The Soul Condition

The day to day practice of General Internal Medicine can be particularly challenging and trying, but also thoroughly rewarding. I have found that the most incredible moments of privilege and wonder in this profession come in the most unexpected times and places. Especially during this past year, which has been particularly trying for me personally, just when I think I can’t bear any more suffering, there is a surprising glimmer of light that penetrates the darkness. I’m thankful for those moments, and being mindful of recognizing them when they present themselves.

One morning recently, I entered an exam room to see a patient of mine during a busy Tuesday morning clinic. He was sandwiched in my schedule between a lovely middle aged woman with a newly diagnosed metastatic lung cancer (sigh) and a young adult patient with a sore throat. I saw him on my schedule for that morning and smiled – he was a lovely elderly man that had a difficult past few years with depression, obesity, and was ever skeptical of my western medicine approach to his longstanding hypertension. Despite it all, we always found a way to have a good talk, able to cross the chasm of our cultural and religious differences and find a way to speak a common language with each other. I take care of his wife and his adult daughter, as well, so I have a multi-dimensional sense of his life at home.  In the flurry of the day, I closed the door finishing with the patient across the hall and stepped in the doorway of his exam room to say a big hello. I looked up and barely believed my eyes – “Oh my goodness, how are YOU?!” I said. There he was, big sparkling smile, bright eyes, “Hello there, doc!” He looked twenty years younger than his 74 year old self, and strong and happy.  This was such a stark contrast to our last meeting, about year ago. “Well, doc, I thought you’d be proud. I lost 70 pounds.”

I smiled. I paused. I looked at him lovingly and proudly and then squealed with excitement as I gave him a hug. “How did you do it? And how do you feel?”  He went on to tell me how he feels terrific, both physically and mentally.  When we last saw each other about a year ago, he was sad, lacking motivation, irritated with his wife who was ‘nagging’ him, and about ready to move away to a warmer climate.  He was morbidly obese, had aching knees, and just didn’t feel like himself. I recall distinctly (one of these moments that just are quite captured in the EMR documentation!) at that visit we talked about “why are we all here?” –I had referenced a friend who had recently passed away at the age of 49 and I was feeling great loss at the time – he too was feeling loss and disappointment about moments in his life and was reflecting on his 73 years, having an existential crisis of sorts. We hugged at the end of that office visit. And now here we were, a year later, and he is bright and happy and has lost so much weight. 

A year has changed so much of who we both were. I was about to hear about his year long journey. Over the last year, I had seen hundreds of patients while I tried to keep my own tattered life afloat. My marriage broke up, I sold my house, I moved, and have tried to weather the storm of a messy divorce while parenting two little kids who were trying to understand it all. I couldn’t help myself as these thoughts rushed in--the year since we saw each other last had affected us both so profoundly. And here we were, again. And I think we found unspoken strength in each other.

“Well doc, this is all about my ‘Soul Condition’.”  I looked up, saying nothing, but my eyes gesturing ‘tell me more.”  He went on to tell me that he thought a lot about his life after our last appointment. He realized that his poor health habits, for him, were about failing to care for himself and his ‘soul’. He realized at some point he is worth more than his poor health habits, so slowly he started eating better and exercising. He said “Doc, you told me to go for a walk. So, I’ve gone for a walk everyday ever since I saw you last.”  Wow! I admit I had a moment that I couldn’t believe someone actually listens to me!  We went through the rest of the visit, me with genuine joy for him, him with the pride of a child reporting back a good deed to a parent.  And then we finished, as he and I somehow always do, sharing tidbits of our lives and hopes, and he teaching me more about the Soul Condition. He said “Doc, if you are unhappy, just work on your soul. You should tell your other patients that. I’m not even tempted to smoke or drink alcohol, or eat ice cream. Why would I now that my Soul is so happy in this body?”

I’ve thought of him a lot since that day. I could certainly learn a few tips from him – or at least my Soul needed a new kind of condition after all I’ve been through this year.  I couldn’t help but wonder if he saw it in my eyes, if he knew I needed this advice.  Divorce is ugly and bitter and deeply devastatingly sad – it does break a soul as it breaks a family.  I bear witness to so much human suffering on a daily basis in my role as physician, and sometimes the only thing I can do is sit with a patient and listen and hold his or her hand, offer a supportive word or a hug.  I have found it an incredible burden to also carry my own suffering into the room with my patients as I listen to their stories, offer kindness, support and advice. I’ve often wondered over the last year if I’m good for any of them and if I could possibly bear any more. During that 20 minute appointment, I earnestly rejoiced in his improved health and happiness and learned from his wise counsel. 

Just like my patient worked to make his Soul happier, I’ve learned I need to deliberately take steps to do the same. I savor my kids’ giggles, and give more hugs, and spread more love, and have learned my own needs count.  I have long taken care of others, and I’m just now learning the skills to recognize my own Soul Condition, and tend to it.  Today I went out of my way to spend time with a long lost friend, take a walk, and bake banana bread. I went slowly through my day, took note of how I felt, and listened to what my Soul needed today.  I also held my son, as he cried in my arms for a half hour after coming home from a weekend with his dad. He wanted to know “why can’t mommy and daddy just live together?”  And so I hold these things, some so difficult, some so beautiful, and think about what we all need to care for ourselves and our Souls. In this moment, my heart ached wide open for my sweet child, and was also warmed by his earnestness and his openness and his absolute softness in my arms.  My Soul has a little farther to go to feel healed, but I’m listening and trying. My patient is a beautiful man and a special, special Soul. May both our Souls triumph in a beautiful year ahead of us, until we meet again.