Tuesday, May 21, 2019

Eating the Schedule

I’ve been thinking it would be nice to have a polished piece of turquoise to carry around in my pocket to remind me of Santa Fe and school; I’d like to buy it there, but so far I haven’t come upon such a thing. Someone suggested a certain store, but someone else said to first visit the Native Americans who sit at the edge of the Plaza to sell various wares. I had a bit of extra time on my way back to the airport—this was the Tuesday after Easter—so I walked over there. A vendor told me that the Santo Domingos sell loose stones, but that they weren’t there because they were still dancing for Easter.

My shuttle driver was one I’d had before, and he is one of my favorites because he doesn’t tailgate. I told him about how all of his colleagues tailgate and about how he is the rare exception. I said none of them seem to have heard the thing about allowing one car length per 10 miles of speed. He said no one does that—that if you leave enough space for a car to squeeze in between you and the vehicle ahead of you, you can be sure someone will do it. (I guess that’s bad.) He said leaving a courteous amount of space causes you to be seen as weak.

He told me that ABQ is second-windiest major airport in the whole country to fly into or out of, because of the wind over the mountains and the Rio Grande; he said Denver is the windiest. As we drove along I-25, we could see clouds to the left and right, almost as if we were on a plane, because of the altitude.

During sesshin, one of our teachers talked about how oryoki helps us to treat everything with care: the cup, the doorknob, the book. I found myself doing this once I returned home, and noticed how pleasing it is compared with rushing around doing things carelessly.

Back at work, I found myself consciously asking myself, “What else is here?” and noticing more about people: their posture, their facial expressions, what they were doing with their hands.

It had gotten to be a bad habit of mine to sit in front of the computer in the morning for an unduly long time before going off to see patients, which has often made me feel guilty. After returning home, I decided to “eat the schedule,” as they say in Zen: to do what absolutely needed to be done on the computer, and then get going to my units. (To eat the schedule is to follow it precisely. I don’t have a precise schedule to follow at work, but if I did, nowhere on it would it say to goldbrick for 90 minutes in the morning.) So far I have found that, instead of being exhausted, applying energy seems to generate more energy. It feels good to know I’m doing what I’m supposed to be doing, and to be able to report at the end of the day that I saw 17 patients instead of seven.

Another thing I changed was to start sorting my patient list by length of hospitalization rather than room number, which leads to much more walking around the unit, which I think is good. I start with the people who have been there longest.

One morning, Hammett inspected his breakfast briefly and walked away lowing mournfully to himself. I think he was thinking, “I can’t believe that person gave me cat food to eat.”

At County Hospital in palliative care rounds, the current fellow (physician) talked about hoping family members could “entertain some preparedness around the end,” which I thought was a nice way of putting it. We discussed an Asian family where all the children except the oldest were at peace with not pursuing aggressive treatment for their parent; someone in our meeting said there may be a cultural expectation that the oldest son in an Asian family will make sure all treatment options are tried. It was also mentioned that if a patient is on chronic opioids for pain management, that may cause him or her not to be considered for an organ transplant, though this may be an arbitrary criterion, and maybe not fair.

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