I reach inside the orange plastic bag and grab a fistful of unsalted mixed nuts. I draw a particular comfort from the sweet buttery cashews. I tolerate the rest of the Extra Fancy nuts: the paper-crisp walnuts, the hard almonds, the in-between peanuts. On the front of this 40-ounce bag is the familiar Kirkland signature logo; on the back, the words “For Dr. Vijayan” are neatly printed in what looks like brush calligraphy. It all provides me solace. The black Sharpie used to write my name so neatly. The script. The nuts. The gifts my patients have given me carry traces of our relationships, some brief, some years long. Most of my patients don't give me anything, but some really feel compelled to do so, as though I am an old country doctor bartering, and not their urban infectious disease doctor. It is almost always a little awkward, but it is hard to say no. I am moved by all of them. The dozen eggs from a patient's farm, wafting of tobacco smoke after a 2-hour long car ride; neither the tobacco nor the ride likely helped the needed wound healing. The face cream from another, who I imagined spent a good amount of time watching shows like the Home Shopping Network, perhaps trying to say something about my perpetually haggard makeup-less look. The bejeweled hairpins for my cropped haircut, a style I have sported for all my attending life: the small things people notice. The apples from a tree that one efficiently squeezed into a used plastic juice container, the care and commitment to sustainability simply inspiring. The fresh sockeye salmon. He had been a longshoreman. He was 30 years older than I, but I reminded him of his mother. How could I say no? Sometimes the gift is just a photograph in my patient messages. A moment of joy, among many moments of sorrow. A moment maybe I played some small role in helping them trod toward. Standing by the Eiffel Tower, a trip they saved up for, silver hair swept back, laugh lines deep, eyes twinkling. A storybook scene after decades of a life hardened by disease, by stigma. A week before I had surgery on my neck, a patient gifted me a simple black scarf. He had no idea I was going to have surgery or that his doctor had a serious illness. This, too, is part of what we do. We give people mere glimpses of our own lives while we carefully dissect parts of theirs. Over the years he had shared with me pieces of his story, some of which was at once similar and disparate from my own. We shared histories of recent immigration, mine once removed, his more recent. He once worked in textiles and now spent his days creating accessories, hence his carefully chosen gift. He shared how he was in love with a man (this too we had in common). He loved his family deeply but disagreed with their politics and didn't always understand them. (Sidebar: his family's “politics” were in fact more in line with mine. He decided to stick with me, nonetheless.) I wore that scarf to cover my surgical scar in the weeks after. Not everyone is gifted with a job that is not just a job. But I am acutely aware of how the current model of healthcare sometimes tries to rob this gift from me, a gift I worked so hard to earn, with many years of schooling, and many more years of deliberate practice. Monthly reports tell me if I am doing enough, seeing enough, seeing as many, “meeting my benchmarks.” This hyperfocus on productivity carries with it a deep loss in our ability to share and understand the stories. Many of the notes we write have become unreadable, not due to penmanship as it once was, but bloated with copy-forwarded disjointed details, relationships buried in a patchwork of words that make little sense. But these, the notes, the charges, are what pays our bills. And we all have bills to pay. The Benchmark Makers don't know the stories we keep. They don't know what hangs on my office wall, not the degrees or the awards, but the paintings from the artists who hold union jobs or who live in government subsidized housing. They don't understand that maintaining our curiosity and committing to scientific excellence are what allows us to cultivate our humanism. But curiosity demands time, and in a model that values efficiency, it is far easier to run the checklists, to run the through the acronyms to remind us to say “See, I Care.” 1 When the Benchmark Makers make humanism a performance measure, humanism risks becoming performative. We were in danger of becoming robots, long before the architects of artificial intelligence became Time Magazine's Person of the Year. The Benchmark Makers gift us platitudes on the benefits of meditation (on Zoom, nonetheless), while slowly undermining our sense of community with our patients and with each other. This community has always been what has kept us whole as we bear witness to the terrible things that can happen. The warmth I feel is genuine on receiving my patients’ gifts, the tangibles and the intangibles. That exhilarating message they send that they are training for a marathon to maintain their weight loss after the GLP-1s were no longer covered, after years of mourning the loss of a life without HIV, after watching their weight plummet and restored more than they wanted from their life-saving treatment, this message that I read at 9 Pm at night brings me complete, unadulterated joy. And here I sit, my wholly inefficient, messy self, reading the messages that the Benchmark Makers can neither see nor quantify, closing the encounters days later, not meeting my benchmarks, eating all the unsalted mixed nuts. I grab another fistful. For now, my hunger is curbed. But for how long will I sustain?
Tara Vijayan (Thu,) studied this question.