As a clinician, what does a "good day" look like for you? If you don't have a ready answer, you're not alone. Recently, I floundered despite my decades of navigating quality-of-life issues after cancer. Intrigued, I set out to define what a "good day" meant for me, and I succeeded. Along the way, I discovered potential value for clinicians in asking about a "good day" as (1) a tool to facilitate care of patients at all phases of survivorship and (2) a self-care exercise. Used both ways, that question may help you live your best life in the pressure cooker of modern medicine.
My "Good Day"
Last year, a diagnosis of aplastic anemia made me think my time was short, notably in ways my prior cancer diagnoses never had (See Hope for Long-term Survivors Facing New, Treatable Disease at https://tinyurl.com/LTSnewdisease). An intense desire to use time wisely pushed me to reorder certain priorities while undergoing treatment. Months later, after my marrow began responding, my fear abated. My future opened up. That's when inner conflict about which activities to resume led me to borrow a technique learned from palliative care and ask myself, What does a good day look like for you?
First, I needed to clarify what I was talking about. Inspirational writings suggest that every day above ground is a "good day," a sentiment I appreciated. Since my first remission, I've seen the world through rose-colored glasses coated with a blend of gratitude for my survival, faith that "This is the day...," and commitment to find something to "rejoice." As expressed in my poem, View from Remission, "Even unpleasant times are less painful for they are proof that I am still here." (https://tinyurl.com/WSHremission).
Less painful, maybe, but not always enough to make it a "good day." By that, I'm envisioning the general idea of a string of moments tied up at day's end with a sense of satisfaction. No matter what accomplishments, challenges, social interactions, and emotions dotted the hours, the day in toto felt like a gift embraced, not a hardship endured.
I wish every day could be a "good day." Impossible, though. I'm human. From time to time, life throws me challenges that exceed my pain tolerance. No way can I have a "good day" while suffering profound nausea or grief that prevents me from doing anything I want or need to do. Nor while overwhelmed by terrible news or too worn out to handle mundane stresses.
Permission to judge a day as "not good" helps in three ways. First, my verdict acknowledges inherent losses, which creates space for healing grief. Second, instead of wasting energy denying suffering under the guise of "Every day is a good day," that energy gets channeled into making changes. The tiniest tweak of my medications, activities, or perception of a situation gives me reason to hope I will feel better, which usually makes the day better, if not yet "good." Third, I can choose to chalk up the day as a bummer and wipe the slate clean. That tack is especially useful after one-off misfortunes, helping me let go without emotionality, self-questioning, or trying to change anything.
The specifics of each person's "good day" are unique. For me, a good day depends on managing my pain enough for me to handle the day's stresses and to learn something new, address a problem, improve a skill, or do something to repair the world a smidge, whether for one person or future generations or anything in-between. I purposely leave room for unpleasantries. The danger would be letting the perfect get in the way of the good, a recipe for unhappiness. "Perfect" days, while heavenly, are exceedingly rare-and I don't need them for a fulfilling life. What makes for a "good day" will evolve as my condition changes. Projecting to a future when my world contracts to my bedroom, a "good day" may require only that my pain is managed enough to express or receive love.
Here's the amazing thing: Since figuring out what a "good day" looks like for me today, my decisional conflict has been minimal. I'm enjoying greater confidence and calm in everything I do, including onerous or tedious tasks. As judge and jury of what kind of day I had, I'm brazenly biased, giving greater weight to all the things that are right in my world and, consequently, enjoying more "good days" than ever.
A Patient's "Good Day"
Your valiant efforts to diagnose and treat disease serve an overarching goal: helping patients rack up as many "good days" as possible. Some patients may be nonplussed if asked what a "good day" looks like for them. Maybe they never thought about it before. For others, illness changed their world so dramatically, they no longer know what they want, need, or are capable of.
It may help to validate that "a good day" is not an easy idea and to explain that talking about it helps you tailor your care. In the context of "good days," patients who usually respond to How are you? with Fine! may now divulge minor concerns and symptoms that were bearable but taking a toll. Patients who convey no hope of "good days" may be signaling a need for psychosocial intervention. All patients may be more receptive to the information, advice, and therapies they need to:
* Manage pain that prevents them from seeing opportunities for meaning and joy.
* Harbor realistic hopes and expectations that encourage healthy goals and actions.
* Maintain and establish social connections needed for physical and psychological support.
The benefits of your conversations about "good days" begin with their knowing you care about them as people, which strengthens the clinician-patient bond. In a world where test results threaten to drive the narrative, patients may feel more energized and hopeful in a shared mission of facilitating "good days." At best, the conversations motivate them to redefine what a "good day" means now and adjust perceptions and actions in life-enhancing ways, efforts that help them live as fully as possible.
A Clinician's Good Day
How do you maximize your "good days" while repeatedly confronting the limits of medicine and grappling with systemic obstacles to timely, thorough care? Conversations with patients designed to facilitate their "good days" may also help increase your "good days" by preserving the humanity of medicine. Patients feeling your compassion may be more inclined to express thanks and to share stories of happy moments. From my perspective, you've achieved a success each time your care helps a patient experience a "good day." Recognizing those triumphs puts a finger on the scale when judging the day.
No recipe exists for a "good day." As with love and faith, only you can find what works. My recent experiences convinced me that personal reflection on what a "good day" looks like for you in the current medical environment may help preserve the joy of medicine. My hope is that your reflections lead you, as mine led me, to enjoy greater inner peace and confidence in everything you do. With gratitude for your work, I wish you a "good day."
WENDY S. HARPHAM, MD, FACP, is an internist, cancer survivor, and author. Her books include Healing Hope-Through and Beyond Cancer, as well as Diagnosis Cancer, After Cancer, When a Parent Has Cancer, and Only 10 Seconds to Care: Help and Hope for Busy Clinicians. She lectures on "Healthy Survivorship" and "Healing Hope." As she notes on her website (http://wendyharpham.com) and her blog (http://wendyharpham.com/blog/), her mission is to help others through the synergy of science and caring.