I really like Van Morrison.  If I need to be lifted up on a Friday afternoon I’ll play a greatest hits album and will quickly be smiling.  One of my favorite songs is Days Like This. You would expect when someone says “there will be days like this,” they are complaining about days when everything goes wrong and you just have to endure to the end, hoping that “the sun comes up tomorrow.”  But this song takes a different tack:

When it’s not always raining there’ll be days like this
When there’s no one complaining there’ll be days like this
When everything falls into place like the flick of a switch
Well my mama told me there’ll be days like this

When you don’t need to worry there’ll be days like this
When no one’s in a hurry there’ll be days like this
When you don’t get betrayed by that old Judas kiss
Oh my mama told me there’ll be days like this

I had been listening to that song this morning and then walked into the exam room and was greeted with a big smile.  She’s a widow in her early 70s who has been my patient for around 20 years.  She takes care of her grandchildren, loves kids in general, and tries to keep active, despite significant arthritis in her back.

She is also valium for my soul.

Our discussion had a level of familiarity and friendship, her sharing about her granddaughter’s inquisitive mind and me returning stories of my son’s insatiable appetite for information when he was young (as a 4 year old he peppered me with questions about “welcome centers” for about 20 minutes).  We both laughed at each other’s stories, and I took care of her medical problems and preventive medicine.  She complained when I scheduled her colonoscopy.  The visit ended with the inevitable hug, and an “I love you” from her.

Valium.

There is something unique in the relationships I have with my long-term patients.  I’ve practiced now for 23 years, and many of those who followed me to this practice were with me from very early on.  There’s a level of intimacy when you know about a person’s health problems, live through emergencies and tragedies in their lives, and have the responsibility of medical care for a person.  It goes beyond friendship and familiarity.  It really feels like family, but without the complications family brings.

Being a doctor involves hearing a person’s narrative and working to direct it in the best direction possible.  There are some people for whom I have become a significant part of their narrative, and others whose narrative I know better than anyone else.  It’s a bond that doesn’t happen anywhere else.

The dangerous thing is to let the familiarity get in the way of the objectivity I have to keep to do a good job with them.  But the depth of my care for these people can also serve as a motivation, as I want to keep them around as long as possible … for selfish reasons.  Doing the job for this long, I’ve figured out that balance, but I’m always extra aware of my lack of objectivity with these people.

The opposite kind of patient, the ones who somehow find ways to get under my skin, pose an equal threat.  I have to put aside my own emotions and give them all the best care I can give.  Something about giving care to them will often ease the negative emotion.  I guess it’s hard to feel bad toward someone while doing good for them.  In truth, I don’t have many patients I feel negative toward.  Compassion and judgmental attitudes aren’t good bedfellows.

But I do let my emotional walls down some with certain people.  Some people just make me smile when I see their names on my schedule.  It’s not that they are nicer than other patients (although that is often true); it’s more that they look at me with different eyes: eyes that are grateful, relaxed, and interested in me as a person.  My blood pressure goes down after spending time with these people.  They care for me and give me emotional care I am grateful for.

It’s one of the greatest privileges of my job.

When everyone is up front and they’re not playing tricks
When you don’t have no freeloaders out to get their kicks
When it’s nobody’s business the way that you want to live
I just have to remember there’ll be days like this

When no one steps on my dreams there’ll be days like this
When people understand what I mean there’ll be days like this
When you ring out the changes of how everything is
Well my mama told me there’ll be days like this

Rob Lamberts is an internal medicine-pediatrics physician who blogs at Musings of a Distractible Mind.

Image credit: Shutterstock.com