Opinion
A PIECE OF MY MIND Meaghann Weaver, MD St Jude’s Children Research Hospital, Memphis, Tennessee.
Corresponding Author: Meaghann Weaver, MD, 262 Danny Thomas Pl, Memphis, TN 38105. Section Editor: Roxanne K. Young, Associate Senior Editor.
Recognizing Pride My dad could mop the auditorium floor better than any white coat–clad parent on the stage. At the conclusion of the white coat ceremony, the dean of my medical school displayed the generationals on stage to the sound of much enthusiastic applause. Cameras flashed. Families beamed. The podium boasted related pairings of father-daughter, mother-son, fatherson, or mother-daughter physician alumni in sterile, white coat armory. The same cursive surname embroidered the chest pocket of a triple threat: grandpa, dad, and son. I glanced over at my dad, humbly seated in the dark distance of the auditorium. And my chest boasted pangs of gratitude and pride. I was raised by a janitor. It started with shame. Adolescent awkwardness isn’t eased when your dad is the one scrubbing the school toilets. Truth be told, he didn’t have to push the heavy cafeteria tables to sweep the lunch crumbs or straighten the desks each night. He had a paying day job in a faithbased charity. But my family was living in western Africa, and while most of the other missionary families sent their children to boarding school, my dad wasn’t ready for the distance. Hearing that a private diplomat school provided free tuition to the children of employees, my dad worked as a janitor in the school at night to afford our schooling in the day. This arrangement imposed a sleep schedule in clear violation of the current medical work hour restrictions logs. Mom packed his breakfast in my lunchbox, always accompanied with a sweet note, which I handed off to my dad in the school hallway before he changed from his janitor garb to collared shirt and tie for the day’s work each morning. Recognition of my dad’s sacrifice has evolved into admiration of his work, extending to keen appreciation of the quieter roles in the hospital system. As Galileo realized the earth is heliocentric, I have come to realize the patient’s lived hospital experience is patterned by those who physically spiral the patient (a patient-centric orbit). The astronomical realization is that the surrounding bodies aren’t always wearing white coats. As a physician, I have daily tasks that may align patients’ overall course and tilt their outcomes, as I research treatment options, check labs, review imaging, write chemotherapy, arrange supportive care, and coordinate care. And yet the patient’s daily hospital experience does not exclusively orbit around my “critical” role because this role is often necessarily remote (workroom tasks vs patient-room presence). The gravitational pull of the computer screen’s online orders and electronic documentation eclipses physical presence among patients. Although I deliberately return to patients’ rooms throughout the day, the nursing aide who collects the urine bottle every two hours has a consistent, continual trajectory, and the man collecting the trash from the room three times per day is as steady as planetary
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spin in the patient’s lived hospital experience. Certain roles, sometimes the less applauded roles, are a reliably formative presence. Pride, to include pride in one’s work, is often contemplated negatively, a tilted amour propre. Certainly, bragging and self-glorification represent harm. I think of pride in the context of a social force, as a family of lions is called a pride. In the nuzzling, the repertoire of roaring, and the circling of cubs, the lion pride recognizes social belongings. There is pride in each member’s role as a lion pride acknowledges origins. A lion pride recognizes companionship and social presence as a collective community force. My dad, a smart guy with two master’s degrees, says that in his custodial work, people often worked or talked around him. Maybe with the demands of his interactive day job he appreciated this space, this quiet presence. But maybe he was also hinting at the sensation of feeling invisible to a rank-run and productivity-dominated world. Recently, I walked down the narrow hospital stairwell while the custodial worker patiently held the door with a sincere smile, despite my being at least 17 steps slow. She balanced a red hazards trash bag in one hand and grasped the door handle with the other. I wondered about her pride. Who was her family? Had she held children? From where did she come? In what ways does she benefit the hospital family or influence patients through her service? One of my premedical professors in college asked the name of the daytime custodial worker on our midterm exam. The gunners, the ones who stayed awake all night to memorize the pentose phosphate pathway, groaned that such superfluous trivia should be extra credit, at best. My biochemistry professor reminded us that medicine was about observing details, about acknowledging the dignifying particulars of the humans nearby. Sometimes the figures in the hospital hallways acknowledge us in unique ways. Not in a J. D. and Janitor humorous “Scrubs” episodes way. But in the way the environmental services worker in the bone marrow transplant unit quietly brought a warm blanket and cup of coffee to my desk when she saw I was charting on a difficult case late in the night. In the way the solid tumor unit evening janitor left a breakfast dish at the potluck table in the morning because she had seen the sign for nursing appreciation day. In the way the evening custodian rescued my ID badge from its stuck location in the elevator shaft (of all inopportune times for the clip to fail!) by applying his mighty Mississippi fishing practice to recover the badge. In the way the person who ties the heaping hazards bags, empties the full sharps boxes, and attentively scrubs the countertops in Clostridium difficile– positive patient rooms still manages to warmly smile in greeting when entering the patient’s room. JAMA December 18, 2013 Volume 310, Number 23
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a J H Quillen College User on 05/29/2015
2505
Opinion A Piece of My Mind
We miss out when self-pride in our important jobs prevents us from seeing the essential roles of others. I was walking to the parking lot after finishing a consultation at an urban hospital at the same time as an environmental service worker. Tired, I was tempted to ignore her hair gray with age, bent back, and shuffled gait, which accompanied my path. As a new fellow, new to the profession, and brand new to the city of Memphis, I decided to ask her about her hometown to fill the awkward quiet as we walked the sidewalk together. I was half-listening since my mind was still focused on the importance of my medical recommendations from the recent consultation. She shared a recommendation for the city’s tastiest dry ribs. Pointing westward, she referenced passing the Lorraine Motel as a driving landmark. Noticing my widening eyes, she paused to gauge interest. Her story unfolded, Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for the
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a story that involved a childhood in a rural share field, the birth of four boys, and participation in the Memphis Sanitation Strikes with her brother (a trash collector) that fateful spring in 1968. That is a pride worth recognizing. My dad came to tour the hospital one afternoon during his recent visit to the States, and, as many who see a pediatric cancer unit with new eyes, he teared up. Although gentle, my dad is a pretty stoic guy, and so this extent of emotion wasn’t familiar to either of us. Assuming he was touched by the resilience of the children pushing along IV poles while skipping or the incredible spirit of the parents keeping up, I was surprised when he said his tears were because he was so proud of me for being part of this work. But it was his unannounced sacrifice, his work ethic, his quiet strength that instilled the values to enable this work. That is my pride.
Disclosure of Potential Conflicts of Interest and none were reported.
JAMA December 18, 2013 Volume 310, Number 23
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a J H Quillen College User on 05/29/2015
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A PIECE OF MY MIND Meaghann Weaver, MD St Jude’s Children Research Hospital, Memphis, Tennessee.
Corresponding Author: Meaghann Weaver, MD, 262 Danny Thomas Pl, Memphis, TN 38105. Section Editor: Roxanne K. Young, Associate Senior Editor.
Recognizing Pride My dad could mop the auditorium floor better than any white coat–clad parent on the stage. At the conclusion of the white coat ceremony, the dean of my medical school displayed the generationals on stage to the sound of much enthusiastic applause. Cameras flashed. Families beamed. The podium boasted related pairings of father-daughter, mother-son, fatherson, or mother-daughter physician alumni in sterile, white coat armory. The same cursive surname embroidered the chest pocket of a triple threat: grandpa, dad, and son. I glanced over at my dad, humbly seated in the dark distance of the auditorium. And my chest boasted pangs of gratitude and pride. I was raised by a janitor. It started with shame. Adolescent awkwardness isn’t eased when your dad is the one scrubbing the school toilets. Truth be told, he didn’t have to push the heavy cafeteria tables to sweep the lunch crumbs or straighten the desks each night. He had a paying day job in a faithbased charity. But my family was living in western Africa, and while most of the other missionary families sent their children to boarding school, my dad wasn’t ready for the distance. Hearing that a private diplomat school provided free tuition to the children of employees, my dad worked as a janitor in the school at night to afford our schooling in the day. This arrangement imposed a sleep schedule in clear violation of the current medical work hour restrictions logs. Mom packed his breakfast in my lunchbox, always accompanied with a sweet note, which I handed off to my dad in the school hallway before he changed from his janitor garb to collared shirt and tie for the day’s work each morning. Recognition of my dad’s sacrifice has evolved into admiration of his work, extending to keen appreciation of the quieter roles in the hospital system. As Galileo realized the earth is heliocentric, I have come to realize the patient’s lived hospital experience is patterned by those who physically spiral the patient (a patient-centric orbit). The astronomical realization is that the surrounding bodies aren’t always wearing white coats. As a physician, I have daily tasks that may align patients’ overall course and tilt their outcomes, as I research treatment options, check labs, review imaging, write chemotherapy, arrange supportive care, and coordinate care. And yet the patient’s daily hospital experience does not exclusively orbit around my “critical” role because this role is often necessarily remote (workroom tasks vs patient-room presence). The gravitational pull of the computer screen’s online orders and electronic documentation eclipses physical presence among patients. Although I deliberately return to patients’ rooms throughout the day, the nursing aide who collects the urine bottle every two hours has a consistent, continual trajectory, and the man collecting the trash from the room three times per day is as steady as planetary
jama.com
spin in the patient’s lived hospital experience. Certain roles, sometimes the less applauded roles, are a reliably formative presence. Pride, to include pride in one’s work, is often contemplated negatively, a tilted amour propre. Certainly, bragging and self-glorification represent harm. I think of pride in the context of a social force, as a family of lions is called a pride. In the nuzzling, the repertoire of roaring, and the circling of cubs, the lion pride recognizes social belongings. There is pride in each member’s role as a lion pride acknowledges origins. A lion pride recognizes companionship and social presence as a collective community force. My dad, a smart guy with two master’s degrees, says that in his custodial work, people often worked or talked around him. Maybe with the demands of his interactive day job he appreciated this space, this quiet presence. But maybe he was also hinting at the sensation of feeling invisible to a rank-run and productivity-dominated world. Recently, I walked down the narrow hospital stairwell while the custodial worker patiently held the door with a sincere smile, despite my being at least 17 steps slow. She balanced a red hazards trash bag in one hand and grasped the door handle with the other. I wondered about her pride. Who was her family? Had she held children? From where did she come? In what ways does she benefit the hospital family or influence patients through her service? One of my premedical professors in college asked the name of the daytime custodial worker on our midterm exam. The gunners, the ones who stayed awake all night to memorize the pentose phosphate pathway, groaned that such superfluous trivia should be extra credit, at best. My biochemistry professor reminded us that medicine was about observing details, about acknowledging the dignifying particulars of the humans nearby. Sometimes the figures in the hospital hallways acknowledge us in unique ways. Not in a J. D. and Janitor humorous “Scrubs” episodes way. But in the way the environmental services worker in the bone marrow transplant unit quietly brought a warm blanket and cup of coffee to my desk when she saw I was charting on a difficult case late in the night. In the way the solid tumor unit evening janitor left a breakfast dish at the potluck table in the morning because she had seen the sign for nursing appreciation day. In the way the evening custodian rescued my ID badge from its stuck location in the elevator shaft (of all inopportune times for the clip to fail!) by applying his mighty Mississippi fishing practice to recover the badge. In the way the person who ties the heaping hazards bags, empties the full sharps boxes, and attentively scrubs the countertops in Clostridium difficile– positive patient rooms still manages to warmly smile in greeting when entering the patient’s room. JAMA December 18, 2013 Volume 310, Number 23
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a J H Quillen College User on 05/29/2015
2505
Opinion A Piece of My Mind
We miss out when self-pride in our important jobs prevents us from seeing the essential roles of others. I was walking to the parking lot after finishing a consultation at an urban hospital at the same time as an environmental service worker. Tired, I was tempted to ignore her hair gray with age, bent back, and shuffled gait, which accompanied my path. As a new fellow, new to the profession, and brand new to the city of Memphis, I decided to ask her about her hometown to fill the awkward quiet as we walked the sidewalk together. I was half-listening since my mind was still focused on the importance of my medical recommendations from the recent consultation. She shared a recommendation for the city’s tastiest dry ribs. Pointing westward, she referenced passing the Lorraine Motel as a driving landmark. Noticing my widening eyes, she paused to gauge interest. Her story unfolded, Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for the
2506
a story that involved a childhood in a rural share field, the birth of four boys, and participation in the Memphis Sanitation Strikes with her brother (a trash collector) that fateful spring in 1968. That is a pride worth recognizing. My dad came to tour the hospital one afternoon during his recent visit to the States, and, as many who see a pediatric cancer unit with new eyes, he teared up. Although gentle, my dad is a pretty stoic guy, and so this extent of emotion wasn’t familiar to either of us. Assuming he was touched by the resilience of the children pushing along IV poles while skipping or the incredible spirit of the parents keeping up, I was surprised when he said his tears were because he was so proud of me for being part of this work. But it was his unannounced sacrifice, his work ethic, his quiet strength that instilled the values to enable this work. That is my pride.
Disclosure of Potential Conflicts of Interest and none were reported.
JAMA December 18, 2013 Volume 310, Number 23
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a J H Quillen College User on 05/29/2015
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