What comes next

​One of my patients had a major event, and very nearly died. It was very touch and go, and after several months, she is finally on the path to recovery, and I was a little surprised that she pulled through, because of all of my patients, she is the most accepting of death. She's been a widow for years, and we frequently have talked about how she is ready to go. So I was surprised to see her clinging to life with such tenacity. She is not going without a fight, the person I had thought to be the most eager to have her ticket punched. 

Life is funny sometimes like that. On the news sometimes, you see people ready to commit suicide, and at the very moment they are ready to leap, they grab onto the edge desperately. There's a line in "Crime & Punishment" by Dostoevsky where he says:
... where was it that I read of how a condemned man, just before he died, said, or thought, that if he had to live on some high crag, on a ledge so small that there was no more than room for his two feet, with all about him the abyss, the ocean, eternal night, eternal solitude, eternal storm, and there he must remain, on a hand's-breadth of ground, all his life, a thousand years, through all eternity - it would be better to live so, than die within the hour? Only to lie, to live!
I don't know what comes in the next life, but I don't have much expectation for what remains for me in this one. Maybe I will have a different perspective when I am in my eighties, but if I look at my life honestly, I am already coasting in neutral. I really wonder if when my time comes, will I also grab onto the edge?

5 minutes

There is a lot of research and publications about different interventions during patient encounters. A brief smoking cessation intervention, a brief psychological assessment, a brief social stressor history, a targeted exam to identify depression, get up and go, cognitive evaluation, MMSE, MoCA, GAD7, PHQ9...

When I went to a productivity seminar, the speaker noted something very straightforward. The only truly fixed quantity we have in life is time. Everything takes time. Sleep takes time, eating takes time, fun takes time. There is nothing in life that we do not value with time, and there is only a limited time that we have, in a day and in a life.

I have 15 minutes to make a change in a person's health. That is my fixed quantity. In that time, there are things that have to happen, things that can be quicker or slower, and when everything is tallied up, I have -3 minutes. It is no longer a question of which brief intervention I can fit in, but what required thing can I cut out? Can I skip diabetes management this time? Can I ignore the BP until next visit?

So when I am less than enthusiastic about your presentation on a 5 minute intervention on fall risk or a new screening tool for domestic violence, please understand that I agree it's important, but is it more important than a BP of 185/105? Is it more important than signing a patient up for a patient assistance program?