When we talk about making a difference in my line of work, I think what I should say is investing in a difference. Most of the time, I have no idea what the repercussions are of the choices I make. To come in to work on a day off, to council a patient, to comfort a family member. I look across my career and to my peers and I believe we are in the business of making a difference. The greatest frustration is not knowing the extent of our impact, if we able to make a meaningful difference. What is different? And does it last?
One night I was asked to assist in transporting a patient to children’s hospital. I had finished working a 5 days stretch and had just arrived to have dinner with my wife and friends. I haven't eaten with my wife in over a week and tonight was going to be a special time of fellowship. The call came just before dinner, and after we left the hospital it would be at least 6 hours before I would return. Chronic diseases like cancer are often a lot of bad days interrupted by a couple good and a couple really bad days. My patient was having a really bad day. The family was kind and supportive, often a sign of just how long their journey has been with the disease. Thankfully the transport went very well and the patient was smoothly transitioned into higher level specialty care. I got home a few hours before my wife woke up for work, and slept all I could before going back in to work for my scheduled shift that afternoon.
What difference did I make? 99% of the time, I’ll never know. The question that has bugged me after 6 years of always saying yes to coming in is, “What sacrifice is worth that difference?” How many missed dinners does it take before pride and encouragement turn to scorn and being accused of loosing balance? When people all look back and judge if a person “worked too hard” or “lost themselves in their job”, even I have been judged with a conviction so damning it's as if the opportunity cost was motivation for the decision to go make a difference. We drill our children to be change-makers, we admire and respect people who have made a difference. We are a culture who revers those who make a difference. In my work, making a differences happens as often as a barista makes coffee or a teenaged girl checks her phone. Making a difference is a given in my work, all I have to do is show up and help people not die. Making a difference isn't the hard part, its being the difference.
I make a difference by helping a scared father understand the plan of care. I am the difference between a 20 min wait and an hour wait in the ER due to staffing issues. I am the difference when I tell a great joke that helps the staff feel bonded and united in a busy night. I am the difference between early goal directed therapy and poor patient outcomes when I study hard on my off days and stand up for my patient. To make a difference, all you have to do is Be kind, Be honest, and Be what’s needed. To be the difference, you have to sacrifice. True now as it was thousands of years ago, if you want good things to happen, your sacrifice has to be meaningful; which is why we see marriages, family’s, birthdays, holidays, dinner dates, first steps and goodnight kisses sacrificed on the "Be The Difference Alter". We in medicine are more likely to loose our personal life the bigger the difference we become. When you are what’s needed, how will you choose what to sacrifice?
When I got this call that my help was needed, I didn't even hesitate.
I don't know if you have this same feeling, but my decision making often feels out of my control. When I am asked to come in extra to help, I will often say yes out of habit. Teamwork, dedication, feeling important and needed, it all gets balled up into a responsibility to my co-workers and the patient to be the difference. More recently I have tried saying no once in a while to allow my family, marriage and friends to also know what it feels like to be dedicated to, and to feel important. Yet when I got this call to transport a patient out of town for needed specialty medicine, there was no question in my mind if I would do it.
When I ask my wife, friends and family to climb up on the Be The Difference alter again and again, I take a loan out on our time together. I ask them to give me credit, since I’m spending this time doing meaningful work. However, because they are the opportunity cost, by definition their time is not as meaningful as being someone else difference; a difference I often never really know is meaningful or not. By grace and love my family has extend me credit on our relationship so that I can turn my back on them and still be loved by them. Everyone of us in medicine know that feeling in your stomach when you have to call and cancel a plan, or the pain in your heart when your children or spouse look at you with indifference as they start to shield their disappointment with robot-like approval and the routine of changing plans kicks in while you turn your back to save someone else. That moment, when we value strangers survival over family happiness, is the scariest and most difficult part of this industry. Every family handles it differently, and each will have swings of how well or difficult they handle it. We should never be caught off guard, pretending like our sacrifice will come for free.
Today almost 10 months later, I met that little girl. Her hair had grown back, she was finished with therapy, and starting to get her life back. Her father and mother remembered me, and I was given the greatest gift this industry, perhaps even this life will ever give: That I did make a meaningful difference when I chose to be the difference. That sacrifice was worth it, and I am so thankful to my wife, friends and family who are still willing to climb on that Alter. Now I’m learning to not ask them to do it too much, striking that balance, searching for the Nirvana known as, “Sustainable. Meaningful. Difference”
An amazing family who blessed me with the gift of meaning. click the picture to learn more about their story
Update Fall 2017
This beautiful young lady lost her fight to cancer. Having lost my own mother to cancer, I resonate with the earth shattering experience it is. It is said that loosing a child is the worst experience imaginable. I do not know your pain, but I know pain. And I stand with you as much as I can. I acknolwge this is horrific, and pray that someway it will get better.