Adapted from the inaugural address of the 152nd Colorado Medical Society Annual Meeting

by Patrick Pevoto, MD, MBA

The 1972 song “Too Late to Turn Back Now” by the Cornelius Brothers and Sister Rose talks about the possible pitfalls of falling in love. However, trying to “turn back” for other reasons has its own dangers and pitfalls.

According to Brené Brown in her book “Atlas of the Heart” (Random House 2021), we need to not only understand our own emotions and experiences, but to also be good stewards of others’ emotions and experiences to make meaningful connections with one another.

One such emotion is nostalgia, a medical term coined in 1688 by Johannes Hofer, a Swiss medical student, by combining the Greek words “nostos” (homecoming) with “alga” (pain). He saw the patterns of those living far from home; the symptoms included decreased appetite, fainting, as well as an increased risk of suicide. Albert Van Holler, a Swiss physician, added the occurrence of hallucinations of the people and places one misses as experienced by many Swiss mercenaries who were fighting far-flung wars at the time.

Historian Stephanie Coontz states: “There is nothing wrong with celebrating the good things of the past. But memories, like witnesses, do not always tell the truth, the whole truth, and nothing but the truth. We need to cross-examine them recognizing and accepting the inconsistencies and gaps in those that make us proud and happy as well as those that cause us pain.”

I have been guilty of having nostalgia; wishing we still had paper charts, wishing I could have segued into a less busy and more lucrative gynecology practice, wishing there were no third parties involved in billing…the list is quite extensive. During the process of reminiscing, there are things spoken and things not spoken.

 What’s spoken:

  • “I wish things were the way they used to be in the good ol’ days.”

What’s not spoken:

  • When people “knew their places.”
  • When there was no accountability for the way my behaviors affected other people.
  • When we ignored other people’s pain if it caused us discomfort.
  • When my authority was absolute and never challenged.

In further defining nostalgia, it could be characterized as a yearning for the way things used to be in our often idealized and self-protective version of the past.

Historian Coontz also adds: “Were the comfort and safety of that past experience real? If so, were they at someone else’s expense?”

I think I have tried to be in control of as much of my life as possible. It is probably one of the main reasons I chose medicine as my career. It seemed to me that many other occupations had the hidden threat of losing one’s job, many times at the whim of someone else, for a myriad of reasons. At least if I started my own medical practice, and became proficient at it, I could “call all the shots.” One could say that I had a fear of losing control.

What do we really control in life? As Michael Singer often says (with editorial changes), “We are on this speck of dirt in mostly empty space. Why do we let things that are entirely out of our control (weather, traffic, legislatures) affect us so much?” We either grasp and cling to the “feel-goods” of life or resist/push away those things we don’t like. It is like the following.

I like it when:

  • Things go the way I want/plan.
  • I don’t have to respond to “Google-researched” questions.
  • There are no “soul suckers” on my schedule today.
  • Traffic is not “heavy,” and people drive with intelligence.
  • The foursome in front of me actually plays “ready golf.”
  • We tend to grasp these sorts of things.

I don’t like it when:

  • Patients/nurses/etc. challenge my advice.
  • The same patient comes in weekly, if not more frequently, with the same complaint.
  • The surgical tech throws away the sterile marker that I requested on “my card” because she does not think I need it, telling me “no one else does.”
  • The rules/protocols change almost daily.

We tend to push these away.

Our responses to events, interactions with others, and decisions can usually be responses of either love or fear. One day my oldest son Andrew came to me for advice about a decision he needed to make. Somewhere out of seemingly nowhere at the time I responded, “just don’t make a decision out of fear.” It is hard to be vulnerable enough with others to respond in love.

Dr. Viktor Frankl was an Austrian-born psychiatrist who lived in Nazi-occupied Austria in the 1930s. He had the opportunity to leave for the United States and escape Nazi aggression since he was of the Jewish faith. He decided to stay and assist his parents who could not go along with him. His mother and father were exterminated; he lived captive in Auschwitz, Dachau and other concentration camps for three years before being liberated by Allied forces. He observed his fellow inmates, many of whom were murdered or succumbed to illness, but universally those who lost their hope did not survive. Viktor continued to hope for being reunited with his wife, to eventually get to the United States to practice psychiatry. While Sigmund Freud postulated a human’s primary quest was for "pleasure" and Alfred Adler proposed that the quest was for “power,” Frankl stipulated that the quest was for “meaning.”

He further delineated the three sources of meaning:

  • Meaning in work.
  • Meaning in love (relationships).
  • Meaning in courage during difficult times.

To quote Dr. Frankl: “Forces beyond your control can take away everything you possess except for one thing, your freedom to choose how you will respond to the situation. You cannot control what happens to you in life, but you can always control what you will feel and do about what happens to you.”

How does one achieve the ability to hope? Researcher C.R. Snyder summed it up with the following trilogy:

  • Ability to set realistic goals (“I know where I want to go”).
  • Ability to figure out how to achieve those goals (requiring flexibility as well as accepting/developing alternate pathways).
  • Having agency – believing in ourselves (I can do this!).
  • Brené Brown also adds: “We need hope like we need air.”

I believe in the call to surrender, to let go. This does not mean giving up in any way. When the person in front of you is driving way below the speed limit and there is no way to safely go around them, let go...take a breath and let the feelings pass through you. Know who you are in there! Know your “why,” what your meaning is in this life. Choose to open your heart, not close it. This will take practice! Refuse to live in the past; choose to live in the now.

Mahatma Gandhi stated: “Our ability to reach unity in diversity will be the beauty and the test of our civilization.”

According to Dr. Cornel West: “None of us alone can save the nation or the world. But each of us can make a positive difference if we commit ourselves to do so.”

Dr. Martin Luther King, Jr. said: “Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.”

The Gospel of Luke, Chapter 17, verse 33 (New Living Translation) says: “If you cling to your life, you will lose it, and if you let your life go, you will save it.”

The hope for medicine is service. The Prayer of St. Francis is the following:

“Lord, make me an instrument of your peace.

Where there is hatred, let me bring love.

Where there is offence, let me bring pardon.

Where there is discord, let me bring unity.

Where there is error, let me bring truth.

Where there is doubt, let me bring faith.

Where there is despair, let me bring hope.

Where there is darkness, let me bring light.

Where there is sadness, let me bring joy.

Oh master, let me not seek as much to be consoled as to console.

To be understood as to understand.

To be loved as to love.

For it is in giving that one receives.

It is in self-forgetting that one finds.

It is pardoning that one is pardoned.

It is in dying that one is raised to eternal life.”

That, my fellow colleagues, is the hope for medicine. It’s too late to turn back now! Let’s move forward together in this great endeavor. We can do this!

Categories: Communications, Colorado Medicine, Cover Story