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A love letter to my patients

Liveris, Marissa, MMS, PA-C

Journal of the American Academy of PAs: June 2019 - Volume 32 - Issue 6 - p 1–2
doi: 10.1097/01.JAA.0000558240.06875.30
Mindful Practice

Marissa Liveris is an instructor in the PA program at Northwestern University's Feinberg School of Medicine in Chicago, Ill. The author has disclosed no potential conflicts of interest, financial or otherwise.

Tanya Gregory, PhD, department editor

“In September of 2005, at age 22 years and with no medical experience, I accepted a part-time position as medical assistant in a pediatric pulmonary medical office. It was the start of a journey that has become one of the great passions of my life. In the ensuing years, I learned pulmonary medicine from the ground up. Within a few weeks of employment, my part-time medical assistant position transformed into a full-time ‘second-in-command’ position, learning medicine under the tutelage of a brilliant physician and mentor. I learned physiology and pathophysiology, outpatient and inpatient clinical medicine, how to navigate the complicated and ever-changing insurance landscape, and so much more. Along the way, I completed my formal physician assistant graduate medical education.

“I have learned so much more than that, however, over the last nearly 12 years. More than science, more than textbooks, more than numbers. And this is where I falter; this is where my eyes water and my voice cracks, and why I'm writing this first instead of saying it out loud. To my patients, and my families: in my years with you, I have been witness to your strength, resilience, bravery, dignity, and determination. From you I have learned compassion and empathy. I have learned laughter along with tears, hope along with fear. I have learned loss. I have learned kindness. I have learned love. I have learned of so much humanity. For all these lessons, which you demonstrate daily, THANK YOU. THANK YOU. THANK YOU. Thank you for giving me the gift of being a part of your lives and learning from you.

“It's April now. And I'm not 22 anymore. I have been given an opportunity to pass on some of the lessons that I have learned with you and from you to the next wave of healthcare providers, as faculty at a physician assistant program. I have accepted this position, and will begin teaching full-time beginning late May of 2017. And while this does mean that I won't be around the office, it hopefully does not mean that you won't see me again, and it certainly doesn't mean that you won't be in my heart. It has been my privilege to spend the last 12 years with you.”

In March 2017, I wrote that letter to my patients. Working in a pediatric pulmonary private practice and cystic fibrosis center caring for children and young adults with chronic illness, I had watched many of these children grow up in the 12 years I knew them. In many ways, I grew up alongside them. I moved away from home, went to graduate school, established a career as a PA, and experienced many of the personal triumphs and failures that accompany youth and young adulthood.

Somewhere along the way, however, I stopped growing. I loved my patients, I loved the medicine, but I had stagnated. Even more, I was burnt out. I was suffocated by 70- to 80-hour workweeks, by constant on-call duties, by my professional seniority equating with a constant demand for my time, energy, and attention. My physician partner needed me, the hospital needed me, my colleagues needed me, my office needed me, the insurance companies needed me, my patients needed me. There was never enough of me to go around, and somewhere along the way I forgot an essential truth: I needed me, too.

This point was driven home over the 2015 holidays. My sister was in town from Seattle, my other sister was in from Denver. My family was celebrating, and it was the first time my siblings had been fully together in the past 5 years or so. I was at work. More than 18 months later, I still can't think of this time without feeling a profound sense of sadness. I am sad that I missed this opportunity with family, but I am also sad that I had so lost myself that I allowed this to happen without even realizing it.

I spent the bulk of 2016 trying to take a step back while continuing with the practice that I cared so much about, which had been my day-to-day existence for 10-plus years. I championed efforts to enhance work-life balance and attempted multiple initiatives that would allow me to pull back. I was unsuccessful. The more I pulled back, the more suffocated I felt.

And so, for the first time since I was 22 years old, I asked myself: “What do you want to be when you grow up?” It was when this question was looming large in my mind that I began regularly precepting PA students and, unwittingly, I found the answer in PA education. I liked my students. I liked teaching them. I liked being able to show them my individual and old-fashioned practice of medicine, one that values implicitly the relationship between provider and patient, a relationship built on years of shared growth and mutual respect. I liked challenging my students and watching them grow. Their energy and excitement for medicine was refreshing and rejuvenating. When an opportunity arose to interview for a PA faculty position, I decided I had little to lose by exploring the option.

Many factors ultimately led me to join a PA program: the program's small class size, dedication to underserved communities, and close-knit core faculty and staff among them. When decision time arrived, however, one question from my interview pushed me forward. Ironically, it was a question I couldn't answer. It came from the program's medical director, a family physician who I have come to respect immensely: “What do you do to take care of yourself?”

I couldn't answer that question during my interview, and it shook me then as it still does now. Medicine, I have now heard my medical director describe to our students, can consume you; it can eat you up. You need to care for yourself along with your patients. This question, which he posed to me during my interview, which I still am trying to answer, is one that is inherent in our program curriculum. So part of my decision to make this change was a desire to be able to answer that question. To be able to answer it for myself, and to be a part of a program that teaches clinicians to do the same: take care of your patients, and take care of yourselves.

Before making this leap, I wrote the letter to my patients, who had meant and still mean so much to me. I wrote it to tell them I was leaving. I wrote it to thank them and to reflect on the time that we spent together. I wrote the letter to my patients, and I wrote it for myself, to acknowledge the incredible journey that I was lucky to have experienced, and to remind myself of the many lives that touched me along the way. I wrote the letter as a promise to myself to take these experiences and carry them with me every day, and honor them as an educator. I will try to share some of what I have learned with these new, eager, nervous students. I will remind them of the gift it is to care for another and the gift it is to care for one's self.

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