OR Tears →

Pamela Wible Tears

Tears in the operating room are different from tears cried by civilians, by veals. There are rules.

A single tear from one eye is unobjectionable. Two tears, either one from each eye or two from one eye are permitted if they are unaccompanied by sniffles. Three tears risks discovery and humiliation. There are rules. 

The mechanics of crying in the OR are difficult. You may not brush a tear away. Sterile and dirty may not touch. Gloved sterile hands may not swipe unsterile eyes. Best to let your tear take a quick dive into your blue pleated mask which will blot it up before it can drop into the sleeping patient’s incision. There are rules.

You can sneak peanut M&Ms one by one at decent intervals under your mask, but you cannot touch your face just a little higher up to flick away a tear when a child’s severed leg thunks into the stainless steel basin. There are rules.

Eyes can be red but not too red, wet but not too wet. Many in the OR are sleep-deprived, and a few are hung over, so you will blend in. Some eyes blink rapidly, chasing an errant eyelash or contact lens, tearing up and reddening. You could be one of those. It is not permitted to rub dirty eyes with sterile hands to prevent a snail trail of tears sneaking down cheek and over mask. There are rules.

OR tears are different from veal tears, civilian tears. They burn. They track fire down unprotected cheeks, leaving a faint trace of light umber against the sky blue mask, disturbing the pressed-down fibers and making fuzz as they go. The color is from the anesthesia in the air, seeping out from around the mask and the tube. It does burn, and there are rules.

Although others can tell you’ve been shedding tears, if you follow the rules they will not mention your shame. If you break the rules, others can be mean. You may acquire a nickname.

Poem (sans original formatting) by Anne Vinsel who works at a large academic medical center. Previously published in Pulse.

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How to do a no-hands-on physical in 3 minutes (or less) →

Pamela Wible Big Box Clinic

Step 1) Greet patient.

Step 2) While chatting, check all boxes in electronic medical record for a complete review of systems and physical exam. Copy and paste parts of previous chart note while looking at patient every once in a while. Smile if possible.

Step 3) Tell patient to do yoga.

Step 4) Bill insurance company for complete physical exam.

Welcome to big-box assembly-line medicine.

Ever wonder what happens when a doctor goes to the doctor? Same shit.

A physician friend recently told me: “My last trip to my PCP was shorter than the time it takes to brush my teeth! If I hear one more suggestion to drink chamomile tea and do yoga . . . I just don’t need the 3-minute bullshit session.”

The truth is health care can’t happen in 3-minute increments. Assembly-line medicine doesn’t work for patients or doctors. Here’s why: doctors aren’t factory workers and patients aren’t widgets.

I shared my physician friend’s experience on Facebook and turns out it’s the norm for many Americans.

EB Sheffield writes, “Lol…this made me laugh…the last time I went to see a doctor for a yearly lab and all check…he didn’t touch me….the stethoscope never left his neck and he kept talking about Suzanne Somers??..but he is board certified ..sigh”

“I’ve had the ‘no-hands’ PE [physical exam] before, which is always really, really, weird to me. I’m a veterinarian and our PEs [exams] are totally hands-on, all over and everywhere…” claims Margaret Brosnahan.  

Dr. William Halstead shares, “I thought this only happened to me. Haven’t had a complete physical exam since I finished residency.”

Amina Moghul reports, “Yup, recently developed a tremor, went to a neurologist who didn’t even examine me and shooed me out the door telling me to do yoga because I must be stressed out.”

“My internal med doc spends about 5-7 minutes with me,” claims Theresa Stier Brown, “He never listens to my heart/lungs or lays a hand on me. He only asks about my diabetes meds even though I take meds for 7 other health problems—so no medication review.”

I’ve had fraudulent physical exams where no hands on, no listening to heart or lungs but he dictated lungs clear to auscultation and heart rate regular, etc etc. such B. S.” confirms Louann Harrack, “That’s why my primary care is a nurse practitioner. (No offense to the good doctors out there).”

So what’s a patient to do?

  1. Boycott big-box assembly-line medicine.
  2. Find a good doctor or nurse practitioner.
  3. Can’t find one? Go see a veterinarian.

Pamela Wible, M.D., is a family physician and founder of the Ideal Medical Care Movement. She loves helping docs, PAs, and NPs get back to being healers, not factory workers. If you need help, contact me or come to our retreat. 

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The history of American medicine in 2 minutes. What happens at 1:31 will make you sick. →

Once upon a time you could see your trusted family doc right in the neighborhood with house calls and all the attention you needed. Then big-box clinics bought up all these cute clinics and moved these sweet doctors to assembly-line clinics. Now doctors are like factory workers and patients are just widgets.

Great news! Solo docs are coming back to a neighborhood near you. . .

If you’re a doctor who wants to leave assembly-line medicine and bring ideal care to your neighborhood, here’s a free guide to launching your dream-come-true clinic. Questions? Please contact me. I promise I’ll call you back. I’m so excited to see all these cute clinics again! 🙂 Yay for all of us.

Pamela Wible

Pamela Wible, M.D., is a family physician and founder of the Ideal Medical Care Movement. She loves helping docs get back to being healers, not factory workers. If you need more help, come to our physician retreat.


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Medical school has killed my soul. What can I do? →

DearPamela

Hi Pamela,

I’m a medical student in the UK. Though I’ve only been in med school since September, it has already taken its toll on me. Before I started I was so in touch with my emotions, spirituality, and nature. Now I feel so empty and desensitized. I hate that when faced with the horrible circumstances of another person, I just don’t feel anything anymore. How can I overcome this? I so badly want to tap into the vibrant me from 6 months ago!

Before starting medical school, I was a curious and loving young man. My life hadn’t been plain-sailing: I had been through my parents’ divorce as a young teenager; I had suffered bullying in a hostile school environment, and I had come out of the closet as gay. All of these things sound quite monumental for a young person to go through, but nothing prepared me for the agony of medical school. You see, when my parents divorced, I was sad, I cried, I grieved for the family life I would no longer have, and I recovered. When I was bullied at school, I was hurt and upset, but knew they were wrong which gave me strength. And when I came out of the closet, I was bursting with emotion: of anticipation, excitement, terror. All of these experiences were by no means pleasurable, but I FELT them, and that’s what made me feel alive. They were painful, but they illuminated the happy times in my life and made me a stronger and more empathetic person as a result. I looked into people’s eyes and could sense their pain a little more because of my own personal experiences, and enjoyed feeling connected to their lives. I was spiritual. I would pray and meditate and marvel at the beauty of nature and humanity around me. I was genuinely excited for my life, the people I might help. I wanted to be intimate with people, rejoice in their success, and feel the pain of their sorrow.

Then I entered medicine.

From the first few days, I could tell something wasn’t right. I entered this profession with the intention of becoming a healer, yet, when I looked at my lecturers, I mainly saw didactic scientists, not healers. I looked around me and saw egotistical, power-hungry students. Many were concerned with status, competitive to the extent that they all wanted to outdrink each other on boozy nights out and have the most sex out of our whole group. They wanted to be the best at everything: in their exams, and in their personal lives. Yet no student has ever spoken with genuine concern and feeling for patients. When I organized a talk by two individuals suffering from HIV, hardly any of our class turned up—I’m talking about 2-3% of the students. When I asked some why they did not attend, many just didn’t care. “We don’t need to know it for our exams,” one said. “I don’t think I’d get anything from it,” smirked another. I was aghast by how little they cared. 

At this point, I really questioned the establishment of which I was becoming part. Even with the brightest soul and the best will in the world, it is hard to survive in an environment at complete odds with our own intentions. This soon took its toll on me. I felt like I was in a constant battle to retain my care, my love, my empathy. But I feel like I am losing. 

While the challenges in my life were at times very painful, medicine has caused me to feel something I never imagined could be so bleak—nothingness. It is quite astounding actually how little I feel nowadays. I have lost my libido (In fact, I have been convinced I was asexual for a time), and I feel numb on a daily basis, like a nurse has injected some local anesthetic into my heart which hasn’t worn off. Nothing seems to bother me anymore. After cadaveric dissection, nothing is gruesome, the boundaries by which I could operate on someone without feeling any hesitation are endless. There’s something about hammering a ribcage open with a chisel on a deceased old lady that breaks down those barriers for you, and they can never be built back up. In addition, disease and death are talked and laughed about in such matter-of-fact ways that they’ve become boringly dull to me. No longer am I heartbroken for the cancer patient, or devastated for the young mother who died in a car accident, because I feel nothingness. We are only ever taught about the scientific basis of afflictions, never the emotional or spiritual impact on both the patient—and ourselves.

My spiritual life has suffered too. No longer do I appreciate the world around me with the overflowing gratitude I used to hold. Instead, I just wallow. I am strongly considering dropping out of medical school to pursue another path, not because I detest the vocation, but because I am scared I am losing pieces of me that I will never get back. I am scared that after only 6 months, I am just a vessel with no life and that I will never feel what it feels like to feel ever again. I am scared I will never have another tear fall from my eye. Is really worth sacrificing my soul to this profession? I feel ripped apart.

Please let me know if there are any ways to cope with this torturous predicament.

With much love, even though it is so hard to gather from a numbed heart,

Luke

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Luke,

Join our teleseminar this Sunday (scholarships available for med students)

You are not alone. Med students all across the world experience the dehumanizing effects of medical training. The basis of our education is a flawed reductionist medical model that views the human body as a machine—a bag of parts to be conquered. Reductionism (the opposite of holistic medicine) leads to mind-body-spirit disintegration. Consequently, you are losing connection with your heart and soul—the reason you went into medicine—the purpose of your very life. 

Loss of meaning, loss of self, leads to pain. Pain leads to self-medication with alcohol, drugs, sex—anything to numb oneself and distract from the loss of soul. Sustained numbing leads to permanent numbing and an inability to connect with oneself or others.

What can you do to overcome your loss of self? My best advice:

1) Keep a clear and unwavering focus on your dream—the original vision that led you to medicine. Read your personal statement daily. Hang it all around your house. Never allow anyone to steal your dream.

2) Surround yourself with inspiring mentors—other physicians who are living their dreams in medicine. They will guide you in the right direction. Avoid advice from cynics and naysayers for they are wounded too. I will totally get you into our mentorship group. Contact me here.

3) Maintain your physical health. Exercise, eat well, sleep. Balance your intellectual pursuits with time to relax and be INSIDE your body. I highly recommend weekly massage to help you remain present with yourself. The benefits are not just physical. To care for others, you must first care for yourself. Massage is a great way to learn how to receive care and to form a therapeutic relationship with a trusted healer who can help you through medical school.

4) Maintain your emotional health. I believe all medical students should receive weekly counseling with a professional (not a friend, not a spouse). If you feel sad, cry. Tears are cleansing. When humans bottle up their trauma with no outlet, they become numb, detached, sick.

5) Maintain your spiritual health. Whether you meet with your church pastor or meditate at an altar in your home, devote time at regular daily or weekly intervals to spiritual self-care or you will lose connection with your soul.

6) You must be well to guide others to health. By caring for yourself, you will not only help patients; you’ll help your classmates and teachers heal. They are wounded too. Be a beacon of hope for them. Even if triggered by your joy, they’ll be less likely to injure you with their pain. They need you.

7) When you are resourced and well, you will once again be able to look into people’s eyes and be a sacred witness to their suffering. You will experience true intimacy which means “in to me see.” For patients to see inside you, and for you to see inside them, you must be inside your body.

Blessings to you on your journey . . .

Love, 

Pamela

Want to heal your soul? Attend our next retreat!

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Pamela Wible, M.D., was named one of the 2015 Women Leaders in Medicine by the American Medical Student Association. Dr. Wible is the author Physician Suicide Letters—Answered. Need a letter answered? Contact Dr. Wible

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What do modern day shamans do? →

Pamela Wible Postcard

Dear Dr. Wible,

I wanted to pose a couple questions to you after reflecting on your TED talk and a couple of your stories. Also I wanted to say that I truly appreciate the awareness you’re bringing to the dysfunction in medical training, expectations for medical professionals, and the greed infiltrating one of the most tangible acts of empathy (medical insurance companies). You also recently spoke at an event on my med school campus. You made me feel as though I might not necessarily be walking into a bear trap as I become a physician—that perhaps medicine doesn’t equate with martyrdom if I take courage. Thank you.

If you happen to find a spare moment and think any of the following questions are worthwhile inquiries… What do you think med students leave out of their personal statements? What do modern day shamans do? What would the humanistic-doctor-personality do when/if the art of medicine is no longer necessary? Why do you take baths on the Internet?

Also this is a story I think you’d like if you haven’t already heard it. One of my classmates from Hawaii told me about a group of sea kayakers that honor their ancestors by traveling across the ocean every once in a while to their likely mainland of origin using traditional canoes. A few years ago their tiny boats were thrashed by storming waves leaving them lost and adrift. One of the members was a pro surfer, Eddie, and he knew the general direction of land and safety. He also knew he was strong and told the group he would swim for help. The group was found by search and rescue but the hero apparently was never seen again. Now when someone attempts a selfless act people say “Eddie would go” in memory of the young man in the prime of his life with a big heart.

Thanks for your insights and time. Also, I’m fairly certain if you replied it would be the highlight of my day. 

With Great Respect and Kind Regards,

Rusty Jones, OMS2

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Hey Rusty,

Here are my answers:

1) What do you think med students leave out of their personal statements? 

Words that might scare academic institutions that hold reductionist medicine as the only truth. Words like holistic, spiritual, transcendent, intuitive. Concepts that scare those who value only what can be measured, replicated, and billed to insurance companies. Medical students may leave out the most important part of themselves—their souls.

2)  What do the modern day shamans do?

Shamans heal through spiritual means and may consequently improve the human condition by bringing about restored health for all. The modern day shaman stands fearlessly against forces that erode our humanity and spirituality—even against modern medicine which has lost its way, lost its soul.

3) What would the humanistic-doctor-personality do when/if the art of medicine is no longer necessary? 

Search for the wounded. There will always be those who need help. Healing may not require potions, labs, and tests. The wounded may need time, attention, love. The humanistic doctor is adaptable and serves the needs of the world in the era in which he or she finds him/herself.

4)  Why do you take baths on the Internet?

To be real. To demonstrate how simple and fun and easy life can be when we don’t take ourselves so seriously. To show what doctors look like without the white coat. To break through the stereotypes that imprison us all. To break down the complex PowerPoints into simple rubber ducky routines. Maybe because I’m a cross between Lucille Ball, Patch Adams, and Marcus Welby. Maybe the modern day shaman doesn’t wear a white coat.

Love,

Pamela

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Pamela Wible, M.D., is the founder of the Ideal Medical Care Movement. She was named one of the 2015 Women Leaders in Medicine by the American Medical Student Association for her pioneering contributions to medical student/physician suicide prevention. Dr. Wible is the author of the best seller, Physician Suicide Letters—Answered. Need a letter answered? Contact Dr. Wible.

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