I’ve become so attuned to that which isn’t real
And with each injection and photo filter, I too, drift into that ethereal space
To know and be deeply known is what I say I want
But I fear that I am already gone, floating atop a wave of likes and manicured selfies
Updating my status while my children try to get my attention
I don’t understand why “be here now” is the hardest commandment to keep
I don’t understand why “tell me about yourself” is the hardest question to answer
I have learned to accept the silence. When I first started in my practice of medicine I found myself talking quite a bit. I would imagine most of it was nerves. The anxious excitement of having come so far and worked so hard to become a practicing physician. The worry about saying the right thing in the exam room. The fear of not doing what needed to be done for that particular patient. All of these things combined to create an energy in me that was unstoppable. One that filled every single pause in a conversation with words.
In this society this is not abnormal. We are a culture who is unnerved by silence. A study of 580 undergraduate students undertaken over six years, reported by Bruce Fell on The Conversation, shows that the constant accessibility and exposure to background media has created a mass of people who fear silence. We feel awkward and the silence unfamiliar as a result of this. And so our conversations continue, hurried and without so much as a pause to collect our thoughts.
As time went on, I began to be more confident in my skills as a physician. At the same time, I began to truly take the time to invest in myself. For me that meant taking small pauses throughout the day to center myself and continue to move forward. The benefits of meditation even in small forms have been proven over and over. Through this practice, I learned to value the silence. Silence is powerful. Not filling the silence with words, even moreso.
This comfort with the silence began to appear in the exam room as well. The outcome of which I was unprepared for. Patients are used to hurried physicians who have limited time to spend addressing their problems. They are accustomed to the way government has interfered into healthcare and turned this into the norm. They are not at all alarmed at our pressured speech or our quick small talk while we are doing four other things simultaneously. What they are not prepared for is the silence. As I started to allow a few seconds of silence while the patient was telling their story rather than the typical “what I hear your saying is” or some sort of redirect to hurry things along a beautiful thing began to happen. Patients began to open up about things that truly were affecting their lives and subsequently their health. They felt heard, listened to, and valued. Comments such as “I have never had someone listen to me like this” began to be regularly mentioned to myself and my staff. I began to see the healing power of listening. Many of my patients had conditions that I could not improve. Conditions that would ultimately end up taking their lives. What I could do was to meet them on a human level, attempt to understand and respect the silence. That in and of itself has such healing power.
I am a private practitioner and feel daily the pressure to see more and more patients. What I realized, however, was that allowing a few seconds of silence in a conversation took no substantial time out of my day. It did not put me behind. It did not create anxiety, stress, or a hurried sensation. However, the effects on my patient interactions and therefore my patient’s perceptions of care were astounding. This translated into increasing my job satisfaction and allowed me to feel more involved in my patients lives. And it all began with a few seconds of uninterrupted silence.
I am an Interventional Pain Physician. I spend most of my days doing spine injections with a fair amount of kyphoplasties and spinal cord stimulators thrown in as well. It seems to me that these are minor procedures that shouldn’t evoke anxiety in patients…..but they do. Patients get nervous. They get anxious.
I am also a singer. I had the privilege of being classically trained through my college years. Like so many other passions, singing was put on the back burner in my pursuit of medicine. Music is a blessing that I hold dear to my heart, and it has pained me to not have an outlet for this gift.
When I got out of fellowship and started in private practice, I began to occasionally hum some tunes as I was doing injections. That hum naturally turned into singing. Over a short amount of time I found myself singing during each and every procedure all day long. I sing hymns usually with some Italian opera and show tunes thrown in. Most of my patients are over 65 and they seem to enjoy those genres. For my younger patients I add some Adelle and even some Disturbed as indicated.
Patients began to write me letters of appreciation. They began requesting songs and I, of course, obliged. I heard comments about how the songs took them away from the procedure to a happy place where they were relaxed and at ease. Patients started to decline sedation for procedures and simply request that I sing their favorite song. The more I sang, the more my patients began to request it. If I didn’t sing my patients noticed. I was asked to sing in churches, for grandaughter’s weddings, and for friends funerals. I began to connect with my patients in ways I hadn’t imagined—and in those connections I rediscovered my joy in music.
Music has long been known to have impressive impacts on the human brain. Music increases dopamine in the brain, a chemical that regulates the pleasure-reward system. It allows us to experience feelings of enjoyment, bliss, and even euphoria. Could this be what my patients are experiencing when they go to their “happy place”? Or perhaps it is the oxytocin that is released? Oxytocin is a hormone that promotes trust and connection.
As the months went by, I began to realize that singing to my patients was in turn having an effect on me. Having this intimate interaction with my patients strengthened the physician patient relationship. It provided a unique bond and trust that I hadn’t experienced prior to this. Singing and discussing music provides a unique glimpse into who patients are. At the end of the day amid the regulations and authorizations and insurance dictated care in my private practice, this interaction with my patients brings a smile to my face. In a world where physicians are increasingly burned out and frustrated it allows me a glimpse of why I entered this career field in the first place. To meet patients where they are in a time of need and leave a small mark on their lives.
Good pain physicians are dying. Just a few weeks ago Dr Todd Graham was shot dead in a parking lot over refusing to prescribe opioids to a man’s wife. Physicians who care deeply and try to do the right thing are being murdered for not prescribing opioids.
I prescribe very few opioids in my chronic pain practice. I do so in a judicious and safe manner for my patients. I have excellent training and I care deeply about the health and welfare of each and every one of my patients. Why is it that I as a double board certified pain physician have to consider whether or not I should have a firearm in my office to protect myself or my staff? Should I carry one at home in the event someone tries to find me or my children? It is easy to think “wow, this lady needs some Zoloft and a few counseling sessions.” I’m here to tell you that I do not know any pain physicians who have not been threatened in one way or another over the prescribing or not prescribing of opioid medications.
“Well, I will have to turn to heroin.”
“If you don’t fill my prescription I will find you…..” and even
Its unnerving to say the least. I had a mentor in fellowship who was truly stalked over opioids. The man followed her for six months. Sat outside her house. Followed her to work. Watched as she picked up her daughter from school. This is a real and serious concern for the practicing pain physicians in this country. Where is the happy medium here? Where is the patient responsibility? What is wrong with our society that this is becoming the norm?
I worry every day. I worry about the ramifications of not prescribing opioids. I look over my shoulder when I walk to my car. If I’m forced to terminate a patient for violations of their opioid contract I consider whether I should put a handgun in my purse for a few weeks. But it doesn’t end there. I worry about the ramifications of prescribing opioids. I worry about a 2am phone call from the authorities saying that my name is on the bottle. I worry about the DEA showing up in my office unannounced.
I would like to suggest that the root of this opioid epidemic lies far deeper than “physicians overprescribing”. The problem is that we are now a society of adults who have no coping skills. No ability to deal with the curves that life throws us. Everyone is looking for a quick fix. We have taught our children that they should never have to feel any sort of discomfort whether emotional or physical. When pain or suffering occurs, there is a quick fix for it and it is the responsibility of someone else to provide that fix. Opioids certainly treat physical pain, but they simultaneously provide a temporary solution for things like emotional pain, sadness, and anxiety. The reward system inherent in our neurological setup provides the anxious and depressed patient a temporary euphoria when taking the drug. I would argue that a large portion of what we are truly treating with chronic opioid therapy is psychological. Suffering is a part of life. Until we as a society learn how to be present with negative emotions and to effectively deal with and process the things life brings our way we cannot and will not solve this crisis. Sure, we may prescribe less opioids but people will turn to other substances, good physicians will continue to be murdered, and I and my colleagues will continue to look over our shoulders.