It’s my first time here

In my job I have the privilege of getting to see people age. As a family med physician who has prioritized chronic disease management, most of my visits are caring for a population over 65 years old. I get to see people at all stages of life but focusing on an older population has really driven in how precious our lives are.

I saw a cute comic from Anna-Laura Sullivan where all the characters are commenting on it being there first time being alive. They are struggling and making mistakes and admitting that this is all their first time’s doing this. It was such a beautiful sentiment and I think made me realize that no matter which patient I am treating, this is there first time having this exact experience. I sometimes hold patients to impossible standards, question the med regimens that they are on, want to shake them to have better habits, or engage more with their health. But I realize, this is their first time having hypertension or diabetes, maybe their first time having to see a doctor regularly. They may not have grown up seeing these chronic diseases, don’t fully grasp the potential outcomes they may have.

I get to see a dozen or more people a day deal with hardship, disease, contemplate their health. Some are facing terminal disease, some age related changes, some anxiety and stress, depression, loss of loved ones. I get a glimpse into my future with each of these cases. I know I will have friends and family die, will have my own injuries and sickness, will struggle with my weight and with habits, with time management, with prioritizing my health. I often can’t fix these problems that patients face. A lot of it is just the reality of life. Our joints degrade and ache, blood vessels narrow and clot, cells mutate and become cancerous. I can do my best to prevent these things from happening, delay them, or heal them, but medicine is limited in 2024.

My patients bring me a beautiful bit of foreshadowing and appreciation for each moment I have now. I know that’s not why they come to me but in the moments that I cannot fix, like death of a spouse, it makes me greatly appreciate my partner. When I lay in bed next to her I hold her tightly, knowing that at some point I may not have her. I hike or ski or bike and think about my 80 year old patients who could’ve kicked my ass in all those sports in their heyday and I appreciate these moments my mobility is preserved. Often, I get to see some patients get better. Their back pain will dissipate with time and when my back aches, I look at it more academically and objectively, knowing that I will likely get better too.

I also hope, despite my sometimes being paternalistic, or tired, or unempathetic, that each visit I have with a patient is also exactly the first time I have had this visit. While it may be a routine visit, the same med I have prescribed dozens of times, it is never exactly the same. I am trying to grow as a provider, to recognize that each patient is and individual with personal goals, risk tolerances, and wishes. It’s hard enough to keep up with the evidence for each decision we make it medicine. But to apply that to an individual who has lived a whole life differently than me is where the real difficulty lies. I just hope for forgiveness from patients when I don’t get it right. I care and I am trying.

I am finally at a point in my life where I get to reap the gratification I deferred for so many years. I have struggled through school most of my life to get to a stable career, stable housing, stable relationships. With things being lovely now I do have a bit of clinginess to the present moment. But I know what my future holds and I just hope to age gracefully, to live this life, my first time here, as well as I can.

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