“In everything I did, I showed you that by this kind of hard work we must help the weak, remembering the words the Lord Jesus himself said: ‘It is more blessed to give than to receive.’” — Bible (Acts 20:35)
Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA
I often quoted a version of this Bible verse to residents just before they were about to do something to a patient that was unpleasant. Truly, in medicine, it is better to give than receive. Throughout my career, I have had the good fortune to rarely be on the other side of the stethoscope, needle, or catheter. I have always been the driver of these instruments as I inflicted my medical trade on patients. As an acute pain physician, I have always fancied myself more attuned to my patients’ discomfort since I was in the business of relieving said pain. Now in retirement, I can look back with more honesty regarding my patient care. I admit that I was often forced to do uncomfortable things to patients. I did so with a blunted affect and steady hand that would appear callous to the medically uninitiated. The hard reality of our profession is occasionally, pain must be inflicted upon another human being for their ultimate benefit. I believe no patient would appreciate a timid, demure clinician during an uncomfortable procedure. Patients desire the outward façade of cool, competent professionalism as their clinicians subject them to beneficial diagnostic discomforts. Indeed, physicians require some level of detachment to maintain their sanity. I would imagine that patients have always lamented being on the business end of a physician holding an instrument or wielding a latex-gloved hand throughout medical history.
Perhaps it is a cruel irony of the medical profession that eventually, the purveyor of healthcare will end up on the receiving end as a patient or patient’s loved one. This situation is somewhat poignant since a medical career bestows knowledge that is not necessarily an advantage as you observe the doctor flicking an air bubble out of a syringe meant for you. Pam (my wife) and I recently faced the harsh reality of finding ourselves on the receiving end of healthcare as former healthcare providers (Pam is a nurse and has given me permission to discuss her condition). She has managed her chronic low back pain from an L5-S1 spondylolisthesis for years. Pam has done an incredible job through the decades controlling her discomfort with exercise, yoga, acupuncture, and the occasional NSAID. With our new full-time RV lifestyle, we have increased our physical activity exponentially with walking and cycling (we use two electric bikes as our ‘car’). Unfortunately, Pam’s symptoms have been gradually increasing, along with progressive numbness and weakness in her left leg. During the holidays, she obtained new x-rays of her spine, which indicated the spondylolisthesis had progressed from moderate to severe. The nerve impingement noted on MRI was consistent with her progressive symptoms. In short, she needed surgery to fuse and stabilize her spine.
“This is not going to be easy,” the Johns Hopkins surgeon stated during her appointment. He further explained that her situation would not improve without intervention and could eventually prevent her from walking. Pam and I were both grateful for her surgeon’s candor and confidence that he could stabilize her spine. “You are not going to like me very much for about a month,” the surgeon continued, noting this extensive surgery included significant and protracted discomfort during recovery. Wow, it really is not fun being on the other side of the knife.
This situation has obviously been a significant wrench in our ongoing ‘road warrior’ plans (TimBuckTwoBlog.com). Furthermore, we both plan to move from the RV to a sailing catamaran in the next few years. Pam’s unstable spine would not be sustainable with the constant motion inherent to life on the water. After much discussion, she decided to accept the risk of the surgery for the potential to maintain our active lives well into retirement. In fact, she is on the operating room table as I write this editorial. Rarely have I felt so utterly helpless in the face of events. I must say, I am not a big fan of the patient/family role, particularly when sitting alone in the waiting room.
The incredible outpouring of support from family and friends from our old community has truly sustained us during this challenging time. Friends from the hood have graciously lent us their home during the period of surgery and initial recovery. My mother provided a house and a car during Pam’s long-term healing and physical therapy (our RV is in climate-controlled storage). Old anesthesia colleagues have stacked the provider deck in our favor. The refrigerator is about to bust under the weight of food from neighbors in support. The outpouring of good wishes from friends worldwide has been incredible. The love we have been shown has been Pam’s greatest sustaining strength throughout this process. I am convinced it will be the crucial element to a successful recovery.
It appears of late that I may have gotten into a bad habit in 2023 of producing editorials without a clear medical message. Admittedly, I have been distracted by the pace of family events in recent months (that thing called life). Then again, the whole point behind healthcare is to extend the quantity and quaintly of our lives so that we can enjoy and strengthen the connections between family, friends, and community. Whether it is Ukrainian families battling for their very existence, a wounded American soldier struggling to walk again, or a husband tapping on a computer waiting for a wife in surgery, these connections sustain and drive us. We are social animals, and our very existence depends on the support we provide each other.
While the importance of the physician and the healing arts cannot be overestimated, I believe in retirement, I can appreciate that real healing does not always happen in the hospital. We in federal medicine provide the conditions for the genuine healing that occurs at home, among friends, and in one’s community. The most successful clinician will have the humility to recognize how their role in healing, while vital, pales in comparison to the therapeutic benefits of family and friends. We would do well to remind ourselves and our patients of this immortal fact.
p.s Pam is now three days out from surgery and is doing extremely well.