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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.”

Doctoring at Christmas

I find myself thinking about how being a doctor has come to impact the Christmas Holiday for me over the years. I have written about working late and driving home in the snow and dark of Christmas Eve in northern Maine; I have shuffled Osler’s written words into something that speaks to physicians of our times; I have written about the angst around the Holidays I see in my addiction recovery patients.

This year, my thoughts go to the way Christmas is a time of reconnection for many people. We reconnect with family and friends we may not see as often as we would like, and many of us reconnect with secular traditions dating back to our childhood. Many people also reconnect more deeply with their Christian traditions, the ancient celebration of Hanukkah or the newer one of Kwanzaa.

As a doctor, I think Christmas is a time when individuals are more open toward others, more willing to extend “good will toward men” (Luke 2:14). It can be an opener for future relationships to form or grow, a time to share our humanity in the context of experiencing something larger than ourselves and our everyday existence. It allows us to get a little more personal by sharing something of what we all have in common – the need for togetherness with those we love.

Many people in this country routinely say things like, “have a good weekend”. I’m not sure that is such a universal high point in life. For some, it is a time for dreaded chores, for others a time to muster enough energy for that second job to help pay the bills.

Christmas is a more universal time of feeling celebratory and unselfish, and for me it marks the passage of time as well as the consistency of it. It was my time of awe and delight when I was a child, and now it is that for my grandchildren. As Christmas week culminates in the New Year celebration, it also helps me think about what’s next – for me and everyone in my family.

During the coming weeks, I will make sure to share some of the joy and peace I feel in my own heart with my patients and I will be more than usually sensitive to signals of holiday blues or distress in them.

This is not a time to flaunt what we have – lavish presents, successful relatives, gourmet food, fancy decorations or invitations to fun parties. It is a time to share some simple human warmth in the darkness and bitter cold of the northern Maine winter in a time of divisiveness, strife and unrest.

It is a time of “peace, good will toward men”, of greater openness to others. It is a good time for reconciliation or rekindling of relationships we may have neglected since the last time we wished each other Merry Christmas.

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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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