Brokenheartedness

     Sometimes it's more painful to leave someone than for them to leave you.  Most of us have experienced both, and know what I mean.
     That's how I feel about leaving medicine.  I'm forcing the change, so I'm the one responsible for the knotty feelings.  It takes twice the resolve.
     I know it's the right thing to do, but I'll miss a lot of little things about the relationship.  Like the routine--which is comfortingly the same every day--of zigzagging from one exam room to another, and the quirkiness of the staff, how one nurse spaces out for fifteen seconds when I ask for a referral form or prescription pad, or another says, "Yes, Ma'am" without fail,  and how no one will say hello or good-bye to me, per my request, so that my brainwork about patients can mature into diagnoses in the quiet vestibules of my mind.
     It feels like love, the way everything works--patients, staff, the system.
     There's the flag, light and bell mechanism I designed--a seamless method for summoning an assistant into a room without hullaballoo.  There are the exam rooms themselves, like exquisite kitchens, everything within reach, with excellent lighting, finely calibrated tools, spotless surfaces.  I spend so much time in these rooms that they have become a second home.  They reflect my personality, which is practical:  bulletin boards with medical news in everyday language, polished floors, natural light from lots of windows, comfortable armchairs, and bright-hued paintings by local artists.
     And, of course, there are my patients, a concatenation of personalities and bodies--people carrying terrific loads from the past, and tendering tiny questions that hold back rivers of suggestion, like dams.  It's my job to control the flow without affecting the truth, whenever it emerges--which is often at inopportune times, like when I stand up, holding the patient's chart, and start to say good-bye.
     "One more thing..." the patient interrupts, or "Before you go..." or "Could I just ask you...?" with that ellipsis, a few pregnant dots of time during which the patient gauges my true feeling about him or her from my instantaneous reaction to this last-minute entreaty.
     I know there are doctors who say, "Sorry!  Time's up!  Make another appointment!"  At least, that's what I'm told.  But when I am stopped with my hand on the doorknob, I realize the patient is about to give information that will fill in the blanks in my assessment, like clues for completing a tough crossword puzzle.
     I will now confess that sometimes there is a preamble of lightweight banter with patients that threatens to take up the entire appointment and, hedging my bets, I stand up and make a pretense of leaving as a way to coax out concerns that are coalescing like anxious little bubbles near the surface of our interaction.  Pretending to exit may catalyze the pot like salt, churning it to a boil, both of us ready for realspeak.  But just as often the patient sinks back into a weighty silence--distant, rejected, hurt, overtaken by doubt, as involuted as a black hole.
    "What's bothering you?  What?  What?"--I want to say, but this approach doesn't work.  Therefore, I re-assume my post on the blue vinyl doctor-stool and look at the floor, waiting for something as uncertain as a wild animal to come out of hiding.  I hold the space.
     I'll miss that space, in which many things can happen as the patient and I sit alone together in one of those clean exam rooms.  It's like a blank canvas, or a spiritual retreat, or an afternoon in the woods.  It's the experience of being human--the wish to relate, and a certain cautiousness about relating.  It's not easy to pull back the curtain of vulnerability.  I will miss the gift of being trusted.
     In these last weeks of my practice I'd like not to be sentimental.  But it's difficult, when you know something is dying, not to be noticing all the details, archiving them.
     Once, when I was twenty, a boyfriend and I decided to break up.  Really, it was my decision, and I had stowed all my things in a Jartran truck to haul clear across the country in the snow next morning.  That final night I registered every minute--the sounds of our breath, the chill air on my elbow when it poked out of the covers, the glow-spot of a streetlight on the slatted closet door, my cat purring, the garbage trucks clamoring into town before dawn, and the thumping in my chest.
     My brokenheartedness about leaving medicine is not a sign that something is wrong.  Like other pains, it's "the breaking of the shell that encloses your understanding."  These lines from Gibran's poem--which has hung on my clinic wall these twenty years--now come to mind:

     Even as the stone of the fruit must break, that its
     heart may stand in the sun, so must you know pain...

     It is the bitter potion by which the
     physician within you heals your sick self

    Therefore trust the physician and drink
    his remedy in silence and tranquility...