With so many transformations in health care, it sometimes seems that the world is spinning faster. To organize each hectic day, I think about it like it's a string.
My strategy for dividing the string into various fragments is important. You need string of a certain quality and length to do things that require deep thought, like writing a paper or making major strategic or personal decisions.
Other things, like signing routine documents or filing things, can be accomplished using the lower quality portion of the string (i.e., the fragmented string toward the end of a long day).
This idea of strings -- what one faculty colleague called my "string theory" -- triggered a memory of a patient who told me an inspiring story. Inspirations are a gift shared by so many patients and part of the huge privilege of being a physician.
Here is the story that I recalled: "Look at the Strings."
Mr. Z. was a liberal arts professor with widespread cancer, in the midst of chemotherapy. A subspecialist colleague called to ask if I'd see this patient who seemed to have a distinctly profound problem with fatigue.
As a compassionate physician and curious investigator, my colleague wondered if Mr. Z might have a circulating fatigue factor that we could identify to inform our approach to his care. It turned out that the fatigue factor was overwhelming bone pain from advanced cancer that the patient did not acknowledge or discuss with his family -- or his oncologist.
Mr. Z was a war veteran. He always equated complaining of pain as "whining," and he learned long ago in his life to ignore, deflect or transform pain. It's not that he refused to tell us about his bone pain, he simply did not experience it as pain.
The biology of the problem was no different than other patients, but his experience of it and his way of understanding and describing it was unique.
With narcotic medications, this fatigue problem resolved very rapidly. So rapidly, in fact, that this epiphany was both gratifying and frustrating to his family ("Why didn't he tell us he had pain!?")
Mr. Z ultimately benefited from further treatment and finished a major academic project that meant so very much to him toward the end of his life.
Back to the strings
It was Mr. Z's adult son who told me an amazing story of his own epiphany as a musician. We were sitting at the bedside of Mr. Z when we had this discussion, a few days before he died. He told me about his dad's life narrative and legacy. One of the many things we spoke about was his dad's love for music.
Mr. Z's son, a professional violinist, ultimately experienced a revelation from God that made him dramatically better as a violinist in one day. God told him to "look at the strings." Simple message.
The violin makes music, that's what counts. The violinist makes music by vibrating the strings -- nothing more. The violinist can get caught up in a lot of thought and worry about various technical aspects of things. But the strings -- the essence of the music comes from that process.
In palliative care, in oncology and in medical care in general, "the secret for caring for the patient is caring for the patient" (a borrowed quote from a famous physician named Francis Weld Peabody). That is how we "look at the strings."