Learning to say no

Patricia Lindholm, MD,
2010-2011 MMA President

Originally Posted December 2, 2010

We all have multiple roles in life, and I recently found myself filling several of them during my father’s terminal illness and death in early November. 

Several weeks ago it was apparent that my father was very ill and needed to be hospitalized.  The working diagnosis was pneumonia, but it soon became obvious that something more serious was afoot when a thoracentesis uncovered a significant lung mass.  He allowed the physicians to order scans, cytology, etc.  Later he confessed that he already knew about the cancer as it had been diagnosed in another medical facility; he confessed this to his sister, not to the physicians. (Imagine trying to diagnose and treat a patient who decided not to share such information with you!) My father liked to keep secrets.

I was the health care proxy and executor of my father’s estate.  He lived in Florida, so before getting there, I was doing long-distance work with him and the doctors/relatives/social worker, etc regarding pain management and hospice placement.  It seemed relatively easy initially to be on the “family” end of a health care crisis.  My siblings and I arrived in Florida barely in time to say farewell.  Then it was a blur of arranging cremation, cleaning up his apartment, and selling and giving away household items.   During the two weeks I was away, I carried out some media interviews for the MMA and answered e-mails and even participated in a conference call.  As physicians, we are able to go into “crisis management mode” and defer our own emotional reactions to a later time.  This state of numbness (brain-dead is what I felt at the time) continued for a little while.  Thankfully, the long drive home from Florida was a buffer between the intensity of the family loss and the return to work and life as usual.

Since returning, I have taken more time to grieve and process what has happened, and I’ve  surprised myself by saying “no” to a couple of things. Saying no is something I have spent years trying to learn, and with practice I get better at it.  As physicians, we have been trained to rise to any occasion, to get up and work in the middle of the night, to work with little sleep, and to function in spite of whatever personal issues we are facing.  We were not trained to nurture ourselves when needed.  Saying “no” was somehow shameful. I encourage us all to practice the art of saying “no.”  Obviously this must be done judiciously.  Sometimes saying “no” to more work and responsibility is actually saying “yes” to life and health.  One test that I use to decide whether to say “yes” or “no” is to ask this question: “Will this activity suck the life out of me or give me life?”  It is simplistic, but it works for me. 

Are you doing what works for you?