"Take care of yourself"

I saw a psychiatrist in February because of the persistent disengagement from life I've been experiencing. Engaging brings up issues of interrelatedness and interdependence that flummox me. Issues of dependency comprise a huge part of my work-life. We are programmed to travel a path from total dependence at birth to functional independence as adults. For elderly, disabled or chronically ill persons, transitioning gracefully from independence back to various levels of dependency takes an enormous amount of courage, trust, faith, good will, acceptance, and humor. I tell my patients that letting others do for them is a gift that they can give freely or stingily to their caregivers. But I am no expert on this terrain. Unfortunately I have long been entrapped in a vortex of counter-dependency--opposition to any state of dependence for myself. Instead, I trudge through life expecting little from others, causing me to cringe when I have to ask for anything or admit to any weakness, experience despair rather than outrage when I feel mistreated. I take care of others as a way to compensate, I speak out against injustice and advocate for others as a way of sublimating my own needs. I've worked on this, in particular, I admit that it's an arrogant stance, my reliance on others is a profound fact of my living. But something in my work-life repeatedly triggers a retreat to my past, raising dust clouds of anger, frustration, exhaustion, hopelessness, anhedonia. I always hope for meaningful relationships with co-workers (and thankfully have encountered many precious connections with both colleagues and patients) but in the health care institutions where I have worked, the day-to-day atmosphere is a formalized, distant, closed hierarchy that limits my perceived choices to either acting out or inhibiting myself. I can't seem to figure out how to provide healthcare in this atmosphere.

Medical encounters forge relationships, potential opportunities for health or illness. In deciding to see a psychiatrist, I tried to select someone that I hoped I could connect with (within the limits of my insurance coverage, that is). I did my research as best I could. I waited almost three months for the appointment. He was a decent guy, listened attentively, spent almost an hour with me, gave reasonable advice and another medication to try. I have nothing negative to say about him really, but at a second visit last week, lasting about 12 minutes, I just didn't feel any presence. From him--a nice smile, the right words, but ... what? A mode of conversation that sets our roles in opposition--doctor and patient? A tone of voice that signifies: this is a professional encounter? An unwillingness on my part to go where I needed to go, to ask for what I needed, to make the connection stick? There was a falseness, an inauthenticity similar to what I dread daily in personal encounters. What was it? Why do I always feel unsatisfied and ashamed of my needs? Do I just expect too much, is that why I'm so readily disappointed? Do I lack the ability to connect on a level that feels real to me, or do I just lack the ability to accept the distance that exists between persons, the roles that determine relationships, our too-sensitive psyches and seeming lack of toleration for bringing our real selves into our encounters? As I left his office, he said "take care of yourself".

I couldn't help thinking about other medical encounters: how comfortably I converse with my primary care doc, yet how I felt like a piece of meat at my routine mammogram appointment when the receptionist asked for my driver's license and made a copy of it. I understand her job is boring and repetitive, but nothing in her tone of voice came near to suggesting she was speaking to a human being. (And why did they need my driver's license? I didn't even bother to ask.) I had a stress echo test last week, and the doctor was charming and curious about me; a similar test that I had about 8 years ago left me in tears, when the doctor didn't even bother to speak to me. I know that I probably have better medical encounters that most people. I have health insurance, I am a health care provider, I'm not easily intimidated by professionals. This deepens my discouragement about the limits of health care, the lack of connection and caring that might actually make a difference in a life.

So many questions arise from this meditation about healthcare and human relationships. What is the truth of relatedness? Is our primary mode of existence a deep hiddenness covered by a false presentation of self? What is the self we offer in relationship? Are we simply alone, unable to help each other, without reasonable hope of connection for the vast majority of moments of existence? Can I do any good as a health care provider without forming a deep connection, spending enough time, following the patient's lead instead of ticking items off of an agenda? Although I visit patients in their homes and work primarily with palliative or existential issues, I know I speak for many healthcare providers in other settings who want their efforts to make a real difference. Who want to work in a manner that discovers healing through relationship. Many of us are becoming more and more resentful of being asked to see more patients than we can reasonable care about in a day. Yes--care about--we think of that as our job. In my own job, I don't fix much, I don't have a magic wand or substantial resources to offset the suffering I encounter. What I do experience is finding that offering a not-false presence and time does seem to matter. And I know that there is a limit to how much of that inner resource any one of us has to offer in a work day.

I don't fully know what it is like to be unable to get out of bed without a helper; to not be able to read or listen to music because of sensory losses; to not be able to prepare a meal for myself or use the toilet in privacy. I don't truly now how finally alone we find ourselves at the end of life. I do know that life feels like a pretty lone venture most of the time. And the adage to "take care of yourself" is a mountain of truth.