I have too many important tasks during my workday to leave anything to chance in the hazy, slanted dawn. Failure is not on my schedule for tomorrow. So tonight, I will once again pack a lunch, lay out my clothes, and set up the coffee pot.
Before arriving at work in the morning, I will know who I will be seeing and—often—why they are coming to me. If, for some reason, I haven’t looked in advance, I do so at 5:30 a.m. when I roll over in bed. I do this while petting my dog, Trixie, with one hand and inspecting my schedule with the other. Thus begins a well-choreographed launch sequence. From this point onward, I have a roadmap for where the day’s journey will take me, but I am clueless about how it will go.
After so many years of this routine, I consider my office appointments a circuit, one which, in effect, makes my workday similar to what I envision a milkman doing. As I execute my plan, I make a preordained set of stops. Knowing what looms around the corner means that I am constantly gearing up and emotionally preparing for conversations that, viewed through this lens, are inevitable.
Because the demands of my “delivery schedule” are predictable, I have decided to operate my life in a reciprocal pattern. I often eat—almost—exactly the same lunch daily while seated at my desk. I have acquired this collection of quirky habits to, perhaps, perform my best or, honestly, simply survive. To say that I am highly regimented is an understatement, a form of tyranny that, in the strangest of ways, has proven to be simultaneously liberating. Since I am no longer burdened with small choices like lunch, I am free to focus on the road ahead. Or, more specifically, the person in front of me.
Some of my patients have needs that are, in the grand scheme of things, small. Their visits with me are largely social, and the energy expended in treating their asthma, high blood pressure, migraines, eczema, and whatnot is, after twenty years of doctoring, pretty easy. These light-hearted moments feature grandkids on their phones and kids on mine. With hugs and smiles, it’s so enjoyable I would do this for free. By being prepared, this kind of visit affords me the time to share with them my son Liam playing the piano. “What’s Isaac learning on the banjo these days?” was a question from last week. “Is Eliza performing in Hadestown?” I smile and nod.
What is wildly unpredictable, however, is the emotional terrain I may cover, and these landmarks are never found on the roadmap. While I know that I will be seeing Gwen at 2 p.m., it’s entirely possible our conversation steers into uncharted territory. Something may have happened in her life recently, or, equally likely, today may be the day that she unearths some ancient trauma and tosses the shards into my lap. I don’t ask for this, but I expect it to happen. And, if not Gwen, it will be someone else. I make a new “delivery” every thirty minutes.
This is the rhythm of a mid-career internal medicine doctor. By virtue of being trusted and wise, I mean that when I stop and leave the milk bottles on the porch, patients often have their emotional empties ready for me. It’s what we humans do, at least when there is another caring person with open arms, ready to take some of the refuse away.
I used to struggle with this arrangement, wondering why it had to be thrust upon me. Now, I embrace this role—no, this intimate opportunity. This sharing and unloading is what the heart of internal medicine means to me. On the surface, it may seem like I specialize in blood pressure and cholesterol medication. And I do, in fact, treat these conditions. Some medical students might justifiably think that I am forever looking at family photos on cell phones, always skimming the surface with cocktail party chit-chat. But nothing could be further from the truth.
When light moments predominate, and such bright yellow “deliveries” do exist in the clinic, these are the opportunities for me to set my own bottle down and attend to whatever is needed. I thirstily gravitate towards them as they are the ones that fill my own empty bottle, the ones I don’t exchange. Do I drink from this vessel, or do I pour out its contents for others? I have yet to answer these intertwined questions and likely never will. I do know that my bottle is mostly metaphorical, but on heavy days, I feel the heft of its emptiness and hear the clang as it is filled with shards.
Ryan McCarthy is an internal medicine physician.
