Kaleidoscope

As a boy, I was thankful for and humbled by the kaleidoscope.

Wandering and bored while shopping with my mom, I’ll never forget the first time I saw one. A dusky brown, dented, cheap-looking metal tube. Deceptively simple and understated. What riches lay there with a mere gaze and rotation into the light? Turn the wheel and witness red shards, turn again and see orange flowering, next yellow explodes into view, then blue seeping into the scene. From then on, I asked all shop owners if they had kaleidoscopes.

So often now, we hear of physician burnout. My heart always sinks a bit when I hear doctors tell motivated and passionate young women and men not to go into medicine. “It’s not like it used to be when I started,” they groan. “Medicine was exciting and all about the patients. Now all I do is look at computer screens, talk to billing specialists, and try to figure out the new insurance system…” On and on the polluted advice proceeds. And I get it. The times and format of medicine have changed. An all-too-frequent modern day picture of interdisciplinary rounds in ICUs, for example, includes an attending physician on one side of the hall standing outside the patient’s room and a row of computers with heads behind them typing orders and researching answers on the other side. No eyes on the patient, perhaps not even venturing into the patient’s room during rounds.

Enter the kaleidoscope.

In that antique store, the owner sat me down and said, “Son, I know you think this looks humdrum, and most people pass it by, but stop what you are doing long enough to look inside for just four or five turns.” I never forgot his advice and began applying it to many things in my life, such as completing dull but required coursework in college or rote steps done repeatedly in scientific experiments. Most importantly, though, as a newly minted medical student at Charity Hospital in New Orleans, I carried the concept with me as I began discovering the fascinating Cajun and Creole cultures of the population we served. Evenings were spent reflecting back on the people I’d met that day, as if peering inquisitively through that vintage metal tube.

After my training and sub-specialization, this acquired mental habit stuck with me. As Osler counselled a century ago in his 1913 “A Way of Life” address to Yale medical students, “Shut close in hour-tight compartments, with the mind directed intensely upon the subject in hand, you will acquire the capacity to do more and more, you will get into training; and once the mental habit is established, you are safe for life.” This directive resonated with me. It was the ‘safety’ I was looking for – a way of protecting my love for the vocation that drew me into her embrace.

Twenty-five years sped by; I still practice this ritual. Recently after rounds, I looked through the kaleidoscope, as I often do, with just enough time for four quick turns. Immediately, I again saw flashes of color and light built on endless combinations of personal values, faiths, family structures, race, and life choices:

…A 24-year-old patient admitted for Gram negative sepsis complicating peritoneal dialysis. Quick answer (Rx): control the source of sepsis, provide antibiotics and fluids. Dive deeper. After his congenital heart defect was addressed by heart transplantation at only 15 days old (the state’s first newborn heart transplant recipient), he inexplicably endured years of being chained to a bed and starved. Weighing only 49 pounds at 15 years of age, his parents were incarcerated. He devoted himself to years of working diligently with the Tennessee Governor resulting in a law named after him (Josh Osborne law) to help prevent others from experiencing such abuse. Josh worked at Goodwill and won numerous awards for service, yet you’d never hear him or his doting aunt brag about those accomplishments.

…Only a few rooms away was a 46-year-old man admitted for recently diagnosed pulmonary fibrosis and suddenly worsening shortness of breath due to community acquired pneumonia. Obvious Rx: Oxygen, antibiotics, and consideration of newly approved medications. Not enough. The spectacular story of the person awaited. Staring at his ‘older than stated age’ wrinkles and graying hair cascading over his shoulders, I sensed he wanted to talk. With purpose he exclaimed, “I’m a Roadie, and I build and climb huge sets for bands like Widespread Panic and traveling productions like War Horse.” I told him about my daughter, Taylor, who loves music and drama, and he asked to meet her. The next day I brought Taylor to sit with him, and soon enough they were locked in the kind of deep conversation results from sharing rare and fascinating stories. I stood anxiously watching his oxygen saturations and instructing him when to let Taylor do the talking. As we left his room, this re-embattled Marine yelled, “Ruh Rah, Taylor.” His sister later told me that Taylor’s visit was the best medicine he ever had.

…In the adjacent hall of our ICU was a 62-year-old morbidly obese woman with non-alcoholic steatohepatitis, hepato-renal syndrome, and superimposed Staph sepsis. After addressing her immediate medical needs in the morning, I decided to discuss other things with her on afternoon rounds. This quickly led to a flood of tears, and as I handed her a tissue she said, “You know, the woman doctor last night, Erika, please thank her for me.” Choked up, she waited a moment to regain composure and finished, “Thank her for telling me that this illness is not my fault.” At that moment, the other aspects of her medical care faded and this element took on a humbling hue – I’d totally missed it.

…Lastly, I cared for an 85-year-old patient whom I knew was a bit feisty, helping her stave off recurring complications from colon cancer. Her face was gaunter and eyes deeper than several weeks earlier. Despite obvious suffering, there was a peace about her that was instantly evident in her desire to talk about end of life. Gazing at me, then cocking her head, Annmarie declared, “Doctor, I want to die a good death.” Though we often discuss “good deaths” in medicine, I asked to clarify what she meant. With just a few words came a ton of meaning: “A death not necessarily completely free of suffering, but control my pain as much as you can and please help decrease my awareness of trouble breathing.” She continued, “You know I like making decisions, but I trust you and Catherine (her daughter) to help me if I’m not thinking clearly. I guess, Doctor, dignity is the main thing.” Looking up from her bed, Annmarie moved on to what seemed to be her main point, “I imagine Heaven as a huge kaleidoscope of energy. We’ll see beauty beyond imagination.” Annmarie had soared right past all of the things that weigh us down—schedules, worries, regrets, and pettiness. She was completely focused on the main point, which as she put it was love from God to us and from us to each other.

Color my world…

The voices of my mentors remind me to take stock of this treasure trove of humanity I share as a physician. One day in class during my training at Tulane, I jotted down just one thought from a lecture given by such a mentor, and it rings as true today as it did then: “Medicine has as its means diagnosing, curing, and saving lives towards the end-goal of preserving and improving health, self-worth and personal dignity. Do not confuse the ‘means’ as the ‘end.’ To accomplish the means at the expense of the end is to fail.” (Irwin Cohen, 1989). That phrase “self-worth and personal dignity,” for me, is the entire key to the kaleidoscope. It’s where the conversation must take us, day-in and day-out. The depth of the complicated and mysteriously delicate lives of the men and women we approach lying in those hospital beds every day is where both our heartache and joy are anchored as medical professionals.

Acknowledgement: The author would like to acknowledge the generous editing of Hedy S. Wald, PhD.

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