I was reading this in Gratitude by Oliver Sacks. I was on a train to London and it made me ponder on a big life change that I have precipitated. I stop being a GP / English family doctor in less than a month and although this will free me to follow my heart and seek work in low-income countries I am ambivalent. I don’t want to desert my lovely patients.
The theme in Sacks’ writing – and he is lauded as the poet laureate of medicine – is that he has had the privilege to give something back. That is important to me too especially as I prepare myself and certain patients to cut some umbilical cords. The incipient separation has me reflecting on some of the lives I’ve become intimately involved in. Patients have made me laugh (lots), made me cry (less often), frustrated me in their reluctance to take responsibility or absorb good advice (every day), taught me so much, annoyed me (occasionally), astonished me, made me proud. And I have felt trusted.
Often patients open their consultation with a request for scan or some other investigation. That can niggle as usually the diagnosis isn’t so obscure or illusive and it isn’t investigations that are needed. It niggles but I mainly worry that someone who goes away for a CT scan might not learn how to treat their symptoms or understand how to avoid the problem next time. Sometimes patients suspect I am not keen on investigations because of government pressure to cost-cut. But it isn’t that. I want my patients to feel better, and an MRI isn’t going to ease their back pain. Perhaps they will be reassured for a while but it won’t cure their mental anguish or anxiety.
I meet so many people who ceaselessly give themselves such a hard time. They are self-critical; feel worthless. What makes people unhappy? Is the key to achieving inner peace living a good worthwhile life? Sacks seemed to think so. But how is worthwhile defined? Contributing? Giving something back? 
I suppose that my giving-something-back-ethic has always been with me and it is certainly present as I write. My motivation in writing health guides was to prevent illness in my readers, and I intended that A Glimpse of Eternal Snows would help others heal and feel less alone. I hope too that my writing entertains and brings sunshine to those lacking it. Maybe I’ve brought comfort to people and if I have I hope it is in the true sense of the word – to make strong, to fortify.
Have I, like Sacks, loved my patients? Being an inhibited Brit admitting that is not going to happen and anyway I would have been struck off by the General Medical Council if I had. I haven’t loved but I have respected those who have consulted me. I have liked many and sometimes I’ve admired my patients. They have certainly moved me. They have all been important in my life, just as other patients were important to Sacks. I am grateful.