last week of clinic

Last week was my last week at my clinic at SFGH, our county hospital, and while I feel ready to finish residency, I would stay in clinic here forever if I could. It can be frustrating, and can feel futile, and much less concrete than other parts of medicine. But saying goodbye to my patients and to the flow of clinic, despite there never really being a true flow to the hectic lumps and bumps of SFGH clinic, was and is hard. We often don't feel the role we can have over the course of intermittent 15-minute visits with people, but bonds form in all sorts of odd ways. And in particular for the patients who have few other support systems in place, I feel lucky to have been able to offer a base, as flimsy as it often was.

I feel so lucky to have borne witness to the paths of my patients. Over three years I've gained about a hundred primary care patients, maybe half of whom who come regularly enough for me to say that I know them; the other half I know of and for that I also feel lucky. I've seen a woman through the diagnosis and treatment of gastric cancer, and seen the strengths and vulnerabilities of her family through it, and seen the anxiety and worry that lingers afterwards. I've seen a man with physically debilitating inflammation of his skin and heart become emotionally debilitated by living with his illness, and see him slowly recover inside and out as he received treatment. I've seen young people my age whose characters have been shaped by a lifetime of battles fought by their bodies struggling through illness and bad environments. I've seen people with about a dozen life-threatening issues to their name continue to plug along, giving hope that we have time and space to tackle each in turn. I've felt so lucky to accept the stuffed animal, orchid, half dollar, scarf, and tears that patients give so, so generously in their farewell visits. Feeling that it is misguided to dismiss these physical gifts as material, because I know how it feels to want to be able to encase so much in something you can hold.

It's true that coming into residency you have little sense of what it is that you're actually going to do, and it's true that a lot of your visions are refuted by reality. But coming into primary care feeling that this is what I want to do because it's the most holistic perspective has proved itself right many times over. This doesn't mean that it always possesses the most holistic solutions, or even individual solutions to all of a person's needs, but it does mean that you see a whole lot of people. I will really miss the people who let me see them.