Thirty-six years ago, I arrived an hour early for my first medical school patient care rotation at the East Orange, NJ, VA hospital. Over the years, ‘I’ve seen and learned (and unfortunately also forgotten) a lot about medicine and life. I have been writing down wise nuggets since that first year and keep reviewing and adding at times.
Here are 36 random reflections in honor of these 36 years that I wish I had been able to ponder on in 1983 while waiting for my team to arrive. Nothing earth-shattering, but I’m hoping some might strike a chord with you.
1. Kindness matters and is free, contagious and — like generosity — never goes out of style. Try to be kinder than you feel. Rude and difficult people remind us how not to act.
2. Spend a midnight shift in the ED on a Friday or Saturday night anywhere in the world to know some of the dark things in that community … and to confirm that not a lot of good happens after midnight.
3. The silence of an emergency department (or the OR or the ICU) team taking care of a critical patient is a sign of a well-oiled machine running efficiently. Soak in the ones you are fortunate enough to experience. But never mention the “Q” word.
4. One can do/put up with almost anything for a year and learn from it. (‘I’ve had a couple of those years.)
5. Care for patients — not a disease or room number. Their names are important. You can’t put all their emotional energy into every patient, or you will break down. But you can find the one or two patients (or family members) per shift that you should put your full heart into.
6. Appreciate everyone — colleagues, receptionists, security, cleaning and meal staff, etc. — while you can. God is working in the lives of everyone you come in contact with.
7. Everyone has a story. Some chapters need to be coaxed out to provide the best care. Don’t take it personally when they tell each provider a different angle of the story. Surviving a Nazi concentration camp, the foster care system, addicted stealing and lying relatives, deep trauma and/or abuse. It’s amazing what some people have been through and how cruel some people can be.
8. No kid should eat lunch alone.
9. It’s a fact that people of all ages can and eventually die — even when everything possible was done. Patient deaths hurt doctors and other caregivers a lot! Death or hospice is sometimes the victory and not a failure. Prepare to see a lot more death than most other people.
10. Most patients do not want to visit a family doctor, much less an emergency department or even be admitted to a hospital. Often the real reason they are there has little to do with their initial chief complaint. Create an atmosphere for people will tell you things that they ‘can’t even tell their family. Guard their trust.
11. No one gets along with every person they come in contact with (despite Press and Ganey’s opinion). It’s OK to be upset. It’s never OK to be cruel.
12. No one is perfect. ‘Don’t be afraid to “fail” and learn from it. Do what you can to not let it happen again. Be wary of folks who think they do know it all – especially if you are becoming one.
13. Be prepared to learn something every day. Never be afraid to admit that you don’t know. Life is full of people who know more than you do and people who know less. Try to learn from the ones who know more and share with the ones who know less.
14. A sign of a good teacher is when their students surpass them. Great teachers inspire in addition to teaching.
15. Miracles do happen.
16. Humor and embracing change are important for endurance.
17. You can always find someone that is worse off than you are.
18. Your life will not turn out the way you expect it to. Learn to deal with uncertainty. We can’t control most of what happens in life, but we can control how we respond. Happiness is letting go of what you think life should be now and appreciating it for what it is.
19. Forgive others not because they deserve forgiveness, but because you deserve peace. Often peace is better than being right. We don’t need to join every argument we’re invited into. Forgiveness has tremendous healing power.
20. Scars are important in caring for yourself and others. A scar means the hurt is over, and the wound is healed. You can’t make scars disappear completely, but you can change the way you see them. Discussing your patients’ physical and emotional scars with them can be very insightful.
21. It takes 10 encouraging comments to overcome a hurtful one. Most people are in an encouragement deficit by the time we encounter them each day.
22. Dead patients have very stable vital signs.
23. Your life is more about the way you impact others than it is about you.
24. Just being named in a lawsuit makes one a loser — even if one wins the court case.
25. Understand before judging. Seek the truth. hear from both sides … usually neither is 100% right.
26. Technology may help us diagnose more, but a big part of healing still lies with human touch and compassion.
27. It’s OK to say no. Sometimes, you have to ask, “What do you want me to give up in order to do that?”
28. The best predictor of future performance is past performance.
29. Some of the most powerful words one can say or hear are: Thanks. I believe in you. Your opinion matters. You make me proud. You were right. That’s a great question. That was awesome. I’m so glad you are here. I trust you. What a difference you make.
30. Take care of yourself so you can take care of others.
31. Some of the most beautiful people you will meet are wrapped plainly.
32. Watch for sudden changes in behavior of friends and colleagues and don’t be afraid to address them — you may save a life. Doctors and nurses have personal problems like everyone else.
33. Manage money so it doesn’t manage you. Avoid spending money you haven’t earned to buy things you don’t need and can’t take with you. You don’t see a u-haul behind a hearse.
34. Funerals and graves are not for the dead, but to help us that are still breathing to live out the rest of our lives more fully. It’s useless to wait for a funeral eulogy to tell someone how much they are appreciated. I need to remember this and not add to times I want to kick myself for not expressing these thoughts earlier.
35. If you wait until things are perfect to act, no one will ever hear from you.
36. Don’t give to get. We’ll be disappointed if we expect everyone to do for us what we do for them. We might not have much now but soon will. Remember how much gifts helped.
Joe Bocka is an emergency physician.
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