Whole-Hearted for the Hole-Hearted

Sometimes I think about the things that I will miss about deployment: the lonely seven mile run around the flight line, the corny AFN commercials, and the unscheduled appointments and the time to sit and really listen to patients. But most of all, I will miss the medical technicians. Of all the things that bring me joy on this deployment, the technicians are at the very top of my list. They sit at the front desk down the hall from my office. I can hear them arguing, laughing, and teasing each other about their goals, test results, weights, ethnicities, their marriage problems, religions, and physical fitness test scores. They whittle and sharpen each other, building and breaking tirelessly. Nothing is sacred, and nothing is spared the scrutiny of their razor-like minds. To walk in on their exchanges is to be subjected to their rough love of each other. They love to be roughed up as well. They like being challenged and quizzed. When they present a patient they like being forced to state what they think is going on and what we should do about it. I challenge and quiz them, both to find their blind spots and fix them, but also because I need their help. The better they understand some of the complexities of medicine the better they hold me (and other providers) accountable, and the better they protect the patients. They take it further; wanting to know what the diagnosis was on that guy with the belly pain and how I could tell. They want to know why the patient left crying. By allowing the technicians to hold me accountable I become a better physician because I am forced to see if I truly understand it myself. They greet patients with a stunning intensity. If someone wants to see a doctor they have to get through the technicians’ defense. Sometimes someone will get an attitude with them and foolishly try to bully their way through. All their divisions are dropped instantly and the room congeals into a phalanx of spears and sharp words. “I know you didn’t just say that to my airman,” the Sergeant says, standing up and dropping all memories of the fact that she was just teasing that very airman about the strange Mexican candy his family had sent him. “Why should I let you see my doctor when you come in here like that?” I am not the base’s doctor. I am not the military’s doctor. The technicians claim me as their doctor. I am transformed into some sort of oracle that is guarded by sphinxes. If you do not answer their riddles correctly, you cannot pass. I have no idea how many problems they address at the lowest level that I never see. I have no real idea how much they triage and protect me. In their defense of me, and they stake their claims on me. They claim a piece of my heart as their own space. When I treat them well, their loyalty is breathtaking. Technicians seem to derive part of their identity from the physician they work with. I overhear them talking about “my doc back home.” I love it when I come on shift and they greet me with “there is my doctor.” Some have tattoos of red crosses or caduceus. One of my former techs e-mailed me to tell me that he was getting one of my quotes tattooed on his arm. I was horrified and deeply honored in equal parts. Medical technicians monitor their doctors carefully and vice versa. At the beginning of a shift we size-up everyone’s moods. I check to see who is refusing to make eye contact, and they comment when I look tired. When we have an emergency, I can feel their eyes measuring my response. When I show fear, they get nervous. They watch for signs of frustration, uncertainty, and exhaustion. Sometimes they tell me to go get lunch and refuse to give me the next patient’s chart until I take care of myself. They warn me when a patient might be trouble. I need their faith in me because our hearts are porous things. We don’t simply pass through the lives and pain of others: their lives and pain pass through us. Sometimes this etches new lessons. Sometimes it punches new holes in our hearts. The patients’ pain flows into me. Most of the time, I am able to bear it. Sometimes I am not. My technicians have seen me angry, and they have seen me frustrated. Once or twice, they have even seen me crying privately in my office. Sometimes, when there is a lull with no patients, one of them will leave the check-in desk where their wild pack has its den to speak with me privately. Being invited into their lives is one of the highlights of my day. I love to listen to them! I listen to the way they talk, watching their eye contact, and nervous ticks. I watch for when their eyes or tip of their nose turns pink. One flushes on her neck when she is about to cry. Sometimes I ask questions to show that I am listening or to challenge them to consider an alternative thought, but mostly I just listen without waiting for my chance to talk. If they have a specific question, I wait for them to form it. They tell me about their fears for their parents and about trying to take care of them. Some send them money each month. One tells me about his father in jail, another about trying to stop his father’s abuse and both about how they want to be better men. They tell me about growing up in part of our country and parts of the world that are so Family Medicine Residency Program, 307 Boatner Road, Suite 114, Eglin Air Force Base, FL 32542. doi: 10.7205/MILMED-D-14-00596