You Don't Ever Let Go of the Thread
Authors: Rana Lee Adawi Awdish
Journal: Annals of Internal Medicine (2021)

On Being a DoctorNovember 2021You Don't Ever Let Go of the ThreadFREERana Lee Adawi Awdish, MD, MSRana Lee Adawi Awdish, MD, MSHenry Ford Health System Detroit, MichiganSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-3542 Audio Reading - “You Don't Ever Let Go of the Thread” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads “You Don't Ever Let Go of the Thread” by Rana Lee Adawi Awdish, MD, MS Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail There's a thread you follow. It goes amongthings that change. But it doesn't change.People wonder about what you are pursuing.You have to explain about the thread.But it is hard for others to see.While you hold it you can't get lost.Tragedies happen; people get hurtor die; and you suffer and get old.Nothing you do can stop time's unfolding.You don't ever let go of the thread.—William Stafford, “The Way It Is”There was no need to review her chart. Over 10 years, we had navigated her cancer diagnosis, lung resection, disease recurrence, radiation, and recovery. She had knitted the softest-imaginable sweaters of delicate ivory yarn for my son, born 2 years after we lost our first pregnancy. Her church's prayer list included the name of the daughter we had lost.I was smiling under my mask as I walked into the examination room.She rolled her eyes, then glared at me. She pulled down the hospital-mandated mask and spat, “Oh, take off your mask! What are you afraid of? You of all people should know this is all just a moneymaking scheme.”The force of her words set my jaw on edge and caused the muscles in my upper back to knot. My limbs tensed, and a rhythmic rage of blood flushed my face. My nails dug deeply into the meat of my palms. Her voice took on the propagandistic tone of cable news commentators, then the pitched fury of the picketers outside school board meetings and threatening intonation of the militia. Her features were no longer distinct; she blurred and swirled in a haze of flags and guns and co-opted mottos. My body, my choice. Live free or die. She was The Mob. I stood stunned and unmoving as she pried open my darkest space and unpacked all that I had lost as if it were sheets of paper dolls. A mentor, a friend, an uncle. Cautious, brave, kind people, and they were dead. Yet, she was still here.I watched the last, loosely held feathers of my compassion fall to the floor. I considered gathering them, wanting only to start an all-consuming fire.I couldn't save anyone.My eyes stung and swelled, and my heart sank in an undertow of hurt and shame. Her words had released a tide of grief that filled the charged space between us, trapping us in the small cinder-block room.We were spun of different thread.I wanted to believe in the illusion that there would be no cost to harboring the anger and indignation, although I knew those emotions would incinerate me. Even as I stood, awed by their potency, I knew. I took a breath and, in the stillness of that breath, found a millimeter's width of distance between myself and the anger. After another breath, I found the smallest bit more. I softened my jaw, and I knew; I couldn't act from that place. I would commit not to the anger but to myself.I allowed myself to move toward her, and her face reemerged. I sat down across from her and said only what was true. “I do have a desire to protect myself based on what I've seen, and I will be keeping the mask on. And I wonder, what has this experience been like for you?”Her son had barred her from seeing her grandchildren because she wasn't following safety protocols. No one had a right to force her to accept the vaccine. She would disown him first. She didn't need anyone. Anger turned to anguish as she admitted to feeling “disposable” and even “abandoned” at times. Her sharp edges softened; our grief vibrated between us, in different frequencies but recognizable to each other.“I wish I could make this all go away, for both of us,” I offered, my voice shaking. “More than anything I wish that.” I pressed the backs of my hands up to my eyes to push back the visions and memorials and agonizing denial. “The losses I've seen have been unbearable.” She patted the damp back of my hand.She recounted her fears; I listened; and, eventually, she was able to reframe getting vaccinated as a choice she could make—not because of the government but because it aligned with how she wanted to spend her time: with her grandchildren. She left saying, “My son thinks he knows me. Well, I'll show him!” She had rediscovered her agency. I sat in the corner and cried.“I was worried you were putting down roots in there,” the medical assistant said when I finally walked out of the room. “You have three other patients waiting.” I stared at the doors, wondering whether the rooms would be the kind of stifling, airless places that could extinguish anything good in me.Moment by moment, we must pick up the thread of who we know ourselves to be.We are so accustomed to healing others. In exhaustingly difficult times, when we have nothing left to give, we treat the person in front of us with all the humanity we can muster. We treat the shooter and the victim. The drunk driver and the passenger. We have been trained to refrain from judgment. Medicine trained us in altruism and self-sacrifice, too. We may be so practiced, so adept at this that it's become a hindrance. We may have lost sight of how to care for ourselves.If we are to find a way to live our values in these demoralizing conditions, we must hold on to what is nonnegotiable in ourselves—not because it will heal our patients but because that is the only path back to ourselves. And, yes, it will be a different version of ourselves that we meet on the other side of this. One that no longer believes in neat and tidy happy endings. Someone with perhaps a little less faith and who is still in need of healing, but potentially—hopefully—someone we recognize. If we hold on to the thread.You. Don't ever let go of the thread. Comments0 CommentsSign In to Submit A Comment Nancy McCulleyRetired RN, CCRN, Trauma Neuro ECMO ED.30 September 2021 Strengthen the thread so it will not break…our souls hearts and minds Strengthen the thread so it will not break... our souls,hearts and minds. I'm having a difficult time coming to grips with health care workers who refuse to get vaccinated especially when they come face to face with the outcome everyday. Donald E Williams, M.D., FACP, FACEnone15 November 2021 Thank you for a powerful account on being a doctor I have been retired for sixteen years, so I have not been in the fray of caring for patients with COVID. But this article brought me back in a visceral way to memories of long past encounters with difficult patients, dealing with an array of life's challenges. Thank you to the author for such a moving account of today's challenges. Alan D JusticeOcmulgee Physicians28 September 2021 Practicing Physician This essay really hits home. I have been in private practice for 30 years. I have had to have this same conversation every day. At the end of day - above all do no harm. Alan D Justice MD.FACP Disclosures: ocmulgee physicians Author, Article, and Disclosure InformationAffiliations: Henry Ford Health System Detroit, MichiganCorresponding Author: Rana Lee Adawi Awdish, MD, MS, 2799 West Grand Boulevard, K-17 Pulmonary, Detroit, MI 48202; e-mail, [email protected]org.This article was published at Annals.org on 28 September 2021. PreviousarticleNextarticle Advertisement Audio Reading - “You Don't Ever Let Go of the Thread” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads “You Don't Ever Let Go of the Thread” by Rana Lee Adawi Awdish, MD, MS Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetailsSee AlsoGetting Through COVID-19: Keeping Clinicians in the Workforce Eileen Barrett , Susan Thompson Hingle , Cynthia D. Smith , and Darilyn V. Moyer Metrics November 2021Volume 174, Issue 11Page: 1628-1629 ePublished: 28 September 2021 Issue Published: November 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...