Emergency Medicine News:
December 2010 – Volume 32 – Issue 12 – p 16
doi: 10.1097/01.EEM.0000391506.60666.e1
Second Opinion
Second Opinion: The Best Gift of All: Permission
Leap, Edwin MD

Free Access
I like to think back on favorite Christmas gifts I have received over the years. I don’t think I can do any better than the children of mine who were born around Christmas. Three of the four came within one month of Christmas day. One came on December 23rd. What wonderful presents!
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Image ToolsGoing farther back, I recall sitting by the Christmas tree at my childhood home or the homes of my grandparents. I found toy soldiers, toy horses, Matchbox cars, pocket knives, and many other little boy wonders. I remember the beautiful wooden stock and golden trigger of my first shotgun, and how it pulled me irresistibly toward manhood to know that my father and mother trusted me enough to give such a gift.
I have been thrilled to give gifts to my wife and children over the years, too. I smile when I consider stuffed animals, American Girl dolls, Polly Pockets, toy knights, castles, iPods, bicycles, books, a small harp, and a shiny sword. I admit that I love putting their packages under the tree.
I enjoy hearing about the things my loved ones love. It is my delight to know their hearts and to find the perfect thing that will make their eyes light up and give them delight.
But there are people other than my family, and there are many kinds of gifts. I can’t help thinking if I were giving the perfect gift to my patients, some would love to open a gold-embossed Oxycontin prescription with the infinity symbol in the number-of-refills box. And others would be speechless to dump out their stockings, and find their disability paperwork completed. The tears of joy would flow!
Others need things of greater depth. Some would love nothing as much as finding that their chronically ill children were suddenly well, that their diabetes was magically gone, their recurrent infections healed, their cancer dissolved like snow in the Carolina morning sun.
But what about you? What could I give you, my friends and colleagues, my faithful friends and readers? You know how collections are in this economy, so I can’t afford to send you much. But what if I could? It reminds me of how Jan and I sometimes play the lottery game. We imagine how we would spend our money if we won some ghastly amount of money, like $50 million. We divide it up among family and friends and causes (with a beach house thrown in for hedonistic self-interest).
So I can, at least, imagine what I would give you for Christmas. First, I would give you permission. I would give you permission to do what you think is right, even if other people in your group, hospital, or family disagree. Even if your actions are neither popular nor politically correct.
I would give you permission to speak the truth. If you cannot do it at work, at least to your spouse, friend, or dog. Or into a hole in the earth. It has to come out somewhere. Truth is a rare commodity, and if trapped in our minds with no outlet, it can become toxic or drive us mad as it tries to claw its way out. Modern medicine, private, corporate, or academic, has a way of discouraging truth for political and economic ends. But you don’t have to be party to falsehood. You can be your own person. I don’t know what truth you need to tell, but please, go and tell it.
I would give you permission to be human. And most importantly, that would mean knowing that whatever mistakes you have made as physicians are not the result of cruelty or incompetence but of frailty and morality. I give you permission to shrug off your sense of deity and embrace your incapacity. If you have ever made a mistake, minor or grave, remember that “mistake” does not mean “sin,” no matter what attorneys or administrators say. We all fall down, just like children in “Ring Around the Rosie.” We all are flawed. Accepting that is like collapsing into a soft bed and sleeping off exhaustion.
I would also give you the capacity for forgiveness. Learn to forgive those who have wronged you: patients, colleagues, friends, and loves. The anger and bitterness we so often carry is too great, and is a distraction from whatever joy we can wring out of life.
Likewise, I would give you the desire for confession. Confession done properly is like opening an abscess so that disease can flow out. The old country folks call the contents of an abscess “corruption.” How appropriate in terms of confession!
I would give you so many things, if I could! I would give you at least one miraculous medical event per year, so that the person you knew would die came back a week later to say, “Thanks. I feel much better!” And one miraculous nonmedical one, a wayward child brought home, a shattered marriage made whole, a broken relationship welded together in tears.
I would give you the ability to select 10 shifts each year when your department was like a ghost town, so that on those rare occasions when you did not or could not sleep or were overwrought with life, you could sit in a well lighted department and sip coffee with your eyes staring off in reverie, without wondering what horror was coming through the door next.
And finally, I would give you, once each day, a patient or co-worker in whom you could see your purpose, your necessity, your importance as clear as the winter dawn, as clear as the star above the manger. Someone who needed you, someone you saved, someone you eased out of this life, someone you comforted or touched. I would send you a person who showed you that success is not measured only in procedures or diagnoses, billing or volume, but in compassion. I would give you, every day, someone you reassured who said (if only with their eyes), “Thank you for being there!”
Merry Christmas! I pray that all these gifts come to you this year and every year. Thank you for being my family. May you find beautiful gifts beneath the tree and beautiful loved ones at your side.
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