— NARRATIVE ESSAYS —

My Row of Flashlights, and Other Talismans

Elizabeth A. Fleming, MD

Fam Med. 2022;54(5):396-397.

DOI: 10.22454/FamMed.2022.553468

I’m packing up. As I prepare to move on to the next phase in my career, I struggle to know how to think about my last 7 years as a community-based family physician. I have been told to value metrics: patient satisfaction percentiles, relative value unit targets, HgbA1c goals met, and missed. But what I will carry with me are the stories my patients have shared and the physical reminders of the lessons I have gleaned by caring for them.

I will miss my little corner of the large multispecialty clinic that has been my work home since I graduated residency. It is where I pumped breastmilk to feed my own babies while catching up on result notes or paused for the sip of coffee to fuel my next visit. It is where I filled out FMLA forms for new parents and one woman with a brain aneurysm I wish I had found on imaging before it ruptured.

This physical space where I became a physician has bolstered me before phone calls to discuss cancer diagnoses and one especially difficult conversation with the mother of a woman who died too young. She had recurrent unresponsive episodes and despite ordering every test I could think of, I was unable to find a treatable diagnosis before she had the episode that ended her life. I was devastated. My hand trembled as I dialed, but her mom simply thanked me for making her daughter feel heard and cared for.

Out the window I have watched snow piling on the Wisconsin sidewalks and informally evaluated my patients strolling, shuffling, rushing, or stumbling their way to the clinic entrance. More recently I have observed my colleagues dressed in PPE swabbing noses for COVID-19 through rolled down windows, blue plastic gowns flapping on windy days. Twice I have felt the thud of a car driving into the brick wall below my office, a consequence of having the handicapped parking spots against the building.

I will miss the view, but I’m bringing along the objects I have collected.

There is a row of flashlights on my windowsill. The first arrived for me and my nurse years ago with a note “to light the long winter darkness.” We couldn’t decipher the signature, but that next fall our 78-year-old tennis player brought them in person. He brings a bag of flashlights to nearly every visit now. At first I declined, but he suggested they could be useful to my children at bedtime or to me trekking out to my car on late work nights. So now they light blanket forts in my living room and locate lost items under the seat of my van. I knew he was struggling when he arrived without a token for me or my staff. He had progressive dizziness and became more discouraged with each normal test result. He reluctantly agreed to decreasing his medications, but the first change gave him insomnia. Decreasing his antidepressant induced suicidal thoughts. I felt completely inadequate, but he trusted me because of our earlier visits addressing each item he carefully wrote in a spiral bound notebook. I stared at those flashlights, willing them to spark a cartoon lightbulb over my head. I wanted a clear, fixable cause, but I have learned there isn’t always a discrete diagnosis. Gradually he felt better, one incremental change at a time.

There is a sticky note with two tiny faded arrows that I often find myself staring at when puzzling over a patient. I tacked it up years ago because I simply could not remember whether bupropion or buspirone might increase anxiety. It remains there because it reminds me of how many tiny things I have learned, each fact eroding the imposter syndrome I carried when I first arrived.

There is a card with watercolor sunflowers from a patient thanking me for guiding her recovery from a severe concussion. I got to know her kind and generous spirit as her symptoms progressed from debilitating headaches and dizziness, to fatigue and anxiety, to a simple note in her medical history. When schools closed due to the pandemic, she offered to care for my children while teaching her third-grade students from home. I declined, but at the time when it seemed like no one outside of health care understood how bad it could get, when I was allotted one surgical mask per week while the guideline was an N95, when we didn’t know children would mostly be spared, when going to work felt so risky, but we all kept showing up because our patients needed us, her thoughtfulness brought me to tears.

There is a toddler handprint transformed into a dinosaur, a contraband candle wearing a tiny crocheted hat, a broken seashell, and laughing faces are tucked into frames, because as a young mom it is impossible to fully separate my personal and professional life.

There is a poem dedicated to the transgender community, written by a dear patient in her 80s. Her three daughters started seeing me after she died. I keep learning about her life even though it has been years since our last visit. I remember the relief expressed in the deep exhales after I shared my support of their decision to let her go when it was clear her organs were failing. Her identical twin daughters schedule their visits with me together. Their chatter warms my exam room, and I can imagine the kitchen table alight with the chirping of girlhood during family meals decades before. I miss them already.

There is so much I am leaving behind, but I will keep a flashlight or two at my new desk. I hope students will ask me why, so I can tell them about the place I learned to be a doctor and the people who taught me. I will explain that they are grounding artifacts from my early career, reminders that the meaning and joy in medicine comes from building relationships with the people we have the privilege to care for.

Lead Author

Elizabeth A. Fleming, MD

Affiliations: Department of Family Medicine & Community Health, University of Wisconsin, Madison, WI

Corresponding Author

Elizabeth A. Fleming, MD

Correspondence: SSM Health Dean Medical Group, Department of Family Medicine & Community Health, University of Wisconsin, 1821 S. Stoughton Rd., Madison, WI 53716. 608-213-6981. Fax: 608-260-6366.

Email: Elizabeth.ann.fleming@gmail.com

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By Louis Verardo, MD, FAAFP (retired)  /  Posted 5/6/2022

Dr. Fleming, the piece you wrote was eloquent and lovely. Thanks to your vivid descriptions of patients and events, I was able to visualize the clinical scenarios you outlined as well as the emotional responses they elicited. Hang on to those memories as you move forward in your career; they will energize and sustain you as a physician. Thanks again for taking the time to write of your experiences, and best of luck in your new position.