ON BEING A DOCTOR
Annals of Internal Medicine
Homesick: From Beirut to Rochester Homesickness is not always a vague, nostalgic, almost beautiful emotion, although that is somehow the way we always seem to picture it in our mind. It can be a terribly keen blade, not just a sickness in metaphor but in fact as well. It can change the way one looks at the world . . . Homesickness is a real sickness—the ache of the uprooted plant. —Stephen King, The Breathing Method
I
t was our first meeting. He lived 100 miles away but had come to the clinic over the past 5 years for various medical concerns. I was the eleventh physician to see him in this short span. Not a good sign. He was only in his early forties but already an executive in an international business. His father sent him away as a young boy from the cataclysms of war in their native Beirut to a British boarding school. He continued onward with sojourns in Montreal, Georgetown, and eventually the American Midwest. Short return trips to the Middle East had maintained a measure of connection with family and place. But only a measure. His visits to the clinic had included concerns over poor memory, anxiety, anger, stress, insomnia, chest heaviness, labored breathing, and diffuse numbness. They were presented in the wake of the following comment during an early interview: “When I was about 20, I saw my father trying to jump out of the balcony at home, and my mother and uncle were holding him. That event triggered a lot of anxiety in myself.” Both he and my colleagues labored to understand his sufferings. The memory of his father hovered. There were laboratory tests, cardiac stress tests, radiographs, and multiple subspecialty consultations. Uncertainty remained. His father eventually committed suicide. It happened the year before we met. He jumped from the fifth floor. In the wake of the event, the son returned to our clinic for an aortic aneurysm screening and an evaluation of a dystrophic nail on his right ring finger. His father had developed an aneurysm among other issues. This was a worry. The son also had an anxious compulsion to compress the nail bed of the fourth finger with his thumb. It had deformed the nail. Another internist at the clinic had tried earlier to address the patient's mostly unspoken yearnings and dreads after the death of his father. Stressreduction techniques were offered. Even creative options like daily reflective readings from The Meditations of Marcus Aurelius were put forth. The benefits were unclear. Now, 1 year later, he was back. The multiple symptoms remained. They were joined by another— proctalgia. How should we proceed yet again? The
specter of failure loomed. More procedures. More consults. More expense. More uncertainty. I entered the examination room; introduced myself; offered a hand; sat down; and asked, “How can I help?” He spoke about his “anal pain” for several minutes. Questions and responses were exchanged. Tests and consultations ordered before our meeting were reviewed. No additions were made. A brief formulation of the new problem in the context of the old ones was offered. I then invited his clarification of any misunderstanding. None came. We sat together silently. After a few seconds I asked, “What's life been like since your father's death?” He looked away. He then turned back with an unblinking stare and began to talk. He spoke of being more conscious of time, of trying to find meaning in the moment, of being more focused on his job and in his relationships. He spoke of unexpected emotions surfacing. He then paused and looked away again. I waited and then offered, “Do you feel homesick?” He turned back toward me with a look of surprise on his face. He began to speak. “I've felt nostalgic most of my life,” he said. He told of missing his family and home from childhood onward. He spoke of his British boarding school as a boy and of university training in Canada and the United States afterward. He related learning to live independently from the start as “no one was really there for me.” He described his habit of not sharing feelings because he had few close friends and his family was far away. He then commented, “This is now beginning to change.” I asked, “What do you mean?” “I've just returned from the Middle East,” he responded. He had gone back a year after the suicide. He spoke of going to his old neighborhood and the family home. He described ongoing concern for his aging mother. Then he detailed the most important event of the journey. On one day of the visit when all the relatives were outside the house, he went upstairs alone to his father's bedroom. There he took his father's photograph in hand and sat down on the bed. He began speaking to his father and did so for several minutes. He released words and emotions accumulated over past decades. He left me wondering what they were. He said only that this intentional act brought undeniable comfort. He described still feeling his father's presence in his life. “And is it with blessing?” I asked. “Yes, with blessing,” he answered. We sat together silently again. No more details. No more questions. I then thanked him for sharing his story with me.
524 © 2015 American College of Physicians
Downloaded From: http://annals.org/ by a Penn State University Hershey User on 05/28/2015
ON BEING A DOCTOR
Homesick: From Beirut to Rochester
His proctalgia evaluation was completed a few hours later. There were no concerning findings. It is now 4 months. I am waiting. John H. Davidson, MD Mayo Clinic Rochester, Minnesota
Requests for Single Reprints: John H. Davidson, MD, Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; e-mail, davidson.john @mayo.edu.
Ann Intern Med. 2015;162:524-525. doi:10.7326/M14-2101
www.annals.org
Downloaded From: http://annals.org/ by a Penn State University Hershey User on 05/28/2015
Annals of Internal Medicine • Vol. 162 No. 7 • 7 April 2015 525
Annals of Internal Medicine
Homesick: From Beirut to Rochester Homesickness is not always a vague, nostalgic, almost beautiful emotion, although that is somehow the way we always seem to picture it in our mind. It can be a terribly keen blade, not just a sickness in metaphor but in fact as well. It can change the way one looks at the world . . . Homesickness is a real sickness—the ache of the uprooted plant. —Stephen King, The Breathing Method
I
t was our first meeting. He lived 100 miles away but had come to the clinic over the past 5 years for various medical concerns. I was the eleventh physician to see him in this short span. Not a good sign. He was only in his early forties but already an executive in an international business. His father sent him away as a young boy from the cataclysms of war in their native Beirut to a British boarding school. He continued onward with sojourns in Montreal, Georgetown, and eventually the American Midwest. Short return trips to the Middle East had maintained a measure of connection with family and place. But only a measure. His visits to the clinic had included concerns over poor memory, anxiety, anger, stress, insomnia, chest heaviness, labored breathing, and diffuse numbness. They were presented in the wake of the following comment during an early interview: “When I was about 20, I saw my father trying to jump out of the balcony at home, and my mother and uncle were holding him. That event triggered a lot of anxiety in myself.” Both he and my colleagues labored to understand his sufferings. The memory of his father hovered. There were laboratory tests, cardiac stress tests, radiographs, and multiple subspecialty consultations. Uncertainty remained. His father eventually committed suicide. It happened the year before we met. He jumped from the fifth floor. In the wake of the event, the son returned to our clinic for an aortic aneurysm screening and an evaluation of a dystrophic nail on his right ring finger. His father had developed an aneurysm among other issues. This was a worry. The son also had an anxious compulsion to compress the nail bed of the fourth finger with his thumb. It had deformed the nail. Another internist at the clinic had tried earlier to address the patient's mostly unspoken yearnings and dreads after the death of his father. Stressreduction techniques were offered. Even creative options like daily reflective readings from The Meditations of Marcus Aurelius were put forth. The benefits were unclear. Now, 1 year later, he was back. The multiple symptoms remained. They were joined by another— proctalgia. How should we proceed yet again? The
specter of failure loomed. More procedures. More consults. More expense. More uncertainty. I entered the examination room; introduced myself; offered a hand; sat down; and asked, “How can I help?” He spoke about his “anal pain” for several minutes. Questions and responses were exchanged. Tests and consultations ordered before our meeting were reviewed. No additions were made. A brief formulation of the new problem in the context of the old ones was offered. I then invited his clarification of any misunderstanding. None came. We sat together silently. After a few seconds I asked, “What's life been like since your father's death?” He looked away. He then turned back with an unblinking stare and began to talk. He spoke of being more conscious of time, of trying to find meaning in the moment, of being more focused on his job and in his relationships. He spoke of unexpected emotions surfacing. He then paused and looked away again. I waited and then offered, “Do you feel homesick?” He turned back toward me with a look of surprise on his face. He began to speak. “I've felt nostalgic most of my life,” he said. He told of missing his family and home from childhood onward. He spoke of his British boarding school as a boy and of university training in Canada and the United States afterward. He related learning to live independently from the start as “no one was really there for me.” He described his habit of not sharing feelings because he had few close friends and his family was far away. He then commented, “This is now beginning to change.” I asked, “What do you mean?” “I've just returned from the Middle East,” he responded. He had gone back a year after the suicide. He spoke of going to his old neighborhood and the family home. He described ongoing concern for his aging mother. Then he detailed the most important event of the journey. On one day of the visit when all the relatives were outside the house, he went upstairs alone to his father's bedroom. There he took his father's photograph in hand and sat down on the bed. He began speaking to his father and did so for several minutes. He released words and emotions accumulated over past decades. He left me wondering what they were. He said only that this intentional act brought undeniable comfort. He described still feeling his father's presence in his life. “And is it with blessing?” I asked. “Yes, with blessing,” he answered. We sat together silently again. No more details. No more questions. I then thanked him for sharing his story with me.
524 © 2015 American College of Physicians
Downloaded From: http://annals.org/ by a Penn State University Hershey User on 05/28/2015
ON BEING A DOCTOR
Homesick: From Beirut to Rochester
His proctalgia evaluation was completed a few hours later. There were no concerning findings. It is now 4 months. I am waiting. John H. Davidson, MD Mayo Clinic Rochester, Minnesota
Requests for Single Reprints: John H. Davidson, MD, Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; e-mail, davidson.john @mayo.edu.
Ann Intern Med. 2015;162:524-525. doi:10.7326/M14-2101
www.annals.org
Downloaded From: http://annals.org/ by a Penn State University Hershey User on 05/28/2015
Annals of Internal Medicine • Vol. 162 No. 7 • 7 April 2015 525
