Monday, October 18, 2010

Off-Service Notes

As medical students and physicians go through their training, they rotate onto various specialty services: internal medicine, surgery, pediatrics, obstetrics, etc. And one aspect of these rotations is that they're limited by the calendar. If I have a six week rotation on surgery, I'll start on July 1. Six weeks later I'll make rounds one final time, gather the charts of all the patients, and write an off service note. This is a summary of the patient's case, including future treatment that's planned and anything else the new doctor on the case needs to know to guarantee continuity of care.

Sometimes I was sorry to write off service notes. Perhaps that was because I'd enjoyed the particular aspect of medicine to which I'd been exposed. Maybe I'd liked the physicians and nurses with whom I'd worked. I might even be anxious to follow the progress of a patient I was leaving behind. But tht wasn't always the case.

There were times when I watched the calendar like a man awaiting his release from prison, mentally marking off the days until I could write my off service notes and escape. But hate to write them or look forward to them, the notes came around and it was time to move on.

Once I went into practice, I quickly learned a valuable lesson: there are no off service notes in life. It was up to me to handle the difficult case, no matter how long it took or how hard I had to work. Further, this extended to life in general, not just medicine. Confronted with a sticky situation, I had to work through it. Faced with hard choices, I had to make them. There was no escape by sitting down and writing a note summarizing what I'd done and the choices coming up, then passing it to someone else.

I've talked with lots of people who want to quit. They say, "I just want to chuck it all. I'll declare bankruptcy. I'll get a divorce. I'll move and not leave a forwarding address." Some have even spoken about ending their life. It looks hopeless from their side. Sometimes things in life get tough. But, even though we may not be able to walk away from them, we can do an off service note of sorts. Remember, the reason for an off service note is that someone else is coming on board to take over the case.

When faced with a seemingly untenable situation, why not share that load? It may be with a trusted friend or family member. It could involve seeing a counselor. It might be talking with a pastor or spiritual advisor. The trick is to communicate. Get a fresh set of eyes viewing the problem. Be open to the advice of others. Let someone come alongside.

And don't forget to lean on God. After all, He not only already knows about it, He knows how it's going to end. And God never writes off service notes.

11 comments:

buck@midstateinsurance.com said...

Thanks Richard . . . Again. Astounding how God can harmonize His Sovereignty and our Responsibility.

Richard Mabry said...

Thanks for your comment, Buck. We've all been there--want to chuck it all--and have to remind ourselves that God's in control.

Crystal Laine Miller said...

Just wanted to pop in to say I really appreciated this illustration of such an important point. Great post!

Richard Mabry said...

Thanks, Crystal. Lately I've had a lot of first-hand contact with folks who just plain wanted to quit (in a number of ways, sometimes a very permanent one), which was the reason for this post.

Rosslyn Elliott said...

I love this post. Being open with others about our struggles is so important, and it's sad that so many people have no earthly friend to trust. Many people who make big, painful mistakes are well-intentioned and just needed better counsel.

Richard Mabry said...

Thanks, Rosslyn. We're called upon to bear one another's burdens, but that's not possible unless we're willing to share them with someone else. I've been on both sides of this situation, and it can be really tough.

lauradroege said...

Good thoughts here. But now I'm curious: which areas of medicine were your favorites, and which were your oh-get-me-out-NOW ones?

Richard Mabry said...

Laura, the nice thing about the passage of time (lots of time) is that it dulls some of the bad memories, so it's hard to recall which rotations were the worst. The best for me, believe it or not, was OB. I entertained the thought of going into obstetrics until I figured out that babies are born 24/7. Since ENT offered a great combination of medicine and surgery, I opted for that, and it was a good decision.

Elaine said...

I appreciate your comments. Very good application.

Rosslyn Elliott said...

I love this post. Being open with others about our struggles is so important, and it's sad that so many people have no earthly friend to trust. Many people who make big, painful mistakes are well-intentioned and just needed better counsel.

Richard Mabry said...

Thanks for your comment, Buck. We've all been there--want to chuck it all--and have to remind ourselves that God's in control.