Shadow
Shadow
My lab coat is stiff. It has been sitting unused in the trunk of my car. It has endured subzero chills and heavy snows. Tucked away. Forgotten. I throw it over my shoulders and slip my arms throughthe sleeves as I sprint towards the front door of the nursing facility. Such a nondescript movement learned over years of repetition. Until lately. Living in the shadow of a life previously lived. Stethoscope and lab coat. The tools of a trade. The tools of a trade abandoned. Left.
For just cause.
Face To Face
I am an impostor. A shadow of my previous self. I am adorned in my lab coat and stethoscope, but I am not truly returning. My hospice needs a face-to-face visit for an elderly demented nursing home patient. There is no family or next of kin to chat with. She is nonverbal. I am the only doctor in the area, so I have volunteered. There will be no diagnosing. No in depth history taking.
As per Medicare guidelines, I will interview the nurses, review the chart, and examine the patient. I will determine if she still is hospice eligible and document the decline.
Kind of like being a doctor but not really.
Old Friends
Like old friends, I grasp my stethoscope and reflex hammer. I haven’t used them in months. The ear pieces slip into place in an unexpectedly easy fashion. Muscle memory. I gently move the patients hand to the side as I speak softly.
She is barely alert. There is no sentient thought. I hear the heart sounds and palpate the abdomen. Data points dancing through my mind without distinct thought or reason. My brain catches each nuance and categorizes them.
Heart sounds regular and steady. Abdomen soft and non tender. Extremities cool to the touch with no edema. Pulses intact.
A shadow bouncing in and out of my mind.
Exit
I write my note and prepare to leave. A nurse waves as I enter the elevator. They used to see me every few days in this facility. Now I am a shadow. Sneaking in on the rare occasion when duty calls and no other clinician is available.
They still think of me as a doctor. The nurses, and clerks, and technicians. But I see myself quite differently. How else can I look upon myself when my coat sits dormant in my trunk? Day after day. Week after week. Waiting expectantly. To be worn and prized again.
I slip the lab coat off in one swift move on the way to the car. I open the trunk and it slides off my arm into the lonely recess in the corner. Tucked between unused umbrellas, a few bags, and other assorted refuse.
Epilogue
I hop into the car and speed off toward a meeting. Or back home to write a blog or record a podcast. My lips parched and dry from a small sip of what I used to be. A moment to linger in the shadow before the sun sets and artificial light illuminates even the darkest corner.
One day that trunk will close and the it’s contents will remain unused for a lifetime.
There can no longer be shadow if there isn’t at least a speck of light.
And there will always be at least a speck of light.
Great stuff Doc, that describes my situation for the past two years as well. Great writing!
Thanks Dave, you and I are in the same boat!
Unexpected return of the “imposter syndrome,” which typically affects medical students…
Yah, Kinda.
You are not what you do, you are what you became and continue to be. You don’t un-become. My kid recently had an ovarian cyst with hemo-paraetonium. Her complaint was rapidly accelerating belly and back pain, but no fever or shock signs and no real localization. My concern for her situation was torsion requiring surgery first, bleeding second, infection third, kidney or bladder stone forth, everything else fifth, so off to the ER she went. No way to diagnose adequately without radiology and some blood work and some expert hands on. Took 15 seconds to figure out possibilities and the plan from 1500 miles away. She generated a $10K hospital bill but she WILL have my grandchildren. If the old lady had rales 3+ edema and a slow irregular cannon waves would you have just walked away with the diagnosis of “+1 on continued hospice care”? I doubt it. In this instance there was nothing else to do. In another instance the steel trap of decades of experience would snap shut automatically. Either way the right thing for the patient would get done.
“You don’t un-become”. I like that.