Just point your skis down the mountain. That was a phrase that I heard often when I first learned to ski, among many others. The trouble is, pointing your skis down the mountain is much harder to do when you’re in your late 20s, in medical school, than if you were 5. The myriad of possible injuries started to pile up in front of me, like ACL tear, meniscus tear, broken legs, arms, necks, fractured skulls, and on and on. So of course, I didn’t point my skis down the mountain. I didn’t even dare to look down the mountain, which, of course, was the exact opposite of what you were supposed to do.
I was thinking about this on my last night float rotation for our adult inpatient medicine service. I was tired, when the nurse paged me for the umpteenth time, about how this one patient was refusing his medicines, arguing why he shouldn’t take them, and wanting to take off his telemetry leads. I simply just didn’t understand. I didn’t understand why he was doing that, considering that he was the one who wanted to seek help for his heart. He had severe pulmonary hypertension and mitral stenosis. He hadn’t been able to breathe well for weeks. His mitral valve had dehisced again, for the third time. He wanted to get his valve replaced, which was why he came to the hospital in the first place. And now, he was refusing medications and things that would help his heart, arguing with the nurses. I was frustrated at him, and angry at his behavior.
He may very well have just been an unreasonable man. But he was also scared, actually “panicked”, was the word that he used. His fear and panic manifested as poor, unreasonable behavior counter to what he actually wanted to achieve. It’s ironic that we tend to do the exact opposite of what’s good for us, that in our moment of fear and panic, most of us do the worst thing possible for our survival. I started to think about my skiing earlier in the day before my night shift. When the terrain got rough and steep, I still leaned backwards, turned away from facing down the mountain, and made myself unstable and at risk for falls and injuries.
It’s hard to face the scary parts of life, mine more literal than his. Somehow we’ve developed this poor defensive mechanism. As a primary care physician, I think a large part of my job is to guide behavior change, based on medical knowledge, and to help patients learn to face the unpleasant and scary parts of where their medical conditions may take their lives. I have to make my patients trust me and believe that taking these medications can help their heart conditions, that drinking soda, though their taste buds are telling their brains otherwise, is actually bad for them. Behaviors are hard to change, even in myself, especially when on some days I still have a hard time pointing my skis down the mountain. But over time, with some trust, it gets easier.
Skiing helps me understand and overcome the anger and frustration I may feel in regards to my patients for doing the exact thing that’s bad for their health. Lucky for me, we’re so close to the mountains; it’s easy to practice pointing my skis down the mountain. Well, if it ever snows again, that is.
Betty Liu, MD is a 3rd year Family Medicine Resident with the University of Utah. She is currently serving as Co-Chief Resident.