Medicine from the heart . . . Hugh Silk

March 31, 2011

 Each Thursday, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: 

Hugh Silk, MD, founder and moderator of Thursday Morning Memos, chimes in with thoughts on pursuing balance and having glimmers of success and moments of hope. 

Hugh Silk 

Pursuing a better balance 

Last weekend, as I spent part of the day running errands with my 6-year-old daughter, she said something unexpected. It came after many short conversations between the hardware store, stopping for some pizza and talking about our recent random outing to the bowling alley with her sister. As I looked in the rearview mirror, I could see she was enjoying just having time with me alone. “Whatcha thinkin'?” I asked. 

She smiled. “That you are the best person in the whole world.” I smiled and tried not to cry. That was enough to make any dad feel unbelievably blessed. Turns out, I may not be the best person in the whole world; however, for her to think that, for a fraction of a second, made me feel pretty good. 

A week earlier, I had read in Maclean’s magazine—a Canadian Newsweek-style magazine—an article about how guilty women feel when they are working. The article explained that men don't feel this way. I was perplexed. I would agree that it is different; I would even say much different for women versus men. My wife puts our family before everything else, always, period. I get swayed too easily by a needy patient, a deadline for an article, or an early morning meeting that seems so important on that given day. 

But I still have the guilt. I feel it when I rush to put my kids to bed so that I can finish writing that article with the deadline. I feel it when I get home late from precepting, deferring dinner duties to my obstetrician wife who is equally busy. I feel it when I make that “one more call” on the way home to a patient “who needs to talk to Dr. Silk TODAY” and cheat myself out of a few minutes of transition during my commute; gone is my chance to see what is happening to post-tsunami Japan on NPR. 

In 1999, David Loxterkamp wrote in his landmark JAMA [Journal of the American Medicine Association] essay (“Facing our Morality”) that “our Waterloo waits in the stack of messages at the end of the day . . . and in unwritten cards of condolence” and other short cuts with patient care. I would add, that the medical son, father, husband, friend and neighbor—also stares across that Waterloo with so many decisions each day that might rob us a few more minutes with the night time story, a few minutes of exercise or a shoulder rub for a tired spouse. 

What is the balance and where does it lurk? As a six-foot, three-inch man, it feels to me like having a four-foot, twelve-inch blanket. As I pull the blanket up to cover my shoulders, my feet get cold—pull it down to warm the feet and the shoulders are cold again. Perhaps the balance for this stage of my career is allowing for the movement of the blanket. Some weeks I get a little more exercise and my children get to chase me up and down the hallway playing “catch me if you can.” Other weeks, the article gets done and the patients get the extra calls. It could be worse—one side of the equation could always feel robbed. Perhaps it could be better. 

As a former competitive rower, there was always a pleasant uneasiness knowing that there was still a way to be a little better. But on race day, when the medal was hung around your neck, you got to cherish the moment for a minute. On that day, this was the best you could be. It was OK to be proud but not cocky. So, I will cherish my daughter's words for another week—my metaphoric medal for being a successful dad and doctor. And then next week, I will continue the pursuit of the better balance that lurks somewhere out there.

I hope some of you have gotten even closer to it.