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Autobiography in Five Short Chapters by Portia Nelson is a poem that I like. I have seen it come up in counseling, self help, and addiction circles. A short search brings up the following:



I walk down the street.
There is a deep hole in the sidewalk
I fall in.
I am lost...
I am hopeless.
It isn't my fault.
It takes forever to find a way out.


I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don't see it.
I fall in again.
I can't believe I'm in the same place.
But it isn't my fault.
It still takes a long time to get out.


I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in...it's a habit
My eyes are open; I know where I am;
It is my fault
I get out immediately.


I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.


I walk down another street.

I have written two poems that are influenced by this:
Chaos and Balance/Off Balance,currently residing at June 2, 2009.

I wrote Chaos first. In Chaos I was thinking that being a physician, married, two small children and doing rural medicine including obstetrics, was insulating me against feeling because there wasn't time. Medicine is very good at training us to set our feelings aside and deal with the emergency. Think of all the other jobs that we celebrate as heroes and heroines where feelings must be set aside: the military, fire fighters, police, medicine, all sorts of first responders, the coast guard. Growing up in a household where a child learned to hide and numb feelings, one route is to use substances to continue numbing. Unfortunately these are addictive. Another route is to be the rock, the pillar, the person who can manage a crisis. I had realized that I chose the second route. There is still an accounting to be paid: eventually we either have to unstuff the feelings or else we become ill. Sometimes both.

Balance/Off Balance is the second poem. As I started to unstuff my feelings and talk about them and deal with them, it affected relationships. I was changing and some friends and family did not like it. I was supposed to remain quiet and strong and not talk about feelings. The poem ends with loved, cherished and safe, but I did not feel that way. Some of my poems are a map of where I want to get to, not a map of where I am. In 2009 I was still very much in the second stanza and felt that I had a long way to go.

I like Portia Nelson's version, but it is very gentle. It's just a hole in the street. Why would you fall in after the first time? But addiction is like that and enabling is like that and really, relationships with people are complicated. And Luke 4:22-23 says

22 And all bare him witness, and wondered at the gracious words which proceeded out of his mouth. And they said, Is not this Joseph's son?

23 And he said unto them, Ye will surely say unto me this proverb, Physician, heal thyself: whatsoever we have heard done in Capernaum, do also here in thy country.

Medical people should be an example of health and take care of themselves. I think US physicians in general suck at it. The training is to do the opposite and be tough. In residency when I was post call on internal medicine and had admitted 6 people, I would be in clinic. I had a woman complain of a headache. I thought, yeah, but right now I am hurting all over. I am worse off than you. The training is to think of her as lesser because I could continue and finish my 36 hours or more. But I told her to rest, drink enough fluids, reduce stress and also thought, this is a really stupid way to train people to give care, by working them until they want to drop.

With the military and PTSD, the dues now have to be paid. We can't send people on four or five tours of duty and expect them to be ok. Pills won't fix it. They all have families who love them and who are told to be proud of them and who want them well. For each of the hero and heroine jobs, we will have to allow time for self care, time for family, time for healing. A recent journal reported that their survey of burnout shows that among primary care providers, those reporting burn out has risen from 40% to 50%. Is that a crisis yet? What are we going to do if everyone burns out?

Burnout among physicians 2015: http://www.medscape.com/viewarticle/838437

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