Yes, and the vagueness of it can frustrate the physician to no end. And while it may turn out that nothing was amiss after all, the reward is in finding the problem starting with that small kernel of information.
That reminds me of the time in my pediatrics clerkship in medical school, when the resident was presenting a case and started out with " the patient is a 7 yo FLK". When I asked what an FLK was, he said "funny looking kid". That "something amiss" gets the physician to consider possible genetic or congenital syndromes in the upcoming differential diagnosis.
I don't generally notice an acute "Look", I more fully recognize the ongoing phase of life that everyone involved has to deal with - adult children, spouses, nieces, nephews. I enjoy becoming part of the support team and helping guide the various participants through it. The emotions experienced are communal ones - shock, anxiety early on. A focus on making sure everything medical that can be done is done. Then the realities of restructuring lives and relationships - this takes time. Grief enters here as people realize the relationship they had is no longer what they thought it was and would be. Readjusting roles. A process.
For an internist, this is a frequent position. Helping the family group see the big picture, adjust to new roles, understand resources and supports - a rewarding but often time-consuming job. Any family or relationship dysfunction gets magnified here - especially between parent-child.
Hospitals don't seem to serve as much a role as they used to here. From my perspective, the systems are overwhelmed, discharge planners are more limited.
Anyone who has a focus or job in this phase of the life experience is needed, now more than ever! The bottom line is that this phase is just a stressful and anxiety provoking period - even for physicians as Adam experienced (and I did as well).
Oh gosh, your definition of productive codependency is my marriage (and so many others, I know) in a nutshell. There are even activities that my husband and I contribute to 100% equally that are so elevated by having us both participate, like dinner conversations with guests.
You have beautifully articulated the recognition of a natural, yet often staggering experience. As an End of Life Doula, half of my practice includes the hidden warriors..men and mostly women, though adult children as well, who care for their loved ones who are moving along the end of life's arc. While identifying the initial stage, "the look" signifies a time of life most of us will pass thru. I have the privilege of every day walking hand in hand guiding thru this little recognized, often medicalized stage of most lives. The bridges to cross, as life irrevocably winds down may be tread more easily when there is a community, person, family, and professionals who remain open thru this unfolding. With support, Grace moves into place.
So beautifully articulated! You have a huge heart. I was a critical care nurse for many years, then did hospice. I used to think of "the Look" as akin to shell-shock, to a lesser or greater degree. Your patients are indeed fortunate, as are your students--and by extension, their patients. Please keep writing posts like this. Medical care can be so dehumanizing, and docs such as you are the antidote.
Oh I misinterpreted The Look at first. The Look I was thinking about was the desperate pleading look you get when you are walking out the door and hear, “Oh, and just one more thing…” Usually a request for opioids or benzos. I have always described you as the professional’s doc since getting to know you here; what I see now is the every person’s doc. What a gift your patients have in you.
Your opening comments resonated deeply with me. I spent 49 years working as a hematologist/oncologist and for most of that time in a large military hospital. I still miss the camaraderie of working with outstanding colleagues (in all departments), as well as the helpful and dedicated nurses, pharmacists, and hospital staff. "The Look" from patients and family members was relatively common in the Oncology Clinic as they came to understand that life as they previously knew it would be drastically different. I was blessed that my patients allowed me to participate in their often very difficult journey. I cannot remember a time when I didn’t enjoy going to work and do miss the work I did but generally don’t miss "The Look".
Writing here as a non-medical person, I just want to thank you for this essay. I am the spouse of a man with terminal lung cancer, and am actively going through the changing of our relationship and experiencing a variety of emotions including guilt. You helped put words to it all and made feel a little bit more normal.
I do not know if the listen option is new but I hit the listen button to hear Adam's post. Wow. Very powerful. You can still hear the pain in his voice describing "the look". I would definitely agree with the other commenters about how fortunate to be a patient of Dr Cifu.
What an amazing job we have. Thank you for always keeping me in touch with the human meaning of the work we do, even is I often struggle to keep it in perspective amidst the competing demands of training (almost done!!), marriage, job hunting, and being a father to a passel of young kids (never done).
Even though you will not miss “the look”, I suspect that its presence (or at least your recognition of its presence) is inextricably related to the possibility of human connection that gives our work such meaning.
There were many patients whom I saw once or twice per year when I was a practicing ophthalmologist. For me, The Look was the face of a woman who had lost her husband within the previous year. I knew upon entering the room that she had lost her husband. Her face would be drained, pale, and flat. It seemed to take 1-2 years for that look to fade. I did not notice this with men who had lost their wives. They were sad, but not as physically affected by their loss.
Another visual sign to me was embodied by a gentlemanly 90 year old Italian immigrant, who always wore a suit and tie to the appointment and got out of the chair to greet me when I entered the room. One day, I entered the room and, while he was still in suit and tie, he did not get out of the chair to greet me. I was immediately struck by that, and I felt that he would not be around next year for his visit. This turned out to be the case.
It is the benefit of the doctor accompanying the patient to the exam room. As a PT, I can't tell you the number of times I have to point out to a PCP that a patient has Parkinson's. The PCP is clueless because they never have the patient move off the exam table. And then add the wife or husband who is hiding what they may know deep down (something is a miss, maybe not a formal diagnostic term).
Thank you for capturing in eloquence my recent thoughts and musings about this very topic. As a nurse and also a daughter of aging parents, this really hits home. I'm sure you know it, but you're a doctor's doctor. Blessings!
Yes, and the vagueness of it can frustrate the physician to no end. And while it may turn out that nothing was amiss after all, the reward is in finding the problem starting with that small kernel of information.
That reminds me of the time in my pediatrics clerkship in medical school, when the resident was presenting a case and started out with " the patient is a 7 yo FLK". When I asked what an FLK was, he said "funny looking kid". That "something amiss" gets the physician to consider possible genetic or congenital syndromes in the upcoming differential diagnosis.
I don't generally notice an acute "Look", I more fully recognize the ongoing phase of life that everyone involved has to deal with - adult children, spouses, nieces, nephews. I enjoy becoming part of the support team and helping guide the various participants through it. The emotions experienced are communal ones - shock, anxiety early on. A focus on making sure everything medical that can be done is done. Then the realities of restructuring lives and relationships - this takes time. Grief enters here as people realize the relationship they had is no longer what they thought it was and would be. Readjusting roles. A process.
For an internist, this is a frequent position. Helping the family group see the big picture, adjust to new roles, understand resources and supports - a rewarding but often time-consuming job. Any family or relationship dysfunction gets magnified here - especially between parent-child.
Hospitals don't seem to serve as much a role as they used to here. From my perspective, the systems are overwhelmed, discharge planners are more limited.
Anyone who has a focus or job in this phase of the life experience is needed, now more than ever! The bottom line is that this phase is just a stressful and anxiety provoking period - even for physicians as Adam experienced (and I did as well).
Amazing piece. Thank you for sharing.
I can’t say anything other than “God Bless You”.
Oh gosh, your definition of productive codependency is my marriage (and so many others, I know) in a nutshell. There are even activities that my husband and I contribute to 100% equally that are so elevated by having us both participate, like dinner conversations with guests.
You have beautifully articulated the recognition of a natural, yet often staggering experience. As an End of Life Doula, half of my practice includes the hidden warriors..men and mostly women, though adult children as well, who care for their loved ones who are moving along the end of life's arc. While identifying the initial stage, "the look" signifies a time of life most of us will pass thru. I have the privilege of every day walking hand in hand guiding thru this little recognized, often medicalized stage of most lives. The bridges to cross, as life irrevocably winds down may be tread more easily when there is a community, person, family, and professionals who remain open thru this unfolding. With support, Grace moves into place.
So beautifully articulated! You have a huge heart. I was a critical care nurse for many years, then did hospice. I used to think of "the Look" as akin to shell-shock, to a lesser or greater degree. Your patients are indeed fortunate, as are your students--and by extension, their patients. Please keep writing posts like this. Medical care can be so dehumanizing, and docs such as you are the antidote.
Oh I misinterpreted The Look at first. The Look I was thinking about was the desperate pleading look you get when you are walking out the door and hear, “Oh, and just one more thing…” Usually a request for opioids or benzos. I have always described you as the professional’s doc since getting to know you here; what I see now is the every person’s doc. What a gift your patients have in you.
Your opening comments resonated deeply with me. I spent 49 years working as a hematologist/oncologist and for most of that time in a large military hospital. I still miss the camaraderie of working with outstanding colleagues (in all departments), as well as the helpful and dedicated nurses, pharmacists, and hospital staff. "The Look" from patients and family members was relatively common in the Oncology Clinic as they came to understand that life as they previously knew it would be drastically different. I was blessed that my patients allowed me to participate in their often very difficult journey. I cannot remember a time when I didn’t enjoy going to work and do miss the work I did but generally don’t miss "The Look".
I have just retired, and the first paragraph is the best explanation of how it feels.
Writing here as a non-medical person, I just want to thank you for this essay. I am the spouse of a man with terminal lung cancer, and am actively going through the changing of our relationship and experiencing a variety of emotions including guilt. You helped put words to it all and made feel a little bit more normal.
Thank you, and I am so sorry. Good luck with the journey. Hugs.
Adam
I do not know if the listen option is new but I hit the listen button to hear Adam's post. Wow. Very powerful. You can still hear the pain in his voice describing "the look". I would definitely agree with the other commenters about how fortunate to be a patient of Dr Cifu.
I recorded all the "reflections." I like doing it (and it helps me with the proofreading).
This is a beautiful essay. Thank you.
What an amazing job we have. Thank you for always keeping me in touch with the human meaning of the work we do, even is I often struggle to keep it in perspective amidst the competing demands of training (almost done!!), marriage, job hunting, and being a father to a passel of young kids (never done).
Even though you will not miss “the look”, I suspect that its presence (or at least your recognition of its presence) is inextricably related to the possibility of human connection that gives our work such meaning.
The human meaning of our work. Wow! Maybe we should rename healthcare Human Meaning Care??! That might help reorient us to care.
There were many patients whom I saw once or twice per year when I was a practicing ophthalmologist. For me, The Look was the face of a woman who had lost her husband within the previous year. I knew upon entering the room that she had lost her husband. Her face would be drained, pale, and flat. It seemed to take 1-2 years for that look to fade. I did not notice this with men who had lost their wives. They were sad, but not as physically affected by their loss.
Another visual sign to me was embodied by a gentlemanly 90 year old Italian immigrant, who always wore a suit and tie to the appointment and got out of the chair to greet me when I entered the room. One day, I entered the room and, while he was still in suit and tie, he did not get out of the chair to greet me. I was immediately struck by that, and I felt that he would not be around next year for his visit. This turned out to be the case.
“Something is a miss” can be a super important chief complaint…
Learning those signs you can see from the door are so important, right?
It is the benefit of the doctor accompanying the patient to the exam room. As a PT, I can't tell you the number of times I have to point out to a PCP that a patient has Parkinson's. The PCP is clueless because they never have the patient move off the exam table. And then add the wife or husband who is hiding what they may know deep down (something is a miss, maybe not a formal diagnostic term).
Something is a miss
Thank you for capturing in eloquence my recent thoughts and musings about this very topic. As a nurse and also a daughter of aging parents, this really hits home. I'm sure you know it, but you're a doctor's doctor. Blessings!
Thank you.
Adam