help cope not just with the physical illness but with the logistical nightmare of being a patient?

Sometimes we forget just how bad we are at this.  A big part of what sustains me at work are our clinic's shared goals to provide the best possible care to our patients who are at the highest risk for being sick and have the fewest resources to get better.  I always thought we're pretty aware of how our system fails them at every level, because we deal with the daily BS of not being able to streamline so much that seems basic: we can't get medical records, we can't get a medication covered by insurance, we can't find a specialist, and so on.  And we try to be cognizant of all the chaos and instability that makes it difficult for people to organize all the things it takes to be well.  We know that transport is expensive and physically difficult, that homes (if patients are housed at all) are not structured well for mobility, that food access and insecurity can matter more than diabetic medications.

But now being a patient myself (with plenty of resources) who is blown away by how much a small fracture can change your day to day, I'm even more struck by just how difficult it must be to be a patient at the clinic where I work.

Access: Last night, when I realized how swollen my ankle was getting and how little I could bear weight, I went online and was able to book an appointment with my primary provider the next morning.  This is almost never available at our clinic.  Patients can go to urgent care or to the emergency department, neither of which can give appointments, so you'll never know when you'll be seen.  And for a non-urgent injury like mine, this can mean hours of waiting.

Mobility: I saw my primary care doctor and she ordered an x-ray which I was able to get in the same building as her office.  At our clinic, we have to send patients to get x-rays at a totally different site.  It's not far, but if you've broken your ankle and it takes about ten minutes to walk a block, it feels freaking far.  I also got crutches immediately, with someone to show me exactly how to use them.  We don't have crutches at our clinic, and when we have to order any equipment like splints for patients, it can take them weeks and often months to get them.

Diagnosis: My x-ray was read immediately, and I was scheduled with a podiatrist (again in the same building) to discuss the results (which I knew was a bad sign for my ankle but at the time I was more preoccupied by how seamless this whole process was).  At our clinic, we wait for results of tests to be faxed over (yes, faxed), generally several days or weeks later, and often they're not faxed at all.  With thousands of patients, we might not remember that it was even ordered, and if they're not faxed to us, we might not remember to ever look up the results.  And certainly we won't be looking for them on the same day, unless a patient is savvy enough to pester us about it.

Specialty Care: I was pretty amazed that I got in to see the podiatrist just like that, on the same day. We have to refer patients out for most things, and even urgent referrals can take up to a week.  Normal referrals (which are sent out by mail to patients) take a couple weeks to process, which means it takes patients a couple weeks to just get a number to call, to then make an appointment to see a specialist, which can take who knows how long depending on the specialist.  We can expedite things, especially orthopedic issues like this one, but that requires extra effort and a different process (for which we don't get any extra time)--it's not standard of care.

And at our clinic, because public insurance won't pay for two visits in one day, patients can't see more than one provider.  Even though it makes sense, both for convenience and for coordinated care.  So even if a patient could see their primary care doctor, counselor, and gynecologist in one day, they're not allowed to.  (Though, I asked my primary care doctor today if I could also get my PAP done since I was already there, and she said only gynecology does that, and I was pretty proud that all of our primary care providers can do PAPs).

Procedures: Kaiser has in-house people to do everything, so once the podiatrist diagnosed me with the fracture he handed me off to someone else to do my splint.  The procedure was quick, efficient and mostly painless.

It was at that point, though, that I realized how drastically the procedures of my actual life were going to change.  How will I carry anything while using crutches?  How will I get to work?  How will I shower? How will I drive home with my right leg in a splint? (um, I did it against medical advice).

Luckily, I have a lot of resources. I'm easily able to take time off work, which is not the case for many of our patients who try to grab episodic work like manual labor as it comes, or whose employers are not sympathetic to people who need recurring time off because they find low-income workers expendable and replaceable.  I have friends and family who have cars; I have expendable income so it's not the end of the world to take a lyft or leave my car parked in a garage overnight.  I can't tell you how many times a patient declines to go to the emergency room for a legitimate medical concern because they don't want to leave their car parked at the clinic and pay that expense.  I have a loving community of people (thank you again!) who have the kindness and bandwidth to go out of their way for me.

I also have the entitlement of being able to advocate for myself.  While Kaiser was great at efficient medical care, they weren't the best at actually caring about what my life looks like outside of their utopia.  The podiatrist didn't give me much information at all other than I'd have to be in a cast, and I had to ask him for how long I wouldn't be able to do anything.  When he said 8 weeks (and neglected to ask me what it is that I'd want to be doing), I almost cried which was already embarrassing and since he tried not to notice it, I got even more embarrassed so I spent most of my energy sucking it up.  By the time I actually thought of questions to ask, he was gone and I was on my way to getting a splint.  But afterwards I realized I had a billion questions and I emailed him to clarify exactly what was going on and what I should expect.  Though I still didn't ask him about how I would shower (for that I went to google and the answer is cast covers).

I know from experience with many caring health providers that people rarely intend to be cold or unsympathetic, but that there's often a lot of other things to consider as a doctor and it can be hard to remember how to just be a person (ideally they aren't separate, but here we are).  For healthcare providers working in a system much less functional than Kaiser, there's even more to navigate, and we often forget to ask about how patients are going to actually live their day to day after they leave our clinic.  And they, unlike me, are often used to systems that don't cater to them.  They rarely ask: What should I expect?  And I too infrequently ask the questions that would help me advise them what to expect.

One of the first things my friend Diana (one of the best doctors I know) asked me was: "Are you going to be okay at home?"  Her thoughtfulness in realizing that a broken bone really means many little fissures in my life, and my confidence that yes I would be okay, reminded me again how much I have, how relatively easy it is for me to piece things back together after a break.

It's not this easy for everyone (please remind me I said this when I cry and complain over the next couple of months), and I think that's the main immediate takeaway for me in the day after breaking my ankle.  While I don't necessarily believe in pre-ordained reasons for things happening, I do believe pretty strongly in drawing purpose from things that happen.  I've been spending a lot of time doing the things I love lately, and at the same time becoming a little more stressed at work, which seemed a little off as the former usually helps with the latter. So maybe this is a timely way of forcing me to stop and re-evaluate what I'm doing at work so that we're better able to recognize where things are broken and how to help heal in the places that matter most.

April 3, 2018

World : Going Away & Staying

 

In a (possibly manic) mind-frame of wanting to do everything I love with all the people I love, I spent four out of the five weekends in March out of town, immediately after taking a week off in February to climb in Mexico. I don't regret the movement, but I do now relish the ability to process in one place.  The act of constantly going away made me consider what it is that we seek, what we want to return to, the balance between the two.  What I miss when away, what I gain from the perspective, how to integrate the two in my life in a way that's meaningful, useful, sustainable.

Two weekends were spent in real winter (which my California spoiled self defines mainly by the existence of snow): Yosemite with my work family, and Colorado with my actual family.  We cross-country skied during both trips, and this same activity was extremely different with each group. My co-workers are active people who love the outdoors, and it was a near-miracle to get my family to venture into the mountains for the first time in a place they've lived for a dozen years.  But in both, I appreciated the sense of being somewhere different, together.  For my co-workers, it was the first time we've spent significant time together outside the confines of our clinic.  I love them for their natural inclination to take care, but trying to constantly fulfill that inclination can be stressful in the space of work, and I loved seeing them enjoying the space of nature just for themselves.  For my family, it was the first time we have really done anything active outside together, and seeing my 6 year old niece and 9 year old nephew experience this newness was the best gift.

Two weekends were spent climbing, one in Red Rock (outside Las Vegas) and the other in Bishop (in the Eastern Sierras).  These are among my very favorite places in the world, first for their incredible beauty, and second because they are places I've returned to most frequently.  This combination of familiarity of place and changes in myself is like the love for old friends. At Red Rock I was really lucky to be there with the kind of friend who both supports who I already am and makes me consider how to be better.  There I was able to make progress on climbs I'd tried before, and attempt new ones that I'd like to return to in the future.  It's a comforting, challenging feeling to know that this is rock--mostly stable at least in our lifetime--and we can come back to it as we change and have different experiences with it.

I think we are especially drawn to this feeling in Bishop, where I've gone annually since starting to climb outside.  In 2016, it was me and one girlfriend. In 2017, we brought another girlfriend.  Between that time and this year's trip, we've formed a group of four women, who have become dear friends and climbing partners.  The roots, and what we've grown into, are something I know I want to nourish indefinitely, and I'm grateful for that kind of certainty.

Bishop is a small town, and after the nine hour drive to get there, you can get everywhere in town within minutes.  By this third trip, we have established our place to stay (Hostel California), our place to get pre-climb coffee (Looney Bean), our place for post-climb burgers and beer (Mountain Rambler).  But there are concrete changes: we now know a local, who points us to new options and introduces us to the community.  And so we have coffee at Pupfish and dinner at Yamatani (substituting sushi and sake for the usual burgers and beer).  After failed attempts to get there the two years before, we finally make it to the hot springs.  We meet people for whom the magic of Bishop is their everyday.  And there are subtle changes in ourselves.  The four of us met and became close during a certain time of transition, and we've remained close as we navigate the unraveling and restitching of different parts of our lives.



In these remote, natural places less burdened by people and by the work people create, we become less burdened too.  We dream about a life dominated by climbing in these landscapes that don't ask anything of us.  We see stretches of space, and we know that we can traverse them if that's what we are feeling in the moment, or in the future.  The main problems to solve are presented by lines and ridges in rock, which are challenging but in many ways so much less so than the textures we find in other people and ourselves.  There's an ease of connection with others with similar dreams who do live this dream.  Every minute I spend in Bishop, I think to myself, how is it that I have so much right now? We're free to move quietly amidst beauty and power of the kind that assures of us of our own. The gifts of these places are so easy to see and to absorb and to wish would last forever.



And maybe it's the never-ending giving that makes me eventually want to leave and come back to where I am.  Where my movement is a little more restricted, and reminds me that not all places are so free, that not everyone has so much room.  Because I want things to be asked of me, to take on some burden and sacrifice some ease for a little purpose, if I've been given the privilege to choose that.  I don't necessarily believe in difficulty for difficulty's sake, but I do feel that the accumulation of so much good arms us for the hard, rewarding work of sharing it. 

The one weekend when I didn't go away, I spent in Oakland.  After two and a half years at my job in the East Bay (in Berkeley, on the border of Oakland), I still feel like I don't know our patients' communities very well.  This was the main motivation for running races in Berkeley last fall and Oakland last weekend.  While running through cities is heavy on the visual senses and most of the backstory is beyond simple sight, it does make me feel more connected to these places, and to the people who live in them.

After coming back from the magical weekend in Bishop, I wanted even more to cultivate this connection--to be with people different from me, who don't have the same choices to unburden themselves.  It seems to me that the best part of the vastness of mountains is that they're so far-reaching, they don't have to be enjoyed just in the physical place in which we experience them. We can take the feelings to other spaces that have less obvious beauty, and therefore more need.  We can use them to sustain us when we're presented with the lines and ridges in people and in the systems of people.  When we come across beauty and power of the kind that makes us question our own.  When we occupy space occupied by people with needs that are the same and different, making for a crowded and confusing life.  There's a lot there that can make me feel weak and sad.  More so than when I'm actually away, it's sometimes here that I most feel the impact of leaving.  We can remember how much strength and stamina these places give, and try hard to use it in the environments that challenge us most.



While all these experiences made for feelings that seem complicated, because there were so many feelings and to extreme degrees, processing them reveals a pretty simple formula.  I want to go away with beautiful people to beautiful places where I can physically move in the ways that suit me best.  These remind me that everything I want has been freely offered to me: from people, how much I can learn from others; from places, how much there is beyond me; from movement, how much I can and can't change with my own agency.

And then I want to return, to try hard to share what all this gives.  As much as I love places like Red Rock and Bishop (and I really love them so much), I think they will always give me a fullness I won't want to keep forever.  Each person has a different way of receiving and giving, and so I'm only speaking for my introverted self when I say that if I were to stay, I'd likely be more of a receptacle than a connection.  I know I'm incredibly lucky to be able to go away, and even more so to be able to come back.  It's this movement more than anything else that I want to stay with.

February 15, 2018

People : Chunk of Change



As I get older and the people around me get older, I see two general trajectories of personality: we become more stuck in our ways, or we mellow out and become more open.  One of my general ongoing goals is life to be more of the latter, especially because stubbornness is pretty rooted in my genes.  Once, a friend said to me: "don't be stubborn," and another friend responded, "that's like telling her, don't be."  Another part of getting older is distinguishing when a quality is beneficial to myself and others, and when that same quality is harmful to myself and others.  I've found that I learn the most when listening to things outside of myself, which is one of the things I love most about a job that exposes me to people so different from me, pasts and futures so off my own path.

At the same time that I'm changed by our work in primary care, I try to stay mindful of its primary purpose: to promote increments of change for other people.  Recently, I was telling someone about how a big part of keeping this work sustainable is accepting the small scale of change we can effect.  Otherwise we're discouraged and disappointed.  So I've learned to keep my expectations low, and be glad for the small and the slow.  He asked me a question that I don't think has ever been asked of me before: "Are you okay with that?"

I knew instinctively that my answer was yes, but I wasn't sure how to articulate why. I thought maybe I'd never fully processed the reason for myself, and if that was the case, was my answer valid?  I continued to think about the question for awhile.  

Soon after, I saw Passion Pit in concert at the Fox Theater (one of many reasons for my lapses in writing is because I'm not good at transitions, but I promise this is related).  I loved this band back in medical school, but hadn't listened to their music in years.  They played most of their famous songs, but it was a song from their lesser known EP Chunk of Change that really made me re-feel my love for them.  They sang "Smile Upon Me" and I kind of wanted to cry. It felt really familiar and also far away; I hadn't listened to that album in so long, and the reunion made me pay attention to the words and sounds in a way I hadn't the first time around listening to it.  

It made me think of another friend who often comments on the lyrics of the songs I play in the car, who made me realize that for all my love of language I rarely pay attention to what songs are literally saying.  I went home and listened to Chunk of Change in its entirety.  And discovered that in addition to the gorgeous sounds that always made me feel so much, the lyrics are incredibly kind and loving in this way that feels raw and scary, like when you're sharing something personal you know everyone can relate to but no one talks about.

Then that made me think of the title of the overall album, whose meaning I can honestly say I've never considered other than as a way to refer to the album.  It also helped to look at the cover art.  It's a smattering of hexagons in different colors with unequal sides, superimposed on one another.  Each shape is one-dimensional on its own but when layered on each other, and connected with straight lines that cut across the shapes, create a three-dimensional structure.  

The album is short (6 songs) and songs in general are short (a few minutes), and Passion Pit recognizes that for all that we put into our work and our creations, they're just thin slices. They're stray pennies and nickels (Marie Kondo tells us, throw away that spare change, stop saving it up because you'll never use it and who gets real joy from small coins).  But these things that occupy very little space, that have maybe little tangible value--they can carry a weight independent of their thickness or quantity.  They also shift, and show up in different places at different times, and they change us.

Which is how I feel about work, and about our slight interactions with people who deserve way more than we can give.  Each encounter is a layer, shed or accumulated.  Because it's little, we can miss it or neglect to nurture it.  We forget to trust that the things pressed upon us don't always leave concrete impressions, to have faith that caring has ineffable effects, to let go of the need to achieve successes in a conventional, direct way.  I'm not just okay with small increments of change--I love this process more than anything else.  It's the most natural way we progress, and we too often dismiss it for the promise of something shinier, something more immediate, something more definable.

Which is why one of many lines that I love from Chunk of Change is "I cry tears like diamonds."  A reminder that we arbitrarily assign value to things whose heft we can hold, and dismiss the weight of things that lack form unless they're running down our faces and even then, they're wiped away.  I love the difficulty, and the complexity, of searching for color and line in those things.

And for my own process, I'm really grateful to all the people and experiences in my life that promote layers of change, of re-framing.  Grateful for the person who asks a question of me to re-consider work I've done for years, for the person whose intuitive way of listening makes me actively re-listen to music I've loved for years, and for all our patients who challenge us every day to push our sphere of living and theirs too.

February 5, 2018

People : Our (In)Humanity




For Christmas my dad gave me all of Viet Thanh Nguyen's books--one of which I've read and didn't love (The Refugees), one of which I've tried to read twice but couldn't finish (The Sympathizer), and one which I hadn't read (Nothing Ever Dies: Vietnam and the Memory of War).  So I started on the last one with somewhat low expectations, and it turned out to be one of the best things I read in 2017.

In Nothing Ever Dies, Nguyen argues that a different mindset is required to prevent war and its traumas.  This mindset must be inclusive of all people affected by war; it must recognize the humanity and suffering of each and every side, including people who are not our own.  At the same time, he points out the danger of focusing only on humanity.  He points out that conventional anti-war sentiment often emphasizes the humanity of the victims, of the other side.  Which is very important, because it's natural to ignore the effects borne on people but because this perspective sometimes cast victims as "other," and different, it can actually undermine their status as humans equal to everyone else.  We view victims only as subjects of dehumanization, rather than as whole beings with the same capacity for good and bad as everyone else.

Because an inclusive mindset also means recognizing our inhumanity: the capacity of each and every side to inflict suffering.  We often view the people who fought on our side as committing noble sacrifices.  Nguyen doesn't deny the need to respect this courage, but he argues for a more complex view of people, one where a person can both selflessly give and inhumanly take.  It's only when we see our own capacity to harm others that we can really prevent wars from happening again.

This gave me a lot to think about in terms of war, and it also made me think about our daily work in clinic.  We often advocate considering our patients in the context of what society takes from them: equal opportunities in health, education, and safety.  This reminds us to be cognizant of our own privilege, and to share it as much as we can.  This reminds us of the humanity of those who are most vulnerable, whose humanity can be masked by the outward visibility of poverty, homelessness, language barriers, gaps in education, substance use and mental illness.

At the same time, maybe seeing them only in the context of what society denies them, denies our patients something else important: the full spectrum of who they are and can be.  Both good and bad.

We tend to feel a certain sense of guilt when our patients frustrate us: when they have demands that seem unreasonable and assert we aren't doing enough, when they seem to disregard our efforts and assert we aren't doing enough.  I think it's partly because we feel like we can't and shouldn't get angry or impatient with people who have been subjects of so much injustice and trauma.  Reading Nguyen's book made me realize that these emotions are okay to feel, because it recognizes that suffering doesn't change your innate humanness.  That to really respect the humanity in people who have suffered, means to recognize that they still have and elicit the whole range of human emotion and qualities.  I feel strongly that we should still be aware of a person's context and how it influences their behavior, so that we can provide more patient and effective care even when we're frustrated.  But instead of perceiving these frustrations as things to overcome, I'd like to accept them and see them as reminders of our patients as whole, complex people.

It's also a reminder that I'm whole--that I have the same capacity to frustrate other people, to harm other people.  The very term "provider" suggests that we are always giving, which we know isn't always the case.  I sometimes (often) find myself internally defending myself against a patient's frustrations with me, thinking I work so hard, I just want to do the best for you.  But this isn't always true.  There are times I don't want to go out of my way, when I'm tired, when I'm not sure it's worth it, when I cut corners.  When I'm like this, at best I'm not actively providing and at worst I'm taking away.  I think an important part of preventing harm is to recognize this in ourselves, not to self-deprecate, but to be honest and accepting and better.


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