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Another Christmas Message

I am writing this by the fireplace in my Swedish looking farmhouse in northern Maine. It is a couple of days before Christmas and we have 8″ of new powder snow on top of last week’s snow. Without all wheel drive and studded tires I wouldn’t have made it up the driveway after work today.

This season of celebration is shrouded in uncertainty. Last year at this time I wrote about the threats of the coronavirus and of anarchy. Both of these threats to life as we knew it played out worse than I had imagined.

And here we are again, with Omicron raging and the political divide widening. All I can do as a physician and a human being is keep my own house in order, cherish my loved ones and stay focused on what it means to be a doctor.

My world has stayed small, physically, but my thoughts and my words travel freely. My post views have more than doubled this year. I’ve been writing this blog for almost 14 years now and it has been a way for me to balance my frustrations with the system with the continuing enthusiasm this job nurtures in me.

I have written a Christmas piece most years. Below, I am linking to last year’s installment and also to the one from ten years ago, when I gathered sentences from Sir William Osler’s writings, imagining what he would want to say to today’s rural primary care doctors; Hippocraticus Rusticus, he called people like me.

Osler was a brilliant physician, a dedicated mentor and an optimist. He is one of a select group I call my imaginary mentors. By now I’m one of the oldest physicians in my organization, so I sometimes imagine what Osler or one of the other great teachers would guide me to do when I hit a snag or a difficult choice.

As one more year in medicine is about to end and as I prepare to start another, I would like to extend holiday greetings and best wishes for the new year to everyone who reads this. Writing this blog and compiling the books based on it has been both therapeutic and fun for me. And, just so you know, I have another book in the works – all new material, and this one in hardcover.

Stay tuned, God Jul & Gott Nytt År.

A Christmas Message to All Physicians From a Swedish-American Country Doctor in Maine

A Christmas Message to All Physicians from Sir William Osler

A Christmas Message to All Physicians From a Swedish-American Country Doctor in Maine

Near New Sweden, Maine – just like the old country…

Growing up in Sweden without a Thanksgiving holiday, Christmas has been a time for me to reflect on where I am and where I have been and New Year’s is when I look forward.

I have written different kinds of Christmas reflections before: sometimes in jest, asking Santa for a better EMR; sometimes filled with compassion for physicians or patients who struggle during the holidays. I have also borrowed original sentences from Osler’s writings to imagine how he would address physicians in the present time.

This year, with the pandemic changing both medicine and so many aspects of life in general, and with a gut wrenching political battle that threatens to erupt in anarchy or civil war within the next few weeks or months, my thoughts run deep toward the soul of medicine, the purpose of being a good doctor, even being a good human being.

We live in ideological silos, protected from dissenting opinions. News is not news if it is unpopular. Fake news and fake science are concepts that seemed marginal before but have now entered the mainstream.

As a physician, I serve whoever comes to see me to the best of my ability. But this year I have had to pay extra attention to the fact that so many people have already made up their minds about the nature and severity of the pandemic we are living with. If they don’t believe the country’s top experts, they are not likely to believe in me. Still, I try to gently state that we are still trying to figure this thing out and until we do, it’s better to be cautious.

I am starting to read about what some are now calling the Fourth Wave of the pandemic, the mental health crisis this winter may see in the wake of the physical illness we are surrounded by.

With this raging pandemic and the pandemonium it has created in our personal lives and the lives of those around us, we as doctors need to keep our priorities straight:

  • A physician’s mission is to ease suffering.
  • We save lives when we can.
  • But sometimes, all we can do is help inevitable death happen with dignity and without unnecessary suffering.
  • Because we have seen suffering and death in our work, our words of experience and our empathy can help others.
  • We are all mental health workers in the eyes of our patients.
  • We must work hard to the best of our abilities.
  • But we cannot sacrifice our own health in the process.
  • We must put our own oxygen mask on first, as during in-flight emergencies.
  • We must accept that bad things happen in spite of our efforts.
  • We must accept that in life, there is no light without darkness, no joy without sorrow, and no good without evil.
  • We must recognize that we need to make every day count, because time, and life itself, is a finite resource.

Life is certainly messy, confusing and unpredictable. And while scientists and politicians may be using their brains for thinking of ways out of the situation the world is now in, the rest of us, doctors on the frontlines, are hunkering down in our shrunken worlds – reconnecting with the soulful, inconsistent underpinnings of who we really are but were perhaps too busy to really think about, recommitting to easing suffering, one patient at a time.

Remember Hippocrates: “Ars longa, vita brevis, occasio praeceps, experimentum periculosum, iudicium difficile” — “Life is short, the art is long, opportunity fleeting, experiment treacherous, judgment difficult.”

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

BOOKS BY HANS DUVEFELT, MD

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