As physicians, there is a lot we give to our patients on a daily basis. We lend our expertise, our time, our compassion. We lend our hearts and minds. We receive gifts in return as well. The privilege of walking alongside our patients and their families as they journey through illness. We often receive the gratitude of those we have served. Of course, we receive financial compensation for the work we do as well.
And yet I think about all that is not given and received. I think about the words that we hold inside, doctors and patients alike. The emotions kept silent. The embraces not shared. The tears not shed. We worry about crossing lines, letting too much in or out, perhaps showing too much vulnerability. We put up walls to protect us from our own humanity and the humanity of others.
Perhaps what is kept inside most, is the love between doctor and patient. I don’t mean romantic love. I mean the deep love I feel for my patients’ well being, and my desire to help them get better. I mean the love I feel for the ways in which they trust me and let me in. I mean the love I feel as I watch them step into themselves and own a mental health diagnosis, as well as own the commitment to acceptance and recovery.
We don’t talk about love much in medicine. But we should. It is what drives me to return a page at 3 am. It is what motivates me to squeeze in a crisis patient when I need to get to a family commitment. Love is what keeps me here, despite late-night paperwork and board recertification demands, and hours on the phone with insurance companies.
But how do we express this love in a way that feels true, appropriate, and respectful of the necessary boundaries between patient and physician?
For me, the answer was poetry.
I often write poems about my patients. The words, phrases, silences, all that was said and unsaid, distilled into poems that downloaded onto the pages of my journal every night. Some of those poems made it to my blog, some to social media, some shared with medical students or residents when appropriate. Some even shared with my patients.
Often, it wasn’t the poem itself that mattered. It was the broader message. That this work requires our full presence and our whole heart if we are to hold onto the meaning of what we do. That our patients and their experiences of illness and health are important, and we are listening and reflecting long after they have left the room.
A couple of months ago, on a late night whim, I decided to make poetry cards for my patients. These were small square cards, burgundy in color, on thick stock. On one side was a photo I took of the towering California redwood trees during a recent visit to a retreat center. On the other side was a prose-poem-wish that read:
“My wish for all my people tonight: that you find your space, deep within your own heart, where love is abundant and ever-present. Space where you know you are home and you belong. Your place to be free, laugh the loudest, cry the hardest, and always discover the words closest to your truth. This magical space lives deep within you, and has been waiting for you, doors wide open and light always on. I hope we all return there again tonight, and never leave, even when the sun rises tomorrow.”
My thought was that the cards could serve as a transitional object of sorts, from one appointment to the next. Or that patients could put them in a purse or bag or use them as a bookmark, and might find the words or image reassuring during challenging times.
I placed a small pile of the cards on the table that sits between me and my patients, right next to the tissues and the clock. And a few more went on my receptionist’s table. They often went unnoticed, unless I picked a card up and directly handed it to my patient, or my receptionist did the same as my patient’s checked out of their appointments. It often made for an awkward moment. I didn’t want patients to feel obliged to take one. I didn’t want to feel self-promoting. I was a little embarrassed about sharing my photography and my words.
And yet, invariably, when I could put my own fears to the side and simply share the cards in the spirit of love in which they were created, my patients’ faces would light up. They were touched to receive a gift to carry away, one that reminded them that they were indeed cared for and remembered. Some asked to take an extra for a friend or family member who might benefit from having one tucked away.
As psychiatrists, we are generally not supposed to accept gifts from our patients, from fear that it might contaminate the psychiatrist-patient relationship. But I have never turned down homemade cookies, or a heartfelt card, or a drawing. These are expressions of love and gratitude, and I received them as such.
My poetry cards are my gifts to my patients, also an expression of my own love and gratitude for the privilege of walking alongside them through life. I don’t know what words and photos will be next when this particular pile of cards runs out. I don’t know if they will be a different size or shape or color. What I do know is that they will come from the heart, and that is what matters most.
Monisha Vasa, MD is a board-certified General and Addiction Psychiatrist. She is in private practice in Newport Beach, California, and also teaches medical humanities and topics related to physician well-being at the UC Irvine School of Medicine. She is currently a scholar of Narrative Medicine at Columbia University, and enjoys playing with words on her blog. Dr. Vasa is a mother of two children, has a house full of animals, and enjoys long-distance running and mindfulness practices when she needs a break from all of the above. Vasa is a 2018–19 Doximity Author.