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.