Where did She go?  Where did that determined, driven, goal oriented person go?  I really wish I knew because about now I crave her and I’m tired searching the end of the earth for where she could be hiding.  I don’t blame her though, despite the cover, the pages of this book has some harsh chapters and tragic losses.  However,  I hope She is doing all those amazing things we used to dream about.  Like finding sustainable health care in impoverished countries.  How about hitting another summit, why stop at just 2?  Maybe, just maybe She’s not responding as She is focusing on that IronGal training.  Although we never conquered that fear of drowning.  I hope She comes knocking on my door soon.  Wait, no, this place is a disaster and I wouldn’t want her to see the real me.

Today I contemplate, what makes someone so accomplished disappear?  What turns the go-getter into the just “come get me if you want me”?   How can the real me sit here in this dilapidated room with no motivation, a broken heart and a fractured soul.

Somewhere along the line, her self esteem and self worth plummeted.   Slowly over the years, with some significant loss and heartbreak, mountainous levels of destructive thoughts ran thru her mind.  She started to feel that unless she lived up to everyone’s expectations, she was worthless.  Reality struck and scared She as she was  never  going to be able to buy her dad that boat she promised, and eek, “you didn’t give us grandchildren”.   All those friends with six bedroom homes and already jockeying for those coveted alumni admissions spots.    She was supposed to be the successful one, more diplomas and tassels than all other family members combined, but now just gets by paycheck to paycheck.  Why couldn’t she just have stuck with computers!  As the job and relationship failures continue, the self devaluing cycle continues to spiral downward.  And in time, the last remaining cheerleaders are gone.  There She was alone, with nothing left to do but hide.

It is in that darkest and lonely day where she tries to confront the barriers preventing “She” from returning.  Was it unrealistic goal setting, previous bad choices, uninvolved parent coupled with the loss of another?  I could debate whats to blame but that doesn’t change the the future.  The future only changes when we can rekindle the fire, the deep burn to change and the guts to push thru to become that young vibrant She again.

All I ever asked for was a cake.  It could have been store purchased, vanilla frosting.  I don’t even eat the inside.  No decorations, just frosting.  Well maybe balloons (more frosting).

All I ever wanted was a final Smile.  That same gleaming smile that I saw 6 years ago. Accompanied by the sparkle in your eyes as you looked directly into mine.  The smile that said “I’m into you”.

All I ever wanted was to grow old with you.  To share adventures, to ski in our beloved PC and to create sustainable communities with an abundance of  love and laughter in impoverished communities.

But what I’ve learned is you don’t always get what you want.   No matter how hard you work, no matter the dedication to the relationship and no matter the price you pay,   there will come that day when you realize you can’t alway get what you want.   That day will change you.

I could list the three thousand ways you have tried to tell me “I’m just not into you” . Not in words, but in actions (or should I say lack of actions) but this would not change anything.    A simple smile, a single flower plucked from the garden, a simple touch.  Cost nothing, effort little.  You said you were “going thru the motions”.   I found myself tiptoeing on eggshells, trying not to create waves.  You uttered “I love you”  behind a forced smile and not the one I fell in love with.   I’ve given you all that I can and regardless how perfect my love was, it is not what you want.

Unfortunately,  I can’t tell you how to love.  That is an emotion that comes from within your own heart and soul.  Some of us are born lovers,  some of us long to love, and  some of us just simply can’t allow themselves to love fully.  What I do know for certain is that I was born a true lover.  I cherish friendships and I ache when they end.  I crave deep intellectual and spiritual relationships and I cherish every little “I Love You” text which comes my way.

But what I did gain from this loss was a deeper understanding of who I am.  I’ve learned that I am incredibly profound at caring for others.  I’ve learned that I have traits of an Empath and that I am willing to dole out  more love that I take.   I’ve also learned that ten years from now, you still won’t love me as much as I’ve loved you.   I want to say you deserve the best but I won’t because you had the best and you took advantage of it.

Just know, I will miss you more than any words can explain.  That I’ve cried enough in the last month to resolve any worries about a drought.   I will miss that smile and I will long for one more glimpse of that happy guy I used to know.    But what I won’t miss, is not getting what I want, even if it came for free.

Dear Hospital Administrators,

We accept the fact we’ve had to sacrifice every other weekend, family celebrations and national holidays for you to meet your JHACO accolades and your yearly bonus, but we think you are crazy to ask us to do more with less. To you we are simply a physician, a PA, a nurse practitioner with a brain full of diagnostic criteria and ICD-10 codes and to you we lack a heart, we should rid ourselves of emotions and quit wasting time on caring. However, what we have found is that each and every one of us is a compassionate group of clinicians. Together we wish to bring compassion and the art of listening back to the field of medicine.

We took time to carefully review the multitude of year end emails, comprised from your exquisitely catered lunch at that fabulous banquet facility. We understand the continued need to focus on “patient and family centered care”, but you ask us to discharge them sooner. No ride, no worries, we’ll send them in a cab! Get them out before 10 so we can bring in more gravely ill people with reputable insurances. Of course, that is exactly what my father said after his recent cancer surgery. And no, I am sorry, we have not heard how wonderful the reimbursement is with Blue Cross? Our CFO asks us to “spend time listening to your patients, but keep it under 15 minutes” because we need you to split those 10 hours across 25 acutely sick MRNs, yes Patient MRNs, don’t get to close with the patients. We don’t want then to know we are humans and not robots. You want to see better PRESS GANEY scores but make sure they know that their hypertension is better addressed by their PCP and not during their inpatient stay. Remind them they are here for a SBO and the small bowel isn’t that close to the heart. They’ll be fine. Oh and please pay attention to the 30 day red star readmission rates. Those insurers are really holding us accountable.

Now Mr MBA, non-licensed RN and man in dark suit, I see what you are asking and in the world of ObamaCare, I understand the need to increase my RVUs, but I’ve gotten called out by a patient for staring at the clock (in dire fear that I’ve missed a case management huddle and I’ve been reported). They’ve noticed the beads of sweat pouring when they mention that last “chest pain ” symptom with my hand already on the brass knob (quite lovely knobs I might add). They can sense the stress when they want to review their bowel habits in grave detail and I’ve already mentioned I needed to run because I have 20 other patients to see and its already 3 pm. However, this delightful young lady has had a lifetime of bowel pain and constipation and I am her clinician. With huge smile, Of course I have an extra 30 minutes for you! No worries, my daughter can get herself home from pre-school. I have plenty of time to discuss your tarry brown stools and excruciating pain with our top-notch Gastroenterology colleagues, order your colonoscopy, discuss the plan with your HCP via telephone and get the pre-op anesthesia clearance given your 30+ co-morbidities.

The problem is there is a side of medicine beyond our fee for service. Unlike our MBA comrades, we did not seek out endless years of studying, we do not sacrifice our young adult lives in didactic rounds to hear that better ROI means more $$$ for us, because it does not mean anything to us. We’ve gone years without a raise, a bonus or even recognition. Wait, I forgot to ask, how was the Cabernet at the year end celebration?

The way medicine works today, if we want to be compassionate providers we can likely go broke or completely insane stifling our emotional provider within us. I want to help those who suffer, I want to draw anatomically correct pictures of the stone lodged in your distal ureter and how a stent can help your hydronephrosis. $230K in debt to gain this knowledge and this is billed as a 15 minute visit. I want to cry with the patients and I want to show them the tumor in their lung and discuss how invasive ventilation is unlikely to improve their outcomes. But I don’t have time, because what I really need to do is go admit some newly sick patients in ER so I can bill at a higher level of care. You understand, right?

So despite earning more money for you and destroying all my non professional relationships, Why do I continue to work here? Because it is a privilege to be born with the skills to ease someone’s pain. I am honored that these hands can provide a therapeutic touch to a patient and need and because it is a gift to be able to deliver a grim diagnosis with a healthy dose of compassion. The ROI which matters is the hug from a patient’s daughter or the penned letter which arrived on your desk but was never acknowledged.

Sincerely,

Somebody on your payroll

I run so my feet can hit the pavement. Wait, they pound the pavement.  When they hit they release pain, hurt, suffering.  I run to sweat. The type of sweat which burns you from within and releases pent-up anger and angst. Why Run? Life isn’t always fair.  It can take people from us thru disease, accidents, addictions, cancer, hate.  It can hurt people. Life doesn’t do it intentionally but some people hate life, wish for a different life, unsuccessfully search for the answers to life.   Life can make people cry, cry as if there is no end to the weeping horror.  Why we ask between the tears, why? Life isn’t fair.

So I run.  2.62 to 26.2, whatever I can squeeze in or have the power to finish.  I train in wind, snow, sleet and rain.  The heat of summer when the rubber on my Mizunos is on the brink of melting.  The icy, harsh January frost when my shoes fail to grip the sleek covered roads.  Sometimes I grip a tree for balance, a fence for protection. I run to make the bad pieces of life fade away.

I’ve fallen. I’ve fallen to my knees.  I scattered my own blood on the pavement. My elbow, my knee, my head.  Running has hurt my body. It has beaten me down but it has let me beat down the ugly demons who try to derail the happiness in life.  It has brought me to tears when all I wanted to do was run from sadness. I’ve cried and I’ve been defeated at times but I always come back to the pavement.   The pavement will always be there for me and I must always be there for it.