Editorial: A welcome gift

November 6, 2009

The author describes feeling busy and bored - the perfect recipe for burnout - until a reacquaintance refreshes his perspective.

I'd been an employee health physician and attending physician in an alcohol and drug recovery program in the same hospital. Years of screening desperate job applicants for medical problems they hoped to conceal until after they'd been hired and the inherent stresses in dealing with chemically dependent patients had left me wondering about the rewards for my chosen profession.

The elevator stopped on the second floor. A tiny woman I estimated to be in her 80s entered with a gentleman companion of the same age. The doors closed, and the woman turned and looked up at me.

The elevator stopped at the third floor. She and her gentleman companion departed with a smile for each other and a smile for me, communicating without words.

I remembered her well. Twenty-five years ago, she had been a volunteer at the hospital where I worked. I had treated her only once, in an urgent care area when she presented with her rapid heart action and near collapse. Her electrocardiogram documented her paroxysmal (abrupt-in-onset) supraventricular tachycardia (PSVT).

Physiologic maneuvers prior to pharmacologic interventions appeared reasonable. Thus, initially, gentle, unilateral carotid sinus massage with continuous electrocardiographic monitoring for one second restored her heart rate to a regular sinus rhythm. She was pleased that I had alleviated her tachyarrhythmia without resorting to any pharmacologic interventions at all. She admired and appreciated my cost-efficient, cost-effective resolution of her acute cardiovascular condition.

Later, she typed me a letter on stationery with tiny flowers along the border. It read:

Dear Doctor G., A "thank you" is very inadequate for the services rendered to me last Thursday morning when I needed them. You did what my doctor had been trying to do for the past three years, that is, get an EKG when my heart was acting abnormal. Doctor P. is very grateful to you for your report and copy of the EKG you sent him. His words were, "Now I know what the trouble is, and I can treat it without guesswork!" Doctor P. changed my medicine. I am now taking [digoxin]. I will see him again in one week, and sooner if I need to see him. At present, I am feeling fine and hope to be doing my volunteer work next Thursday. Thank you again for your services. I will always be grateful to you! Sincerely, G.R.

I have kept that note in a scrapbook for 25 years.

As the memories flooded in to fill the elevator, I realized there is much that I did not know about the woman. I did not know what her relationship was to her gentleman companion. I suspected they had been significant to each other for quite some time. I did not know whether her gentleman companion knew exactly why she kissed me. Mais bien sur (French: But of course), that would be for her to explain to him if she felt the need!

But I did know that within the confines of a dingy hospital elevator and in no more time than it took to travel from the second floor to the third, I had received not only a kiss but a gift.

Within the framework of our day-to-day stresses in allied primary healthcare, it is my humble, respectful joy to experience that special moment of respect, that moment of appreciation, that moment of validation.

Could it be that our antidote to burnout just might be experiencing and sharing these joyful memories, moments of our "natural high" as primary healthcare providers?

Because she, G.R., served our hospital as a volunteer, I made damn sure that she received no bill from the institution nor from my office.

Twenty-five years later, she repaid me with her kiss of inestimable value.

I can still feel the exact place on my neck where she kissed me!

Joshua Grossman, MD, is an internist in Johnson City, Tennessee. Send your feedback to meletters@advanstar.com