• Rosalind Kaplan, MD

But I Digress

by Rosalind Kaplan, MD

Welcome to my new, hopefully improved, website and blog! It’s spring, the days are getting longer and the crocuses are up in my front garden. After a long slog through the Winter of our Discontent within the Plague Year, there are signs of hope: vaccines, a covid relief plan for those who are suffering financially (no, nothing’s perfect, but it’s helpful) and a president who is, most notably, not Trump. What better time to start anew? This blog is a clean slate, some new stories and ideas and discussions.

I named the website The Digressive Doctor, so this blog is the ‘Diary of a Digressive Doctor.’ I love the alliteration, but there is more significance to the name than an opportunity to use a lot of D’s.

The definition of ‘digression’ is a ‘temporary departure from the main point in speech or writing.’ To digress is to wander away from the main topic or purpose at hand.

For much of my life, the ‘main purpose’ was to be a doctor. Medicine is a tremendously demanding profession, as most people know: those who wish to pursue it usually begin many years before medical school, working hard for top grades in high school and college, taking lots of standardized tests, including the onerous MCAT, and seeking out extracurricular activities that will be attractive to medical schools. Once someone begins med school, their life is highly programmed for the next four years, and the work is hard. Then there’s residency—the infamous years of toiling day and night in the hospital, lack of sleep, and, for many, overwhelming stress. So much time, energy and money is invested in medical training that there is little choice for physicians: becoming a doctor is the main event during those years.

For me, despite marriage, children, ailing parents, a home, dogs and some health problems of my own, doctoring continued to be the focal point in life after residency. Not that I didn’t love my husband or my children, or pay attention to them. It wasn’t like that at all. But Medicine had a way of constantly reminding me of its central place, its weight, its need for attention. Part of it was that my husband was (and is) also a physician. Dinner conversation was often a continuation of patient care. Another part was the nature of taking responsibility for others’ wellbeing—I worried about many of my patients after work hours, particularly if someone was seriously or critically ill. Still another piece was that, as a doctor in a small medical practice, as I was for a long time, I was often on-call for emergencies at night and on weekends.

My pager tended to go off at all the worst times, like when I was in a deep sleep, or in the middle of dinner, or on the way to my own doctor’s appointment. Lest I begin to believe that my family was central, or that my focus was life in general, of which medicine was just one part, my beeper or phone or my own anxiety would remind me that, in fact, every other facet of my life was a digression. Medicine was going to put itself front and center.

As the world became digital, Medicine found more ways to insinuate itself into everything else in our lives. Charts came home with us on the EMR. Email, texts, and cell phone calls at all times of the day and night. The ‘secure electronic patient portal’, which practice administrators wanted us to tend to even on weekends, allowed non-urgent questions and requests to come to us 24/7. Because of inadequate support at work to take some of the administrative and nonurgent, minor issues off of the doctors’ shoulders, more and more work came home with me.

A couple years ago, it all became too much for me. Call it burnout, or exhaustion, or moral injury (more about this later), but I finally decided, at the age of 57, to walk away from my Internal Medicine practice. I digressed, and Medicine was no longer the main focus.

I’ve digressed into a whole lot of other things. Writing is one, and I earned my MFA last year. I spent time with my now grown kids (I worry that I was a terrible parent, looking back at how overwhelmed I was with all the things I was trying to juggle when they were young, but they tell me they don’t remember it that way. They’re thriving, so I guess I was ‘good enough’, as the pediatrician and psychoanalyst Donald Winnicott put it. But I digress). I started taking care of myself better. I tried my hand at medical content writing. Eventually, I found my way back to practicing medicine in a more controlled way doing urgent care shifts.

Now, having a more balanced life is my main focus. Digressions happen when I get --temporarily--very involved in one thing, and the balance is, for a while, thrown off. But it doesn’t last. I come back from the digression, and return to equilibrium.

Of course, ‘digression’ is meant to be used in relation to speech or writing, but I find it a fine metaphor here. (Perhaps in life, it would be called ‘disruption’ or ‘diversion’ but both have connotations that I don’t intend) I am mostly a writer of memoir, and digression is an important element of memoir. The associated memories and thoughts that ‘veer off’ from the central narrative are responsible for a lot of the texture and depth in memoir. In that same way, digressions in life—a trip away from home, an exciting event, an illness, a loss, even the pandemic—all bring texture and depth to our lives, for better or worse. But with luck, we return to a sense of equilibrium and rest in between.

So look forward to weekly Diary of a Digressive Doctor Blog posts about :

The good, the bad, and the crazy of health care in the US

Finding balance in a medical life, or finding medicine in a balance life

Physician wellness

Alternative clinical and non-clinical careers for doctors

Narrative medicine and medical memoir

Medicine and Creativity

In other words, a lot of digressive medical topics!

If you are interested in being a guest blogger on these or related topics, please let me know!

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