Where are the mnemonics for saying goodbye
when you,
the clinician,
are the one transitioning?
CURB-65 for pneumonia severity
REMAP for goals of care
And a bright blank wall of nothing
For this not so unfamiliar transition of care.
There’s medical school:
with the eclectic short-term rotations
Barely enough time to get the full extent of a patient’s history,
Learn their disease and trajectory,
Quite enough time to get to know the patient, their fears, fearful hopes, their prayers.
But the clock strikes six on that final day of the rotation,
We, anonymous medical students,
Trudge our way to the patients’ rooms
And find the ways to say goodbye.
Wondering whether this is helpful to the patient,
Knowing that it matters to us.
Fumbling through my
“thank you for your time”
“I hope all goes well,”
My goodbyes as a medical student included
An awkward smile from a patient with dementia who couldn’t recognize me, hugs from the patients who did, a conversation about worries of what is to come, a barrel of prayers for a successful journey in my training ahead, a box of mangos, a handwritten card that I keep with me.
And always well-wishes.
Each of these became metal welded into my armor,
as I propelled onward in my training,
through the many moments that
doubt
found its way slithering in,
questioning my ability as a doctor,
aiming for the imposter.
There is also the transition that occurs as a resident,
moving through teams.
This one feels more,
Calculated,
At times, distanced
You’ve had your patient care time reduced greatly
As the swath of tasks focused on patient care,
But directly away from patients,
Has grown like a set of weeds in the garden.
Methodically learning to say,
“Today is my last day on service,
Tomorrow you will have another doctor
But they will know everything you have told me.”
I expected the robot-like quality to the goodbyes,
made them easier,
Less complicated.
They rarely did.
Now, here I am
At one more medical transition point,
The final days of residency.
Writing this after one of the my last clinic days.
Tearing up at the goodbyes from today
And the goodbyes coming tomorrow.
I am starting to gather the moments again,
The best wishes, the travel recommendations, the cardamom candle,
Stockpiling these into my armor once more,
I’m counting on this armor to hold sturdy,
Keep me unwavering,
As the doubt inevitably begins to sow itself again
For what is to come,
the next phase.
We are not the experts in the
art of saying goodbye.
But perhaps
It’s in the fumbling through,
The vulnerability of
These moments
That we gain
Healing
Closure, even.
We are,
before anything,
human, afterall.