I did a little \”self care\” earlier this week. Â I did it by not caring for myself.
I went to the doctor.
I was sitting in the waiting area for my appointment and saw the mother of one of my patients. Â \”Why are you here?\” she asked.
\”I have a doctor\’s appointment.\”
She got a curious look on her face, asking, \”Don\’t you doctors just take care of yourselves? Â I thought that was what doctors did.\”
We do take care of ourselves, in fact we do it far more often than we should. Â Being your own doctor allows for a lot of denial. Â When you spend your day advocating healthy lifestyles after you had trouble finding pants would fit in the morning, denial is necessary. Â Do as I say, not as I do.
I realize that this is hypocrisy; that is why I was at the doctor on Monday. Â My patients have noticed my expanding waistline, commenting on it more than I would wish. Â Certainly my pants get in the way of denial as well, not forgiving the fact that I have been under a whole lot of stress. Â Pants don\’t accept excuses.
So I found myself in the unfamiliar experience of being the patient. Â Instead of closing my mind and emotions to my own body, I had to frankly assess what I was doing to it. Â Standing on the scale was as frank of an assessment as I would ever want.
\”So why are you here today?\” asked my doctor, a man 5-10 years my junior.
\”For a physical. Â I just need to start taking better care of myself. Â I\’m getting fat.\” I said, feeling a bit ashamed at being \”outed\” to a colleague (as if he didn\’t notice my pants).
\”Yes, you are up 10 pounds from last visit,\” he said without judgement. Â \”I think you know what comes next.\”
\”Yes I do; I have given the same talk numerous times each day. Â I need to be eating better.\”
\”What about exercise?\”
I smiled. Â \”To be honest, I don\’t really like exercise all that much. Â I won\’t say that I don\’t have time for it, because I know I do.\”
He seemed to appreciate my honesty, and we launched into a discussion of how to find an exercise routine that would be easier for me to do. Â Going to the gym takes too much preparation, and it requires that other people (some of whom are my patients) see me in my non-exercised body. Â I suppose this may be a good thing in some ways, as they would see me as practicing what I preach, but that doesn\’t salve the ego enough. Â Going to the gym gives me too many excuses to put it off for a day.
Then we talked about exercising at home. Â I have some weights around the house, but they presently serve only as things to kick accidentally and test my resolve to avoid cursing. Â I\’ve gotten exercise equipment in the past, and it has done really well at holding laundry. Â I am afraid to invest too much money in something that will serve as a guilt-trip.
Still, I know I have to take the plunge. Â Reasons are reasons, but eventually they become excuses. Â My pants don\’t listen to excuses.
In some ways it is harder to be a patient as a doctor. Â Despite the fact that I know what symptoms to look for, know what food to eat, and what the latest information is on exercise, it is hard to listen to my own voice. Â When sitting in the exam room, doctors are trained to shut off part of their emotions. Â This is necessary because we have to face a whole lot of pain, doling out some of that pain ourselves. Â I have to be brutally honest with people who I want to like me. Â I have to order painful procedures and even perform them at times. Â When looking for pain, I have to inflict some of it (as in \”does this hurt?\” while grabbing, poking, or pushing on a spot of declared pain).
Beyond that, my job necessitates that I watch people get sick, suffer pain, and die.  I am holding back an irresistible force.  Everyone eventually gets sick and dies, and I have been tapped with the task of helping them through it, and often shepherding them through to the end of their lives.  I have to do so with compassion and kindness, but I also have to emotionally survive, because there are thousands of people depending on me to do this job.
So when I am tasked to become the patient, I have to put down defenses that have been constructed over decades. Â It\’s not easy, but I have to do this.
I can\’t make excuses.
My pants won\’t accept any.
So what are you doing? I have the same problem. I only seem to be able to exercise for a few weeks or months before something happens to change my routine. Also, I love to eat. Even when I’m eating good food I eat too much. It’s been a constant fight for 40 years. Help!
Just walk. It’s the easiest way to start. And anyone can do it. Especially you!
Wonderful post! I’m a year away from becoming a Family Nurse Practitioner and have been musing about how to detach emotionally from all the suffering I see. Glad I’m not a freak 🙂
Also, read an awesome book by Gina Kolata about the history of exercise. Basically she says studies show that if you don’t get a benefit from exercise you’re not likely to do it. I’m one of those myself sadly. I’ve never felt any improvement physically from consistent exercise but now I’m afraid if I don’t start doing it I’m going to be bed bound by 60! And fear/guilt/shame is not a good motivator.
Anyway, your post mattered to me so thanks!
Sasha
My little city has a “Walk with the Doc” program in one of the parks. You could do something like that: Let all your patients know that you’re going to be walking in a particular location at a specific time for the sake of your own health, and invite them to join you. Making appointments–especially appointments with others–and having exercise buddies are both ways of increasing commitment. You can wear street clothes so no one has to see you in gym clothes, and make it clear to your patients that the occasion is strictly social (no walking-path consults) to maintain confidentiality and to make it a more pleasant experience for all involved.
You can also keep a log of your walks; as we say in public health: what gets measured gets done. Nothing fancy; a dimestore notebook for time or distance walked or a simple notation on your calendar would do it. After a while, gaps in the log can start to bug you enough to get you out the door.
Consider taking-up bicycle riding with a buddy or a few buddies. No need for a fancy racing machine or spandex (although biking shorts reducing possible chafing). A hybrid model (upright, but relatively light) and a helmet are all you need to get exercise and see the world. Riding with friends helps keep the commitment and provides diversion from the exertion.
Let us know what ends up working! For me, exercise is the easy part – get it done in a little bit of time.
Unfortunately, we have to think about food and what we put in our bodies the entire day! Oh how I miss the teenage years when I could eat with reckless abandonment without consequences!
Do you enjoy any sports at all?
Hey Rob, I totally empathize with you. Nurses often have the same difficulties and hypocrisies, trust me. I agree with those who suggest having buddies who will walk or ride bikes with you on a regular basis. It means you hold each other accountable to your commitment to exercise, plus it’s a great stress breaker too, both the physical activity and the socializing. I did the walking with some neighbors of mine, made great friends and lost nearly 50 lbs. Ha!
I’m a gastroenterologist who at age 50 underwent what I advise all of my 50 year old patients to endure. It was an ‘enlightening’ experience being on the other end ofthe scope. I think that GI fellows should all have one during their training so they can understand personally the joys and excitement of the cleanout, the probing examination and the hangover.
You are one of the best, most honest writers out there. You did a great job relating a struggle many of us share but also explaining how being a doctor makes it even more difficult. My doc and I had the “creeping weight gain” talk for about three years before my husband and I got serious about dieting, then later, exercise. I was like you–exercise equipment is great for holding laundry. We now have an elliptical and I actually use it. I hate it and I always get bored and want to quit 10 minutes in, but I like the way I feel when I’m done. (Music helps!) I wish you the best in making your peace with exercise and I hope you blog about this again to let us know how you’re doing.
As someone who has lost a lot of weight, then gained some back, I know where you are coming from. Get started in small ways, where possible. I work in a building that has six stories and a basement below. I work in the basement. I’ve gone from taking the elevator to using the stairs. My building is one of four in a quad arrangement, and I take the long way around to get to the destination. I have a kettlebell in my cubicle for lifting/swinging, and a jumprope that I take everywhere with me so I can get the heart racing. It’s the little things you do to start that will eventually add up, and make adding more exercise easier.
You always feel better when you know you are taking care of yourself.
Brilliant! As a heart attack survivor, I’ve been thinking that all doctors should get to be heart patients at some point. Right now, there’s a popular patient forum running on WomenHeart: The National Coalition For Women With Heart Disease called “Stupid Things Doctors Say to Heart Patients. This list would be hilarious if the comments weren’t all true and tragically inept, like the woman who was told she merely suffered from “Housewife Syndrome” (that was right before she ended up in hospital with CABG x2).
The truth is: until you’ve sat on the other side of the exam room table, you just have no clue even if you do have the letters M.D. after your name. It’s like a celibate priest offering couples marriage counselling or a childless shrink advising how to raise teenagers. Your experience, simple yet profound, will likely make you an even better doc. GOOD LUCK!
PS I love Finn’s “Walk With A Doc” idea here, don’t you?
Take a class (one you can fit in your schedule). The externalities — the fact that you have paid, the presence of an instructor who expects your presence, the social nature of a class — these are powerful behavioral motivators. I like martial arts* myself, but heck, whether it’s a cycle or crossfit or ultimate frisbee, anything will work, so long as it is an activity that you enjoy enough that you can look forward to going to class.
(*I like martial arts because you get to hit people and you don’t have to go to jail. Just sayin’)
nice! enjoyed your writing and stories. keep on!
I liked it so much in fact, I referenced you in my own blog post :). Keep talking!
Thanks! Glad you enjoyed it!
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My wife is a nurse and she has to deal with the same kind of situations on a daily basis. Sometimes taking our on advice is the hardest thing to do. Congrats on being able to look at yourself in the mirror and realize you need to change. Good luck and keep us posted!