Self-administered narrative medicine produces a valuable currency of peace and clarity. Listen to Andre Lijoi, MD, read "For One Who Is Exhausted, a Blessing" by John O’Donohue, and read his essay.
The Poet’s Voice Got It Right
by Andre F. Lijoi, MD
The poet’s voice got it right, “The rhythm of [my] heart had become hectic.” As I entered John O’ Donohue’s poem I realized that when I turned on the computer I was transported to an industrial wasteland: I envisioned a gray, dilapidated forest of concrete and steel. It was depressing to turn it on. I attributed the feelings in my chest to the cardiac equivalent of butterflies or possibly the ventricular excitability that has bothered me for years. Regardless, the symptom now required heart poison to settle it.
The voice prompted me to consider my own exhaustion and the issue of burnout.
“The tide you [I] never valued has gone out,”…And I found myself “marooned on unsure ground.”
I wondered often, “am I burned out?” Exhaustion was a familiar visitor, but I never stopped loving caring for patients, teaching my residents and students, pursuing clinical conundrums with colleagues, caring for my patients and learners with compassion.
The Poet’s speaker describes depression, darkened thinking, the flow of tears, sadness, weariness invading the spirit. But I did not feel depressed, nor did I sense within me the “weariness of spirit.” I never seemed to lose that spirit, but I found the moment of turning on the computer depressing, and I resented it, and I was fed up with it. I believe there is a difference between burnout and being fed up with an ever-growing list of unreasonable expectations – “laborsome events of the will”.
The exhaustion was quite real. As some weeks ended, I found it nearly impossible to wend my way up the two flights of stairs to our flat, my thighs burning merely from the pathology of exhaustion. I could feel “Gravity…dragging down every bone”. I experienced a dimming of light, but fortunately, never darkness.
What was exhausting, I discovered, were the tasks required of the current state of patient care, none of which I found necessary to conduct my craft of good clinical medicine connected to the common humanity before me, a suffering humanity which I had sworn an oath to help. My work was conventional, not contractual, and was predicated on relationships, and listening, and watching carefully.
My faculties were not failing me. I am an expert of Family Medicine, yet my work and craft were fettered by the chains of digitizing patients (something that I had not trained for, nor imagined) in the interest of revenue flow. I had learned from mentors that our ethic was steeped in desiring what was best for our patients, an indelible focus ever present on our radar. The same held true for our learners. Our dedication to their education and to those who taught us were sealed with the same Oath.
My embrace of my Catholic faith informed me that when the Christian concept of person belies the physician-patient relationship, that relationship becomes one of caritas. It led me to conclude that I could be a vehicle for God’s compassion, that I was positioned to bring the face of a merciful Christ to the face of a suffering Christ. Corporatization of medicine was interfering with work that I viewed as vocational, a call to use one’s talents to the utmost to serve and better others and give glory to God.
The idea of empty time presented itself daily in the seemingly meaningless hours of tasks required to complete the job. Signing off on the so called “In Basket” was an added, unaccounted part of the day.
The Ethnographer, Edgar Rivera Colon, described what was occurring in corporate medicine as “imposed mania”. Everyone knows that mania is an unhealthy condition, and Rivera goes on to state that the sure way to die is to go along with it.
With a beautiful turn of the pen the poet turns the poem toward a litany of hope beginning with the idea that “You have been forced to enter empty time.” The voice reassured me that I had choices. I could…
“Receive myself back, allow the soul to take me back…”
“Be inclined to follow the way of rain that falls slow and free…”
…and not only enter slow time but embrace its healing remedy.
The voice continued to encourage, “pay attention to all that each of the senses are telling [me], to all the small miracles rushed through.” I must say I was blessed not to rush through or rush by the small miracles. My experience has taught me to notice them. It was instinctual. I would stop and receive them. I call them the miracles of everyday life. If not miracles, then, I would accept them as Holy Spirit moments, consolations, providence.
Ironically, it occurred to me that there was a blessing in being forced into empty time as there was nothing left to do…but “rest and patiently learn to receive oneself back”, my soul had come to take me back.
But the poet does not leave this reader hopeless, nor does he promote passivity. The litany of hope demanded action. The urging to, “Be inclined to follow the way of rain that falls slow and free,” became a mantra that prompted the embrace of slow time. Looking into a gray sky and permitting a gentle rain to caress my face opened the well of color of the coming twilight, sunset or sunrise, and I found myself no longer marooned.
I believe one of my adaptations has been what some have called, “Andre time”, the ability to recognize the time to stop, to listen carefully and extend conversations. The sense that "I have time" may have been an unwitting function to the bruises of the imposed mania of our corporate medical establishment.
The voice continued, “Learn to linger around someone of ease, who feels they have all the time in the world.” Reflecting on this line inspired me to be that one of ease for my colleagues and learners, and yet I am disappointed by the times I failed to be that person of ease.
The wise admonition to "stay clear of those vexed in spirit," prompted me to be very mindful when I found myself in proximity of the vexed and not react but attend to what my senses were telling. Disturbing, however, was my wondering, “how often the vexations of my exhaustion vexed others?”
The antidote to the mania of corporate medicine is slow time, slowing down, where I have found respect for my heart and great joy dwelling within, and the conviction that I know what I am doing and I remain focused on what I came here to do, what I am called to do. When vexed by a situation or another person, I would go find a patient or a resident and shift into the slow time of listening to them, watching them, and offering my care and tutelage. Within seconds I would find myself calm.
Morning prayer walks, starting daily in slow time, let me experience the beautiful celestial evolutions as each season arrived and the walks transitioned from darkness to the subtle hues of morning twilight. Standing alongside a stone being washed by the flowing water of the quiet brook and allowing its “calmness to claim me” would restore the depth of my breath and I learned to embrace those breaths and let them escape very slowly.
As the poem closes, the poet’s blessing was fully realized: my heart had come to take me back and settle my hectic heart, and I realized that the solution resided within. It required slowing down, slow time, close reading of the self and allowing that self to re-emerge. I found within me that growing respect for my own heart and the joy of dwelling within slow time.
Andre F. Lijoi, MD
