A Physician’s Plea.

A message rekindled for the caregivers of today…


A medical student. A simple question.

“How am I supposed to go on caring?”

At the time, suggestions abound.
Work-life balance. Self-care. Hobbies.
Remembering our initial calling.
Remembering we still make a difference.
Remembering our love for medicine
and the privilege we have as caregivers.

But then the realization-
I don’t know the answer.

I only know that I have witnessed around me-
at every stage of training and practice-
evidence of emotional exhaustion.
Dissatisfaction.
Disillusionment.

Burnout.

So this is my plea…

Continue reading “A Physician’s Plea.”

You Are Appreciated

Tendered is this touch that
saves and soothes, comforts and mends–
strength sustained by the pulse of
a heart constrained by its own calling,
the candle within softened by flame,
its waxen tributary a remembrance to
the joys and sorrows, gains and losses
…moments treasured in the care for mankind.

A few lines from Healerin recognition of the efforts of all the nurses, techs, and everyday caregivers out there.
Thank you for being you.
💙

 

A Bitter Thanksgiving.

Many of you may recall having read these lines from past Thanksgivings; it is a retelling of a visit I had with one of my patients during this time of year—a woman whose life and struggles were unlike mine in many ways, but who nevertheless taught me many things about courage and integrity.

I hope you enjoy these words, and have a blessed Thanksgiving week.

•      •      •

Allow me to spin upon the spindle
a tale of an encounter true.
A patient once, a homeless mum,
her words now shared with you:

The hour of autumn arrives anew
when mirth and feasts abound.
But let me confess my days to you,
true gifts which have been found…

The steady cadence of my heart,
voice to praise when souls fall dark,
vision to behold each fresh day’s start-
For this, I am thankful.

The assured exhale of every breath,
joys gone by, its memories kept,
cloth to shield from winter’s death-
For this, I am thankful

Days when I can veil my cries,
days I look you in the eyes,

to know on night lies brighter skies-
For this, I am thankful.

So for this…I am thankful.

Chronic Pain & You

By Phoebe Chi, MD, MPH

Do you live with chronic pain? Does pain seem to infiltrate every area of your life, to the point that it is affecting your quality of life?

If so, you are not alone. 

In this post, I will focus on the complex condition that is chronic pain and discuss how it works. In a subsequent post, I will present a “Chronic Pain Toolbox” that will equip you with essential self-management skills, so that you can be empowered to regain the quality of life you deserve.

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Continue reading “Chronic Pain & You”

Taking Control of Diabetes [part 2]

By Phoebe Chi, MD, MPH

In my previous posts, I discussed both the importance of knowing your Diabetes A-B-C’s as well as how to easily meal plan your way to health. In this post, I will focus on another essential skill that everyone with diabetes needs to have: how keep your blood sugars at an optimal level. By knowing what to watch for and knowing how to react, you can be empowered to truly take control of this condition. 

So let’s get started!

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Continue reading “Taking Control of Diabetes [part 2]”

The Ketogenic Diet: Fact or Fad?

By Phoebe Chi, MD, MPH

Over the past year, there has been a lot of buzz surrounding the ketogenic diet. Not surprisingly, I have encountered many questions regarding them. What is it? Is it safe? Would I recommend it? 

Despite the recent trend, a “ketogenic diet” is actually not new at all. In the 1970’s, Dr. Atkins popularized his low-carbohydrate diet for weight loss that began with a very strict two-week ketogenic phase. Over the years, other popular diets also incorporated similar approaches for weight loss. But in medicine, we have been using this method for almost a century to treat some forms of epilepsy, especially drug-resistant types in children.

As you know, whenever something is popularized, much information goes around—some accurate, some not so accurate. The purpose of this post is to summarize for you what the medical community actually knows so far through its research on the health effects of ketogenic diets. This post is not to make a stance either for or against, because as you will see, there are both pros and potential cons (as well as some unknowns); rather, I simply want to equip you with the right information in order to empower you to make the best decision for your personal situation.

So let’s get started!

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Continue reading “The Ketogenic Diet: Fact or Fad?”

Complete Relaxation Techniques

By Phoebe Chi, MD, MPH

For many, relaxation means zoning out in front of the TV or staring at the phone at the end of a stressful day. But this does little to reduce the damaging health effects of stress. To effectively combat stress, it is necessary to activate your body’s natural relaxation response. One way to do this is by practicing effective relaxation techniques. Fitting these activities into your life can help reduce everyday stress, boost your energy and mood, and improve your mental and physical health. When combined with effective stress management skills, you end up with a powerful, stress-busting combo. 

This guide provides relaxation techniques that are best performed when you have 15 minutes and a comfortable environment, but which are extremely effective at countering your body’s stress response (by eliciting the “Relaxation Response”)….as a result leading to calming effects that can linger for days. 

Don’t have 15 minutes? Then you need these quick relaxation techniques. 

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Continue reading “Complete Relaxation Techniques”

Stress and Your Health

Do you often feel stressed out? Do you have things in your life that frequently cause you high levels of stress? Do you find that you have little time for self-care, or you spend most of your time caring for others? Do you just feel burned out?

If you do, you are not alone. 

In this post, I will talk about the effects of stress on your body—both short and long term (chronic) stress—and then introduce the most fundamental aspect of Stress Management: the identification of the causes of your stress and the identification of unhealthy coping mechanisms. In subsequent posts, I will discuss tried and true Stress Management techniques that have been proven to work in both lowering stress and decreasing the harmful effects of it on your health.

This post is the first in a series on Stress Management. The other articles are listed below for your convenience:

Taking Control of Stress (part I)
Taking Control of Stress (part II)
Instant Relaxation Techniques
Complete Relaxation Techniques

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Continue reading “Stress and Your Health”

Taking Control Over Salt

By Phoebe Chi, MD, MPH

Do you enjoy salty snacks? Or find yourself reaching for the salt shaker at the dinner table?

If you do, you are not alone.

In general, people in the U.S. eat much more sodium (salt) than they should. But why is it important to watch the amount of sodium you eat? It is because the more sodium you consume, the higher your blood pressure becomes. Some conditions, such as certain heart and kidney problems, cause the body to hold onto sodium, which causes extra fluid to build up in the body. This extra fluid forces the heart to work harder. Therefore, if you live with chronic conditions, it is especially important to control the amount of sodium you eat.

So how much sodium should you be consuming in a day? While for most people it is recommended to not go over 2,300 milligrams (mg) of sodium, for those with heart conditions, high blood pressure, diabetes, and kidney problems, the daily limit for sodium is even lower– 1,500 mg ideally, but no more than 2,000 mg.

Pop quiz: How many milligrams of sodium are in one small teaspoon of salt?

Answer: 2,300 milligrams!

1 teaspoon of salt
=
2,300 mg of sodium

Surprised? What this means is that adding any salt to your meals can cause you to go over the recommended limit. So is it even possible to stay within this recommended limit? Yes–it is possible! And today I will discuss exactly how.

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Continue reading “Taking Control Over Salt”

Eating for Heart Health

By Phoebe Chi, MD, MPH

Your diet, as most people know, is a big component of healthy living. There’s even much truth to the idiom, “You are what you eat!” However, when it comes to living with chronic conditions such as heart disease and diabetes, having the right diet becomes even more important, as the foods you eat can make a huge difference not only in the symptoms you experience day to day, but also in the way your chronic conditions progress over time.

What this means is that with the right diet, when incorporated into a healthy lifestyle, you can take control of your health by helping to slow or even reverse your chronic conditions. When it comes to heart disease, being on a heart-healthy diet can protect you against further narrowing of your heart’s blood vessels and in turn help prevent further complications such as heart attack and strokes.

In this post we will discuss what types of foods make up a heart healthy diet. In a subsequent post, we will cover the essentials of a specific component of heart healthy eating–the low salt diet.

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Continue reading “Eating for Heart Health”

5 Signs of Vitamin D Deficiency You Should Know

By Phoebe Chi, MD

Vitamin D deficiency. Do you know the symptoms? How do you know if you are at risk of having it? What should you do if you are, and how do you prevent it? These are the questions I will answer today…

Continue reading “5 Signs of Vitamin D Deficiency You Should Know”

10 All-Natural Ways to Improve Your Blood Pressure

By Phoebe Chi, MD

Perhaps you’ve been told you have “high blood pressure.” Or maybe you checked it yourself one day and noticed that it was 146/90. What now?

Today I will discuss some ways in which you can improve your own blood pressure without taking medications. But before I do, let’s first answer an important question: What is hypertension and what’s the big deal?

Continue reading “10 All-Natural Ways to Improve Your Blood Pressure”

Got a Headache? Be Sure To Try This.

Do you ever get headaches? Do you sometimes hesitate to pop a pill or find yourself without pain medications? I do. Therefore, I would like to share with you a technique that I find personally helpful for head and neck discomfort that you too can easily do anytime, anywhere.

Continue reading “Got a Headache? Be Sure To Try This.”

A Caregiver’s Heart.

I cared for you even before we met.

As letters meandering the page
sketched the contours of a portrait,
I looked forward to meeting you.

As I enter the room,
I sense a fragrance of time past,
of struggles endured years before–
silent whispers of a mind’s unrest
reflected through misted eyes.

As we talk,
of a soul’s facade you steadily disrobe.
Words of suffering and pain, joy and pride-
each syllable a silvered twine
weaving your life’s story.

I examine you.
Your heart-
that fulcrum deeply hinged.
A bittersweet thrum
of a battery strong but worn.
Your lungs-
that which sing
their own melodious song,
a lulling carol
invigorated with each exhale.

From there a journey it becomes
to strengthen you, to make you whole.
A disease conquered, a valley bridged.
A hollow filled, a life restored.

We work together.
As ripples in a wake,
your life affects mine,
for the same heart that aches
when you suffer
rejoices with you
in your victories.

Because this is what I treasure–
the chance to care for you,
to walk with you.

It is a privilege.

So thank you for letting me.

The Waning.

You already knew.
Gaze unflinching, 

you told us to say the words.

Amyotrophic lateral sclerosis

A. L. S.

Despite sparse questions,
your eyes revealed
an understanding far deeper
than our answers-

that with one moment,
robbed were you

of the years ahead,
of memories awaiting,
of stories belonging to you.
Now lost.

Strength dissolving,
your conviction remains
unscathed.

You savor
each passing sunrise.

Each caress, each step.
For you know.
As your legs cease to support,
arms stop to comply,
you still feel
your child’s touch.

Absorbing her love.
Pretending
you don’t care the roles
have been reversed

as you yearn
to return her embrace.

As its hunger ascends,
You treasure
the remaining days.

Every word, every smile.
For you know.
Soon it
consumes your voice,

drains your visage,
until all that is left is
the silence
of a vacant mask.

Unable to reflect
your thought’s grin,

your heart’s laugh,
your soul tears
as you blink away the moisture.

As your breaths
increasingly betray you,

you are not defeated,
for the flames
of your bruised spirit
are not quenched,

and you give thanks
for the time you had,

even as your body dims
and you fade away.

Little Luis.

 

• Monteagudo, Bolivia •

Meet little Luis– otherwise known as Puppydoc’s partner in crime. He was a regular visitor to the hospital, as his father had tuberculosis and was undergoing a long course of treatment. 

Since the hospital was a scary place for Luis, we always tried to make the visit pleasant for him. In short, what began as innocent playing quickly escalated to mischievousness as little Luis and Puppydoc discovered the treasure that was the hospital candy stash.

As you can imagine, the supply rapidly diminished into their tummies.

(But don’t worry; Puppydoc later replenished the stolen candy with a fresh stock of Dum Dums.)

😊

 bolivia-boy

A Lunch with a Gift.

I had lunch with a homeless man.

But not just any man. An elderly man, a former high school teacher…and a former patient of mine from a charity clinic where I used to work.

It happened as I was driving through downtown, stopped at a light beneath an overpass. Suddenly, I heard a familiar voice. 

“Hi Doc!”

Since we were both hungry, we did the natural thing: we went for lunch at a nearby cafe. Despite intrigued glances from others, we had a lovely lunch. Looking back, it may have been one of the most enjoyable lunches I’ve ever had.

A few days later, I was contacted by the clinic who informed me that I had received a letter from a patient. And here I will share it with you—in a form put into verse by me but which maintains its original wording:

Dear doc, you have been so kind to me.
Why, you even took me to lunch.
I wish I could give you something in return,
but I know I don’t have much.

So I write these simple words to you
in hope that on those days
that they’ll make you smile and give you strength
and peace in many ways.

You are a doctor to many,
but an angel you have been to me,
who encouraged, cared, and healed my pain,
and a light you made me see. 

I am sad that you are no longer my doc
but am glad that you are my friend.
And I hope we can keep in touch
until the very end. 

So why did I share this? Because I was “challenged” by Liz to give a gift to someone. But now I realize—I don’t think I succeeded in giving anything to anyone.

Rather, the gift was given to me

 

 

Tea Time!

• Vinto, Bolivia •

When Puppydoc wasn’t working, she would step right next door to her home…the hospital guesthouse.

There, waiting for her, would be the afternoon tea…fully prepared and served by her host sister, little Esterita…

esther.JPG

…and together, they would then chat about their busy day while they took their tea…with two lumps of sugar, of course.

😉

Meet Mayra.

mayra.jpg

• Vinto, Bolivia •

 One of our littler and bravest guests, I first met Mayra when she was admitted to the hospital with cerebral malaria (a severe form affecting the brain) a month prior. Few thought she was going to make it, but as one can see here…she absolutely did. 

From scared little girl to fearless survivor, she quickly became an inspiration to those caring for her. Bonding over children’s songs and Dum Dums (green apple was her favorite), our friendship grew, and she quickly became a ray of light in my day.

Here, she is pictured at one of her follow-up appointments with—what else—
—but a green apple Dum Dum. 

😀

Angel.

Cursed by thirst unquenchable
beneath a blazing sky,
Gaze distorted by burning mist
that wells within her eyes.

A soul that weeps before mankind,
for truths they’ve never seen–
of jaded hearts, of bleeding flesh,
of wounds that lie between.

An angel to the suffering,
a guardian to the soul,
a seraph who has fallen,
sunk within beguiling shoal.

Who will deliver this fragile one
whose eyes, too worn to cry?
To lift her up on mended wings
into the blazing sky?

The Hug.

Bitterness.
Each word, a slap.
Each consonant, piercing.
Bursting in like a winter’s storm,
you permeated into our lives.

We wanted to help you,
but we only came to fear you.
Many shook their heads in pity.
Some avoided you.
Others talked about you.

Contempt.
Each gesture, scornful.
Each insult, stinging.
My attempts to talk to you
only seemed to anger you more.

You terrified me. Yet I yearned.
To see. To know. To understand.

I knew you were frustrated.
Your disease, unforgiving.
Slowly devouring. 
I knew you were discouraged.
Your body, powerless.
Slowly succumbing.

But why wouldn’t you let us care for you?

Desperation.
Each day, the same.
Each encounter, fruitless.
You turned us away again and again. 
Until one day I confronted you. 
I asked you why.
And you told me.

I know you don’t really care. This is only your job. 

My job.

It all made sense.
The bitterness. The coldness. The distancing.
I understood.

Stepping forward,
leaving behind the pride, the decorum, 
my arms enclosed around you.
The fear escaping my racing heart
only after you made a move to wipe your eyes.

You then collapsed into me.
My shoulder, an insulation
to the sound of choked sobs.

You never said a word.
But in your cry I heard your anguish.
I heard desolation.
I heard relief.

Things were never the same after that.

Your bitterness was gone.
Your words, softer.
Your eyes, warmer.
You allowed us to care for you, 
remaining strong even
as your disease progressed.

Until one day, like winter’s snow, 
the seasons beckoned for you to leave.
But even then, as you faded away,
you reminded me of the day everything changed–

The day I gave you the hug. 

The Patient.

I met you my intern year. I remember the first thing you said to me.

“I don’t care to be here.”

With a countenance creased from decades of hardship, a gait staggered from illness, eyes steeled by sufferings, your restrained presence betrayed a sheath impervious. I believed you previously had poor experiences in similar settings, because you told me so. I knew you didn’t trust me, because you told me so.

Our first few visits were stippled with formality. I posed questions; you answered. But they weren’t your answers, but perhaps words you knew I wanted to hear. I half expected you to stop coming. But you never did. Instead, you continued to sit there, guarded, a portrait of cordiality and cautiousness. 

And then one day it happened.

Your hard gaze glimmering with moisture, I saw your shell break. I then got to know you. Little by little, visit by visit. I learned of the pain you endure. I learned of your frustrations, your desperation…your despair. I learned of your deep heart. I learned many things. But most importantly, I learned who you were.

Months went by. Gradually a smile seeped through. Your eyes now shined as you shared with me the latest on your life. A life that I was lucky enough to now be a part of. But suddenly three years pass, and as my time with the clinic comes to an end, we now must part. On your last visit, I sense your frustration and anguish again, and I think I understand why. As you cry I reassure you that everything will be okay. But as I comfort you I am struck by a sudden surge of emotion, and I also struggle to keep my composure.

You see, through this experience, I have started to recognize what it is you were talking about. An understanding. A connection. Some may even say a friendship. Because even though you may not know this, I am now happier because you are happier. Because you are now healthier, more satisfied. Full of life. 

Now as we part I feel the tearing of a piece of my soul. As we hug one last time the goodbye is silent and understood. But then you pull back, look me in the eyes, and say simply, “Thank you for helping me live.”

As I hold back my own tears, I realize I am thinking the same thing.

Thank you for helping me live.

When We Simply Stop Caring.

I see it all around me.

Burnout. To be burnt.

When we simply stop caring.

Most of the time we don’t even need
to say anything.
But you know.
You hear it in our voice.
You see it in our eyes.
And you feel it too.
You know what
is going through our
mind with each wayward glance.

Is this what I signed up for?
Is this all this profession has to offer? 

Because I have seen the articles.
To prevent physician burnout.
The A-B-C’s.
Changes we must make.
Limiting expectations. 
Self-empowerment.
Decreased hours. 
Putting us first.

I too used to be desperate.

What is happening to me?
What is happening to my colleagues?

What is happening to medicine?

But then one day, I saw you.

You.

Not you the patient.
You the person.
You’re just
a person.
You are me.
And you are hurting.
And maybe I am too, although
you may never know.

So I thank you for being here.

Not only do I want you to know that
I honor the privilege of being able to
help you, but you should know that
you have in your own way
taken care of me.

And I do care for you.

◊ A Physician’s Plea ◊

To Let the Heart Speak.

Dear Diary,

What do I write about when I have nothing to write about?

When my lips have nothing to say?

Do I paint for you portraits
of hollow chimes adrift
in dew whose songs
mesmerize with
each sway of
the wind’s
caress?

Do I liken you to a single rose
who has but endured a
winter’s wrath to
weave a quilt
of fragrant
hues?

Or do I reflect upon my life as it is,
to tell you how much I treasure
the privilege of being able to
help you, to care for
you, whenever
you are
ill?

Do I try to express how tremendous my
heart feels when I tell you that it is
going to be alright, or when we

know that it may not, that
we will 
conquer it

together?

Do I admit to you that whenever you
smile, my day is brightened,
my heart is warmed,
and that when you
weep, my soul
tears with
you?

And do I tell you how much I appreciate you-
your presence, your courage- as you
battle through your illnesses,
uncertainties, and fears-
while reminding you
that you are an
inspiration
to me?

So what do I do when my lips can find no words?

I suppose I let the heart speak.

I’m Sorry I Couldn’t Do More.

You took your life.

I’m sorry I was only
fifteen feet away.

The doctors were only fifteen feet away.

You didn’t know this.
But I spent days and nights
next door to where you decided
to end your life. Where the doctors
gather, pondering over differentials…
treatments…dissecting our every move
to ensure that we are doing the
right thing for you.

The right thing…

If I had known you,
I would have fought for you.
I know you weren’t my patient;
I know we had never even met.
I am just the person who found
you. Who pronounced you.
You were already cold,
but still, I placed the
stethoscope against
your chest and
listened.

I didn’t hear anything.

Did you hear me as
I wept for you?

I’m sorry.

I’m sorry
you were suffering.

I’m sorry you felt
as if
you had
no way out.

I’m sorry I couldn’t do more. 

This is a reflection over an event that happened during residency.
An event I still think about at times. 
A lingering guilt.

Hope.

“My life laid before me… my treasons my troth
Wrapped with transcendence in fine sacred cloth
My breath must surrender to cold mortal brew
As wildflowers bend neath pure morning dew.

And then there were angels
Filling the sky
Lifting me upward…

And then I could fly.

These are the words of a fellow blogger and poet.
Words that affect me more than one can know.
So I would like to use this post to thank him today
for being a glimmer in the night…and an inspirer of hope.

Because in our own way, we are all physicians.

He is Steven Michael Sanders,
‘Michael33’

I am asking you to visit him, 
because his poetry will enliven you,
and his story will inspire you.

♣ The Vision of Poets – His poetry blog ♣

♣ Vision of Hope 33 – A blog of his journey ♣

With Love, 

PuppyDoc

Poetry & Medicine, part II.

“I could prescribe any of a dozen antibiotics to cure
endocarditis, 
or even a thrombolytic agent
to stave off a heart attack; 
but what I
yearned for was the elixir of poetry,

which could heal the otherwise
untreatable 
condition of
my broken heart.”

This quote, by poet and physician Rafael Campo*,
beautifully captures the essence of the union
between the arts…and the art of medicine.

Therefore, today I will let him speak for me. 
This is from his poem What the Body Told:

“To somewhere distant in my heart, they cry.
I look inside their other-person’s mouths
And see the wet interior of souls.
It’s warm and red in there–like love, with teeth.
I’ve studied medicine until I cried.”

*Rafael Campo is an internal medicine physician and poet currently on faculty at Harvard.

 •      •      •
 
A few bloggers I would like to ask to share a quote or two:

Rules of the Quote Challenge:

1-Post on three consecutive days.
2-You can pick one or three quotes per day.
3-Challenge three different bloggers per day.

 
With love,
PuppyDoc

Poetry & Medicine, part I.

Tidbits about William Carlos Williams (1883-1963):

♦ A renowned writer, he was said to be a “doctor by day, poet by night.”

♦ He attended medical school at the University of Pennsylvania, was trained in family medicine and pediatrics, and served as the chief of pediatrics for 40 years at what is now St. Mary’s General Hospital in New Jersey.

♦ He painted during his early years, similar to his mother, who was a Paris-trained artist.

♦ As one closely associated with modernest poetry and imagism, he also had marked influence on the American literary movements of the 1950’s including the San Francisco Renaissance, the Beat movement, and the New York School. 

♦ He is an inspiration to PuppyDoc. 

Thank you, Mysterious Mind of Mine, for challenging me. 

🙂

Now I would like to ask these ones to share a quote or two:

Annie at Gentle Kindness

Chris at The Brown Bag Special

Claudette at To Search and to Find

•      •      •

Rules of the Quote Challenge:

1-Post on three consecutive days.
2-You can pick one or three quotes per day.
3-Challenge three different bloggers per day.

 

With love, 

PuppyDoc

The Flawed Physician.

She stands facing a closed door.

Your door.

As her gaze converges onto
enameled surface, she notes its
texture- the evenness a comfort to
a moment of hesitation within.

Smooth and finished–flowing
imprints mapping the course of
fine fibers swept over timber.

Flawless.

She makes a move to knock,
but her hand pauses,
and for a moment she wonders
whether you will find her pleasant.

Whether she will be worthy of your trust.
Whether you will believe in her.

Because she is flawed.

Like veneer upon wooden door, she
is but a polished version of herself.

As she again surveys its exterior,
she is let in upon a different truth–
that from underneath the surface
the grain peeks through, coarse
and jagged, its valleys exposed,
blemish revealed, age betrayed.
It is but fresh lacquer upon a
damaged interior, eroded and
frayed by the stress of time.

Like a white coat to the skin,
it cloaks the imperfection
and vulnerability of that
which lies beneath.

A coat enshrouding
scars of personal defeats–
An awareness
of critical introspection while
striving to exhibit confidence and certainty.
A struggle
to remain objective while
craving to empathize with you.
A hunger
to continue feeling through perpetual
immersion into death and suffering,
while self-preservation casts increasingly

impenetrable layers of emotional shield.
And a fear
of not doing enough, while similarly
recognizing the peril of doing too much.

But as her knuckles meet the door,
she is reminded of an oath–taken
at the dawn of this journey–
an oath of compassion, of
integrity, of humility–

an oath to do no harm.

So as she enters
your room,

she smiles–
for she never forgot its
concluding admonition:

That one would never lose the joy of helping others.

Therefore as an imperfect human being,
she will do her best to ease your suffering,
treat your illness, be your advocate–
Not because it is her obligation,
but because this is her love–

To help her fellow man.

To care for you.

•      •      •

“…may I long experience the joy of healing those who seek my help.”

-Oath of Hippocrates

•      •      •

caduceus

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