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The Choices We Make

Last year, I met with director of the Medical Humanities Program at UC Irvine, Dr. Johanna Shapiro. She is a lovely woman, a brilliant psychologist with a love of literature and writing. She has spent the better part of her career training medical students and residents to develop reflectivity and empathy through the reading and writing of stories. We spoke about our interests in writing and the education of physicians, and how I might be able to be more involved in the program that she has cultivated.

This was a dream conversation for me. I have always believed that, as physicians, we need to have a deep understanding of our own internal emotional worlds, and the ways in which we are touched and hurt by our patients. We have to understand the complex, multi-layered stories that our patients tell us–both the explicit, and the implicit. And then we have to understand the intersection between the two, the patient’s story, and the stories in our heads and hearts. I believed in the power of reflective writing to gently immerse us deeper in this awareness. If we can manage to really listen to all that lies beneath the words that are shared in our sacred space, then a true therapeutic relationship can begin to form. And from that point, healing can begin to occur.

Here was an opportunity to build upon these beliefs in a more formalized and important way, with medical students and residents. To help develop more aware and empathic physicians, hopefully translating into both improved patient care and improved physician satisfaction and well being. A chance to finally unite my love of psychiatry, teaching, and writing.

However…there is always a “however.” The volunteer time that would be required would mean time away from other things that were major priorities in my life. My family, my patients, my practice. And last but not least, time away from my own therapy, writing, and self care.

I found myself staring at my google calendar and my practice schedule in dismay. Was it realistic to fit everything in? Of course, I felt fortunate to be in the dilemma that I was in. Fortunate to have a full life where I have the opportunity to give of myself in fulfilling and rewarding ways. At the same time, I am wary of my long standing tendencies to say yes to too much, and overcommit myself. Being stretched too thin means that I feel overwhelmed. It becomes more difficult for me to be mindful and fully present in any given moment. That trickles down to all of those around me. My children and husband feel it, my patients feel it. Most importantly, I feel it. I feel it in my lack of immersion, my lack of fully occupying the place I am in, replaced by a sense of acceleration and anxiety. I feel it in my body, the tension in my shoulders and the achiness of my hips.

We all come to places in our life where the road in front of us diverges. It can be so difficult to make a choice. Choice means risk. We feel like we are closing the door on a whole path, a whole potential future of opportunities that we will never get to experience. A parallel universe that we will never inhabit. There is a leap of faith, in the knowing that the door that we choose to open leads us in the direction that we were meant to travel.

Patients ask me for help in making decisions all the time. Should I leave my marriage? Should I terminate this pregnancy? Should I stay in school or drop out? Should I continue therapy or take a break? Should I change my medication? Small choices to big choices, it is the decisions that we have to make that can keep us up at night.

I usually don’t have a “right” answer. I try to remind myself (and my patients) that there is no right or wrong, that there is just the path that unfolds in front of us. We make the best decision that we can with the information that we have at the time. We take the opportunity to review our priorities, which very well could be different than the priorities of those around us. And we take the opportunity to remind ourselves of the importance of not overwhelming ourselves, such that life doesn’t pass us by at breakneck speed. We look to others, greater powers, and the universe for signals and signs of how we can best make meaning of the time that we have been blessed with…and what we can afford to give up in order to create a life we can love.

And whatever comes of that path, we must fully revel in what it brings. We might have our questions and thoughts, the “what ifs” that arise in the dark of night. But we have to trust that whatever evolves in life is the right intersection of our decisions and our destinies.

These are the choices we make in life. What choices are you facing in your life right now? Is there a well traveled or unexplored path that is calling your name, one that tugs on you when your world is quiet and you can hear your soul speak? Listen to that voice. Trust that it will guide you with safety and wisdom.

I will try to do the same.


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