Journal of the American Academy of Physician Assistants:
doi: 10.1097/01.JAA.0000451870.40825.9f
Mindful Practice

Two tattoos

Hanley, Katherine Y. MA, PA-C

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Katherine Hanley practices family medicine and urgent care medicine in Lexington, Georgetown, and Frankfort, Ky.

Tanya Gregory, PhD, department editor

Everyone forges and wears different life armor, depending on their needs, circumstances, and options. This is the story of one of my shields, which took the form of two tattoos, and is intimately tied to my journey as a PA.

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On some days more than others, I am battered by the storm of the day. My general approach on busy clinic days is to manage the flow as well as possible, keep my head down, and dive in as deep as I should, hopeful and helpful. But sometimes, when I dare to peek into the packed waiting room, I am occasionally struck by the array of people I'm bound to disappoint. I know I probably won't make the tired parents of the grumpy kids happy; those recurrent cold symptoms largely represent undertreated allergies and viral syndromes, not an infection that any antibiotic will cure. The pinched look of the chronically stiff and sore, looking for respite from cruel pain, will not find novel answers here. That doesn't count the everyday fatigued, stressed, anxious, and neurotic, who “just need something to make me feel better.” I can alleviate the worst fears of those with functional gastrointestinal complaints, chronic headaches, vague neuropathies, and panic attacks disguised as chest pain; but I know that truly addressing the causes, managing the conditions, and reconciling patients to the imperfect understandings, treatments, and support systems available will frequently require a fraught journey, not the elusive enlightening/liberating single office visit.

Looking back on what now seems so obvious, I don't know why I didn't see that getting older and “wiser” would lead to more uncertainty than confidence; that maintaining positivity would require more acceptance than fight. The vastness of this awareness strikes me as profoundly as realizing the depths of the ice floes that trap the ships. It seems I was blissfully presumptuous when I was younger: as shallow as not wrapping around the massive reach of global warming as I blithely recycled all those years. And the pervasiveness of this reality colors all I know and care about, both personally and professionally. It's a set of 3D glasses I can't take off or use selectively, a paradigm shift as permanent and unwelcome as the wrinkles that appeared on my neck seemingly overnight. I'm fairly pragmatic and observant, and I like to believe that I willingly accept the lessons I'm presented with and then modulate them with a positive spin. So it's baffling that this fundamental reality snuck up on me so stealthily, so rudely. Why couldn't I see it coming, just based on what I've observed in the lives of those older than me? How did I misunderstand that hard-won wisdom, patience, insight, and maturity would actually lead me to less clarity, less solid ground under my feet? I guess I arrogantly assumed I was deserving of the grace of a sort of maturity rewards card. And wait—what other alternate realities may blindside me? How vain, I know.

Yet, I suppose that naiveté spared me useless dread because now I do realize the inevitability of this paradigm shift, and that the alternative is self-delusion, which I have never been able to sustain for very long (despite its relative comfort). I know that navigating well requires a good, functioning rudder and some form of compass. And although I grudgingly accept the worth of reconciliation to this circumstance, and the value of past lessons learned toward preparing me to steer the deeper waters, none of this is particularly comforting, on certain difficult days.

I work now in urgent and primary care; having come full circle after beginning in the mid-1990s in internal medicine, with multiple various specialty fields in between. I have loved and hated the work, and everything in between. I learn daily from great, mundane, and awful alike; blessed and disheartened time and again by what I witness and share, personally and professionally. I strive to listen, reflect, study, revisit, practice, and model the good. I'll also avoid, forget, ignore, keep quiet, and speak up depending on what seems the better path. I've certainly misjudged, misunderstood, alternated between heavy-handed and too vague or superficial; occasionally been dismissive or abrupt, and sometimes unkind. Those are my regrets, and I strive to remember what being on the receiving end feels like, as penance and future deterrent. I've adjusted to my limitations and myopia, my quirks and mistakes, and my changing self and perspective continually nuance my approach to life and work. My best/hardest tip—be still—is excellent advice for many things. The practitioner I am today is both more vulnerable and stronger, but I'm unsure that hard-won perspective always translates to a better patient approach. I drop back to hope, on that one.

My patients experience my current state in typical exchanges I have with them on a daily basis, for a variety of concerns: “As with many things in life, there is no sure way to [pick any] (avoid, shorten, cure) this particular (illness, event, circumstance, disease process) without (time, cost, pain or discomfort, sustained effort, multiple approaches, inconvenience), and no guarantee of (degree of response, resolution, remission, solace).” Not surprisingly, they are often variably dissatisfied, disappointed, and/or dismayed, much as I am. I guess I always assumed that at this point in my career, 20 years in, I would have honed the lucidity or capacity to share more straightforward answers, robust approaches, and confident assurances of good outcomes for the effort and attention. Gold stars, if you will. But, alas, I have learned professionally, as I have in my own life, that for much of what we are dealt, even seemingly simple things, such wishes are illusions of a reassurance or fast pass that we cannot be granted by anyone, no matter how much we try to deserve it, and to imply we as providers can conjure it is merely a self-indulgent soul toupee.

What I offer instead, to myself and others, is all that I have; an imperfect, still often crude, but well-intentioned and perpetually honed tool kit of experience, care, time, listening, and empathy. “I will walk through this with you, and do my best to help and support you.” Humor and graciousness are buffers but only mean so much. Hard is hard.

And so, at the age of 47, on a hot summer day, I went alone to a small local tattoo parlor. Among the 18-year-olds and alternative artisans, I got two small tattoos, one on the soft underside of each wrist. One says strength. The other says belief. They are my talismans of resilience, and I rub them often, for me and those I care for.

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© 2014 American Academy of Physician Assistants.

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