thanks Denny

Everyone needs a Denny. Some character, perhaps a little rough around the edges that introduces you to the idea that, sometimes, Typhoid only disappears with the disappearance of the sewer. Some character that helps you see the reality of small towns laden with bureaucratic, red tape. Some character that tells the truth—raw and painful though it may be to hear that your new employer isn’t actually going to be able to teach you much from his deathbed. Some character that tells you how things are actually done in the real world.

Especially in medicine, everyone needs a Denny.

Sometimes that Denny role turns out to be played by a different actor than the one you thought you cast. You know—the mentor who seems polar opposite? It turns out that therein lies the balance for your stage play where other characters foil you and end up teaching you something, precisely, because they aren't like you at all.

Everyone needs a Citadel. A shelter or stronghold to which one goes during battle. A place from whence you retrieve your soul stored under a big rock.

Sometimes that Citadel is an old novel from the 1930’s, written about some green doc establishing a medical practice in a coal mining town across the sea. A far away tale of medicine travelling your own soul back to you. An old tale curiously parallel and strangely relevant to your own little world.

on writing as physician

Somehow, writing takes on an almost hazardous tone, in the role of physician. HIPAA protects patient confidentiality even down to the seemingly mundane details. Are you scheduled for Wednesday or Thursday? Protected. Are you my patient? Protected. What are you being treated for? Protected. Etc. Sure the goal is to minimize the information leakage. And in the day to day running of a medical practice, you might see Joe Blog’s name on the sign-in sheet above yours because you arrived 30 seconds after him. Some of these security breaches are unavoidable. The point of HIPAA is to minimize them to the extent reasonably possible.

Guarding the sacred space of doctor-patient relationship, HIPAA cozies up, seeking to embody trust. Of course, trust isn’t something easily embodied, especially when it comes to mental health. And of course, HIPAA regulates only one side of the relationship—the physician’s side. It is a somewhat one-sided venture, since as patient, you can share whatever the hell you want about your health with whomever you choose. It’s your business, after all. The spirit of the law is to essentially regulate trust. Of course, information has to be shared sometimes, for insurance purposes, or to foster high quality care, and in a general way it can be shared for educational purposes, as long as it is divorced from any identifiers, with relevant details changed.

But following the spirit of HIPAA is easier said than done. Sometimes it feels paralyzing from the Physician side of things. A significant part of one’s life, one’s being, the core and soul of what one does every day, always needs to be sifted through a HIPAA sieve of perpetual censorship.  In constant flux, one vacillates, share this, not that.

Complicated by people’s perceptions, falsehood or truth matters not. As patient, you know not that one in four people has a mental illness. You know not that depression is the “common cold” of mental illness. You know not how many people have suicidal thoughts or intense anxiety. You know not that everybody bleeds this way, just the same. To you, these are the intimate details of your story—not humanity’s. And this is how, even amidst mutant sifted details on a blog, you might see yourself in the story. In the composite, with the humanity peering out through the words. Hey that’s me you are talking about. And therein trust gets snuffed out. The sacred space darkens, as it warps and twists into something a bit different.

Even if HIPAA hasn’t been thwarted at all, the fact that you think it might have been, undermines one of the most critical elements of the doctor-patient relationship. Next time, you might struggle to tell what needs telling. Because of a perception—a false one at that. Something uttered might snake its way into the ether regions of your story. Your experience of life. The words said might be lifted from context, or might be misunderstood as some personal message. Across my desk, this thought is sometimes both frightening and inspiring.

I’d love to write more directly about my healed patients. How they don’t really recognize themselves anymore. How so much of the old has slid away. How we’ve avoided mood episodes of deep darkness. Or just how life feels so different gliding through it with a homeopathic Gortex suit. I’d love to emote for hours on just how beautiful a person can be when healing via Tuberculinum,

Stramonium 

Natrum Mur

Belladonna  

Sulphur  

Sepia    

Ignatia  

Carcinosinum  

Thuja 

Staphysagria 

and Nux Vomica.  These remedies and many others, foster an almost nostalgic feel in the prescribing physician. They are like old friends as Margaret Tyler used to refer to them. Even their names roll off the tongue and hang in the air, like the art that they make out of life. I suspect with my going on about remedies, I've waded away from the point. Which is simply that these miracles aren't exactly my stories to tell. Sure, I can tell unidentified snippets and fragments. Sure, I can tell pieces while ever conscious of my pet snake, HIPAA. And truth is, you probably won't believe me, anyhow, dear reader. For the stories almost sound made up. Hyperbolic. Ridiculously exaggerated. As Tim O'Brien once wrote, Fiction is often more honest than the truth, and the truth often rings false--something to that affect.  

In this case, the facts seem false. Such as the fact that somehow Patient C can’t remember the time when she didn’t have Problem X. All my life, she says in the intake. And there it is gone. Almost insulting. Can she really have had that symptom gone away in a few months with a few sugar pellets under tongue? I don’t think so. Can he really be feeling that much better? You must be exaggerating, Jenn.

Except that I try quite hard not to exaggerate. To be accurate. To understate. I lean so hard into that wind of transparency and attempted honesty that sometimes I think I might fall over. One of my mentors says I’m too honest.

And this puts things in a quandary when it comes to writing, in this role, as I see it. The intersection of HIPAA, transparency, and trust unfolds. I am left to struggle with the balance: how to reach toward the catharsis of writing. How to share the powerfully inspiring stories that remind me of the joys of being a physician, yet protect the sacred space of doctor patient relationship. Above all, I struggle in holding the sacred trust tightly enough so as to not drop it, yet loosely enough so that it doesn’t wrap around and strangle the very relationship it is supposed to protect. Easier said than done.

ode to ignatia

Ignatia amara is the name of a homeopathic remedy often given to those that grieve. I wrote this piece a while back as a student… My apologies to those that have read this before.

Oh healer of closet weeping,
bulging doors
holding at bay suppressed avalanches
issuing forth
at inopportune moments
burying recipients in old sorrows.

Shaking trees of endless anguish,
rooted deep in the dry, crystallized earth
shattering time forever.

Oh Sire of desired loneliness,
choking back pain
pretending ease of speech
while bearing apple-sized lumps in throat.

Cloaker of sadness heavy and long,
Oh that You should be needless
disappointment ailing none
death
mere figment in the minds of men.

miles

It was the middle name that he dutifully carried like a good son for 22 years. Not an easy task when the namesake you bear lived life as mythical character, as in Herculean sized standards. Named for Dad's mentor--a bald, little spitfire of a guy wielding Bible verses on street corners, holding a small college together by the seams, inspiring many even into his 80th year. The shoes were definitely big.

We needed for him to be epic. To back up the carrying on of the family name after a decidedly long line of X chromosomes. The even longer line of five older siblings claiming niches in life complicated matters for my brother. He needed to be epic and distinct. We needed a knight.

Did our needs and expectations somehow contribute to the creation of the epic adventures? To the creation of this Bipolar Disease as foe? No. But sometimes my mind wanders there. To the place where guilt and shame and blame throttle you and wrestle you to the ground.

In particular, I wonder sometimes at how mania made him larger than life. How the mania granted the opportunity to be epic. Grandiose. O Fortuna. It was the mania that birthed the Knight, or the Phantom of the Opera, or the Prophet, or Jason Bourne and his identity crisis. It was the mania that made him invisible as he danced around the block on the run from the government conspiracy.

The Knight.

I'm not sure he ever knew that the Latin word for Knight is Miles.

And he'll never know that my medical practice names him as it treats mental health patients.

Miles.

His namesake. Favored piece on the chess board, L mover, plunderer of Queens and Kings alike. Good at chess, because he knew how to use the knight to such advantage. And because he studied to the point of obsession.

Miles. Suggestive of a journey. Travels. Epic. Knight. Brother.

What's in a name?

A memory. History. The boy that never ages finally reaching knighthood.

how the story goes

I spend a lot of time hearing stories. Leaning back in my chair, I listen for clues of emotive content steeping beneath the surface--the song beneath the song. Waiting for the pieces that make sense of it all. The pieces that tie all the lines on the face together, wrinkling seamlessly into one another. The pieces that make my patient’s choice seem, the most logical thing of all to do. The point in the story, where I think I might have done the same thing, responded in some similar way, that place where I’m caught up in the moment of the story and thoughts of what-to-have-for-dinner, or if-I’ll-make-it-to-the-bank-before-closing, recede into the background. The place where I stop having to say, tell me more about that, because the story spills out like the yolk of an egg, my patient and I seemingly second string teammates on the sideline, watching the game. Almost as if the story breathing a life of its own, flows like current toward the falls.

This is the place, I intuitively struggle towards. The place where all the psychologists say good blending occurs and one manages to catch understanding. For me the moment is about finding the features that fit an appropriate homeopathic medicine.

But I’d be amiss to say that the moment is only about finding the most appropriate medicine. In many ways, the moment is part of the medicine.

Telling your story is powerful.

Most of my patients tell me so and mental health literature bears this idea out. Many of them tell me, I've never told anyone this... Much of the time, they feel better just telling the story out loud. If the story is particularly dark or messy, the telling of it seems to be even more valuable.

Indeed, telling your story is powerful.

A good friend of mine recently wrote on her blog about the act of writing, itself. Wondering aloud on the feed, she asked,  why do I  write, anyway? Not ready to quit her day job, and not really wanting to she blogs her own unique story. She doesn't think she's all that good at writing. Incidentally, she is--but that isn't why her story is so powerful. I think her story is powerful precisely because she writes to sort out the messiness of life on the page. To process honestly, sometimes painfully, the details of a struggling daughter or an elderly, Alzheimer toting adult with erased memories.    

James Pennebaker wrote a book entitled, Opening Up: the Healing Power of Confiding in Others. In it he discusses research demonstrating that talking about your problems—or not talking about them as the case may be—can have profound effects on your physical health. That’s right—physical health. According to Pennebaker, talking, even writing about our problems, our struggles, our traumas heals us.  And conversely, not talking about our junk harms—not merely psychologically—but physically. Of course, we know it's all connected, anyway. Chronic inhibition and suppression of our emotions and feelings, in particular anger, leads to increased risk of all sorts of physical diseases—heart attacks, hypertension, cardiovascular problems, asthma, diabetes, and cancer.  

For some of us, letting go and telling our story is more difficult. Parading our shadowy sides scares us. Climbing into the boat and letting the current take us places, makes us feel vulnerable. What if my friends think I’m complaining? What if I’m labeled “whiny?” What if they think I have a mental illness? What if my children don’t like who I really am?

And so we bind ourselves up. Thinking somehow, that we are protecting ourselves from the inevitable isolation of rejection. Telling ourselves that it’s the good, Christian thing to do. Telling ourselves we’re becoming better people by hiding our struggles, our griefs, the badness of our story wrought with flaws.

The truth is we do manage to protect ourselves. We do manage to cut ourselves off from venues of possible rejection. We do manage to protect ourselves from something that might get out of control--something that might take on a life of its own--sticky, messy, and difficult. In not sharing our story, we effectively cut ourselves off from the larger communal story, with its unique power to transform and shape our own story into something more. And that's how the story goes.

dear mental illness

I don’t need you

to help me be smart

or creative, thank you.

I don’t need you

ensuring that people

treat me

and my kind

any differently than they already do.

your stigma carries enough

shit

on its own, thank you.

I’ve had to battle

uphill for decades.

with families

abandoning

well enough on their own

without

your damn stigma

pushing further,

after learning

of habits

living under bridges and what not.

I don’t need you

guaranteeing

people assume violence,

or that I push a shopping cart, full of haphazard piles of random conspiracy laden stuff,

my M.O.

I don’t need you

telling your classmates

at community college

that

I’m not smart enough to finish anything.

assumptions happen anyhow

without your damn influence.

I struggle enough
trying to be normal without instructor's help,

or extra time

to make it through my 3 classes

on my own,

tutors smutors,

only make for more-what’s-up-with-him-attention?

that I don't need, ghostwriter.

I can do this.

without your damn stigma.

take your

false pity

elsewhere.

I may preach

on the street

of hell

fire

and brimstone

but

maybe I’m just trying to survive like anybody else.

they,

might expect me ready

to shoot up

youth in Norway or Tuscon.

maybe,

I’m dangerous

and

turning my apartment complex

into a luxury condos for high flalutin college students

with rich dads or moms

is obviously

a grand idea.

but
i must say,

its different when you’re the one left

moving  

to another part of town

for the umpteenth time.

because

you,

aren’t good enough

for borrowing

that cup of sugar for that gluten-free birthday cake.

on superheroes and villains

Sometimes I feel caught between two worlds. Stranger to both. I think I missed the memo from Madeline about how best to wrinkle between worlds. I suppose not being sucked into either vortex could be advantageous. Namely, the advantage of perspective on both.

To hear the naturopathic community and all its appendages, drugs are mostly evil. Look at how those Kryptonite laden Pharmaceutical companies are in bed with Lois Lane, MD! Existing to torment individuals on the planet, these toxic poisoning agents of some Lex Luther character in the sky, bring down the Clark Kents of this world, which conveniently happens to be an herb-toting, birkenstocked, crunchy doctor. Treat the cause, the root of the problem. We like roots and all in naturopathic medicine.

To hear the allopathic community and some of its quackwatch appendages, the naturopathic medicines I prescribe daily are either placebo or toxic agents bordering on the realm of negligence and my practice of medicine and admiration of the genius of Hahnemann harbors some similarity to following a cult leader. Hahnemann and his minions were some crusading characters insanely bent on--Like cures Like fighting the "dark aged" Regulars. 

And yet Naturopathic world misses the point. Fish the telephone pole out of your own eye. Isn't Clark Kent, ND in bed with Nutraceutical Company? How is that relevantly different from Lois and Pharma? Can't we admit that vaccines are rather naturopathic and save lives? Can't we acknowledge that Allopathic medicine does certain things like Emergency Medicine, amazingly well?

And yet Allopathic world also misses the point. Fish the telephone pole out of your own eye. Can't you see how the history of human kind is all about the history of human mistakes and the process of detecting and overcoming those errors in thinking? Isn't it possible that in waging this war against those that think differently from you, you've missed the point? If you aim to squelch the position that balances out your own, you burn the bridge to future growth and banish yourself to an island of your own idiosyncratic thinking?

Can't both worlds ingest a dose of humility? And, no I don't mean a homeopathic dose. Can't both acknowlege that extremism and polarization help no-one?

Unfortunately, all of medicine merely seems to mimic the culture at large. We live in culture of extremist sound bites. A culture that needs the boxing ring to keep the viewers interested. How will we ever get our message into the limelight without an evil villain character? Who is the foil? And so we polarize. We spin. We push the gap between two ideals wider and wider. In the name of spin or viewers or "ideals" we feature our opponent's ideal in a crossbow on a website or pronounce a democracy focused camp, a "Hitler Youth Camp." Really? Accuracy doesn't seem to matter so much as capturing that emotionally reactive content, placing our message center stage at Carnegie Hall.

In the meantime, outside polarized TV world, boys sucked into the story, show up with guns at grocery stores in Tuscon or youth camps in Norway, and blow up evil villain characters for ideals.

Taking our lessons from culture at large, maybe its time for medicine to back away from extremist-superhero-naturo-or-allo positions, acknowledging that at least some portion might be spin designed to harness emotionally reactive content. Our voice as medical moderates might not be as glamorous, might not take sweeps week, or win us roles on Jerry Springer Live, but it will be heroic nonetheless. For it will be our voice acknowledging that many of our fiercest idealistic battles are not waged in order to contend with some evil villain force outside ourselves. Rather, those battles are often waged when we can't aknowledge  the villain within who gathers strength precisely as we feed our superhero counterpart.

dallas divide

NAMI

I attended my first NAMI meeting tonight. I have no idea why I haven't been to a meeting until now. Per the confidentiality agreement I’m not allowed to talk about stated meeting. But I suppose I can talk about NAMI in general and my own personal response.

NAMI is a beautiful organization. The acronym stands for National Alliance on Mental Illness. They support people and families with mental illness. Aiming to reduce the stigma of mental illness, they structure support in a gazillion different ways, perhaps too many to count. Support groups, educational classes for families, community wide fund raisers to increase awareness, and more are all part of the NAMI package.

Of course, in going to such a meeting I couldn’t help but ruminate on my brother. I couldn’t help but dwell on the fact that I found a beautiful organization, six years too late. I couldn’t help but feel guilty for not finding these people--committed to plugging some of the holes in the treatment and service to the mentally ill after his death.

But that is not the point of NAMI. NAMI is not so much about wallowing in your guilt over what you should have done, or would have done, or maybe could have done to help someone. NAMI is about holding all of these should of, would of, and could ofs and deciding to walk forward anyways. Its about recognizing your own limitations, your own humanity, your own shortcomings, and still getting up in the morning to put your shoes on. And so I shall.


In case you are interested in checking NAMI out, here's the national website.

http://nami.org/

camp soul

Mt Sneffles peaks from behind the swaying evergreens. Tall and majestic, the contrast between Sneffles and our “lowly” valley camp spot on the edge of the meadow gives you the sense of a lower elevation than the known 9000 feet of the Dallas Divide. But, don’t let the weakened contrast and Sneffles less-than-impressive name fool you. Sneffles still boasts 14,000 feet and patches of snow in July.

Somehow, the aging Boss Hog (aka our embarrassingly-loud-beeper-in-reverse-circa-1993 conversion van) made it all the way up the lonely, dirt road to our ideal camp spot. We ventured all this way to strip away some of the clutter from our lives, making more space for the soul. Envisioning more soul in the everyday experience. Playing trolls on a little two logged bridge. Claiming portions of creek as six or eight or ten-year old real estate play properties. This is my house from this tree to that rock. Wading bare footed in barely melted mountain water til tiny fish startle you into racing your crocs for fun. Puffing dandelion seeds into the breezy light air. Finally getting a fire going after a long rain with wet, still-green wood. Hiking trails through a Yarnell sized botanical playground. Leading pet Llamas around Teepees and meadows yellow.

When it comes down to it, the clutter strips more readily and more drastically if you’re a kid. Fully engaging the rocks and caterpillars and matted, dreadlocked Llamas seems to become more difficult as we age.

Even so, up here among the clouds and flowers there is time to think. Time to ponder. Time to reconnect with all things natural, which few of us do enough. The machinery of life and concrete jungles begin to slip away. Stephen Harrod Buhner describes our disconnect from nature as western post-enlightenment thinkers in his book, The Lost Language of Plants:

Once the Universe becomes a machine, no longer alive, once human beings are defined as the only intelligent life-form, a unique kind of isolation enters human lives, a kind of loneliness that is unprecedented in the history of human habitation on earth. It is a source of many of the emotional pathologies people struggle with. In addition, people begin to judge themselves internally, to identify their level of value according to how much or how well they think. Any internal expressions, perceptions, or thoughts that come from older epistemologies—that are based primarily on feeling or intuition or aliveness in the Universe—they label as unscientific, irrational, unreasoning, or illogical. Such thoughts and perceptions, it is assumed, have less value, are based on improper assumptions about the nature of reality, and are therefore something to be discounted, dismissed, degraded. This dynamic has become so ingrained that people routinely monitor and censor perceptions that are contrary to universe-as-machine. And so people cut themselves off from the Universe in which they live; they become passengers on a ball of semimolten rock hurtling through the Universe. They internally denigrate and deny their most basic experiences of the livingness of the world in which they live, their connection to it, and the importance of that connection. The interior wound…

And so I sit watching, pondering and healing for a time. Struggling to reconnect as I disconnect from from the hamster wheel. Meditating on the biophilia infused words of Buhner and learning large from three small teachers that have no idea what soul is, yet live with soul so much of the time.

little renaissance

I have my eyes on a particular piece of art for my waiting room. Local Arizona artist, all the right colors oozing into one another, layers of mindful matter depicted on canvas. The piece moves me like art is supposed to. Unfortunately, financial responsibilities compel me to wait for more stable times. Massive piece, really. Able to loom large over my little white bookshelf, both in size and creative depth. Somehow, the artist managed to nestle the calm look in a beautiful face while a storm of thoughts swirl around.  

The piece has spawned my own creativity in thinking of ways to acquire it.

No, I haven’t thought of robbing a bank or anything remotely like that. Rather, I’ve imagined calling up the artist and offering a trade.  Hmmm. Homeopathic Mental health services for a piece of creative genius art. Hmmm. Perhaps, a little problematic. Might be insulting to suggest a trade given the services I provide. Sticky. Essentially, I’d be suggesting some sort of mental health diagnosis to someone I’ve never even met. Not necessarily the way to win friends and influence people, as far as I can tell.

But, statistically, chancing such an offer—the odds wouldn’t be all that bad. Artist. Creative type. Clearly and most extraordinarily gifted. Kay Redfield J has published volumes of research demonstrating the more frequent occurrence of mood disorders in the creative population. I could play the odds.  

And I can attest to the connection, anecdotally, with my brother.

Art moved and breathed in him. Spilled out on the page in plays on words, or high, emotive notes on the trumpet, or sexy chess moves spun like silk from turning over Bobby Fischer’s classic moves in a book.  Creativity often turns out to be part of the Bipolar package. At times, I’ve even wondered if my brother’s Bipolar Disorder was the very thing that made him so extraordinarily creative. It was as if the gifts were on Speed. Mr. Renaissance Man. He wasn’t merely a trumpet player. He had to be the high school trumpet player invited to make a guest appearance with the Navy Band. He wasn’t merely an artist, he had to be one to capture that look in the eyes that narrows the gap between art and real world emotions on paper.

All things artistic stung for a while after his death. For a time, it seemed as if the grave froze up his artistic gifts alongside his body. My own creativity somehow wound up buried in the adjacent plot. Too painful to dig up out of the earth.

Recently, as the salve of time soothes my soul, I’m moving back toward all things artistic. My own little Renaissance. I’m angling toward the creative arts in whatever ways I feel like: music, writing, dance, painting furniture, or hanging wall art in a medical office. Sometimes even the practice of medicine itself demands a little creativity when interviewing a patient struggling to open up. In some small way, the world feels righted in these small expressions of who I am as creative being. I guess I shouldn’t register surprise at the healing found in precisely the same spot as much of the pain and the grief. It is rather homeopathic, wouldn’t you say?   

P.S. Check out this local Arizona resource that utilizes artistic expression therapeutically for mental illness:

http://www.artawakenings.org/

tilting at giants

A knight stands atop my desk, reminding of days long passed. Rescued from the corner shelf of a thrift store, hidden behind an old tire, missing shield and sword, he gazes through visor slits toward my maroon leather chairs, meant for keeping patients comfortable during long homeopathic intakes. But the knight’s purpose has little to do with entertaining my patients during long intakes.

The knight is there for me. The doctor. The naturopathic physician that would rush headstrong, into charging at windmills or oppressors of my cause, my all-important ever-so-bombastic quest.

Honor, duty, and the dangers of romantic idealism sometimes swirl around on this medical path. Tempted at every turn to fix your own insecurities by embellishing that savior complex, you have to fight not to spin the yarn that all the world needs is for you to show up in your suit of armor, sword in tow and knock that evil disease off its horse. (brilliant, shining knight that you obviously are.)  

Yes, you can heal people.

And yet, not everyone.

Yes, you might even cure some.

And yet, not all. Fighting for your cause, you must remember that those visor slits create blind spots. That visor might be nothing but blind spots. Therefore, occasionally, it might be a good idea to get off your high horse, remove the cardboard head gear and look around. You just might discover, like Quijote, a few of those giants conjured themselves out of the reflection bouncing off your own romantic delusion of yourself.

authenticity

I grew up in a little, plastic bubble of a culture. A place where judgments sometimes fell from the sky, pounding imperfections and flaws and even illnesses into the dry earth. Life in this bubble was often based upon how things appeared to be and not necessarily how they actually were. People spent a great deal of time hiding behind plastic smiles and falsities, and words were spread around like jam on bread in order to cloak the taste of mold or hint of staleness.

I've interacted with plasticity for a long time.

Sometime in the past few years, perhaps in med school, perhaps influenced by a mentor bent upon transparency in medicine, I began shifting away from plastic-bubble world. Sure, my soul screamed out at the fakeness long before the authenticity lessons—the unnaturalness of the lipstick smiles, even as the eyes seemed to say something else, the pretensions of perfection, the pressure to not talk about flaws or mental illnesses but rather to package it all up in hair-sprayed, feathered wings and blue, eye-shadowed personas.

Bubble world didn’t have all that much space for authenticity; there was barely enough space for breathing oxygen. Rather than speaking honestly, much time was devoted to guessing at the meaning hidden behind words behind mouths lip synching things. No one really said what was actually meant. Generally, real meaning was buried somewhere underneath layers of niceties and hidden agendas. You had to read between the lines. You learned the art of suppression. How to do mental gymnastics in order to hint at what you meant, so that someone might get what you said, so that you could possibly get angry, in an-ever-so-loving sort of way, at their insensitivity. How dare they be so rude?

Perhaps, I shouldn’t be surprised that it was psychosis that squeezed my own brother’s authenticity to the surface in bubble world. Floridly out of his mind, he could freely pick the neurotic neighbor’s flowers or just park on the road in front of neurotic neighbor's house. He could say anything, be anyone, do anything for a time in a culture designed to squelch thinking outside the bubble. Seen from a certain perspective, his psychosis temporarily solved a few problems. Of course it also created a few problems of its own, too.

I think of my brother now as I step more fully into the role of doctor and while attempting once again to sort out authenticity.  I’m not sure how to be real as a doctor. I’m still figuring out the details of being a physician in the first place. I don’t know how to communicate competence and the fact that I’m still learning at the same time. I don’t feel especially doctoral. I feel uncomfortable not knowing exactly where the balance point lies between being present and yet professional. And my feeble attempts to balance atop this surfboard make me feel as if I’m pretending; playing some character in a TV drama, waiting for the moment when Meredith, the narrator’s voice over from the beginning, suddenly cues  back in and the plot ties itself neatly together, while the emotive music carries us through the teary-eyed part to the credits.

People want to feel confident that doctors have answers.

Somehow it cuts into our collective need to feel safe, to feel taken care of, to feel like all is well in the ocean of our lives. As if somehow all our sharking worries can dry up because somebody knows what to do about our cancer or our bipolar disorder or our Lou Gehrig’s.  The universe has been preserved. The beach is safe. The bubble has not popped.

But, if I’m authentic, I might have to say that I don’t have all the answers. Sometimes, I might even have to admit that I don’t have any answers. That the Tsunami might still crash on your shoreline carrying you out to sea and I cannot prevent it.

And you, holding your schizoaffective son in your arms, might crumple into a heap in the corner of my office.

All of these things make it difficult to be authentic, to surf the waves of both compassionate ache for your struggles in tension with one's human capacity for emotions, or irritability when appointments cancel themselves at the last minute. Or when compelled to be both real and honest about your prognosis and yet gentle and caring and humane at the same time. And so sometimes we wind up in a doctor bubble world of our own, struggling to find our way out, to connect with you, our patient, in a real human way. We might seem cold, or aloof, or distant, as if we have some sort of superiority god-complex; but in reality, we're often merely struggling epically to hold the complexity of our own humanity in such a way that won’t frighten you that we aren’t, in fact, god-like.